1973 Legislative Session: 2nd Session, 30th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, MARCH 12, 1973

Afternoon Sitting

[ Page 1205 ]

CONTENTS

Routine Proceedings

An Act to Amend the Government Liquor Act (Bill No. 121)

Hon. Mr. Macdonald.

Introduction and first reading — 1205

An Act to Amend the Public Schools Act (Bill No. 131) Mr.

Wallace.

Introduction and first reading — 1205

Oral Questions

Possible sale of Okanagan farmland. Mrs. Jordan — 1205

Increased fees for UBC students in residence. Mr. Wallace — 1206

Egg price increase. Mr. Williams — 1206

Increase in Mincome to watch food price rise. Mr. McClelland — 1207

Purchase of Glenshiel Hotel. Mr. Chabot — 1207

Political science course at Oak Bay High School. Mr. Wallace — 1208

Court decision on Kamloops amalgamation. Mr. Fraser — 1208

Proper notice for ferry service suspension. Hon. Mr. Bennett — 1208

Steveston to Yellow Point ferry study. Mr. D.A. Anderson — 1208

Absence of Ministers. Mr. D.A. Anderson — 1208

Bilge oil wastes on ferry route No. 1. Mr. Curtis — 1209

Committee of Supply: Department of Health Services and

Hospital Insurance estimates.

Mr. Wallace — 1209

Hon. Mr. Cocke — 1217

Mr. Williams — 1220

Hon. Mr. Cocke — 1222

Mr. Cummings — 1222

Mrs. Webster — 1225

Mr. Lea — 1225

Hon. Mr. Cocke — 1227

Mr. Fraser — 1227

Hon. Mr. Cocke — 1228

Ms. Brown 1228

Mr. McClelland — 1229

Hon. Mr. Cocke — 1230

Mr. D.A. Anderson — 1232

Hon. Mr. Cocke — 1232

Mr. Radford — 1232

Mr. McGeer — 1233

Mr. Brousson — 1233

Hon. Mr. Cocke — 1235

Ms. Sanford — 1236

Hon. Mr. Cocke — 1236

Mr. Smith — 1237

Hon. Mr. Cocke — 1238

An Act to Amend the Workmen's Compensation Act (Bill

No. 130) Hon. Mr. King.

Introduction and first reading — 1238

Reports Select Standing Committee on Standing Orders and Private

Bills.

Nos. 10 and 11 — 1239

The House met at 2 p.m.

Prayers

MR. SPEAKER: The Hon. Minister without Portfolio.

HON. F.A. CALDER (Minister without Portfolio): Mr. Speaker,

I would like the Hon. Members to join me in welcoming two

representatives of the Chamber of Commerce from my headquarters

of Stewart, British Columbia, in the persons of Sharon Hosick

and James McKelvie.

MR. SPEAKER: The Hon. Minister of Mines.

HON. L.T. NIMSICK (Minister of Mines and Petroleum Resources): Mr. Speaker,

I would like the Hon. Members to welcome a member from my constituency, Mr.

James Patterson, who is the business agent for Local 651. He is down here as

part of the delegation from the B.C. Federation of Labour executives.

MR. SPEAKER: The Hon. Member for Mackenzie.

MR. D.F. LOCKSTEAD (Mackenzie): Mr. Speaker, we will have

with us today at 3 o'clock, 50 school children from the

Elphinstone Secondary High School at Gibsons. Please join me in

welcoming them.

MR. SPEAKER: The Hon. Member of Esquimalt.

MR. J.H. GORST (Esquimalt): Mr. Speaker, it is my honour

today to ask the House to join with me in welcoming 10 honour

students of the political science class at the University of

British Columbia who are in the House today with their

professor, Dr. Walter Young, professor of political science at

the University of British Columbia.

I hope anything done here today does not in any way

discourage them from their goals but instead spurs them on to

the day when they will take a seat in this Legislature.

Introduction of bills.

MR. SPEAKER: The Hon. Attorney General.

HON. A.B. MACDONALD (Attorney General): Mr. Speaker, I have

the honour to present a message from His Honour the

Lieutenant-Governor.

AN ACT TO AMEND

THE GOVERNMENT LIQUOR ACT

MR. SPEAKER: His Honour the Lieutenant Governor herewith

transmits a bill intituled

An Act to Amend the Government

Liquor Act and recommends the same to the Legislative

Assembly, Government House, March 8, 1973.

Bill No. 121 introduced, read a first time and ordered to be

placed on orders of the day for second reading at the next

sitting of the House after today.

AN ACT TO AMEND

THE PUBLIC SCHOOLS ACT

Mr. Wallace moves introduction and first reading of Bill No.

131 intituled

An Act to Amend the Public Schools

Act .

Motion approved.

Bill No. 131 read a first time and ordered to be placed on

orders of the day for second reading at the next sitting of the

House after today.

MR. SPEAKER: Before we start on the question period — I draw

to the attention of the Hon. Members that our faithful and

loyal and aged Clerk, who is unfortunately not here today

through illness, has saved for a long time a particularly

historic bell. He presented it to the House today,

unfortunately in his absence, with the view that it be used to

save the Ministers from disaster 15 minutes after the stopwatch

starts. So the bell, you will note, is on the clerks'

table.

It has an interesting history. It was in the Bird Cages,

which were the first parliament of British Columbia. I think it

is of great historic significance and we should thank the Clerk

for it.

AN HON. MEMBER: Does it work?

MR. SPEAKER: You'll find out if it works.

Oral questions.

MR. SPEAKER: The Hon. Member for North Okanagan.

POSSIBLE SALE OF

320 ACRES OF OKANAGAN FARMLAND

MRS. P.J. JORDAN (North Okanagan): Thank you, Mr. Speaker, I would like

to address my question to the Hon. Minister of Health (Hon. Mr. Cocke). Has

he had an opportunity to investigate the possible and rumoured sale of 320 acres

of north Okanagan farmland to one Colin Andrew Youngstrom, as reported, a member

of the Brotherhood of Eternal Love cult and closely linked to the

[ Page

1206 ]

Timothy Leary cult?

HON. D.G. COCKE (Minister of Health Services and Hospital Insurance):

Mr. Speaker, my department hasn't too much to do with the sale of property.

I have told the Attorney General about the sale. It was a sale I understand,

that was totally consummated and there was lots of warning, Mr. Speaker, about

this sale. It has been going on for something over a year. It is a sale of land.

I would like to defer the question to the Attorney General, Mr. Speaker.

MR. SPEAKER: I may point out the question is not in order

directed to that Minister who has no jurisdiction over the

field of sale of land that I know of. So there really is no

question before the House that needed to have been answered. I

should have stopped it, but I was wondering what it was all

about.

MRS. JORDAN: A point of order, Mr. Speaker. The reason it

was directed to the Minister of Health was that the Attorney

General was absent on Friday when this was a matter of urgent

concern. And the Minister of Health should in fact be deeply

concerned about the sale of this land if the rumours

surrounding the sale are true.

MR. SPEAKER: You are not to bring rumours into the House.

You are supposed to state the facts and be responsible for the

facts and the Minister concerned…

HON. MR. COCKE: You should redirect the question, Mr.

Speaker. You see, unfortunately, it is just not my department.

As I indicated, on Friday, that I would defer it to, or at

least I would recommend it to the…

MR. SPEAKER: Order please.

MRS. JORDAN: …the Attorney General had an opportunity to

investigate the possible sale of 320 acres of agricultural land

in the north Okanagan to one Colin Andrew Youngstrom, reported

member of the Brotherhood of Eternal Love cult, closely linked

with the Timothy Leary drug cult in the United States.

HON. MR. MACDONALD: Mr. Speaker, in answer to the question.

This is a private sale of land and the Government has no power

under statutes now, or to come in the future, or lying before

this House. We are not land dictators in spite of people who

have been running around the province saying we are. We cannot

step in and prevent, and we do not want to step in and prevent,

the private sale of land. However, if there comes to be a law

enforcement problem on that property or any other, I expect

Members of this Legislature and other people to draw that to my attention

and law enforcement will take its usual course.

MRS. JORDAN: A supplementary question, Mr. Speaker. Am I to

understand from the Minister's statement that there is no

intention on the part of the Government, in light of the

undesirability of this sale, to utilize the Green Belt

Protection Fund Act to purchase this land from the current

vendor and then return this land without loss to the involved

parties to the people of British Columbia?

Interjection by an Hon. Member.

MR. SPEAKER: Order please. There is absolutely no

jurisdiction and the Minister has explained it already.

Therefore the question is out of order. The Hon. Member for Oak

Bay was next.

INCREASED FEES

FOR UBC STUDENTS IN RESIDENCE

MR. G.S. WALLACE (Oak Bay): Mr. Speaker, I would like to

address a question to the Hon. Minister of Education, (Hon.

Mrs. Dailly). Are there plans to increase the fees paid by

students in the residences at UBC next year, and if so by what

percentage are the fees to be increased?

MR. SPEAKER: Here again, is this a matter within the

jurisdiction of the Minister or the University of British

Columbia, because they're separate? The Minister wishes to

answer.

HON. E.E. DAILLY (Minister of Education): It's of concern to

me as Minister. It's certainly under the autonomy of the

university basically how they handle their budget. The matters

that affect the students concern me also — as they do the Hon.

Member who asked the question, I'm sure on that reason.

I've had discussions and correspondence on this matter. To

my knowledge at this time, to the Hon. Member, I do not believe

they are being increased.

MR. SPEAKER: The Hon. Member for West Vancouver-Howe

Sound.

EGG PRICE INCREASE

MR. L.A. WILLIAMS (West Vancouver–Howe Sound): Mr. Speaker,

thank you. To the Hon. Attorney General, with reference to the

announced price increase for eggs in the province: would the

Hon. Minister indicate whether or not he or his department had

any advanced knowledge of this proposed increase?

Interjections by some Hon. Members.

[ Page 1207 ]

MR. WILLIAMS: Correction, I'm sorry — Agriculture.

HON. D.D. STUPICH (Minister of Agriculture): Mr. Speaker, my

only concern was that I almost turned off when he said Attorney

General, and went on reading my correspondence.

Mr. Speaker, we did have advanced knowledge of this. My

concern was that the egg board, I felt, was being rather slow

in acting in view of the increases in costs that were being

absorbed by the poultry producers up to that time. They did

discuss it with members of my Department, and myself, on

various occasions.

I felt that perhaps there could have been a more gradual

increase in view of the fact that the costs had increased by

more than the 7 cents a dozen that they are currently

increasing the egg prices to the producers. I felt that there

was no way that we could persuade them to do anything otherwise

than what they're doing.

The price of feed is the factor that has gone up more than

anything else. The price of feed alone accounts in the last six

months for the increase to the producer of 8 cents per

dozen.

MR. SPEAKER: On a supplementary, the First Member for

Vancouver–Point Grey.

MR. P.L. McGEER (Vancouver–Point Grey): I would like to ask

the Minister of Agriculture: in cases like this, is the

Consumer Protection Bureau warned so that there is not

profiteering on the part of the food stores in raising the

price to the consumer immediately rather than selling the old

stocks off at the former price?

HON. MR. STUPICH: Well, Mr. Speaker, they're not warned by

the Department of Agriculture. Whether the Egg Marketing Board

does any warning, I'm not sure. I think the public statements

that have been issued should serve as warning to some people,

though.

MR. SPEAKER: The Hon. Member for Langley.

MR. R.H. McCLELLAND (Langley): Mr. Speaker, I've noticed

that for the third question period in a row the Minister of

Lands, Forests and Water Resources (Hon. Mr. Williams) is not

here in order for us to ask questions.

MR. SPEAKER: I think he's in Washington with…

MR. McCLELLAND: I'd like to address this question, Mr.

Speaker…

MR. SPEAKER: Order please.

INCREASE IN MINCOME TO

MATCH FOOD PRICE RISE

MR. McCLELLAND: …to the Minister of Rehabilitation and

Social Improvement (Hon. Mr. Levi), with regard to the increase

in milk and egg prices. Has the Government given any

consideration now, Mr. Speaker, to raising the old age

pensioners' $200 income, under Mincome, to reflect this

increase for people over 65, who naturally find both of these

items most necessary for their diet?

MR. SPEAKER: On a point of order. I can't see how, under the

rule, you can ask the advice a Minister is going to give the

Crown. You can ask if he's given that advice. I presume your

question…?

MR. McCLELLAND: Mr. Speaker, I'll ask then. Has the Minister

given that advice to the Government?

HON. N. LEVI (Minister of Rehabilitation and Social Improvement): Mr.

Speaker, I made a statement a couple of weeks ago, in reference to the increase

in the old age security pension, that the Government will be staying with the

$200 a month, and will review that pension in the fall.

MR. McCLELLAND: Mr. Speaker, a supplementary. Could I ask

the Minister of Human Resources (Hon. Mr. Levi, Minister of

Rehabilitation and Social Improvement) whether that statement

holds true regardless of what happens to the cost of living? — even though there's a 10.2 per cent increase in one year

alone, without this increase in these…

MR. SPEAKER: There again you can't ask theoretical questions

of that kind. It is out of order. I would ask the Hon. Member

for Columbia River.

PURCHASE OF GLENSHIEL HOTEL

MR. J.R. CHABOT (Columbia River): Thank you, Mr. Speaker,

I'd like to direct a question to the Minister of Public Works

(Hon. Mr. Hartley).

I was wondering if the Minister could advise the House whether he's completed

negotiations for the purchase of the Glenshiel Hotel, which he announced as

being purchased about 85 days ago at a Press conference then, December 15th;

and if so, at what price,

HON. W.L. HARTLEY (Minister of Public Works): The answer as recorded

on the order paper still stands.

MR. SPEAKER: The Hon. Member for Oak Bay. Order please. No

debate.

[ Page 1208 ]

MR. WALLACE: I would like to address another question to the

Hon. Minister of Education.

Interjection by an Hon. Member.

MR. SPEAKER: Order!

POLITICAL SCIENCE COURSE

AT OAK BAY HIGH SCHOOL

MR. WALLACE: Could she tell us whether further consideration

regarding the political science course at Oak Bay High School…whether decisions have been taken as to whether this course

shall be permitted, or whether the department has decided

against such a course?

HON. MRS. DAILLY: I am aware of this particular decision and

I have arranged for a meeting with departmental officials and

the Victoria School Board this afternoon.

MR. SPEAKER: May I point out to the Hon. Members that a

question that has already been answered on the order paper will

not be entitled to further question on the same point. The Hon.

Member for Cariboo…

MR. CHABOT: Mr. Speaker, on that question. The answer was

brought forward on the order paper about three weeks ago. The

matter probably has been settled by the Minister, and probably

a price has been arrived at. I think…

MR. SPEAKER: On your point of order; it's not well taken. If

you look at Beauchesne on page 147, it says:

"A question oral or written must not repeat in substance a

question already answered, or to which an answer has been

refused…."

And I gave this to the Hon. Member. He knows that. Now, the

Hon. Member for Cariboo.

COURT DECISION ON

KAMLOOPS AMALGAMATION

MR. A.V. FRASER (Cariboo): Mr. Speaker, I have a question

for the Attorney General. Has the Minister had time to review

the court decision regarding the Kamloops amalgamation? — and

to advise the Minister of Municipal Affairs (Hon. Mr. Lorimer)

how to proceed with this situation on a legal basis?

HON. MR. MACDONALD: Mr. Speaker, fortunately the Minister of Municipal

Affairs is a lawyer, and the matter remains in his hands. No doubt, he will

be making an announcement shortly after consulting with me.

Interjections by some Hon. Members.

MR. SPEAKER: The Hon. Leader of the Opposition.

PROPER NOTICE FOR FERRY

SERVICE SUSPENSION

HON. W.A.C. BENNETT (Leader of the Opposition): I want to

know if the acting Minister of Highways has instructed his

department that when the ferries are suspended for a period of

time, proper notice will be set up. For instance, yesterday I

arrived at the Mill Bay Ferry, and there was a sign that they

had tied up the ferry. It was closed for two weeks. It was

going to start again today. Dozens of cars were all lined up

there. People were not informed at all.

Interjections by some Hon. Members.

HON. MR. STUPICH: Mr. Speaker, I'm pleased that the Member

has brought this to my attention, and I will certainly bring it

to the attention of those responsible — or if you like,

irresponsible.

MR. SPEAKER: The Hon. Second Member for Victoria.

STEVESTON TO YELLOW POINT

FERRY STUDY

MR. D.A. ANDERSON (Victoria): I would like to ask the acting

Minister of Highways. I wonder whether he would indicate

whether his department is carrying out studies for a Steveston

to Yellow Point Ferry going through Poilier Pass.

HON. MR. STUPICH: Mr. Speaker, everything is under

consideration. But there are no active studies being taken at

this time of that route.

ABSENCE OF MINISTERS

MR. D.A. ANDERSON: Mr. Speaker, I would like to ask the

acting Premier whether or not in future we can arrange some way

of knowing what Ministers will not be present — Municipal

Affairs, for example, and Highways were two departments we

wished to query today. I wonder whether she would indicate to

the House whether it would be possible to indicate beforehand

what Ministers would be here and…

MR. SPEAKER: There is no obligation under our present

question period. If you want a question period with notice, or

if you want to give notice to a Minister, then you can be sure

he'll be in the House.

[ Page 1209 ]

MR. D.A. ANDERSON: No, Mr. Speaker, I'm sorry, my question

must have been misunderstood. The question I was asking the

acting Premier was: if Ministers are to be away, would it be

possible in some way to…

MR. SPEAKER: I suggest that you take that up privately by

writing to the Premier, or the acting Premier. It's not a

matter for the question period. This is why they have the

notice in the British House. Any further questions for the

question period? The Hon. Member for Saanich and the

Islands.

BILGE OIL WASTES ON

FERRY ROUTE NO. 1

MR. H.A. CURTIS (Saanich and the Islands): We are waiting

for the bell, Mr. Speaker. But, if there are a few moments — to

the acting Minister of Highways: would he undertake to

investigate further the question of disposal of bilge wastes,

oil wastes, from ferries plying route No. I — Tsawwassen to

Swartz Bay? I am aware of the fact that these wastes are being

disposed of over the side at night. In an era of strong concern

about oil pollution, Mr. Speaker, I feel this is a matter which

the Department of Highways should investigate.

HON. MR. STUPICH: Mr. Speaker, if he remembers the question,

the answer is simply yes.

Orders of the day.

House in committee of supply; Mr. Dent in the chair.

ESTIMATES, DEPARTMENT OF HEALTH

SERVICES AND HOSPITAL INSURANCE

(continued)

On vote 86: Minister's office, $66,400.

MR. CHAIRMAN: I recognize the Hon. Member for Oak Bay.

MR. G.S. WALLACE (Oak Bay): Thank you, Mr. Chairman.

As I said in the education debate, there are two portfolios

which surely should have the attention of all of us, inasmuch

as they spend about 70 per cent of the budget. But, more

importantly, without health and education we're all in

trouble.

At the outset, Mr. Speaker, I'd like to compliment the

Minister of Health Services and Hospital Insurance (Hon. Mr.

Cocke) for several reasons, since he took office. We have a

Minister who obviously is willing to listen. That's certainly

one tremendous advantage over his predecessor.

AN HON. MEMBER: Hear, hear!

MR. WALLACE: Not only is the Minister of Health Services and

Hospital Insurance willing to listen, and obviously he is

listening, but he rescinded — I notice the Socred benches have

emptied since I started to speak and that doesn't surprise me.

They never listened when they were Government and I don't

suppose they're about to listen now.

The Minister of Health Services and Hospital Insurance has

rescinded a decision regarding wage increases to employees in

hospitals. I can just recite for the House what happened under

the former administration — they agreed to pay 70 per cent of

wage increases for hospital employees. The result was that the

hospitals had to cut back on staff in various ways or, when

staff resigned or retired, they were not replaced. This put a

very considerable hardship on hospitals and, in my opinion, and

in the opinion of many administrative staff who don't like to

talk in public about these things, they did feel that there was

a lowering of the standard of care in the hospital as a result.

I would agree with that opinion.

The fact is that the Minister has rescinded that order and

has in fact agreed that the employees in hospitals should be

paid the wage which they negotiated for.

Speaking with hospital administrators, I know they're

grateful to the Minister. It has meant the difference between

struggling along with a very sizable deficit and breaking

even.

The Minister said that he has received co-operation from all

arms of the health field. I think, Mr. Minister, through you,

Mr. Chairman, the reason you're getting cooperation is that

you're listening and you yourself are cooperating. That again

is one tremendous advance compared to the previous

Minister.

I would like to say a little bit, first of all, about

philosophy of health care. Incidentally, for anyone who's

really interested in this philosophy in depth there's a very

excellent

article written in this publication UBC

Reports , dated February 22, by Peter Thompson, who is a

staff writer. He has entitled this "UBC's Role in the Health

Care Crisis." I can send it over to the Minister if he would

like it.

This sums up somewhat the dilemma, you might call it, of

health care. I think the whole field of health care and the

provision of health services involves a high degree of

administration and co-ordination of what is available, even

beyond that it's very timely for society to look at the

tremendous resources which technology and research are putting

in our hands every day, and then leaving us with the moral

dilemma of trying to decide what priorities should be set and

which patients should perhaps be given consideration ahead of

others.

If that sounds a very cold, calculating statement, I

[ Page 1210 ]

am afraid this is the kind of choice that society,

regardless of which government is in power, is faced with

today. This is why that

article is so good, because I think it

hits it right on the nose. Do you concentrate on setting up

artificial kidney machines or very expensive, sophisticated

heart operations, or do you emphasize preventive medicine or do

you treat the ordinary pneumonia at home instead of treating it

in the hospital? There is a whole variety of questions which in

many ways are moral in nature because surely our philosophy

should be that we should help all people who are in need of

care and whose health, in one way or another, requires

treatment.

It's too trite to say that we're all interested in promoting

good health. We have an established amount of serious disease

and disability. Ten years ago we didn't even have to be worried

about the cost of treating it because we didn't have the

know-how, we didn't have the skilled personnel, we didn't have

the electronic pacemakers for the heart, we didn't have the

various gadgets and machinery to replace heart valves, we

couldn't operate on the arteries in the heart because we

probably didn't have the anaesthesia, and so on and so on. But

there's a tremendous array of new techniques in the 20 years

certainly since I qualified — perhaps 50 per cent of the things

we're now doing in the health field weren't even available. It

is considered that the rate at which knowledge and technical

know-how is increasing is in itself creating a tremendous

problem for our medical educators. Even the students leaving

medical school now find that within a few years — 5 years or 10

years — 50 or 60 or 70 per cent of the material that they were

taught in medical school has to be revised.

One could spend hours — and I won't — discussing first of

all why it is so important for society to try and understand

the way in which governments do attempt to deal with this very

enormous problem whereby the amount of care and the type and

intensity of health services which it is within our human power

to provide, is a bottomless pit. As the Minister pointed out in

his budget speech, you cannot spend endlessly, even although it

might all provide positive results for all the people receiving

the treatment.

I was a little disappointed in the Minister's leaving the

subject of health education to the end of his speech. Through

you, Mr. Chairman, that probably was unintentional and it did

not reflect the tail-end of his speech in the sense that it was

the least important part of his speech. If we hope at all to

begin to cope with the health needs of our citizens, by and

large, we have to embark now on a positive programme of

promoting health rather than trying to deal with disease once

it's established.

In the long run I think this is the hope we have — to come close to providing

the high quality and the amount of care which our society not only expects but

demands. I am talking about sound nutrition and exercise, which other Members

have talked about, healthy recreational habits, proper sleep habits and so on.

More importantly, of course, trying to educate the citizens against or away

from some of the habits which promote disease.

I won't recite, as I've done year after year, the absolutely

convincing statistics in relation to smoking. Anybody who still

tries to argue that it has not been proven that smoking creates

disease and disability and leads to premature death, really has

to be blind. There's none so deaf as those who will not

hear.

While the Minister did mention health education, I think

that this should be the absolute, number one point that we're

hammering away at, particularly in our schools.

Mr. Lalonde, the federal Minister of Health just announced

the other day — I thought it was still peanuts that he was

talking about — that over the next three years they will triple

the funds made available for sports and fitness programmes from

$8 million to $25 million. While I still think that in the

total federal picture of the federal budget this is peanuts, at

least again it appears as though we're getting across the idea

to public leaders that the emphasis must be a positive one on

health measures rather than simply trying to cope with disease

once it's present.

On this subject, and it's mentioned also in that

article

that I sent over to the Minister, there's the question of

annual medical examinations when the patient has no symptoms.

This always fascinates me, Mr. Chairman, that it is such a

sound, sensible, positive approach. Yet for the record the

people of British Columbia should know that that is not covered

by Medicare. You can come and see your doctor about dandruff or

ingrown toenails or a pain in the neck and the Medicare pays

for the visit. But if you as an intelligent, well-informed

citizen, wanting to preserve your health, go to the doctor and

ask for a checkup, if you don't have any complaints, that visit

and the cost of the examination is not covered by Medicare.

Now I forget the quotation from Shakespeare, that something

makes liars out of all of us. The fact is that most doctors, by

taking a complete history from the patient, can find something

wrong. This, in a very devious way, and a dishonourable way in

my opinion, justifies the fact that we can then bill Medicare

for the cost of the examination.

I have mentioned this before and I would like to leave it

with the Minister, that hopefully we won't have to be devious.

If someone comes for a checkup this should be covered under

Medicare.

We are very critical of people who drink too much alcohol and we're critical

of people who smoke too

[ Page

1211 ]

much, but what is our attitude to people who eat too much?

AN HON. MEMBER: Name names.

MR. WALLACE: I won't name names. The guilty parties have

just spoken up for themselves.

Seriously, Mr. Chairman, obsesity, like smoking, is

certainly a strong predisposing factor to certain types of

illness and the need for hospitalization and medication. We

know, for example, that you certainly increase your chances of

sugar diabetes if you are constantly and persistently

overweight. High blood pressure, with all its disastrous

consequences of strokes, hemorrhages, blindness, kidney disease

and a dozen other things I could mention, very often has a very

strong predisposing origin in obesity. Yet as I say, we tend to

feel sorry for people who are obese, but we tend to criticize

people who drink too much or smoke too much. As far as I can

see, the person who eats too much isn't in too much of a

different category in terms of respect for their own

health.

I have mentioned some of the challenges that arise from our

increases in technology and I still think by and large, and I

don't say this with disrespect, that it would help if the

Minister would take a more definite, educational programme and

try to tell the people of this province and Canada more

specifically about the degree to which some of these changes

have occurred.

This whole question of artificial kidneys and kidney

transplants, for example, and the field of cardiac surgery is

absolutely exploding in terms of potential to treat and operate

on middle-aged men with heart disease, which would otherwise

likely shorten their life considerably.

The whole field, I believe, of deafness is on the verge of

another breakthrough. There are two types of deafness. One type

is called nerve deafness, which we have never really been able

to treat. I understand that a famous clinic in Los Angeles, the

House Clinic, is close to devising electronic mechanisms that

will, perhaps, partially restore the ability to hear in the

people who have nerve deafness. We can think of the many, many

numbers of such elderly people who would benefit from that.

I have already mentioned anaesthesia. People today really

don't realize that a lot of the surgery they have isn't just

due to the fact that we have the surgical techniques but to the

fact that we have sound, safe anaesthesia which can last five,

or six, or seven hours to carry out some of these very

extensive surgical procedures.

We have talked a lot about drugs in this House and we tend to emphasize their

abuse rather than their sensible use. Certainly today, again even in the last

10 years, the number of people who are restored to normal functions, particularly

in the realm of mental disease, is really staggering and certainly most encouraging.

I am sure that progress will continue in these areas.

As I said at the start, while this makes all these

treatments and progress available, it is a tremendously

expensive feature. The Minister might care to give some cost

figures, for example, on the open heart programme at VGH. I

don't know what it costs to set up the programme and I don't

know what it costs to operate but I think the Minister would be

promoting education of the public on this subject if he gave us

these specific figures. It often means that a person who would

otherwise be a cardiac cripple and who would be unable to

support his wife and children, perhaps, in middle age, is

restored to functioning capacity in society.

I don't want to sound too negative just based on dollar

cost. It is the last thing I am trying to say. But I do hope

that people across the province will get to know that there

isn't a bottomless pit, and that somehow the money has to be

raised to pay for these expensive procedures, and that as

knowledge of technology increases there are going to be more

and more extensive and expensive procedures that can be

developed.

The Minister touched — and I don't want to go into this in

detail, because you can talk around it forever more and not

reach a conclusion — on diagnostic and laboratory services. The

Minister raised this subject in a different way asking about

the validity of private and public labs. I think that's the

whole debate in itself.

What is very clear, Mr. Chairman, is the tremendous

importance of diagnostic and laboratory procedures in modern

medicine. Many of these complicated operations that I've

discussed could only be made possible if the patient is

properly investigated in the first place. Now we have so many

very complicated tests and manoeuvres and injections and X-rays

and what-have-you which provide us with information about the

patient which, in effect, enables us to go ahead with

treatment.

I recognize and so, I hope, does every doctor that this can

be overused and that we can go overboard in the prescribing of

diagnostic tests. Again I come back to the point that were it

not for many of these tests we would have disease, disability

and early mortality in many citizens who, because of the tests

and the new treatments, certainly can be restored to a normal

function in this society.

So what about this business of costs? We have talked about

how high they can become and I have talked about the potential

for improving health. Nevertheless, to be really practical, we

are landed with certain basic costs, particularly in hospitals.

I was delighted to hear the Minister talk in the way he did

about reviewing levels of care. If there is one relatively

simple key to this problem of health care

[ Page 1212 ]

costs, it is to get us away from almost the obsession that a

patient can only be properly treated in hospital.

This in many ways is an impression left over from the days

when you went to a hospital to die, because our knowledge was

limited, our techniques were limited, and all these advances

that I have just described were not available. A much greater

percentage of patients going into hospital went in to die. The

treatment and the facilities were not available. So the acute

hospital bed became the catch basin for anybody, really, who

could not function at home or where the help that they needed

was not made available at home.

It was interesting to me — I looked back at the old election

material that I wrote in the newspapers in 1969, prior to the

election. Just briefly it is interesting to say that:

"What we need is a coordinated programme of home care to

be developed and provide a wider range of nursing and medical services in the

home." Such a service would be provided by combining the resources of the VON,

the Metropolitan Board of Health, the Victoria Welfare Council and the Health

Branch of the provincial government. The financing would be provided by the

provincial government and would be more than offset by the reduction and costs

resulting from the more efficient use of hospital beds."

I'm not claiming that I was any prophet. This has been

preached all the years I have been in B.C. We had the royal

commission talking about this in 1962, I think it was, and then

we had the federal task forces a few years. They all emphasized

the fact that the expensive, acute hospital beds were being

badly used or inefficiently used. Yet many other Members have

spoken in this House over the last four years, since the 1969

election, asking that the government not give just lip service

to this, but do something about it and provide the other levels

of care and the big level of care.

I know the Minister is aware of this and this is another

area of disappointment to me. I think the Minister is doing a

terrific job, but this is one area where he has disappointed

me. We need some action to provide not only facilities for

intermediate care but to provide some form of government

financial assistance. Again, I apologize to the House for the

confusion that arises over these different words. I'm sure

Members wonder what we are talking about. Acute care, extended

care, intermediate care, chronic care — the words are all used

and I'm sure they are confusing to the layman.

Very briefly, Mr. Chairman, what actually happens is that if you are seriously,

acutely ill, you pay $1 a day. If you are classified as extended care and you

are elderly and senile and need a great deal of nursing care around the clock,

you are classified as extended care and you pay $1 a day.

Right in the middle of this, the two ends of the spectrum,

the people who need some continuing degree of medical care and

nursing care in society, I think, are getting a shocking deal

from society. It doesn't need to be repeated; it has been said

many times and we have questions on the order paper which the

Minister has answered. My colleague from Saanich and the

Islands (Mr. Curtis) has asked about it.

But, Mr. Chairman, one of the subjects about which the NDP

spoke very forcefully when they were in Opposition was this

disgraceful social problem of having elderly people in nursing

homes and private hospitals where they were spending their life

savings, selling their homes, putting their spouse usually into

great difficulty.

If one or other spouse was well and the other one needed a

nursing home, it very often meant that the healthy member of

the marriage had to sell the home to pay the cost of a nursing

home for his wife, or vice versa.

I feel that I just have to be critical of this Government.

Despite much of the positive things that I like that it has

done, it has certainly fallen short in my view. This was such a

central, positive, repetitive measure which the socialists,

when they were in Opposition, said they would move immediately

to correct. The fact is that the patients in nursing homes are

exactly in the position today that they were when this

Government was elected.

I know that providing this coverage will be costly, but it

won't be that costly. The argument is always brought out — and

I hope, Mr. Chairman, that this Minister won't drag out the

same old weather-beaten argument that we had from the Socred

government, that the federal government won't pay 50 per cent

of the bill.

My answer to that feeble argument is simply this: if the

federal government were willing to pay 50 per cent of the bill

tomorrow, the provincial government would be paying 50 per cent

also. So why at least can we not now go ahead and have the

provincial government pay its 50 per cent right now? It's going

to be paying that much anyway, sooner or later.

Certainly in terms of the patients, as we calculated it out

the last time I spoke on this in the House, we're talking of

something in the order of $10 million a year, which, in the

kind of budget that we've just debated, I really don't think is

an enormous sum of money. Certainly in terms of the tremendous

service which the patients who are in acute and extended care

beds need, it's just such a complete contrast and it's so

totally unjust.

It's a promise that you made when you were in Opposition. I just say that if

there is one particular area in which this Government has disappointed those

who supported it, it is in failing to come through with

[ Page

1213 ]

financial assistance to patients receiving intermediate

care.

MR. CHAIRMAN: Order. I would just remind the Hon. Member

that he has a bill on the order paper which deals with this

matter. Therefore, I would ask him not to pursue the

subject.

MR. WALLACE: Yes, Mr. Chairman. I am just finished on that

subject.

My note just reads, "Plead for the patients in the nursing

homes," and I'm on the next heading.

I think the subject of care for the elderly in itself is

tremendously important in British Columbia and certainly in the

greater Victoria area, where our percentage of citizens over 65

is I think twice the national average. This is why I would like

again to say that the Minister is making very good, positive

suggestions when he is discussing the availability of help to

the elderly citizen who wishes to remain in his or her

home.

It isn't just a question of saving dollars. There's no

question in anybody's mind in the health field that if the

patients can be assisted and comforted in their own homes, the

chances of them continuing to live productive and comfortable

lives are improved. It is very difficult to repeat in a

hospital the kind of atmosphere and peace and quiet which can

exist in the home but which is very difficult to create in a

hospital.

This is not with any disrespect to the hospital. I was

looking at Gorge Road Hospital today, which has just created

300 extended-care beds. This, Mr. Minister, through you, Mr.

Chairman, is really a tribute, not only to the Government but

to the people who operate and the people who work in that

hospital. You can sense the real dedication in the staff when

you talk to them, from the administrator down. I think that

this kind of facility is really a credit to the province and to

the people who plan our health services.

I know there aren't enough beds and that we need to create

more. But to look at the Gorge Road facility is certainly very

encouraging. I hope that the regional hospital board in this

district will quickly go about deciding where the other 150

beds are to go. The Minister smiles.

The fact is that I'd have to say that I feel somewhat

disappointed in the delays, for whatever reason, that have

resulted in the greater Victoria area in carrying out all the

plans that were included in the last referendum for I forget

how many millions of dollars. This was several years ago and

there's still no definite decision where these last 150 beds

should go.

This question of intermediate care is important in all aspects of illness,

but nowhere is it more important than in mental disease. The archaic approach

of the federal government towards mental disease certainly answers for me the

reason we've got such a weak-minded government in Ottawa.

Their attitude to the role that mental disease plays in

society is the same attitude that people had 100 years ago,

that is, "if you're mentally sick, well, that's something else;

but if you've got a broken leg we'll spend a thousand bucks

putting you back on your feet."

It's very annoying to find that half or two-thirds of your

medical practice is people with emotional, mental problems and

if we have to, as we should, meet the costs of helping these

people, that we have this very unreasonable, uneducated

attitude at the federal level.

There's tremendous potential for facilities to help people

with mental disease and emotional problems when they leave the

acute facility. I've spoken before in the House on the case of

one psychiatrically trained nurse who tried to set up a

domiciliary facility in Victoria as a — I think the best term

that's understood by lay people would be a "halfway house"

situation; the patient doesn't leave the acute hospital one day

and go right back into a state of independence and

self-sufficiency right away. This lady, Miss Pask, set up such

a facility and unfortunately was banging her head against a

brick wall as far as the government was concerned. She went

through an enormous amount of red tape and bureaucracy just to

get the place set up.

Mr. Chairman, if you could see the correspondence and the

obstacles that were put in her way, from the municipal level

upwards, you would have thought she was trying to build the Taj

Mahal instead of just converting a domiciliary building on

Quadra Street into a facility which, when she finally got

going, proved its worth, inasmuch that of patients that she

helped, the number who subsequently required readmission to the

Eric Martin Institute was very small — smaller than the average

degree of repeat admission.

I understand that her health finally gave out and this was

simply because she wasn't given enough financial assistance to

employ enough help. She tried to work around the clock herself

and I understand her health gave out and finally the facility

was closed.

I would plead with the Minister. I don't know all the

details, but the principle is so sound and so exciting that

it's the direction in which we should be going. If we're going

to help elderly people in their own homes with the methods the

Minister mentioned, there's a whole world of prospects for the

emotionally ill patient leaving the acute mental hospital to

have some intermediate type of domiciary setting, staffed with

nurses who have had psychiatric training, who I think would

hold a great deal of potential for the patient, inasmuch as you

would be reducing the chances of that patient's having a

relapse if he tries to go back into his full

[ Page 1214 ]

responsibilities in society right away.

It comes down to this whole question of the proper use of

our health personnel. There again, Mr. Chairman, the idea has a

lot of merit that we're not using our skilled personnel

properly. Certainly in the last few years we've upgraded the

responsibility of many nurses in the acute hospital and I think

we should pay credit to the nurses now employed in what are

called the "coronary care" units of our hospitals in this

province.

These are the nurses who, far more importantly than the

doctors, have the survival of patients in their hands, patients

who had had coronary thrombosis. These girls are highly trained

in the reading of cardiograms and in the immediate treatment of

a person who either has a heart attack or who had cardiac

arrest or who has some impending signs of cardiac arrest.

If there's any doubt in this area of heart disease about the

role of the nurse, the nurses that have been trained in this

particular specialty certainly come through, in the view of the

medical profession, with flying colours and with contributing

enormously to the success rate and the survival rate of many of

these patients.

There just isn't time to wait for the doctor to arrive when

the patient develops an irregular heart rhythm, or indeed if

the heart stops beating. It is the nurse who takes the action

immediately which very often saves the person's life and gets

the heart going again. I am maybe overstressing this, but I

think not too much credit and respect is paid to the number of

arms of the medical profession and the health services who have

made this kind of contribution in a relatively few years.

There has been a lot of talk, on the other hand, of using

the doctor more efficiently. I agree with that principle, but

I'm also a little worried about the danger of

over-simplification.

The Minister, in his budget speech, said that doctors really

should be freed from the chore of dispensing birth control

pills and family counselling. With respect, Mr. Chairman, I

would have to sound a note of caution. There are few pills that

are more dangerous to prescribe than birth control pills. I'm

not trying to be funny.

I don't mean that they might not work. I'm saying that there

are one or two very basic complications which can arise,

sometimes fatal, from the use of birth control pills. I'm

referring particularly to vascular problems that we call

thrombo-embolism, where you either get clotting in the vessels

or a piece of clot dislodges from the blood vessel and travels

to some vital part of the body, such as the lung, and may cause

sudden death.

I'm sure that the Minister meant this in good faith that we should limit the

doctor's role if it can be done by somebody else. This is something that I think

has to be put on record: while the doctor himself wants to be freed of many

of his paperwork duties, and many of the routine chores that could be done by

somebody else, let us not go overboard and finish up with strictly medical responsibilities

being given to people who have not had the adequate training to make some of

these important decisions.

In politics and in this House it's all too frequent that a

Member attacks a Minister, but I'm just about to attack the

Minister's wife, which I guess is even worse. But in jest, Mr.

Chairman, I would have to comment on the fact that a certain

statement appeared in the Press suggesting that the four Deputy

Ministers have it in their power to decide what kind of surgery

a woman would have if she had breast cancer.

She felt that this upset her very much, and it would upset

me if this was the case. But I think the House and the public

should be clearly reassured that the responsibility for

deciding medical or surgical treatment rests in the hands of

the attending physician or surgeon.

I'd like to make some specific suggestions if I could, Mr.

Chairman. One of the practical complaints that I hear all the

time from the hospitals and from the administrators is the

bureaucracy of BCHIS; that when you start trying to get things

done, there are holdups and red tape and delay and apparent

lack of cohesion between the three different arms. We have

hospital, and we have mental health, and we have public health.

If I ask anybody in the hospital field, "What is the one thing

you would first of all like to see improved about our health

services?" this, from any administrator at least, is the first

answer you always get: that BCHIS seems to be really tied up in

its own bureaucracy, with delay and numerous letters passing

back and forth.

When I say this, I'm passing on the comment in the light of

others in the administrative field. I have very little direct

experience of this myself. But it comes up so frequently when

you talk with people in the hospital field that I have to

assume that there's some grounds for this kind of complaint. I

wonder perhaps if the Minister would comment when he

answers.

There was great misconception in the House the other day in

discussing the subject of hospital boards. Again I think that

the Minister, in attempting to expand the hospital board in

terms of having people on the board who have community

identification and interest, is very important. And the

suggestion put forward by the Hospital Employees Union shows

just how much or how little they know about the important input

of local, voluntary, dedicated help to hospitals. Anybody who

talks about abolishing local hospital boards just doesn't know

what they're talking about.

[ Page 1215 ]

The one improvement which I'm sure the Minister is trying to

make is to have a higher percentage of hospital boards elected

by the local hospital society rather than have a large number

of appointed members of the board.

To correct some of the statements that were made Friday,

there is no hospital board I know of in the province…a few

years ago I did a private study of close to 80 hospitals in the

province. On that occasion I was trying to find out why a

doctor couldn't run for election as a member of the society — election I'm talking about, not appointment.

We all, as doctors, can become members of a hospital society

and pay our annual dues, but we are prevented from putting our

names forward for election at the annual meeting. But anyway,

this study showed that while the percentage varies there's no

hospital board where all the members are elected.

I'd like to touch on a few specific needs which I'm sure

that the Minister would like to comment upon — needs which would

not be of great financial significance, but tremendously

helpful to the minority of patients concerned.

First of all, I'm talking about children with cleft palates.

The Minister nods, and I know we've been around this racetrack

before. We've been around the racetrack on private nursing

homes, Mr. Chairman, before too, and they still haven't been

dealt with.

The child with the cleft palate has a terrible row to hoe in

this life. But at least we can do more for him or her than ever

before. I really must belabour this point, because the surgery

which the plastic surgeon eventually carries out gets very good

results. But he in turn depends on proper orthodontic treatment

of the deformity in the mouth prior to the surgery.

The surgeon's ability to produce in the end a good cosmetic

and functional result, is very dependent on the availability of

preceding orthodontic treatment with various moulds and

appliances.

I'm sure that the Members can understand, Mr. Chairman, that

these happen in young babies and children and that the children

of course grow very rapidly and the degree of the deformity and

the mechanics of the problem change very rapidly — almost from

month to month in the first few months of life and within the

next year or two almost as rapidly.

The orthodontic care required for these unfortunate

children, in the first year or two or three of life in

particular, is very expensive. It continues right up, or can

continue till the child is in its teens. The expense gets less

as the time goes by.

The point that's so important to I understand is that where Medicare is paying

for abortions and sterilization, and it's paying for a whole variety of physical

complaints in society, here we have children with a serious congenital deformity

which influences their whole physical and mental development as they go through

childhood, and Medicare doesn't pay for what is a vital part of treatment in

a very small minority of children.

I can't give you figures. I meant to get them before I spoke

today. The figures are available. The Society of Plastic

Surgeons has tried very hard in years gone by to persuade the

Minister that this would not be an enormous output of funds — but the benefits to the children would be enormous, and in the

long run would benefit society. We'd be less likely to have

emotional and mental troubles and behaviour on the part of

these children who either can't eat or speak properly.

This brings in the subject of speech therapy, Mr. Chairman.

I'd like the Minister to comment on whether we could have a

serious look at providing coverage for people who require

speech therapy. We have many citizens who have a stroke and

initially they're paralyzed in an arm and a leg. But this very

often recovers, at least maybe 70 or 80 per cent, and they

become mobile again.

I think we can all contemplate what a loss it is to have

confused or garbled speech. You can become mobile and go out

and take your walk in the park, or you can go to the corner

store; but if you can't ask the man in the store what you want

to buy, or he thinks you're drunk because you're not speaking

properly, the emotional impact of this kind of complication is

really serious.

We're dealing, not with a large segment of society, but an

important segment, whose functioning and normal mental health

would be greatly enhanced if they had access to speech

therapy.

Another small segment of society who I think the Minister

should be in a position to help are those unfortunate persons

who require surgery and finish up with an artificial opening on

their abdominal wall. I'm talking about people that we say have

a stoma, such as a colostomy. I think that anybody in society

who is unlucky enough to have their survival depend on such an

operation — surely, Mr. Chairman, if we're providing so much

coverage to so many people with really pretty simple minimal

complaints, it's not asking too much that at least we should

financially help the person who has to buy the appliances and

the cream and the ointment and several other aspects.

I don't want to go into details. It gets rather clinical.

But I'm saying that the person with an artificial stoma has

already suffered a tremendous handicap in his life. If we're

willing to pay for the cost of many other procedures which are

much less important to the individuals, things like speech

therapy, cleft palates, stomal openings — I would like to hear

the Minister comment as to whether we're close to giving these

people help.

He mentioned oxygen in the home the other day. It's just joy

to my ears. We asked for that for the last three or four years

too, and the Minister was always

[ Page 1216 ]

going to do something about it but he never did. Again,

apart from the tremendous convenience and help to the elderly

citizen to have an oxygen tank available in the house, it helps

to keep them in the home, where they're comfortable and happy,

and it keeps them out of hospital. So it just makes both

medical and human sense, plus sense in terms of dollars.

In talking about oxygen, Mr. Chairman, I know the Minister

has a request from a new group of paramedical personnel who

have appeared in the last few years. Respiratory technologists,

they're called. I don't know if the Minister recalls right at

the moment who they are. I have a copy of a document dated

February 26. It's actually a petition. I won't go into all the

details, but these are technologists who can train certain

patients whose problem is respiratory, in particular people

with a condition we've come to call obstructive lung disease,

which, simply put, is a form of asthma.

These people train the patient while he's in hospital to use a type of positive

pressure inhalator. If this kind of treatment were more readily available in

the home, once again, we would have the potential to treat the patient at home

and save him from frequent hospital readmission. The thing is, Mr. Chairman,

that this has become recognized as a paramedical specialty, you might say, in

every province except B.C. and Saskatchewan. Any technologist who wishes to

take up this profession or to be transferred from, say, nursing to this, cannot

have the training in British Columbia. The two gentlemen that I've spoken to

were trained in Alberta. They are asking the Government to consider setting

up programmes whereby training would have established standards and the

persons concerned would no longer have to leave this province to take the training.

It would also help to maintain the standard of work by these

technologists in a hospital by giving them a recognized diploma

or some degree of training. They, in turn, are very keen to

upgrade their training and to have in-service teaching and so

on. I would hope that the Minister is aware of this petition.

It's addressed to him. I know that he must receive many, but I

would be interested to know what his advisers have felt about

the sound nature of this proposal.

I would prefer not to talk about acupuncture, but I feel

that certain things have to be said. There are very few times

that a doctor seems to be beyond suspicion when he attempts to

discuss some other arm of the health team providing medical

care. The most frequent criticism that I have received, both

privately and in the news media, is that doctors are opposed to

acupuncture because they feel that this would encroach on their

particular domain — earnings, prestige, call it what you like.

I don't really care. All I do care about is getting the facts

straight.

The fact is that the Chinese themselves do not know how

acupuncture works. They have no clear understanding of how it

works. We do know that there are benefits, particularly in the

realm of the pain-killing effect. Let me make it plain, Mr.

Chairman, that I accept that there's something very important

and useful in acupuncture. I'm convinced of that. We've seen

operations on television where people have operations on their

lungs. There was one where the skull was opened and the brain

operation was carried out under acupuncture. Everybody has to

accept that it has a great deal of merit and value.

The reason that doctors may appear to be unduly sceptical is

simply that we are concerned in this area — as we are in

relation to chiropractors also — that diagnosis, knowing what

the problem is, must precede treatment. It just makes no sense,

because you can kill a pain somewhere in the body, to go and

stick needles in, albeit kill the pain, without having made a

diagnosis to be sure that the patient may not have some

underlying organic disease which requires, let us say,

surgery.

That's all the doctors are saying. And I'm happy to say that

this is, I think, the attitude of the Minister, from his public

statements — that we have to protect the patient.

If anybody thinks that I'm exaggerating, I had one of my

colleagues bring two cases to my attention in the last few

months. There were two patients, each of whom went to the

person practising acupuncture in Vancouver at some travelling

expense and the fee of having the acupuncture treatment. The

patient was only asked, "Where's the pain?". The needles were

inserted and the treatment was over. In both cases the patient

received several treatments without any benefit. They finally

went to a medical doctor because of the failure of response. It

happened that both of them had organic disease which did

require surgery. In both cases, I'm told, the delay did not

affect the final outcome.

The fact is that we, as medical men, are concerned about

patients who might choose all too easily and without any

restrictions to consult an acupuncturist. The application of

needles simply to relieve pain in the absence of a diagnosis is

a very dangerous thing for the public. If that's what the

public want, they can speak out and say so. I feel that, as one

doctor — and I'm not speaking for doctors generally, just

speaking for myself. I've seen other cases happen in the hands

of chiropractors. I make no apology for saying that either.

Somebody down the way here the other day asked if

chiropractors were to be brought under the Medical Act .

The Minister, I think, gave a definite "no", for which I think

he is to be complimented. The chiropractors are not, any more

than the acupuncturist, medically trained in a scientific way

to make accurate diagnoses. In fact, I'll go further and say

that

[ Page 1217 ]

chiropractic practice is really a cult which is not based on

scientifically demonstrated principles. Originally, the concept

behind the chiropractic practice claimed to cure cholera and

diabetes by spinal manipulation. Certainly the dogma to which

chiropractors adhere does not accept the proven scientific

practices such as vaccination and inoculation. The established,

fully trained medical man certainly feels that vaccination and

inoculation are one of the pillars in our preventive medicine

practice which avoids and prevents a tremendous range of

diseases in children and young adults.

Once again, I'm just saying that doctors are not opposed to

anybody who can help the well-being of a citizen. But there has

to be protection for the citizen also, to the degree that

various forms of treatment, which superficially may appear to

hold tremendous potential, should only be applied after

diagnosis.

I have examples here, too, of two particular patients who

had their spines manipulated in the absence of a diagnosis,

after X-rays had been taken and misread by chiropractors, one

of them a patient with cancer of the spine whose condition,

under manipulation, deteriorated rapidly so that she lost

control of her bladder and became paralyzed, then was rushed to

the hospital and had emergency neurosurgery. The X-ray which

had been misinterpreted by the chiropractor showed the

cancerous lesion of the spine.

We have another case of a person with rheumatoid arthritis

who finished up quadriplegic — that's paralyzed in all four

limbs. Now, I'm not saying this is happening every day, or

every week. But the fact is that when doctors take a stand and

sound a note of caution about acupuncture or chiropractic, it

isn't from any selfishly motivated point of view — it's simply

that we have a high sense of obligation as doctors to protect

the public from the dangers of ill-informed, potentially

damaging forms of treatment. And I can't put it any plainer

than that. But I think it's time some doctor did stand out in

public and say this.

I know I am going to have every chiropractor down my neck

after what I've said. But I've got the documentation. I know

the cases. This happens. I think that under these circumstances

it might even be worthwhile for the Minister, through you, Mr.

Chairman, to perhaps do some statistical analysis of the

patients admitted to hospital who have previously had some of

these treatments with a view to evaluating how successful

they've been. And perhaps equally important, to evaluate how

many of the patients ran into serious complications.

I am not going out of my way to attack branches of the health services field;

I am trying to put things in context. I am trying to say that when doctors make

certain statements and call for the Minister to set up committees and so on,

this is certainly not, in my view, motivated by a self-protective mechanism.

The person we're trying to protect is the patient.

One of the other subjects that I just want to finish on and

which has already been mentioned, is the whole question of

prescription drugs. I know it sounds rather tedious, but

sometimes you have to ask many times before you get what you

want in life. Sometimes you never get it.

But this whole question of prescription drugs, particularly

as to elderly citizens, as the Member for Vancouver–Point Grey

(Mr. McGeer) mentioned the other day, their very life depends

on it. When they're on a restricted budget, the monthly sum of

money they can put out for drugs is really considerable. I

think the progressive legislation which has provided Mincome

could easily be extended to provide very substantial assistance

to the senior citizens for drugs. I've talked too long.

MS. CHAIRWOMAN: The Hon. Minister.

HON. D.G. COCKE (Minister of Health Services and Hospital Insurance ):

Ms. Chairman, it's nice to see you back in your favourite chair. Thank you very

much for many kind words, Mr. Member. This day is starting better than Friday

did, I'll tell you.

Let me first deal with the question of recreation — and

thanks very much for the UBC reports. But the old question of

recreation — I met this morning with the B.C. Council of

YM-YWCA's, their whole council is meeting over here. They're

interested, very interested in the question of recreation and

fitness programmes as a preventive measure in health care.

We realize that we have to get a more definite programme, a

type of programme that's going to be sufficiently attractive.

One of the great problems of course is when the federal

government committee met just recently in January, at least one

of the areas in which they agreed was the fact that there isn't

necessarily that much that you add to a person's life. I think

that is one of the studies they have to do.

I agree with you on the cigarettes, and the overuse of

alcohol, overuse of food, and that type of thing. That's quite

clear. But there's a very definite need to get people involved

in a sort of a programme that's going to make them aware of how

to care for their own bodies.

I have here some pictures of a little robot. He's the cutest

little thing you've ever seen. That robot will be seen on

television starting about the end of March. He belongs to us — everybody in B.C., I hope. I hope they get very friendly with

him.

His purpose is to sort of draw in an analogy. If you had a

machine like this, the only one in existence, would you look

after it? This little machine works along and then it shows the

contrasting situation, your own body which is your only machine — would you look after it?

[ Page 1218 ]

We think that that might be an excellent way to kick off a

programme of fitness consciousness in the province. So that

will be a part of our health department advertising programme

sometime around the end of March. If any one wants to see this

little robot, we can send it around. You can name him if you

like. I've heard quite a few, but haven't decided what to call

him yet.

That's one way of getting public information out there.

We're very interested in it, and want to get going.

I notice here we were talking about the high costs of

certain areas of health care. For instance you were asking if I

could tell you what open heart surgery would cost. The figures

all put together, it averages somewhere between $4,000 and

$5,000 per person. That's not just the operation. That's the

medical attention, and the pre-operative care. But that

basically is what our estimate is. It's very difficult to say

because one might cost $10,000 and another might cost a great

deal less. We're getting patients out of hospital now in a couple of

weeks and less. And I'm very pleased of course, with the

addition of the Willow onto stream. It's going to give us a

fair capacity for B.C. But I have to warn the people that you

can only go so far with this kind of sophisticated medicine — there may be other areas that we're going to move into. As you

know, we're in renal dialysis to a great extent. The board

assures me that there are none of these life and death

decisions being made — anybody who can be helped is being

helped.

But, we're getting to a point in time where we have to be

very careful in assessing just how far we can go in

sophisticated medicine if we have to think in terms of

depriving a large number of others by virtue of the fact that

we've gone this way for a very small minority.

The private versus public lab question — I'm glad you don't

want to discuss that to any extent; neither do I. We haven't

made any great decision. The only thing is, I'm not going to

stand around while there's a public lab serving people and

having served people for a number of years, and then somebody

builds a private lab across the street to go into direct

competition with the public lab. That's just it, period.

If some people are accusing the hospitals and other public

labs of being too slow, if necessary, we'll sharpen up then.

We'll get the work done properly.

But, I just don't see us running our own labs out of

business by virtue of saying, "O.K., go ahead and build across

the street." And that's what is happening because that's a

handy place to have it.

The private hospital situation — I think that I have been

fairly definitive about that. I don't think you should be too

surprised about our position. We're working at top speed in

providing care for those people who qualify for care.

We haven't moved to intermediate care yet. One of the

reasons is that it's very difficult to decide where you draw

the line for intermediate care. That's a whole new level of

care. We have one facility that's just opening, and two more to

go, where we're going to be able to test this level of care as

to how far down you go for the day when we introduce it into

Medicare — or rather under Hospital Insurance. It'll

happen.

I don't agree with your price, Mr. Member, however. You said

$10 million. I suggest it might be $20 million plus. And that's

only if those that are actually known now to be in need of

intermediate care.

My suggestion is, once we get in on intermediate care — and

don't forget that's ambulatory chronic illness — once we get

into that, then if we're not careful it could very well be a

dumping ground for people. We feel that the only way to go is

to go home care first so that we can reinforce all of the

chronic illness.

MR. WALLACE: What about people in nursing homes right now?

You're not doing anything to help them.

HON. MR. COCKE: Well, the people who are in the nursing homes right

now, those people who qualified for extended care, we are getting them out as

quickly as possible.

In your Capital Regional District, we've moved everybody who

wanted to go into Gorge Road.

MR. WALLACE: What about the ones who don't qualify?

HON. MR. COCKE: The ones who don't qualify are intermediate

care — and they are stuck at the moment. But as I say, what is

intermediate care? Where do you go, where do you stop? Where do

you draw the line on that type of thing? Now, I'll tell you it

takes a lot of care. Because something that we think in terms

of $20 million could be $100 million before you know it, and

then we're into a very, very rough situation.

We have right now a great number of private hospitals

dealing with us, asking if we'll buy them. We're assessing all

these situations. O.K. We want it just as badly as that Member.

We're going to provide that service as quickly as we possibly

can, With respect to the greater Victoria utilization of the last

referendum, there will be 75 of the 150 beds built in the

Colwood region. I think that they'd better resolve that very

quickly myself. It's been a bit of a problem. There have been

arguments as to where it should be.

Now this morning, as you know, we formally announced the new

referendum, which is to go to the

[ Page 1219 ]

people on March 31. That referendum will be for $22.5

million for the next four years or so. What I want people to

understand is that the $22.5 million that they're voting for

isn't going to come out of their pockets entirely, by any

stretch of the imagination — 40 per cent of it comes from the

taxpayer and the other 60 per cent of it comes from this

Legislature, from the provincial government. So their load is

only something in the order of $10 million. It's not going to

be a charge to the home tax. That's the way the referenda

work.

Unfortunately, when you announce a referendum, it always

looks like a fantastic sum. For instance, in Vancouver recently

there was a $95 million referendum. Many of the taxpayers feel

that that is all going to come out of their land tax dollars

which it won't. Only 40 per cent will.

You, along with the Press, I believe, were misinformed about

the statement. I happened to be at that meeting. I was most

impressed with the speaker who spoke at that meeting about my

four deputies deciding on radical mastectomies. That was two

entirely different conversations but they had managed to box it

in together. However, what she did say was that she didn't like

the idea of a male doctor, or a number of male doctors, making

decisions around radical mastectomies that were often wrongly

made by virtue of the fact that the male does not give as much

attention to that particular part — that is to say he does not

have as much concern about that particular part of the anatomy

as women have.

There's been a great deal of research done on this question.

The research says that many of those operations are totally

unnecessary. The operation for the cancer is quite necessary

but the total removal of the breast is not.

MR. WALLACE: That's debatable.

HON. MR. COCKE: It's debatable, all right. But I'll tell

you, they've got some pretty hard facts. But that was the

statement. It has nothing to do with my deputies making

decisions as to whether or not women suffer that kind of

operation.

BCHIS bureaucracy. BCHIS comes to me and says, "What about

the bureaucracy that we're confronted with?" It's a very tough

question — deciding how much to spend on hospitals and where to

spend it and all the rest.

Another thing too. When a government department in as

sensitive a position as they are makes decisions, they've got

to be right. That's one of the reasons why they're more careful

than a number of government departments. I'm very pleased with

BCHIS. They've got some people in there working long, long

hours for not too much appreciation. Frankly, from what I've

seen in the last six months that I've been in this department,

I'm really pleased.

Cleft palate. We're studying that very carefully right now.

You recognize, of course, that there's no problem about the

surgery. The problem is around the orthodontic work that has to

be done both prior and subsequently. That work has to go on for

a number of years. We recognize that it's a very few cases and

therefore, while it's very expensive for the individual, it

wouldn't be that expensive as a global thing.

Then we have to start thinking how far we carry. Do we carry

it into malocclusions and all the rest of it? You know, the

dentists can give us a really wide range of things that they

should be in right now. We're looking at it and I wouldn't be

surprised that something happens there very quickly.

Speech therapy. There aren't enough speech therapists in the

province to do the job that we need doing. We are adding eight,

we've got 10 now, but there just aren't enough audiologists and

speech therapists around.

If somehow or another the Department of Audiology at UBC,

which is a relatively recent innovation, can really get off the

ground — and they're having some problems, I can tell you, a

shortage of funds among other things — I am sure that there

will be a supply and then we can get involved in this whole

question of speech and hearing deficiencies.

Acupuncture. It's becoming quite a subject. It's hard to

know about acupuncture. But the one question on which I agree

completely with you is that I don't want to see people go to

another health group for diagnosis and then find out to their

sorrow, too late, that they're going to die as a result or

suffer ill health for the rest of their lives as a result.

That's why we're going slowly. The one thing that I want to bring to your attention is that

I have had hundreds upon hundreds upon hundreds of letters on

acupuncture. So far I've yet to receive one that has indicated

any harm as a result of that particular therapy.

We met the acupuncture committee last weekend. We've decided

we're going to move towards — providing we can get co-operation

from some local acupuncturists — controlled, clinical

situations where the patient is referred to rather than just

going directly off the street. Also I think it will give us an

opportunity to assess some of the work that the acupuncturist

is doing.

We haven't got agreement from any local acupuncturists yet,

but we will be going to a number — you know their names,

they're the prominent ones basically — and asking them if

they'd care to participate in that kind of activity. We hope

that they will give us an opportunity to work with them.

The "chiropractic cult." It's a little harsh, Doctor.

Mr. Member, I think that there was a time when you could

very easily say that about the chiropractors. They are

relatively well trained now, according

[ Page 1220 ]

to the information that I get, and they have a large

following of people who feel that they provide good service.

They are not going to be licensed under the Medical Act

because they are not medical people. Agreed.

I think what we want to do is develop a closer understanding

or liaison between doctors and the chiropractors. As long as

there's this impasse, this no-communication situation, then

there'll always be mistrust and lack of understanding.

Interjection by an Hon. Member.

HON. MR. COCKE: Yes, I understand those disasters. But, you

know, disasters have grown. We can go back a number of years

and we can find, for instance, prior to the Carnegie report in

1911, that the medical profession was a disaster too in many

instances.

Interjection by an Hon. Member.

HON. MR. COCKE: No. I'm not arguing that, and I'm not

arguing that the medical profession is in any way a disaster at

the moment…

Interjection by an Hon. Member.

HON. MR. COCKE: That's right.

At the same time I think there should be more understanding

of the chiropractors' problems. I think there should be more

dialogue and we should get this thing together. Because I'm

quite sure they could work together if given an

opportunity.

There are some things that chiropractors do well. There's a

tremendous number of people in our society who say, "Boy, if it

wasn't for that chiropractor I'd be in really tough shape

today." So that's about where it stands at the moment.

I hope that I've answered most of your questions. If I've

overlooked any, you can come back at me. Thank you.

[Ms. Young in the chair]

MS. CHAIRWOMAN: The Hon. Member for West Vancouver–Howe Sound.

MR. L.A. WILLIAMS (West Vancouver–Howe Sound): Thank you,

Ms. Chairwoman.

Dealing with the matter of chiropractors, I wonder if the

Minister could just make a note — I won't be very long — and

perhaps he could tell the committee whether or not he has any

chiropractors or other medical disciplines in his departmental

staff. I know that there are medical doctors. It would be

interesting to know the extent to which these other disciplines

are welcomed into the department.

Ms. Chairwoman, I want to go back to this question of the

government's attention to the chronic care patient and the

facilities that are provided. I don't think the Hon. Minister

intended to sound like some of the answers that we got in

previous years but it did sound much the same. "It's a question

of the classification of patients. There's acute, intermediate,

extended and chronic — it's how you draw the lines." This is

what we used to get from the previous Minister.

The simple question that the Hon. Member for Oak Bay (Mr.

Wallace) asked and that I ask — I don't care whether there's a

person in a private hospital that might qualify for your

extended care unit if they could get a bed. The fact of the

matter is: What is the government prepared to do today for the

patient who today is in a private hospital? It's those patients

that we have to concern ourselves with. It's those patients,

based upon their experience, that led to the $10 million

figure that the Hon. Member quoted.

We are aware that in order to provide for all of this kind

of care would cost $20 million or more a year. But all that the

Member for Oak Bay said was that if you were going to

contribute 50-50 to that scheme with the federal government,

why don't you put up your half now?

MS. CHAIRWOMAN: Order, Hon. Member. I believe you're out of

order. There is a bill on the order paper,

An Act to Amend the Hospital Insurance Act , that covers the

acquisition of buildings and land for the purpose of providing

intermediate care of all types. I think that your questions are

covering it. It's Bill No. 92.

MR. WILLIAMS: Golly, Ms. Chairwoman, I'm sure glad you

brought that to my attention. I wouldn't want to offend against

the orders of the committee in any way.

Let me raise another similar subject, but not dealing with

the provision of facilities.

AN HON. MEMBER: It's a private bill.

MR. WILLIAMS: It's a private bill but it's on the orders.

But there's another matter which arises out of the same

problem. I'm not going to deal with the construction of

facilities even though we could do it the way they've done it

in Alberta. It really works there.

After the October session, Ms. Chairwoman, I'm sure you are aware because all

Members received correspondence concerning the increase in rates that were charged

by private hospitals, ostensibly because of the change in the minimum wage that

was brought in at the last session. I would like to ask the Hon. Minister a

particular question in that regard: Did his department make any examination

into the operation

[ Page

1221 ]

of private hospitals and did that examination show that the

increase in rates which took place late last fall was justified

because of the change in the minimum wage?

It's a very serious financial burden that is borne by people

who are patients in those hospitals and often by the relatives

of those patients. We find elderly couples, one having to go to

a private hospital and the other unable to continue to live in

the family home and look after himself or herself, forced to

find other accommodation and sell the family home. The eventual

consequence of this is that both of them end up on welfare.

It doesn't take very many months at $400 a month to use up

the savings of some of our older citizens even if they own

their own home and sell it and get $4,000, $5,000, $6,000 or

$8,000 in equity back. By the time the one who is not in

hospital cares for himself or herself and pays the large

expenses for the other, that money is very quickly gone. They

have nothing but welfare — after all the years of contribution

to the community. I'd like to know whether those rates were, in

fact, examined and whether they were justified.

I'll now turn to the matter of health delivery in this

province. As I listened to the Hon. Member for Oak Bay — and he

certainly knows the problem — it clarified for me one of the

basic problems that we have in this province. It's always said

that the squeaking wheel gets the grease. I get the impression

that the bigger the wheel, the bigger the squeak.

It's all very well for us to stand here, many of us from

urban areas, and talk about $22.5 million capital referenda,

$95 million in the Greater Vancouver Regional District,

sophisticated care, homemaker service, ambulances that you can

call by picking up the phone, heart surgery — all the

sophisticated medical talent and facilities that technology has

been able to design. We get terribly excited about this because

there are a lot of people involved. There's a lot of money — a

tremendous expense to the public purse. Naturally it must, I'm

sure, consume a very large portion of the time of the Minister

and of his department.

But what about those people who don't live in those major

urban centres? What about the delivery of health care in the

outlying areas where maybe if you're lucky you've got a doctor,

where maybe if you're lucky you're within 50 or 60 or 70 miles

of some kind of hospital facility?

What is the policy of the department now, Ms. Chairwoman, through you to the

Minister, concerning health care delivery under those circumstances? I know

that the Minister has had representations from doctors, from community leaders

who come from outlying areas. Some of them don't have a doctor at all; some

of them may be fortunate enough to have one. That doctor is virtually able to

deliver health care for those communities out of the little black bag that he

carries with him.

We should realize, Ms. Chairwoman, the serious consequences

that this has for some of these communities. It's all very well

if you're in the City of Vancouver and suddenly in the course

of your daily occupation you are injured or become ill. Maybe

you've got a first-aid attendant at your plant if you're at

work. If not, they put you in an ambulance and away you go off

to a hospital. They have all the facilities of that hospital

made available on an emergency basis. What's the cost?

Insignificant.

But if you're in some of these small communities and that

occurs, first of all they have to find the doctor and he may be

at the other end of the community, 25 or 30 miles away. Then,

when they finally get the doctor and the patient together, the

doctor makes his examination and provides what emergency

treatment the circumstances indicate.

But let's say it's a fractured arm; it needs to be X-rayed.

If the doctor has the equipment, maybe you're lucky and you get

an X-ray. If it's X-rayed and the doctor can set the arm, then

he applies a plaster cast. But the doctor pays for the plaster

that's used in the cast. That's all the expense of the doctor.

Whereas, if you're in a position to go to the hospital, it's

all the expense of the hospital.

So we have this strange anomaly where doctors who practise

in the city have the facilities of the hospital available to

them. They send their patients to the hospital where they go

and perform their medical skill. When they're all finished,

they say to the nurse, "There, fine, you just clean up this

patient. Thanks very much." The doctor washes his hands and

away he goes.

But when you're in the outlying areas, that's not the way it

happens. You diagnose, you treat, you bind up the wound and

then you send the patient home. Then it's the doctor or the

doctor's wife or somebody who cleans up the mess, hopefully in

time for the next patient. If there isn't time to do that, then

you go ahead and treat the patient under those conditions.

I happen to think that this downgrades very seriously the

position of the doctor in those outlying communities and in the

kind of health care that gets delivered. I think we owe a very

great debt to those doctors who are willing to go out into

those outlying areas and bring health care to those

communities. I think they need some special kind of

consideration. I think they should get assistance from the

government to ensure they have at least those basic facilities

which will enable them to do a better job.

After all, the doctor who is in that position is on call 24

hours a day. Some of them work just that long. I think that we

have to consider that, after all, they're human beings too.

They're not robots like the Hon. Minister has in his

photograph. They've got

[ Page 1222 ]

wives and they've got families and they like to spend a

little bit of time doing some of the things that husbands and

wives and families do. Therefore, they need to have some

special consideration from the government to ensure that they

can do the job in their community and they can also function as

human beings.

Too long, under the previous administration and the previous

Minister, we had offers of solutions to this difficulty. I

would like to know what the Minister is going to do about it

under his administration.

MS. CHAIRWOMAN: The Hon. Minister.

HON. MR. COCKE: Yes, Ms. Chairperson — if that's what you

prefer.

The question of private hospitals and qualifications: I

know, I've made speeches in this House myself where I've

indicated that it was a very simple procedure. But it isn't

quite as simple as has been indicated by the previous two

speakers.

It's very simple to decide who an extended-care person is.

An extended-care person is a chronically ill person who can't

walk, just that. It's very simple. People who cannot get around

by themselves.

Intermediate care, which is where we want to go, is an

announced policy, and a policy which I just don't understand

how anybody could have expected us to have implemented in six

short months. We're working in that direction. As far as I'm

concerned I just hope that we're going to be able to pull it

off as quickly as possible.

Let's say that we decided that that was the way to go. There

are patients in private hospitals right now that couldn't

conform to any standards. They are there by virtue of the fact

that that was a place to go, a place to retire. Then on the

other hand there are people in there who are very ill.

I'm not unmindful of what happens to people in a private

hospital setting. It took only 3 1/2 years to break my

father-in-law. I'm not unmindful of that at all. But I don't

think that anybody here wants us to hasten to the point where

we're going to undo it as opposed to do it properly. The only

assurance I can give you is that this is one of our top

priorities.

We are going to Ottawa again at the end of March, and again

they're not going to admit that there is any such thing as

mentally ill people. They're not going to admit that as far as

they are concerned there are people chronically ill but not

extensive. So we'll do our very best to come up with the kind

of programme that's necessary.

It's not just the financing, it's the programme. That's the

important aspect.

Now as to the question of whether we justified the rates for

private hospitals. About half of the patients in private

hospitals are my Hon. colleague's clients; half of them right

now are being paid by the Minister of Rehabilitation and Social

Improvement (Hon. Mr. Levi).

The only thing we did was to take a look at our particular

participation in that programme. We said, "Yes, there is a need

to increase the rate by a matter of $40-odd." So we increased

the rates for those people in private hospitals who are on

welfare up to $3.58. That's what we are now paying for those

people who are in private hospitals. That was as a result of

the increase in rates.

As far as what they did themselves, they came out with an

earlier rate to their own patients. I must say that some of

those rates jumped a lot further than I personally felt they

should have. But there's no control over it and that's all

there is to it.

Interjection by an Hon. Member.

HON. MR. COCKE: Our department studied it from our

standpoint. We recognize that the increase of $48 was valid.

But we can't speak for their own private patients.

Delivery of health care in isolated areas: as you know,

we've got a salaried position now right in the middle of the

Chilcotin.

The suggestion that you have about diagnostic and treatment

centres would work out very well, providing we can get

personnel. I think probably it would be a lot better if people

think more in terms of the community health centre concept. In

other words, a doctor and a group of people are told, "Okay,

will you look after this number of people in this geographical

area for 'X'?" You know, if you can keep them well, so much the

better. But we're sure looking at that.

I recognize where some of your concern comes from in the

Pemberton region. As a matter of fact we're discussing this

question of Pemberton right now.

MS. CHAIRWOMAN: The Hon. Second Member for Vancouver–Little

Mountain.

MR. R.T. CUMMINGS (Vancouver–Little Mountain): Thank you,

Madam Chairwoman. I wish you didn't enjoy saying "second" so

much.

As you know, Madam Chairman, our Government is concerned

above all with the quality of life. It is

[ Page 1223 ]

this, perhaps, that most sets us apart from previous

governments, which were only concerned with small businessmen

and how fast they could become big businessmen. This basic

difference in the way problems are approached is already

noticeable. That is why I would like to speak now to extended

care in British Columbia.

In 1965 the previous government discovered that there were

patients being discharged from acute care hospitals who were

functionally disabled. This means that they needed 24 hour

nursing care because for various reasons, mostly non-medical,

they could not perform the simplest tasks, like going to the

bathroom or feeding themselves.

Most of these people, though not all, were just old and had

been dismissed by their doctors as senile. Previous to 1965

these patients had been cared for in private hospitals, if they

had the money, or by their families, if they did not. In many

cases I am sure, Madam Chairman, they died of neglect.

In 1965 extended care was created under BCHIS — a dollar a

day care.

Looking after the aged, however, is not as straightforward

as looking after a patient in an acute care hospital. How do

you deal hour after hour with a 90 year old man who is confused

and forgetful, who is helpless, who can't feed himself, and who

dirties the bed? Who wants to deal with him? No one, Madam

Chairman, who can get a better job. At least, that's the way it

has been.

I think, Madam Chairman, that you remember the recent report

made by BCHIS on the situation in the extended care annex of

the Vancouver General Hospital in which the orderlies were

accused of brutality to the elderly patients. Madam Chairman, I

spoke recently to a highly-placed staff member in another of

this province's extended care hospitals, a hospital with

comfortable rooms, wonderful facilities, and a competent

administrative staff.

This person, who was aware of what had happened, had this to

say:

"Frankly I'm surprised that there haven't been more

headlines like those about the Vancouver General Hospital annex. The

same situation could easily have happened anywhere. Here we deal with

the same frustrations."

This person gave me an example of a common occurrence in

many extended care hospitals.

It is reported that a patient had fallen while going to the

bathroom. There is blood on the patient's face. The attendant

says that the patient fell; the patient insists that the

orderly pushed him.

What do you say to the orderly? Because of this incident the

orderly is already three bed-changes behind in his work. And in

room 10 he knows that an old man is crying because no one will

take him to the bathroom.

How many such incidents are not reported because families,

who know there is a shortage of extended care beds, are

reluctant to cause trouble? How many patients keep quiet

because they fear more physical harm?

What frustrations were behind this incident? How many

elderly patients in our extended care hospitals are suffering

the indignity of having to wear a catheter, not for medical

reasons but because the staff does not have time to change bed

linen?

Are we going to lay all the blame at the door of the

staff?

I think you must know, Madam Chairman, that in most cases

the staff in extended care hospitals are not prepared for their

jobs. It is true that they know how to give custodial care but

extended care patients need much more than that.

They have emotional needs, above all, and the horror of what

they are experiencing in terms of emotional stress becomes

clear when you realize that, for many of them, the staff is the

only family they have.

Madam Chairman, it is not only the aides and the orderlies

who are unequipped for their jobs in our extended care

hospitals. In many cases the professional staff of our

hospitals has been drawn from acute care hospitals. Many have

no special training in caring for extended care patients.

Madam Chairman, is it really necessary that doctors be

required to take special courses in the care of the aged? I

think so.

For example, I have been told that this is a frequent

conversation in extended care hospitals:

"Have you seen a doctor?"

"No, he won't come."

Why won't he come, Madam Chairman? Perhaps he won't come

because he won't be able to give a diagnosis to hang his hat

on. The diagnosis is "old age," and old age is not a

medical problem. Old age, in fact, has become so much of a

non-medical problem that other unfortunate occurrences

arise.

One staff member of an extended care hospital tells the

story of an old woman who broke her leg badly while being

treated for an illness in an acute care hospital.

[ Page 1224 ]

She was at the time also diagnosed as senile, so the doctor

did not set her leg, but instead left it to heal itself. The

woman was afterward transferred to an extended care hospital

where she underwent a dramatic emotional change. What had been

diagnosed as senility disappeared. She began taking an active

part in the activities of the hospital. She is now, however,

crippled for what remains of her life. This is not to say that the doctors are the only

professionals who are insensitive to the needs of the old.

Nurses too, with their acute care hospital outlook, are often

too busy to give anything but physical care to their

patients.

Extended care is first of all nursing care, and yet the

BCHIS guide for extended care programmes gives the medical

supervisors in each extended care hospital the sole

responsibility — "The development and continued application of

a suitable patient care programme." Yet this programme is not a

medical programme. It has nothing to do with medicine. It has

everything to do with nursing. But the nurse is relieved of all

responsibility in this key area.

Jealousy. Perhaps the nurses and the medical staff are only

the victims of this system. Whatever the reason, the patient

must not be sacrificed to it. BCHIS has recently appointed a

nursing consultant for extended care, yet it is still the

medical staff that has the final word about the individual programme in the extended care

hospitals of this province. I know of no prerogative given to

the doctors which says that they alone are responsible for the

qualities of life their patients live.

I will, Madam Chairman, give another example of why the

staff in extended care hospitals must be made aware that the

measure of compassion and understanding they bring to their job

is vital to the well-being of their patients.

Mrs. X is now a patient in an extended care hospital where

she has spent many months. She had withdrawn completely. When

she was admitted to the extended care hospital, Madam Chairman,

her knees were drawn up tightly under her chin in a fetal

position. She could not control her bowels. She was babbling

uncontrollably.

Within several months, because of the unique philosophy of

this particular extended care hospital, of which I will speak

later — she walked again, she spoke again, and she gained

complete control of her bowels. She has undoubtedly received

the best medical care in this hospital, but it was obvious that

the staff of the extended care hospital was able to give her a

totally different kind of care than she received in the acute care hospital.

I believe, Madam Chairman, that there is a need in this

province for strong leadership, which the previous government

did not give, to see that the staff in the extended care

hospitals are aware of their responsibilities to the patients.

This can be done in several ways. We must decide whether more

staff is needed in extended care units, whether better training

programmes are needed or whether we can use the staff we now

have in better ways. We must ask why patients are being

physically restrained — strapped down — because their personal

frustration results in violence. We must ask why it is

necessary to drug an 80-year-old patient for non-medical

reasons. These patients, Madam Chairman, are you and me in how

many years?

There are, Madam Chairman, BCHIS guidelines for the

requirements of extended care hospitals already in existence.

But we must realize that these guidelines were made without

proper studies being made. For example, how many patients in

how many hours can an orderly or an aide really deal with? How

much nursing time per hour does a patient need? And how we have

never determined what rights the patients in extended care

have. These are questions that have until now been ignored. The

previous government did not even think to ask them.

Is it the right or the privilege for a patient to go to the

bathroom? And how many times a day? If it is a privilege, then

let's draw straws and see who goes. How many minutes should a

patient be entitled to be fed dinner in? In 5 minutes — 10

minutes — 15 minutes? How many minutes or hours must a patient

be expected to lie in a wet bed?

We know, Madam Chairman, from the experience of an

80-year-old woman in the acute care hospital that custodial

care only leads to the breakdown of the patient. Let's make

sure we're using our staff properly and showing them that

whether they have a grade 10 education or a post-graduate

degree, they are most important.

Our attitude toward the patients must change too. In the

BCHIS 1971 Guide for Operation of Extended Care Programmes,

there is a chart showing the administrative structure of an

extended care hospital. In this structure, even the community

is included. There is, however, no patient representation. At

Cornwall Hospital in New Zealand, a council of 35 patients,

elected by the patients, handle all patient complaints and make

suggestions to the staff in the extended care unit there. This

is not being done in B.C.

These changes that I have been talking about are philosophical changes, changes

of attitude, changes

[ Page 1225 ]

that require direction from a government that is concerned

with quality of life.

Nothing is more revealing, Madam Chairman, of the

leadership, or lack of it, given BCHIS by the previous

government than a booklet which you may purchase from BCHIS for

$10.50. It is entitled Hospitals for Extended Care: A

Programme and Design Guide . There are 88 pages in this book

and 12 chapters.

The chapters have titles such as Plumbing, Heating,

Ventilation, and Administration. Only three pages in this whole

book discuss any needs of the patients other than physical

needs. Madam Chairman, it must be clear that a new emphasis, an

emphasis on the emotional and personal needs of the patients is

now required. At present, under the current BCHIS guidelines of

administration for extended care hospitals, no one is made

responsible for the quality of life experienced by the patients

in these hospitals.

Do we have no extended care hospitals in B.C. which

emphasize first the quality of life of the patients? Yes, we

have at least one. It is St. Mary's Priory Hospital here in

Victoria. It is the belief of the director of hospital services

there, Mrs. Vera McIvor, that when neglect causes a

deterioration of the mind and the body, it can be

reversed.

The method used at St. Mary's Priory has become known

throughout Canada, and beyond, as the Priory Method. I would

recommend, Madam Chairman, that every MLA with an extended care

hospital in his or her constituency visit St. Mary's

Priory.

At the Priory, patients are not hidden away from the

community. Last year patients there, whose average age is 80,

and who, Madam Chairman, require 24 hour nursing care, planned

and help decorate a float which they entered in a local parade.

Each year patients are responsible for planning and organizing

a mutt show and a rodeo on the grounds of the Priory. Patients

also have their own kitchen in which they make special

sandwiches and other goodies for parties. So obvious is the

spirit at the Priory that volunteers from the community come in

droves. Children run through the halls after school. A

91-year-old volunteer visits patients every morning. This

participation by the patients and by the community doesn't cost

a cent, Madam Chairman. It requires only imagination,

cooperation and dedication.

But there is no doubt that money does enter into it. On

February 20, this government announced a programme of home care

service to take the pressure off chronic and acute care

facilities. The need for this programme is desperate. Perhaps

it has come in time for the woman I would like to tell you

about.

What happens when a person has been rehabilitated physically and emotionally

to the point where she can leave the extended care hospital? Whose responsibility

is it to see that adequate care will be given that person? The answer in B.C.

at present is no one. Not the staff of the extended care units in B.C., except

where they feel morally responsible. Not BCHIS.

There is the case of a 45-year-old woman with multiple

sclerosis, now in St. Mary's Priory Hospital, who is in just

such a position. She was admitted to the hospital four months

ago in an advanced state of deterioration mentally. Her

89-year-old father had been looking after her to the point of

changing her diapers. After four months at St. Mary's, she can

again control her bowels and her mind is alert. The Priory

staff has been told that she is now no longer eligible under

the terms of extended care. Where will she go? Whose

responsibility is it to see that she will not be allowed to

deteriorate again?

Her case is not unique. Many extended care patients are

discharged either to nursing homes or home care from where they

originally came, and within a year are back again in extended

care with the same problems.

Finally, Madam Chairman, let me point out the desperate need

in this province for more extended care beds. There are only

2,870 now. A problem which the previous government ignored.

I would like to close now, thank you.

MS. CHAIRWOMAN: The Hon. Second Member for Vancouver

South.

MRS. D. WEBSTER (Vancouver South): Thank you, Madam

Chairman. I would like to ask just one question, a very short

one. To what extent is extra billing permitted under

Medicare?

Are any limitations put on this practice? I know that not

many doctors use it; however, it does exist.

I had a case referred to me some time ago of a woman who had

been referred by her doctor to a specialist. She required

necessary surgery. One week before she was to go into hospital,

she received a form from the specialist asking her to sign that

she would be willing to pay $150 extra for her operation. She

phoned me in desperation, I got in touch with the medical care

unit in Vancouver and they had the extra billing deferred

because she could not afford it.

I'm just wondering to what extent this is permitted. I

understood when we paid our Medicare fees that that would cover

not only our own general practitioner's fees but also fees for

surgery or anything else when it was referred to a specialist

by our own practitioner. Thank you.

MS. CHAIRWOMAN: The Hon. Member for Prince Rupert.

MR. G.R. LEA (Prince Rupert): Ms. Chairwoman, I would like

to bring up the subject of mental health

[ Page 1226 ]

services, especially those services that affect the northern

part of the province, and more especially those that would

affect my riding of Prince Rupert.

Once again, I hate to use this term, but it seems that

anytime I am talking about services to the north, I have to

preface it by saying, "lack of services" to the north. I do

that because all throughout the north there is a lack of

adequate mental health services. Basically it stems from not

having trained people in the north and I guess we would have to

go back to the reason that we do not have enough trained people

in Canada to meet the need and the demand.

I would ask the Minister, through you, Ms. Chairwoman, to

look into the training of more people in regard to

psychologists, psychiatrists and to Masters in Social Work

because we surely do need those people in British Columbia,

especially in the north.

It always amuses me just a bit when I am talking with people

from the south and they say, "We only have three people in this

particular field and we need six." When I point out to them

that we would like to have just one, or possibly two, they

realize that, even though they may be understaffed in these

institutions in the south, we have literally none.

Prince Rupert is a perfect example. We have had the

openings, or at least the jobs have been posted, and we had

applications for those jobs. But the thing that seems to be

holding it up is lack of money. We are asking people who are

trained to come into the north for very little money, when they

know full well that it costs a great deal more money to live in

the north. For those reasons we are not able to attract people

to come up to give us this very vital service in mental

health.

It is almost getting to be a cliché in this House,

when we talk about "services to people." We always end up

saying, "The previous administration didn't do this and didn't

do that." I think that now we have to forget what the previous

administration did or didn't do and look to what we are going

to do. I would like to have the Minister of Health tell me what

general direction we are going, in regard to mental health.

I believe that society has always treated the mental health

patient, the person with a mental illness, in one way — we put

them to the side and hope we don't have to see them and we can

forget about them. I believe we have done that in government

for a great many years in this province. We have pushed the

Mental Health Branch to one side and hoped they don't show

their face also, because it seems to embarrass us in this

society to have to deal with mental health. I think the way we

can get over it is to take the lead.

It seems to me that the correct method would be to take mental health services

in this province and put them where I believe they should be — under the same

roof as public health. I would like to hear the Minister's views on that.

Specifically, I would like to mention the situation we have

in Prince Rupert, where we have the openings posted but we

cannot attract the people to fill them. I mentioned the fact

that more money, I think, is in order. It seems to me that a

person who is trained as a psychologist or is trained as a

social worker and has his master's degree deserves at least the

same kind of money to work in Prince Rupert as the person who

is trained as a plumber or an electrician or a truck driver

working for the pulp mill, in Prince Rupert, or someone

working in the fishing industry. It would seem to me that they

deserve that kind of money. I would ask the Minister of Health

to use his influence with the Civil Service Commission to have

the wages of these positions raised.

Also, it has been pointed out to me by the director of the

mental health unit in our district that it is probably

ridiculous to ask the people to come up there with a PhD in

psychology, when a master's degree would do just as well. He

has pointed out to me that most PhD's in that field are

academics, and that what we need is a person who is trained,

with experience, and who has a master's degree. That would be

adequate in his opinion. He has convinced me it would be

adequate and I would like to hear the Minister's views on

that.

One subject I'll probably always talk about when the subject

is remotely related to health services in this Legislature is

air ambulance service. There is a need…

MS. CHAIRWOMAN: Excuse me, I believe you are out of order.

Hon. Member, there is a bill on the order paper referring to

air ambulance aid; it's No. 93.

MR. LEA: Right. I think there are a couple. One further

subject that I would like to mention, because it bothers me, is

that when you go in to see a doctor there is no way of knowing — I realize it is impossible to tell where he came out in his

class when he was going to medical school. That is a part that

I don't think can be corrected, because it would be too hard to

put all their marks up on the wall.

Throughout small communities in this province, oftentimes

you go into a community where there is only one doctor who is

not a young doctor, and who took his training some years prior.

I know of one instance where a doctor hasn't been to medical

school for 40 years. He graduated 40 years ago, and it would

very much surprise me whether he has read a medical paper since

that time or even driven by a university. It bothers me that

this kind of service is there for the public and there isn't

any choice.

It seems to me that if we are concerned enough in

[ Page 1227 ]

our society to make aircraft mechanics go back and take an

upgrading course and plumbers and many other of the trades,

that the trade of being a doctor could also have upgrading

courses. I believe it should be a requirement that doctors

every so often have to go back and become familiar with what is

new in the profession. I don't think it is good enough that we

leave the policing and the discipline up to the British

Columbia Medical Association.

I believe we have to accept that responsibility as a

government. I would like to hear also the Minister's views on

that.

MS. CHAIRWOMAN: The Hon. Minister of Health Services and

Hospital Insurance.

HON. MR. COCKE: Madam Chairman, first I shall deal with the

extended care question that the Hon. Member for

Vancouver–Little Mountain (Mr. Cummings) brought up. You are

quite right. There is a real problem around this whole question

of the care for the aged and the geriatrics situation. I would

like to inform the Member, however, that practical nurses, who

are directly licensed, are being trained to a greater extent

than they once were in this particular area.

We feel that one of the things we should do is to broaden

out to the point that everybody realizes that one of the best

places for that kind of training is on the job, but take the

time to provide that kind of training on the job. It is not

going to be easy but it is going to be a lot easier when our

facilities broaden out. In the dark ages in the past we have

had some pretty monstrous operations, that is, grotesque sort

of operations. It was very difficult to train or motivate

anybody under those circumstances.

There are now, just to give you a number, in the last short

while, the Gorge Road Hospital here and the Vancouver General

Hospital has 201 extended care beds now. That is the kind of

facility in which these people can be best trained, in my view.

That is to say that they shouldn't have more of it in their

classes, but I do think it is the kind of on-the-job training

that will be most helpful.

Extra billing: well, you have a right to extra bill, right

now, in this province. There is that right provided. I'm not

here to advocate that right. I'll just tell you what the rules

are, however.

In the Medical Services Act and regulations, it

indicates quite clearly that providing the practitioner meets

certain criteria, he can extra bill. It says here that:

"Where a practitioner renders an insured service to an

insured person, he may charge the insured person a fee in excess of the

tariff in relation to that service if:

(

a) prior to rendering the service he gave a reasonable notice to the insured person of his intention to charge a greater amount in respect of that service; and

(

b) the insured person or some other person acting on his behalf consents in writing to the extra charge; and

(

c) the amount of the extra charge is made known to the commission."

This extra $150 is a large amount. We recognize that it's

certainly counter-productive to the direction of Medicare. We

don't in any way advocate it. I hope that sooner or later we

can come to some sort of an agreement or make necessary rulings

in our own regulations that will stop that sort of situation.

We realize that it's a real problem.

Getting back to the far north. Yes, I agree, Mr. Member

through you, Madam Chairman, that we are having trouble up

there. We're going to have to do something about it.

The Civil Service Commission. Unfortunately this isn't his

estimate, but I would suggest that this be brought up again

under the estimates of the Provincial Secretary (Hon. Mr.

Hall). It's partly their responsibility to set salary scales,

et cetera. I would think that we're probably heading toward a

direction — and we are. It's a Government announced policy that

after the Higgins report came down, this whole question would

be studied thoroughly. I recognize that it must be studied

particularly in health.

I understand that we've lost the person that you were

talking about the other day when you confronted me with this

problem personally — that is, he's gone to another job as a

result of the fact that we were unable to pay the amount that

was necessary. That's just unfortunate but we are bound up by

rules, many of them old rules.

As far as doctors going back to school, I think that that's

probably a suggestion that they will be getting from