Manitoba Hansard — 23 April 1992 (Sitting 51, 35th Legislature, 3rd Session)

35-3-51

Manitoba — Debates (Hansard)

MG-8048 Third Session - Thirty-Fifth Legislature of the Legislative Assembly of Manitoba DEBATES and PROCEEDINGS (HANSARD) 39-40 Elizabeth II Published under the authority of The Honourable Denis C. Rocan Speaker VOL. XLI No. 51 ·1 :30 p.m., THURSDAY, APRIL 23, 1992 Printed by the Office of the Queens Printer, Province of Msnltobe ISSN 0542-5492

MANITOBA LEGISLATIVE ASSEMBLY Thirty-Fifth Legislatu re Members, Constituencies and Political Affiliation NAME ALCOCK, Reg ASHTON, Steve BARRETT, Becky CARSTAIRS, Sharon CERILLI, Marianne CHEEMA, Guizar CHOMIAK, Dave CONNERY, Edward CUMMINGS, Glen, Hon. DACOUAY, Louise DERKACH, Leonard, Hon. DEWAR, Gregory DOER, Gary DOWNEY, James , Hon. DRIEDGER, Albert, Hon. DUCH ARME, Gerry, Hon. EDWARDS, Paul ENNS, Harry, Hon. ERNST, Jim , Hon. EVANS, Ciif EVANS, Leonard S. FILMON, Gary, Hon. FINDLAY, Glen, Hon. FRIESEN, Jean GAUDRY, Neil GILLESHAM MER, Harold, Hon. HARPER, Elijah HELWER, Edward R.

HICKES, George LAMOUREUX, Kevin LA THLIN, Oscar LAURENDEAU, Marcel MALOWAY, Jim MANNESS, Clayt on, Hon. MARTINDALE, Doug McALPINE, Gerry McCRAE, James, Hon. MciNTOSH, Linda, Hon. MITCHELSON, Bonnie, Hon. NEUFELD, Harold ORCHARD, Donald, Hon. PENNER, Jack PLOHMAN, John PRAZNIK, Darren, Hon. REID, Daryl REIMER, Jack RENDER, Shirley ROCAN, Denis, Hon. ROSE, Bob SANTOS, Conrad STEFANSON, Eric, Hon. STO RIE, Jerry SVEINSON, Ben VODREY, Rosemary, Hon. WASYL YCIA-LEIS, Judy WOWCHUK, Rosann CONSTITUENCY Osbome Thompson Wellington River Heights Radisson The Maples Kildonan Portage Ia Prairie Ste.

Rose Seine River Roblin-Russell Selkirk Concordia Arthur-Virden Ste inbach Riel St. James Lakeside Charleswood Interlake Brandon East Tuxedo Springfield Wolseley St. Boniface Minnedosa Rupertsland Gimli Point Douglas Inkster The Pas St. Norbert Elmwood Morris Burrows Sturgeon Creek Brandon West Assiniboia River East Rossmere Pembina Emerson Dauphin Lac du Bonnet Transcona Niakwa St. Vital Gladstone Turtle Mountain Broadway Kirkfield Park AinAon La Verendrye Fort Garry St.

Johns Swan River PARTY Liberal NDP NDP Liberal NDP Liberal NDP PC PC PC PC NDP NDP PC PC PC Liberal PC PC NDP NDP PC PC NDP Liberal PC NDP PC NDP Liberal NDP PC NDP PC NDP PC PC PC PC PC PC PC NDP PC NDP PC PC PC PC NDP PC NDP PC PC NDP NDP

2505 LEGISLATIVE ASSEMBLY OF MANITOBA Thursday, Aprll23, 1992 The House met at 1 :30 p.m. PRAYERS ROUTINE PROCEEDINGS PRESENTING PETITIONS Mr. Gregory Dewar (Selkirk): I beg to present the petition of Rick Keep, Cam Wortman, Craig Scott and others requesting the Minister of Family Services (Mr. Gilleshammer) consider a one-year moratorium on the closure of the Human Resources Opportunity Centre in Selkirk. READING AND RECEIVING PETITIONS Mr. Speaker: I have reviewed the petition of the honourable member for Selkirk (Mr.

Dewar), and it complies with the privileges and practices of the House and complies with the rules (by leave). Is it the will of the House to have the petition read? The petition of the undersigned citizens of the province of Manitoba humbly sheweth that:

WHEREAS the Human Resources Opportunity Office has operated in Selkirk for over 21 years providing trai ning for the unemployed and people re-enteri ng the labour force; and WHER EAS during the past 10 years alone over 1 ,000 trai nees have gone throu gh the program gaining valuable skills and trai ning; and WHER EAS upwards of 80 percent of the trai ning centre 's recent graduates have found employment; and WHERE AS without consultation the program was cut in the 1992 provincial budget forcing the centre to close; and WHERE AS there is a growing need for this program in Selkirk and the program has the support of the town of Selkirk, the Selkirk local of the Manitoba Metis Federation as well as many ot her local organizations and individuals.

WHEREF ORE your petitioners humbly pray that the Legislature of the Province of Manitoba may be pleased to request the Minister of Family Services (Mr. Gil les hammer) to consider a one-year moratorium on the program. * ** I have reviewed the petition of the honourable member for Wolseley (Ms. Friesen), and it complies with the privileges and practices of the House and complies with the rules. Is it the will of the House to have the petition read?

The petition of the undersigned citizens of the province of Manitoba humbly sheweth that: WHERE AS the Dutch elm disease control program is of primary importance to the protection of the city's many elm trees; and WHERE AS the Minister of Natural Resources himself stated that, "It is vital that we continue our active fight against Dutch elm disease in Manitoba," and

WHEREAS, despite that verbal commitment, the government of Manitoba has cut its funding to the city's OED control program by half of the 1990 level, a move that will jeopardize the survival of Winnipeg's elm trees. WHEREF ORE your petitioners humbly pray that the government of Manitoba may be pleased to request the Minister of Natural Resources (Mr. Enns) to consider resto ring the full funding of the Dutch elm disease control program to the previous level of 1990. As in duty bound your petitioners will ever pray. Introduction of Guests Mr.

Speaker: Je tiens a vous signaler Ia presence dans Ia galerie publique de vingt-neuf etudiants de Ia neuvieme annee de I'Ecole Viscount-Alexa nder, sous Ia direction d'Amelie Gauthier. Cette institution est situee dans Ia circonscription de !'honourable minstre de !'Education (Mme Vodrey). [Translation] I wish to draw the atte ntion of all honourable members to the public gallery, where we have with us today twent y-nine Grade 9 students from Viscount Alexander School, under the direction of Amelie Gauthier. This school Is located in the constituency of the honourable Minister of Education (Mrs. Vodrey).

2506 LEGISLATIVE ASSEMBLY OF MANITOBA April 23, 1992 [English] Also this afternoon, we have seated in the public gallery, from the Red River Community College, forty students under the direction of Mrs. Atallah and Mrs. Thorlaks on. This school is located in the constituency of the honourable member for Point Douglas (Mr. Hickes). On behalf of all honourable members, I welcome you here this afternoon. ORAL QUESTION PERIOD Shoal Lake Protection Premier's Discussion Mr. Gary Doer (Leader of the Opposhlon): Mr.

Speaker, Winnipeg has always been envied by Canadian cities and North American cities for being one of only two cities in this country that has untreated water for our water supply, with the wisdom of our forefathers and for emothers in the est ablishment of the aqueduct at Shoal Lake and the water supply to Winnipeg. Last week the Premier of Manitoba (Mr. Filmon) met again with the Premier of Ontario. He met at a time when there are lobbying attempts going on with one of the companies, one of the 12 mining companies that have claims in the area of the Shoal Lake waters hed, Mr. Speaker.

I would like to ask the Premier: Can he advise us of whether he discussed the issue of the Shoal Lake water supply for the city of Winnipeg with the Premier, and can the Premier advise Manitobans on the status of our water supply based on his meetings with the Premier of Ontario? Hon. Gary Fllmon (Premier): Yes, Mr.

Speaker, indeed I did raise the issue with the Premier, and I re-em phasized our desire to have the fullest possible environmental assessment and review done of any proposal that would be within the watershed of Shoal Lake, the source of the city of Winnipeg's water supply. * (1 335) Shoal Lake Protection Negotiations • Ontario Mr. Gary Doer (Leader of the Opposition): Certainly, we concur with the Premier (Mr.

Filmon) to oppose the lobbying by the mining industry and the 12 companies that have the claims in the Shoal Lake water area for the change in the environmental process that they are proposing in the province of Ontario. The Premier, in his Estimates of March 23, 199 2, indicated that he had discussed with the Premier of Ontario the need for a management plan for the total watershed and work on the development of a management plan for the total watershed.

Last time we asked questions to the Minister of Environment on this issue, he indicated that those negotiations were som ewha t in limbo, I gue ss we can characterize his answe r. I wou ld ask the Premier: Can he advise Manitobans what the status is of the watershed negotiations that are going on, which obviously makes good sense for Manitoba? Can he advise us of the Premier of Ontario and his discussions at that meeting in Ontario last week? Hon. Glen Cummings (Minister of Environment): Mr. Speaker, it Is still the position of this government that we want a complete watershed management plan.

I hope that the Leader of the Opposition will use his good office to encourage his colleagues in Ontario to work with us to bring this to completion. We had some confusion for a short period of time between which ministry in Ontario was goi ng to be working with it, whether It would be the ministry of Environment or some other res ponsibilities that were assigned to other ministers. As I stated, I believe, a week ago, Mr. Speaker, apparently that authority is going to be returned to the ministry of Environment.

I have been in contact with Minister Grier, and certainly, as soon as Ontario is willing to proceed in that area, we are more than anxious to get on with it. Shoal Lake Protection Environmental Review Process Mr.

Gary Doer (Leader of the Opposition): Pursuant to the Premier's answer to the ques tion dealing with the meeting with Premier Rae, last week, when I asked the question about the changing lobbying from Consolidated Professor, the minister indicated that they would not be raising this Issue form ally with Ontario because , quote: it was not a formal proposal from Consolidated even though they had the whole mining Industry behind them. In his answer just now he indicated that he has indeed raised this with the minister, which I congratulate him for doing.

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 2507 I would ask the Premier: Did he receive any commitment from the Premier of Ontario not to proceed with a changed environmental process in the province of Ontario? Hon. Gary Fllmon (Premier): Mr. Speaker, I would be surprised, I suppose, If the Premier would make a decision like that on the basis of a short discussion with me.

I will say that I was encouraged by his response and his awareness of the concerns of Manitoba, and I am optimistic that he would be supportive of our position that the fullest possi ble environmental assessment review be done on any proposal , such as the Consolidated Professor within the watershed of Shoal Lake, and in being supportive , that would indicate that there would not be a change in the proposed method of operation as we have been discussing it in the past. Conawapa Dam Project Premier's Discussions Mr. Gary Doer (Leader of the Opposition): I have a new question to the Premier. Mr.

Speaker, the Premier did indeed meet with the Premier of Ontario last week, and he did discuss the issue of Shoal Lake, a very important bilateral issue between the two pro vinces. Another very important project between the two pro vinces obviously is the Conawapa Dam and the Conawapa project and the transmission line that is proposed to go to Ontario for purposes of sale of electricity to that province and the sale or use of electricity eventually for the prov ince of Manitoba for domestic use.

Since the government has signed the agreement with Premier Peterson in Ontario, the domestic load growth pro jections for Manitoba and Ontario have changed considerably. I wonder If the Premier of Manitoba has discussed the issue of the Conawapa project and the time lines and penalties in the Conawapa project with the Premier of Ontario, given the latest data that his government has on domestic use for Manitoba and the data that is available now in the provi nce of Ontario. Hon. Gary Fllmon (Premier): Yes, Mr. Speaker, I did discuss that matter with the Premier of Ontario. Penalty Clauses Mr.

Gary Doer (Leader of the Opposition): Mr. Speaker, ma ny orga niz ations in Manitoba, aborig inal organizations in Manito ba, other organizations In Manitoba are very concerned about the timing and the speed of the environmental processes in this province. Certainly the penalty clauses that were negotiated by the Premier and the Premier of Ontario are very, very extreme in terms of dates for cancellation of the proje ct. They have very, very tight time lines which escalate the amount of money that Manitoba Hydro is required to pay Ontario Hydro and Ontario Hydro Is required to pay Manitoba Hydro.

I was wonde ring, in light of the change in domestic load growth from an early date of 2001 for Manitoba and 2002 for Ontario, whether the Premier has discussed these escalating penalties, these major penalties in the contract, and whether they have discussed allowing a less frenzied pote ntial pace on the hearing process to take place. * (1 340) Hon. Gary Fllrnon (Premier): Mr. Speaker, I am a little amused at the suggestion of the frenzied pace when the agreement was signed in December of 19 89, and we are now two and a half years down the road . That is quite some frenzy that we are dealing with.

The fact of the matter is that the change in load growth that is being referred to by the Leader of the Opposition was anticipated and was taken into account by the Public Utilities Board in their review. The Public Utilities Board review anticipated a possible change of load growth pro jection when they made their determination and their recommendation to proceed with the project. The fact of the matter is that the environmental ass essment and review process will be carried out in as reasonable a fashion as it possibly can.

We see no reason why the Leader of the Opposition or anybody would want to unreasonably deter or in fact delay the project. The review will be done. People have had almost two and a half years to prepare for the review on both sides, to prepare their case, to prepare their information. Now when they go before that very thor ough and complete review, they will be able to make their case. I would ass ume that the Clean Environment Commission and the joint review process before a panel of experts will give it a very thor ough, very complete and very well-consider ed response whenever that time arises.

There is no reason on our part to accelerate it, and there is no reason on the part of the opponents to delay it. The process should take place in a reas onable fashion, and it will take place in a reasonable fas hion.

2508 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 23, 19 92 Premier's Discussions Mr. Gary Doer (Leader of the Opposition): Mr. Speaker, did the Premier raise the concerns from the Manitoba MKO organization that Mr. Michael Anderson, the research director of the organizatio n representing 24 bands , has said that the one-month pe riod that they have to present detailed presentation to the panels Is not enough time to deal with this issue? Has the Premier discussed some of these concerns coming from bands which are most directly affected in terms of the proposed transmission line?

Did the Premier discuss that with the Premier of Onta rio, or can the Premier advise us what he did discuss when he discussed the Conawapa project with the Premier of Ontario last week when he met with him? Hon. Gary Fllmon (Premier): Mr. Speaker, I repeat that all of these people including the bands have had almost two and a half years to consider the proposal and the pote ntial impacts of that proposal. I say, the Leader of the Opposition, from his chair in opposi tion, has the great benefit of being able to be all over the map and change his positio n very regularly. I would like to just quote, Mr.

Speaker, what he said in July of 1 988, in the debate on the first budget of this administration: We will fight the mothballing of our Manitoba Hydro program right down the line this session and next session of the Legislature. He wanted this project and this proposal to proceed expeditiously, as quickly as possible, because he wanted that hydro project to be developed. Now for his own political purposes, he is changing 18 0 degrees and now talking about slowing down, slowing dow n, obfusca ting, delaying, all of those kinds of things. He cannot have it both ways.

I know every day in this House and every day out there he tries to have it all ways, but this Is carrying it to a ridiculous extreme, I would say. Conawapa Dam Project Justification Mrs. Sharon Carstalrs (Leader of the Second Opposition): Mr. Speaker, that certainly has not been the position of the Liberal Party in Manitoba. The Liberal Party in Manitoba has consistently said that we should not build a powe r project unless that power was required for the needs of Manitobans. Mr.

Speaker, it has becom e increasingly clear that not only is that power not needed In the province of Manitoba, it Is also not needed In the province of Ontario. Why are we spending, between the two provinces, $13 billion and $5.7 billion in this pro vince? • (1 345) Hon. Gary Fllmon (Premier): Mr. Speaker, let us not go from the sublime to the ridiculous. The fact of the matter is, this project and the econom ics of this project were considered by an objective third-party review under the Public Utilities Board, and they determined that the economics of the project were positive .

They determined that given the fact that there was an assu mption that the pro jected load growth could be out on either side, positive or negative, and they still felt that the economics were positive . I now find it rather amusing that the Liberal Party argued against this project on the basis that Ontario had made too good a deal, that the Liberal government of David Peterson had put one over on us and made too good a deal on this, and that now we should be concerned about it.

Now the people appearing before a similar review In Ontario are saying that Manitoba made too good a deal, that Ontario is paying too big a price and that David Peterson got snoo kered, Mr. Speaker. Well, I wonder just what exactly the Liberals want. Did they get snookered, or did they not get snookered? Is David Peterson a good negotiator, or Is he not a good negotiator? Make up your mind. Public Utilities Board Review Mrs. Sharon Carstalrs (Leader of the Second Opposition): Well, with the greatest resp ect, Mr.

Speaker, the arguments that are being made in Ontario today are being made by people who would also like to produce the pow er. let us be totally realistic about this. Mr. Speaker, the question being asked is one that is very simple. The Public Utilities Board decided this issue on information provided to them by Manitoba Hydro, information which some three months later proved to be terribly inaccurate. Why is this go vernment so afraid to take this deal back to the Public Utilities Board to ask them to re-evaluate it In light of new information provided by Manitoba Hydro?

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 2509 Hon. Gary Fllmon (Premier): Mr. Speaker, the Leader of the Liberal Party began her question founded on the credibility of those who were appearing at the public review in Ontario. She then, in response to my answer, said that they had no credibility because they were wanting to produce their own powe r. She cannot have it both ways.

The fact of the matter is, the PUB report, after the review of the capital projects of Manitoba Hydro, including Conawapa, said, and I quote: The level of the DSM target assumed for planning purposes today will not significantly affect the concl usions conce rning the profitability of the Ontario sale, nor will it affect any current decisions regarding the construction of facilities. They took it into acco unt. It does not have to be rereviewed. They already took it into account.

I invite the Leader of the Liberal Party to read that report and to go and consult with the Public Utilities Board about this matter ins tead of making outlandish suggestions. Mrs . Carstalrs: Well, with the greatest respect to the Premier, the Public Utilities Board is supposed to be an arm's-length body from politicians and not to be one that is consulted with, one that studies and observes. Why is this government, in light of significant new infor mation, still refusing to do what is in the best interests of the ratepayers of this provi nce, which is to en sur e that our mo ney is bein g spent appropriately?

Mr. Fllmon: Mr. Speaker, there is no new inform ation. The Public Utilities Board said the level of the DSM target, that is the domestic-load-growth target assumed for planning purposes today, will not significantly affect the conclusions conce rning the profitability of the Ontario sale, nor will it affect any current decisions regarding the construction of the facilities. They took it into account. * (1 350) Department of Education and Training Deputy Minister's Salary Mr. Dave Chomlak (KIIdonan): Mr. Speaker, my question is directed to the Minister of Education and Training. Mr.

Speaker, in this budget, the gove rnment talked about belt tightening for all Manitob ans. It tells school boards and universities to hold the line, yet the gove rnment in its actions does exactly the opposite by giving great increases to elite schools while sta rving the public school syst em. Now, this year, we are being asked to increase again the salary of a key appointment of the Conservatives, a deputy minist er, to $1 00,000 this year, which is a 7 percent increase this year and a 37 percent increase in the last three years.

How can this minis ter justify this increase while telling everyone else to hold the line? Hon. Rosemary Vodrey (Minister of Education and Training): Mr. Speaker, I would like to correct first of all some of the information that the critic has tried to put on the record . In fact, we have increased our funding to the public school syste m in this provi nce. We have Increased our funding to the university syste m. We have Increased our funding to community colleges, and we have increased our commitment to training.

The further issues that he has raised I will be happy to answer for him during the Estimates process. Executive Support Mr. Dave Chomlak (KIIdonan): Perhaps the minister can tell me therefore why the Department of Education, in the last three years, has increased Its expenditures for Executive Support to the minister by 40 percent or $1 50,000. Hon. Rosemary Vodrey (Minister of Education and Training): To en sur e that my critic understands it, there is a general salary increase necessary ; however, the details I will be happy to discuss in Estimates. Deputy Minister's Salary Mr. Dave Chomlak (KIIdonan): Mr.

Speaker, will the minister have the courage to limit the increase to her deputy minister at least to the same level that she has given to public schools in Manitoba? Hon. Rosemary Vodrey (Minister of Education and Training): Mr. Speaker, I will be more than happy to debate the issue with my honourable friend during the Estimates process. Health Care System Delnsurance - Impacted Wisdom Teeth Ms. Judy Wasylycla-Lels (St. Johns ) : Mr. Speaker, the Minis ter of Health continues to address concerns about health care costs by

2510 LEGISLATIVE ASSEM BLY OF MANITOBA April 23, 19 92 eroding fundamental principles under our medicare syste m. Mr. Speaker, in the past, this gove rnment has deinsured a number of services under medicare. Today we have learned that this deinsurance has been extended to now cover the removal of impacted teeth under certain circumstances, with new

definitions, in hospital when anesthetic services are required. I would like to know from this minister why this decision was made, what savings he will incur, and what is the impact- Mr. Speaker: Order, please . The question has been put. Hon. Donald Orchard (Minister of Health}: Mr. Speaker, yes, we have had discussions, since approximately June or July of last year, with the providers in terms of the insured removal of asym ptomatic impacted wisdom teeth.

Those procedures have been undertaken in the past from time to time, without medical necessity , in the hospital at a cost to the system when there was not the medical necessity for utilization of hospital facilities. The regulations that we have recently passed assure the continuation, Sir, of medically required surgical removal of impacted wisdom teeth so that this service will continue to be available to those Manitobans who require hospitalization for that because of the medical necessity, either of their personal health or the condition of their impacted wisdom teeth.

However, the system will now reflect removal of impacted wisdom teeth where asymptomatic ones will no longer be undertaken in the hospital with medicare coverage . * (1 355) Ms. Wasylycla-Lels: Could the minis ter please tell this House what consultations he has had with profe ss io nal groups, the Mani toba Dental Association, the College of Physicians and Surgeons, the anesthetists of this province , as well as consultations with the consu mers in Manitoba, particularly the seniors in this prov ince, and what were the results of those deliberations and consultations for this deinsurance move ? Mr. Orchard: Mr.

Speaker, before my honourable friend leaves the impression that medically needed removal of impacted wisdom teeth is deinsured, let my honourable friend not spread that falsehood. Medically required removal in hospital will still be available and insured under the medicare plan in Manitoba. What we are talking about is removal of asymp tomat ic; in other wor ds, no medical symptoms or requirements for that removal to take place in the hospital. That will not be covered as it has been in the past.

Now let me indicate to my honourable friend that we have had discussions around this issue for approximat ely 10 months with the Dental Associa tion. We have had discussions with the MMA through the anesthetists because that also was part of the discussions. Mr.

Speaker, although my honourable friend may wish to attempt to raise a great consternation about this, I simply say to my honourable friend that the regulations that we have now brought into existence in Manitoba parallel long-standing regulations in other provinces where only medically necessary removal of Impacted wisdom teeth are cover ed, such provinces as Ontario. Health Care System Delnsurance ·Impacted Wisdom Teeth Ms. Judy Wasylycla-Lels (St. Johns}: I do not think that long answer will give the consumers or particularly the seniors of Manitoba much comfort in this decision by the Minister of Health.

I would like to ask the Minister responsible for Senior s If he could tell this House if he was consulted about this decision and what impact this will have on seniors' access to our universally high-quality, accessible medical syst em. Hon. Gerald Ducharme (r.tnlster responsible for Seniors}: Yes , I was consulted. I think the Minister of Health explained it very well. When there is a health problem, it will be dealt with In the usual manner, and that was very well explained by the Health minister. Health Care System Delnsurance • Impacted Wisdom Tee th Mr. Guizar Cheema (The Maples}: Mr.

Speaker, my question is for the Minister of Health. The minister has signed an Order-in-Cou ncil, and it does clearl y indicate that some of the services will not be insured. Those services will not be covered by anesthesia coverage also. As the minister would know, there is a major case in Ontario where an inquest is going on about a possible case where the

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 251 1 death occurred outside the hospital . Mr. Speaker, it is a very serious matter. The minister should tell us: Has he had enough consu ltation process to make sure that the proced ures which are going to be done because of this Order-in-Council are not a serious risk to any given person ? Hon. Donald Orchard (Minister of Health}: Mr.

Speaker, since my honourable friend has the Order-in-Council with the attached regulations, he will find in those regulations a significant amount of underpinnin g which would define medical circumstances under which impacted wisdom teeth removal wou ld be insured in the hospital syst em. There are a number of medical circumstances outside of the condition of the teeth, per se, which would qualify and keep that removal of wisdom teeth insured and delivered in the hospital. It is the asymptomatic removal, where there is not a demo nstrated medical need for hospitalization, that is not being cove red.

I simply say to my honourable friend that the kind of circumstance that happened in Ontario-! cannot prejudge the findings of the inquest-but should that, for instance, have been caused by a medical condition of the patient, I think the regulations that were passed provide the kind of protection so that will not happen in Manitoba. Mr. Cheema: Mr. Speaker, the issue is the safety of the patient. H the procedures are done, because of this regulation, outside the hospital, it will expose them to unwarranted risk. Can the minister tell us: Has he had any consultati on?

Can he table his consu ltation in this House so that patients can have some sense of relief that everything pos sible was done before this decision was made? • (1 400) Mr. Orchard: Mr. Speaker, I have already dealt with the issue of consultat ion. I will openly say that the MDA did not agree with the final regulation because it does have an impact on practice patterns of some of their membership, and I understand that. Mr. Speaker, the key issue my honourable friend raised was the assurance of safe care to the patients.

We are talking asymptomatic ; in other words, no indicated health problem with the wisdom teeth to be removed. In the past, the removal of those teeth, which, if there is no medical pro blem, has always been the respo nsibility of the individual to pay either through their private insurance or through their own resources, has from time to time been undertaken in the hospital syste m, so that the taxpayer pays for it, when there is no medical necessity for that removal to take place in the hospital .

What we are doing is assuring that needed medical removals of impacted wisdom teeth are undertaken in the hospital to assure that patient's safety; others will not be paid for by the taxpayers when there is not the demo nstrated medical necessity. Mr. Cheema: Mr. Speaker, the question still remains the safety of the patient when the patients are going to be served outside the hospital system and with a general anesthesia or any other form of anesthesia that will expose them to unwarranted risk.

The question is: Can the minister tell us how he can assure that such incidents as occurred in Ontario-a very, very major tragic incident, a young boy died. Mr. Speaker, we want the minister to tell us why he has taken such a drastic stand without proper consultation. Mr. Orchard: First of all, Mr. Speaker, I reject my honourable friend's allegation "without proper consu ltation." We did have consultation going back to last summer with the Man itoba De ntal Associati on. We agreed to disagree on some parts of the proc edure.

Let my honourable friend not mislead the people of Manitoba that we are putting Into medical compromise any person having asymptomatic, without medical indication, removal of wisdom teeth, Mr. Speaker. The issue is that medically required removal of those wisdom teeth will take place in hospitals as medically req uir ed with the preconditions that the regulations have put In place to assure that oth er medical circums tances of the patient- Mr. Speaker: Order, please. Furnace Inspections Carbon Monoxide Levels Mr. Jim Maloway (Elmwood): Mr. Speaker, my question is to the Minister of Health.

As the minister is aware, health concerns due to faulty furnaces are mounting . In fact, many people such as Dan and Linda Welsh, who have suffered headaches, rashes and nausea over the past year,

2512 LEGISLATIVE ASSEMBLY OF MANIT OBA April 23, 19 92 finally were told that they were at acceptable limits of carbon monoxide . Since the written results are now available and show that they are well over the acceptable limits, can the minister investigate why the testing in this particular case took so long and why they were told wrongly on Friday that they had nothing to worry about? Hon. Donald Orchard (Minister of Health): Mr. Speaker, without accepting some of the

preamble and allegations, I will investigate the role that my ministry had in this iss ue. The primary role has been undertaken through the Department of Labour, and I will provide my honourable friend with as much information as I can. Mr. Maloway: Mr. Speaker, I ju st received a message a minute ago that in Landmark a furnace was shut down, and It had very high, top-level carbon monoxide figures. My question to the minister is: Are people whose furnaces are being condemned, such as this person in Landmark, being told to immediately take blood tests ?

How many other cases of carbon monoxide poisoning that exceed acceptable limits has this minister's department heard from in the past month? Mr. Orchard: Mr. Speaker, I am, as you might expect, unable to respond to the last-minute information of a furnace in Landmark that my honourable friend refers to. However, Mr. Speaker, I think quite po ssibly what my honourable friend is trying to acc omplish is a greater public awareness of the issue of the gas furnaces, apparently made by one manufacturer in Alberta, which as I under stand it, through metal fatigue, have furnaces which ope rate dangerou sly.

I think, if my honourable friend is trying to raise public awareness of individuals in Manitoba who have those furnaces, that brand of furnace, that they ought to inves tigate and access whatever resources available to investiga te, I suggest, Sir, that my honourable friend is serving the public of Manitoba well because certainly that is what we have been trying to do on this side of the House. Mr. Maloway: Mr. Speaker, if the minister would simply check with the member for La Verendrye (Mr. Sveinson), who sits right behind him, he would tell him that he was informed last Friday of the situation in Landmark- Mr.

Speaker: Order, please . Ques tion, please . Furnace Inspections Faulty Heat Exchangers Mr. Jim Maloway (Elmwood): Mr. Speaker, my final supplem entary, since I am not getting answers from this minister, is to the Acting Minister of Labou r. I would like to ask the Acting Minister of Labour: How many brands of furnaces , other than Flame-Master, have been found to have cracked heat exchangers? Hon. Glen Cummings (Acting Minister of Labour): Mr. Speaker, as acting minister, I will take that question as not ice, and I am sure that the minister will be more than willing to respond with any information.

Federal Trade Tribunal Manitoba Cabinetmakers Mr. Reg Alcock (Osborne): Mr. Speaker, to the Acting Minister of Industry, Trade and Tou rism, as a result of an unequal application of federal tax policy, three Winnipeg cabinetmakers have been denied over half a million dollars in rebates which other cabinetmakers in this country have been paid. The federal Trade Tribunal has ruled in favour of these three cabinetmakers, but still the federal gove rnment is re fusing to rebate the funds to them.

I would like to ask the Acting Minister of Industry, Trade and To urism whether or not they have made any representations on behalf of these three businesses in Manitoba. Hon. Jim Ernst (Acting Minister of Industry, Trade and Tourism): Mr. Speaker, I am not aware of the specifics of the matter, but I will certainly take that information back to the minister and have him provide an answer in due course. Federal Trade Tribunal Manitoba Cabine tmakers Mr. Reg Alcock (Osborne): Mr. Speaker, perhaps I could ask the Premier the same question .

Has the Prem ier or his office made any representations on behalf of these three Manitoba businesses that are out over half a million dollars? Hon. Gary Fllmon (Premier): Mr. Speaker, that matter, I know, has been reviewed by a number of people in this governm ent. It is a matter that has been referred to the Department of Anance, with respect to looking at the decision that was made by that tribunal and in attempting to determine whether

April 23, 19 92 LEGISLATIVE ASSEM BLY OF MANITOBA 251 3 or not there is a role to be played by this gove rnment. To my knowl edge, no decision has been made on that matter. Mr. Alcock: Mr. Speaker, is it possible to let these people know when a decision will be made? Can the Premier tell us when his gove rnment will come to some sort of decision, or whether or not they are prepared to assist these three people who, it has now been pro ven, are out over half a million dollars? Mr. Fllmon: When the review has been completed, Mr. Speaker. Seniors Housing • Power Street Lounge Repair Mr.

George Hl ckes (Point Dougla s) : Mr. Speaker, we hear in this Chamber the rhetoric and the discussions about seniors , how important their prog rams are and how com mitted the gove rnment is to help the seniors and on and on and on. At 14 5 Powers Street, which is a seniors block, they had a fire in Nov ember of 199 1. They lost their lounge, which is very important to seniors to pass away their leisure, retirement time, to play pool and play cards. That fire destroyed that lounge in Novem ber, and to this day nothing has been done. I would like to ask the Minister of Housing why. Hon.

Jim Ernst (Minister of Housing): Mr. Speaker, first of all let me correct the record . The lounge was not destro yed. There was an arson that took place at that building. The ceiling of the lounge was destroyed. The ceiling has not yet been replaced. When the matter was brought to my attention about a week ago, I made significant inquiries in my department as to why it has not been repaired, and I concur with the honourable member, it should have been. Seniors Housing • Power Street Lounge Repair Mr. George Hl ckes (Point Dougla s) : Mr.

Speaker, I would like to ask the next question to the Minister responsible for Seniors. I think that is the same minister who deindexed the 55 Plus; now he has the opportunity to stand up for the seniors and get something done because the lounge is very, very important to the seniors. Will he now co nsult with the minister to get immediate action? Hon. Gerald Ducharme (Minister responsible for Seniors): To the member who did not deindex the pension plan over there, for over 1 0 years they did not increase the 55 Plus.

To the member, there goes to show, it was this Premier of this province who established the Seniors Directorate. I consulted with the member from Housing in consu ltation with the Powers seniors home. It is because of that that the minis ter has answered that it will be repaired, and he has asked his staff to quickly do that. Seniors Housing Secur ity Systems Mr. George Hlckes (Point Dougla s) : Mr. Speaker, my third question is to the same Minister responsi ble for Seniors. Security is a great concern for all seniors in Winnipeg.

I would like to ask the minister if he has done a tour of the seniors blocks to ensure that proper security measures are in place. * (1410 ) Hon. Gerald Ducharme (Minister responsible for Seniors): Mr. Speaker, I have toured blocks, seniors accom modations throughout the pro vince, and there are different security problems throughout that area. I will continue to review all those blocks. Mr. Speaker, there are 20,000 units throughout the province to review. Decentr alization Selkirk, Manitoba Mr. Gregory Dewar (Selkirk): My questions are for the Minister respons ible for Decentralization.

In the past two budgets, this government has cut over 25 Civil Service jobs in Selkirk with the closure of the school of nursing and the Huma n Resources Opportunity Centre. Fortunately, we were able to stop plans to move 25 High ways jobs from Selkirk to Beausejo ur. Unfortunately, it now appears that the government is once again considering such a move . Will the Minister responsi ble for Decentralization (Mr. Downey) assure this House that he will forcibly argue with his cabinet colleagues to stop Selkirk from losing any more Civil Service jobs? Hon. Leonard Derkach (Minister of Rural Development): Mr.

Speaker, I would have to say that to this point in time, this government has decentralized somewhere in the neighbourhood of 500 Civil Service positions to various rural locations in Manitoba. That certainly has not been an easy

2514 LEGISLATIVE ASSEMBL Y OF MAN ITOBA April 23, 19 92 task, but it has been done throu gh a tho ughtful, co-ordinated process. Mr. Speaker, let me say that it is up to each and every department to assess the requirements for staffing within their depa rtments, and those decisions have to be made by those departments. Where possi ble, we are trying to accommodate commu nities with decentralization mov es. There are still over 10 0 positions that have to be decentralized, and certainly we will be worki ng as diligently as we can to ensure that our commitment Is maintained. Decentralization Selkirk, Manitoba Mr.

Gregory Dewar (Selkirk): My question is for the Minister of Highways. Is Selkirk going to lose 25 Hig hways jobs to Beause jour? Hon. Albert Driedger (Minister of Highways and TransportaUon): Mr. Speaker, within my department, for the past four years, we have had ongoing reviews of how we deliver our highway program through the pro vince, and that is a con tinuing process that is going on right now. I cannot give the member an indication whether there is going to be any changes in Selkirk at this time or not. I want to Indi cate that we are looking at regionalizing to some degree.

We are looking at the concept of regionalizing to be able to deliver a better service to Manitobans. Decentr alization Selkirk, Manitoba Mr. Gregory Dewar (Selkirk): My final question is for the Minister res ponsible for Decentralization (Mr. Do wney). Can the minister indicate how many jobs he has moved to Selkirk to replace all the jobs that his gove rnment has taken from the commu nity? Hon. Leonard Derkach (Minis ter of Rural Development): Mr.

Speaker, I do not have the specific numbers for each and every com munity at my fingertips, but indeed that is information I can research , and I will be happy to get back to the member. Mr. Speaker: Time for Oral Questions has expired. Speaker's Ruling Mr. Speaker: I have a ruling for the House. On Wednes day, April 8, 19 92, during debate on Bill45, a point of order was raised by the honourable member for Portage Ia Prairie (Mr. Connery) alleging that the opposition House leader, the member for Thompson (Mr.

Ashton), had stated and I quote, "we are having biased chairing In this House" In reference to the Chair. The point of order was taken under advise ment by the Deputy Speaker. I have reviewed Hansard and find that the word s, and I quote, "it goes too far when we have biased chairing. I will challenge biased chairing." do appear in Hansard , but the words are not attributed to a particular honourable member.

In past cases of points of order being raised when words are spoken by a person not in possession of the floor and not attributed to a particular member, Speakers have indicated they are unable to rule on the matter. The point of order raised by the honourable member for Portage Ia Prairie is therefore closed . However, with respect to the Imme diately preceding events, I wish to caution all members and, In this case In particular, the honourable member for Thompson (Mr. Ashton) that once a ruling is made by a presiding officer, no member should question the ruling.

In a point of order immediately preceding the one just referenced on April 8, the member for Thompson stated on the record regarding the Deputy Speaker's ruling on relevance, and I quote : "the Deputy Speaker Is in error ... the member is in or der." I do not wish to have a repeat of such a comment in this Chamber.

To quote Beauchesne's, and I quote: "The Presiding Officer, while but a servant of the House, is entitled on all occasions to be treated with the greatest attention and respect by the individual memb ers because the office embodies the power, dignity and honour of the House itself," and I quote: "the actions of the Speaker cannot be criticized incidentally in debate or upon any form of procee ding." Mr. Steve Ashton (OpposHion House Leader): Mr.

Speaker, in regard to this particular matter, I would just like to indicate that certainly I and members on this side and in fact any member of the Legislature certainly does have the right to challenge a Speaker's ruling.

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 2515 If my comme nts were seen as any way reflecting on the Chair or on the Deputy Speaker, I apologize for that, and I hope that in the future we can proceed accor dingly. Mr. Speaker: I appreciate the remarks of the honourable member for Thompson. TABLING OF REPORTS Hon. Leonard Derkach (Minister of Rural Development): Mr. Speaker, may I have leave of the House to revert back to tabling of reports? Mr. Speaker: Does the honourable Minister of Rural Development have leave to revert back to ministerial sta tements and tabling of reports?

Some Honourable Members: Leave. Mr. Speaker: Leave. It is agreed. Mr. Derkach: Mr. Speaker, I would like to table the Annual Report for the Manitoba Water Services Board. Nonpolitical Statement Mr. Marcel Lauren deau (St. Norb ert) : Mr. Speaker, may I have leave for a nonpolitical statement? Mr. Speaker: Does the honourable member for St. Norber t have leave to make a nonpolitical statement? Some Honourable Members: Leave. Mr. Laurendeau: Mr. Speaker, it gives me great pleasure to rise today to congratulate one of the cornerstones of Winnipeg's business community on its 1 OOth birthday.

Great-West Life Assurance Company started up in Winnipeg 100 years ago in 18 91 as a part-time diversion for its founders, Jeffry Hall Brock and 1 4 partners. The company was born out of a desire to create strong Winnipeg businesses that could keep money in Manitoba. Today , in an industry of over 10 0 competitive companies, Great-West Life has grown to employ over 2,400 people and has invested over $700 million in Manitoba. The current President and CEO, John Green, sees nothing but expanding horizons in the company's future, as new fields are pursued and their hold on older fields are solidified.

Great-West Life benefits from its central location in Manitoba on the North American conti nent, one of the main reasons it was set up here in 18 91 . Our pro vince's proximity to the United States and independence from the centralized financial institutions of Toronto and central Canada has also contributed to the company's prosperity and growt h. Mr. Speaker, on behaH of all Manitobans, I would like to thank the staff and mana gemen t of Great-West Life for their ongoing contributions to the quality of life within our city's communities.

Wrth companies like Great-West Life acting as ambassadors and beacons for the busin ess commun ity of Winnipeg, our pro vince can look forward to nothing but increased growth and prosperity. Mr. Speaker, congratulations to Great-West Life on their first 1 00 years, and the city of Winnipeg looks forward to another 1 00 years. Thank you. * (1 420) ORDERS OF THE DAY Hon. James McCrae (Acting Government House Leader): Mr. Speaker, I move, seconded by the honourable Minister of Finance (Mr. Man ness) , that Mr.

Speaker do now leave the Chair and the House resolve itse lf into a comm ittee to consider of the Supply to be granted to Her Majesty. Motion agreed to, and the House resolved itself into a committee to consider of the Supply to be granted to Her Majesty with the honourable member for St. Norbert (Mr. Laurendeau) in the Chair for the Department of Health; and the honourable member for Seine River (Mrs. Dacquay) in the Chair for the Department of Education and Training. * (1 440) COMMITTEE OF SUPPLY (Concurrent Sec Uons) HEALTH Mr. Deputy Chairperson (Marcel Laurendeau): Order, please.

Will the Committee of Supply please come to or der. This afternoon this

section of the Committee of Supply, meeting in Room 255, will resume consideration of the Estimates of Health. When the comm ittee last sat, it had been con sidering item 2.(

b) Health Promotion, Protec tion, and Disease Prevention, on page 83. Ms. Judy Wasylycla-Lels (St. Johns): Clearly an aspect of Healthy Public Policy is access to medical services when one needs those services. The comfort not only in terms of one's physical requirements but also peace of mind are certainly

2516 LEGISLATIVE ASSEMBLY OF MAN ITOBA April 23, 19 92 part of Healthy Public Policy, and as you know, Mr. Deputy Chairperson, we have been dealing with, today in the House, the issue of coverage for dental services in hospital and outside of hospital when anesthetic is required.

I would like to know from the minister, and we are still all trying to understand what the Order-in Council released today means, if he could tell us how many cases of removal of impacted teeth or wisdom teeth are we talking about that have not been necessary for medical reasons , and on what basis has the minister made that determination, and what kind of savings are we talking about? Hon. Donald Orchard (Minister of Health): Our estimate that we have is between 1 ,200 and 1 ,600 proced ures on an annual basis.

The poten tial impact that we expect as a reduction in the amount of money that the taxpayers will pay is about $500,000. Ms. Wasylycla-Lels: Is the minister saying that between 1 ,200 and 1 ,600 procedures are done that are in hospital, under anesthetic, that are not really required, have not been referred to begin with, and that the cost of all those is about half a million dollars, and that is a total savi ng for the taxpayers of Manitoba ? Mr.

Orchar d : Investigating this issue, the indication is that asym ptomatic wisdom teeth removal in hospitals where the procedure does not have to be done in the hospit al, there is no medical justification for it, amounts to between 1 ,200 and 1 ,600 per year, and that the estimated cost to the medicare program is $550,000. That is why I used the figure, say, a half a million dollars. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, could the minister indicate if he looked at other options for dealing with this issue, that being the unnecessary referral of this procedure to hospitals?

Was there not another way to get at the heart of the problem rather than deinsure from our medicare system a particular service? Mr. Orchard: Well, Mr. Deputy Chairperson , not that I want to get into a big fight with my honourable friend, but we did not deinsure any service. What we have done is conti nue to provide insured service provision and coverage for medically necessary removal of wisdom teeth. That has been in place for many, many years.

What we did in the regulations is to make the best effort we can to prevent the taxpayers paying for nonmedically required hospital use, taxpayer paid, removal of asymptomatic wisdom teeth. There has not been any procedure deinsured. It is impacted wisdom tooth remo val, where medically required, is still an insured service in the hospital syste m.

Where for reasons that one can only speculate about, a number of procedures estimated to be between 1 ,200 and 1 ,600 of asymptomatic wisdom teeth rem oval were un der take n in the ho sp ital inappropriately, because there was not the medical necessity to have that procedure done in the hospit al, there was no medical requirement. What was the driving force , I think, without question was the fact that if it was done in the hospital , the taxpayers would pay for it rather than the individual. But there was no medical necessity to have it there.

I think all of us agree we ought to use our hospitals for medically required proc edures, and that is what we will continue to do with this new regulation around impacted wisdom teeth. There has been no deinsurance of the removal of impacted wisdom teeth where medically necessary. * (1 450) Ms. Wasylycla-Lels: There is a concern that underlies all of this and that is the question of, regardless of what savings, how many people are you putting at risk. It gets to the question: Is the minister confident that no patient will be put at risk?

In fact, by going from the system of simple state ment of a service being covered under medicare to a long list of circums tances under which the procedu re would be done or covered under medicare does create some gray area. It is not all cut and dried. I think the ove rriding concern is- Mr. Orchard: Whose overriding co ncern? Ms. Wasylycla-Lels: Okay, let me clarify. The minister says whose overriding concern? My overri ding concern, and I think some of the concerns expressed by the member for The Maples (Mr.

Cheema), and I will let him speak for himself in a moment-one concern that has been expressed is when it is not cut and dried and you are operating in a gray area, how does one ensure that patients are not put at risk and all the savi ngs in the wor ld, will that be a sufficient answer if one person needlessly dies in a dental office because they did not have the benefit of full anesthetic coverage in a hospit al? Mr.

Orchard: If my honourable friend wants--and it might be helpful for those people who read Hansard, for me to read the conditions under which-1 know you have them, but my honourable friend is saying what if someone might die from the removal of an

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 2517 asymptomatic wisdom too th. If a person died from the asymptomatic removal of a wisdom too th, I gu ess I would have to ask why was that asymptomatic tooth being removed in the first place. I mean, if the danger is in the proced ure, then surely my honourable friend would want to have the assurance for the patients being recommended this proc edure that it is necessary to be done. You know as well as I do that removal of wisdom teeth has become, not a routi nely recom mended proc edure, but a procedure that is often offered to individual Manitobans.

We insure that procedure where there is a medical requirement for remov al. Just to clarify the depth around which that means, here is the definition of an im pacted tooth- Mr. Deputy Chairperson: Order, please. Point of Order Ms. Wasylycla-Lels: I appreciate the ministe r wanting to go over this- Mr. Deputy Chairperson: Order, please. Is the honourable member bringing forward a point of order? Ms. Wasylycla-Lels: Yes, I raised a sincere question. I am not trying to be confrontati onal.

I am simply suggesting, we have the list in front of us the mi nis ter is about to read that was an Order-in-Council tabled, so I did not ask for the information. I appreciate his resp onse, and I would be prepared on that basis to go on and try to ask another question to get at some of my conc erns. I would be quite happy to indicate, when I have asked these questions and the minis ter has answered them to say that maybe our concerns are unjustified. I am trying to get to that point. Mr. Depu ty Chairper son : The honourable member does not have a point of order. It is a dispute over the facts. *** Mr.

Orchard: I am not going to read the whole regulation . I jus t want to say here are the

definitions, because this is im portant in underst anding the issue. An impacted tooth is: (

a) a tooth that is com pletely or partially unerupted and positi oned against another toot h, bone , or soft tissue so that further eruption is unlikely; or, (

b) fails to move into position and function within a reason able length of time. Surgical removal of those impacted teeth including hospital costs is an insured service , so when I said to my honourable friend earlier that we did not deinsur e anything-! will begin again. Surgical removal of impacted teeth including hospital costs is an insured service when performed by a certified oral or maxiHofaclal surgeon or a licensed dentist if the following conditions are met: (

a) the practitioner pro vides a statement and supporting information, including X-rays where appropriate, acceptable to the commission that the proced ure is a dental necessity and that (

i) hospital facilities are required for the proper performance of the proced ure, or (il) a pre-existing medical condition requires in-hospital monitoring of the insur ed person during the peri-operative period; and (

b) the commission approves the procedure in writing before it is performed. There is a very definitive criteria where medical necessity, when estab lished, leaves the impacted removal proced ure an insured service.

I just say to my honourable friend that under 2(1 )(a)(ii) the pre-existing medical condition is the extensive medical conditions which take the next two and half pages so that the practitioners und erstand conditions under which they can readily make the in-hospital insured provision of this service available to their clien ts so that we will not have a circumstance of a medically required proced ure not being undertaken in the hospit al.

But there is a process to go through because-and I do not think anyone argues about this-there were a number of asymptomatic wisdom teeth removals done in the hospital syste m to avoid the requirement of personal payment. Now that is not using our medical system for medically required services and that is what this regulation narrows the criterion ar ound, to assure that we are paying for medically required removal of sym ptomatic wisdom teeth under conditions described and advanced in substantial detail in the regulation. Ms.

Wasylycla-Lels: Let me ask how this would impact on a couple of specific areas and then pass it over to the member for Maples (Mr. Cheema) who I am sure with his medical background will have much more intelligent questions than I on this matter. I am concerned about two groups of people : Senior citizens where there may not be a history of any of these medical cond itions, cardiova scular,

2518 LEGISLATIVE ASSEMBLY OF MAN ITOBA April 23, 19 92 respiratory, et cetera, but because of their age and the fact that such a major dental service or exercise might have in terms of shock and trauma to a senior citizen. I think that does get into a gray area then in terms of a practitioner justifying whether something should be covered or not in hospital, or provided or not in hospital. That is one issue.

The other is with respect to northerners who will have now a further obstacle to access to a necessary service since once a service is no longer covered, however the minister wants to define it, because some parts of removal of impacted teeth will not be covered, they will not have access to the Northern Transportation program, clearly creating impediments to this operation, this service, this medical exercise which could result in secondary infections, could result in problems down the road, could result in much steeper costs for taxpayers down the road.

I think that is a legitimate concern and I would ask on both fronts. Mr. Orchard: Mr. Deputy Ch airperson , my honourable friend used some interesting language. With seniors, she said major surgery. H that major surgery is major surgery, it can be proven under these regulations that it should be done in the hospital and will be covered. If, for instance, the senior with this major surgery in determ ining whether a procedure is a dental necessity under Clause (1 )(a), the commis sion shall consider whether (

a) there is a significant risk to the insured person's oral health resulting from : (

i) inf ection; (ii) a nonrestorable carious lesion, (iii) a cyst, (iv) a tumour, (

v) destruction of adjacent teeth and bone, (vi) local pain that is continuous, such as it impairs the insured person's functioning, or (vii) other criteria that the commission considers appropriate; or (

b) that the procedure is necessary for the safe comple tion of another insur ed oral surgical procedure, including fracture treatment and osteotomy. If it is a major surgery for a senior, as my honourable friend says, and is going to compromise their health care, it is an insured service. H it is asymptomatic, where they are having them removed because there is no pain because the dentist said, well, you know, maybe we should take a look at that and remove them, it will not be. * (1 500) But you know what the decision will be then?

If they are not paining and they are not causing a problem, the senior will probably decide, I do not need them removed. There is no pain, I do not have to worry about infection, I do not have a cyst or a tumor. There is nothing really the matter. It just was recommended they be removed. They will not be removed then, because many people walk around with wisdom teeth, many people, without any problem. But I want to tell you that from time to time, it has been recommended they be removed, and sometimes that removal Is done in the hospital, no medical necessity and no endangerment to the patient.

These regulations assure that where there is a medical necessity, it will be undertaken. Now, my honourable friend describes northerners because they want to work In some great problem for northern Manitobans. Hit is a necessary service, it will be covered. They will access Northern Patient Transportation services. If it is not medically necessary, they are the same as any other Manitoban in that it will not be covered. I realize and I fully admit that after the consultation we did with the Manitoba Dental Association, we agreed not to agree on this regulation.

I accept that because this affects the method of practice of some dentists. I am not wanting to get into any kind of a fight or anything like that, but anytime you remove access to a free medical service, naturally, you are going to have people say that we do not agree to this. I accept that, but I have the responsibility under constant pressure from my honourable friend to spend more money on what she considers to be medically necessary areas of health care service delivery.

I have a responsibility to make sure those resources are available in as much quantity as possible which means from time to time I have to take a look, as previous governments have done, on where Insur ed services are not medically necessary. Where there is clear indication of that and we can change the regula tion without compromising the quality of care, the safety of care, the delivery of necessary care to patients, then we ought to remove that nonmedical cost to the taxpayers.

I mean it only makes sense because those are resources that we can use on medically required procedures in the system, and I just want to point out in completing the answer, New Brunswick has never had impacted teeth removal as an insured service. We were unique in that we had it fairly wide

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 2519 open, and under any circumstances, they are not covered in New Brunswick. Alberta, only senio rs have impacted teeth coverage, and their coverage will be medically required the same as ours, but for seniors only. Ours is for all Manitobans. I mean, if you had a proble m that was medically necessary, the coverage would apply in Manitoba. It would not in Alberta. Saska tc hewan only re moves impacted teeth-they are not insured except for the case of pre-open heart surgery or renal surgery.

Those are the only two conditions they will pay for impacted tooth removal. British Columbia, Newfoundland and Prince Edward Island basically have the same sort of process as we have now, like medical necessity. Ontario was the same as us prior to 1986 and made the change for medical necessity. Nova Scotia made the change in their program effective April 1, 1991 . So it is not as if we are out of step with every other provincial jurisdiction.

I just say to my honourable friend that in crafting this regulation, and this was back and forth with the MDA, we tried as much as possible to clearly lay out patient conditions under which hospital removal would be beneficial in that you would not be compromising the outcome for the patient.

We have written those in and we think we have quite a complete list of patient conditions and circumstances under which the procedure will be covered, but where it is asymptomatic and it cannot be demonstrated as a health need, we are not going to dedicate taxpayer resource for that, and that is estimated to apply in about 1 ,200 to 1 ,600 cases for a total cost of over $500,000, but for a rough figure, a half million dollars. I think we have done a quite responsible job of trying to assure that the medical necessity is still covered. Mr. Guizar Cheema (The Maples): Mr.

Deputy Chairperson, I have a concern as regards the safety of the whole thing, because it is very well explained in terms of what is a necessity and what is not a necessity. The minister knows that we have only five licensed facilities where the outpatient procedu res can be done. If one of these procedures are being done in the outpati ent, for example in the dentist's office, if the patient will get Into trouble even if the person is perfectly healthy, you do not have a standby anest hesia, you do not have the facility approved for all these procedures, there is a great risk.

We have a case in Ontario where an inquest Is going on and they are probably not the perfectly healthy circumstances, but still there is a question. So we are questioning how this procedure is going to be made safe in terms for the public. We are not ques tioning the basic decision which is the deinsuring some of the nonessential services. I do not want the minister or anybody to make a judgment on that, just simply that the safety of the patient is kept at utmost importance. Can the minister tell us how these procedures are being done in other provinces?

Are they doing it in a dentist's office all the time, and if they are doing it, then can he provide us the information from that point of view? Also what were the views of the Manitoba Dental Association in terms of the safety of patients ? Mr. Orchard: Mr. Deputy Chairperson, let me try that because my honourable friend's Issue is slightly different than the general issue that was raised by the member for St. Johns (Ms. Wasylycla-Leis). We had an anomaly in term s of these two issues that are covered in this regulation, the first one being assuring medical necessity where the member for St.

Johns was coming from in terms ofthe procedure across the board. We had an anomaly in that impacted wisdom teeth removal in a dentist's office , the removal being paid for by the patient. The anomaly was that we would insure the anesthetic services for that. We did not do thatfor any ot her, for instance, noninsured plastic surgeries or anything else.

The second part of this regulation is that in the case where a patient is in a dentist's office, is paying for the removal, or has a private dental plan, of impacted wisdom teeth in a dentist's offi ce, this regulation will no longer allow the commission to pay for the anesthetic services. That will be paid for by the patient or the insurer. That is the issue my honourable friend was coming to. Again I simply say to my honourable friend nothing has changed in the way that the decision would be made to do this in a dentist's office versus a hospital.

I mean right now, un der the circums tance tha t I am describing for my honourable friend, I have chosen to have my wisdom teeth removed in a hospital and have it covered by my dental plan. I have had the ability to go under general anesthetic rather than local

2520 LEGISLATIVE ASSEMBLY OF MAN ITOBA April 23, 1992 because it was paid for by MHSC, by the insured services plan. Now it will not be covered by insured service. My insurance company is going to have to pick it up, or if I was paying it out of pocket, I would have to pay the additional $1 00 or thereabouts out of pocket. I mean whether that happened with this regulation in place or bef ore, I am still taking the risk of local anesthetic in a dentist's office without the backup. I mean nothing has changed.

That is why the regulations are crafted to try and list pre-existing medical conditions which is 2(3) wherein the physical condition of an individual would lead one to have that procedure undertaken in a hospital under general anesthesia with the backup that hospitals can provide. Mr. Cheema: Mr. Deputy Chairperson, I have no disagreement with what the minister said until the last word. The Issue here is going to come that when those services are not going to be insured, as you have said, whether in the office or the hospital, there comes the question of safety.

I want to make sure from our point of view that the patient's safety is kept up to the utmost importance. That can only be done if the regulations that were followed before are going to be followed now. That is why we want to know what the MDA said on the issue, how they are going to provide the standby anesthesia in terms of how are they going to be continuing to provide these services in a similar quality care fashion that they were doing when they were paid, or are they going to do it in a different way? That is the issue. I just hope that I make myself very clear.

The issue is the safety of the patient because somebody will go to a dentist's office or any offi ce, and if you are getting a procedure done, even if you are perfectly healthy, you can get anaphylactic shot. It has happened in Ontario. A very young man at the prime of his life just went like that. I understand an inquest Is going on there, and that inquest may change all the procedures of dentists' offices in that province. We just want the minister to be aware of that, be cautious and make sure the dental body will follow the regulations they were following before when they were paid by the MHSC.

That is the issue because that way, we are securing the safety of the patient. * (1 510) Mr. Orchard: All I can say to my honourable friend is that if the procedure for the individual that my honourable friend has hypothetically described, that there is a potential compromise or there is a compromise of his or her health from this procedure because of a medical condition, then that case can be made, and it will continue to be done in the hospital.

But where there is no medical condition or condition of the teeth themselves which requires that hospitalization, it will be done in the private office, in the dentist's office. Now, let me tell my honourable friend that then it becomes very much a question of choice. I mean, If you are not in pain, I mean, with your teeth aching all the time, you might not choose to go ahead with the removal of impacted wisdom teeth. Currently, today, under the circumstance, if you were able to access the system this way, and a number did, you would have the recommendation to remove your wisdom teeth.

It could be suggested they could book you into the hospital and have it done three weeks from now, and you would agree to it because It is of no cost-okay, maybe I should get them removed. But all of a sudden, if you know that you have to pay for this yourself, and you did not have aching teeth and you did not have an X-ray showing you that this is the reason why is has to be taken out, you might decide to leave them ln. Let me tell you, there is always risk whenever you do anything under general anesthesia.

There is always a risk to general anesthesia, so If now we are getting into the issue that the choice the consumer is going to make is to not remove their wisdom teeth, maybe that is a very good choice because we have not exposed them to any risk then,

whereas now, by having It accessible within the hospital, and not for medical reasons but for payment reasons, we are putting the person under general anesthetic, that Itself, by itself, can be a risk. If anything, by putting more informed consumer choice in place, we are probably reducing the risk. We are not going to have them go through unnecessary removal. The Manitoba Dental Association-we did not end up having agreement on the regulations as crafted, and I will stand corrected on Monday, but I am not aware of any medical reason that the MDA brought up which was not included in the regulations because we did make some changes at their suggestion.

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 2521 Mr. Cheema: Mr. Deputy Chairperson, the simple question here is that the procedure, those which are going to be done now, whether they are small numbers or large numbers, that depends upon the individual choice, but if those procedures are going to be carried out in dentists' offi ces, we want to make sur e the safety precautions, the anesthesia coverage and the anesthesia backup is the same as it was done before when they were paid by the Manitoba Health Services insurance. That is our point of view.

We want to make sure the patient's safety is of the utmost importance and kept with the best of the ability and within the same principles as they were applied before when they were being paid by the provincial government. That is what we are simply asking. There is no way that we are going to question in terms of the dental extraction only on the basis of nonmedical reasons. I think those things are gone a long time ago. It should have been done a long time ago. That is not the issue.

I just want the minister to discuss this issue with the MDA and ask them, and for his own protection and from the government's point of view, they want to make sure that those procedures are followed the same way they were done bef ore. That is my concern, and I want to make sure that our views are known because something could go wrong, and then the minister can simply say that we made sure and we were very carefu l.

We made sure through the Manit oba Dental Association that the same procedures, same precautions and same guidelines still apply, even though services are not covered by the Health Services insurance. I think that can only be done by the Manitoba Dental Association, but still the minister's office has to convey to them his concern. Mr. Orchard: Mr.

Deputy Chairperson, I think that this assurance has been part of the regulation draft ing, but with the abundance of caution that I like to approach these issues with , I am going to have staff review my honourable friend's comments to make sure that we are satisfied we have not missed some item because, I mean, we are not perfect. My honourable friend suggested a circumstance under reversal of sterilization last year that was appropriately incorporated that was not originally in the regulations, so I take my honourable friend's caution and will undertake review to make sure that we can offer that assurance. Mr.

Cheema: Mr. Deputy Chairperson, I have just a final comment. I think it is extr emely important, because the associations have their own views and government has its own views. The basic thing is, we wantto make sure that the patient's safety is kept in mind, specifically when we have only a total of five clinics, private surgical clinics-two are eye and three are other general proc8dures where oral maxillary surgery is being done. Those are very approved clinics. The MDA and the college have full control, and they make sure that everything is done in the best possible way.

In the same way, we want to make sure that when services are not covered by the taxpayer, they should be honoured the same way they were done before. Ms. Wasylycla-Lels: I have just one last question on this whole issue. What will be the process for medical practiti oners getting authorization that removal of impacted teeth would be covered? Will practitioners need to get preclearance ? Mr. Orchard: Yes. As I Indicated In 2(1 ) of the regulation, Clause (

b) says, the commission approves the procedure in writing before It is performed- basis the criteria I read out, you know, the Information including X-rays, et cetera. Then, the second criteria-pr eexistin g medical condition of the Individual requiring an in-hospital procedure, and then those will be reviewed and the commission will approve. Ms. Wasylycla-Lels: Thank you. I appreciate that clarificatio n. Is the minister contemplating any other changes to services covered under The Health Services Insurance Act? Mr.

Orchard: Yes, there are other discussions that we have ongoing and hope to conclude, again, around the area of medical necessity, and I cannot be any more clear. I will te ll my honourable friend that this is an ongoing process. As we find our resources-the more demand on the resources than we are able to meet, we are going to be looking very diligently at the whole fee

schedule and a number of procedures that have been included as a matter of habit for many years and some new ones, to assure that we are getting necessary, positive medical benefit from th em. Where we are not, we are going to enter Into discussions with the provider group on ways of removal of that.

2522 LEGISLATIVE ASSEMBLY OF MAN ITOBA April 23, 19 92 It is an ongoing process. This one is the major change that we have made this year. The half -million-dollar impact to the dentists is fairly significant. Ms. Wasylycla-Lels: One other matter that I raised earlier, and it has to do with the change in the per diem rates for personal care homes. I searched high and low for regulations that would have covered that period betw een 1989 and the present and was not able to find anything.

I am just wondering if at some point the minister could table for us the copies of the regulations that made those per diem changes between February 1989 and May 1992. * (1 520) Mr.Orchard: The information that we had just prior to the Estimates was not the right year or something like that, and the staff are just trying to get the regulation that was passed a year ago because we are all quite sure that we passed one. I mean, it is the only way we can increase the charges, otherwise, we might have ourselves quite a little quandary here. Mr. Cheema: Mr.

Deputy Chairperson, while we are on this topic of deinsurance of some of these services, can the minister get us also a copy from other provinces for services they had deinsured for the last few years? Last year, when we had some deinsurance here in terms of some of these skin lesions and then we went into redefining of some of the things, I talked to the assessors at the Manitoba Health Services Commission. They were very co-operative, but we were not able to get to the clear definition of so many things.

I think it would be good if we could get a list from all provinces that will make not only our lives easier, probably the minist er's life will be a lot easier so that comparison is available to make sure that those services are how we will provide those services in Manitoba. Mr. Orchard: Look, I try to bring myself up to date becau se, lik e for ins tan ce, in th is one of asymptomatic wisdom teeth removal. When this came up as an option for discussion, I asked the question, what do other provinces do, how was it handled, et cetera, et cetera?

I found on investigation that as I indicated earlier on, we were probably as generous as any province in the removal of wisdom tee th. The regulation we are putting in place now makes us quite consistent with most other provinces in terms of our restrictions but still more generous than a number of other provinces, because I thi nk New Brunswick, Saskatchewan and Alber ta do not offer any coverage, like, for people our age. They focus in on seniors or specific medical conditions, but they do not cover any kind of wisdom tooth removal.

So there is not always consistency across the syst em, but I know my honourable friend probably has as good a press-clipping file as I do, probably better, but I know that the Ontario ministry right now is considering, becaus e they do Insur e psychoanalysis there and they are considering deinsurance, not just simply clarifying that we are not paying for it in Manitoba as we did last year, but they are looking at tattoo removal and some other procedures. So every plan is doing their investigation right now, and wherever I can I would be pleased to provide my honourable friend from The Maples (Mr.

Cheema) and my honourable friend from St. Johns (Ms. Wasylycia-Leis) that information. Ms. Wasylycla-Lels: I would like the record to show that the Minister of Health (Mr. Orchard) for Manitoba just used the word dei nsurance of psychoanalysis despite- An Honourable Member: In Ontario. Ms. Wasylycla-Lels: In Onta rio, sure, which he suggested that Ontario was looking at the same step that was undertaken In Manitoba last year, a step that the minister was adamantly described In terms that was not a move of delnsurance.

So I think the agenda is clear, the record should indicate that the minister has finally admitted that that was deinsurance, and what we are talking about with all of these things is deinsurance, and lt hlnk the debate should stay on whether it Is good, bad or indiff erent.

Let me ask a question relating to both the ties into deinsurance of medical services and this whole area of Health Promotion, Protection and Disease Prevention, and that is th e-an d I will use another "de" word that the minister will not like-and that is the dellsting of certain drugs under Pharmacare for people who have either very serious chronic illnesses or terminal diseases, and ask the minister for the complete list of drugs that have been removed from Pharmacare coverage that were previously covered under the provision and entitled from the Department of Health and Welfare fede rally under the emergency drug release program?

I am not sure I have got all those words correct, but I think

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 2523 the minister knows what I mean and I am wondering if he could give us the complete list of drugs impacted by that Order-in-Council of the end of 1991 . Mr. Orchard: Mr. Deputy Chairperson, I know my honourable friend just loves to have what she perceives to be little vict ories. She gets so few of them. But when I described Ontario, I said Ontario is considering deinsu rance of psychoanalysis because in Ontario it is an insured service right now, contrary to the fact that we clarified the fact that it was not an insured service in Manitoba.

My honourable frie nd, I realize she likes these little victories, but I guess maybe if "deinsurance" is what my honourable friend wants to call things, that is fine because it has happened for 20 years in Manitoba. It happened around plastic surgery, in the previous administrat ion, where it was not medically necessary. That is why Western Clinic started up; that is why Western Clinic operates and has operated for about seven or eight years to do plastic surgery that was insured until about '83, and it was deinsured in '83. These things happen because all of us have to assure the medical necessity.

That is the kind of debate that I will get on with my honourable friend, any stage of the way. Now, Jet me just see what I have got here ; 1991 , her e we are . By golly, this is signe d . Order-in-Council No. 317, on the matters of stata-l can read it? The regulations set out in

Schedule A be approved, dated 20 March 19 91 , and the regulation was to do with : "A personal care home may make an authorized charge to an insured person of $23.25 per day effective May 1 , 1991 , $23.80 per day effective August 1, 1991 , $24.35 per day effective November 1 , 1991 , and $24.90 per day effective February 1, 1992." So that Order-in-Council was passed 20 March 1991 . That is the year where the per diem increase was greater than before because of the GST rebate , because we factored in the GST rebate into our per diem.

So I do not know why that would not have been available because normally these are always tabl ed. Then, of course, the Order-in-Council 337, this year, April S, 1992: my honourable friend has that one. Now, I think my honourable frie nd, thoug h, pointed out where -oh, no, no. You see, I did not realize what my honourable friend was referring to. My honourable friend was refe rring to Manitoba Health Services Insurance regulati on, Manitoba Regulation 506/88R. That is the regulation which empowers the levying of the per diems, I believe, but is not the actual regulation which sets the rates per year.

So I think that is where the confusion came in. It is an annual thing that we do and we att empt to do it in March-April, effective May 1 , one month after the quarterly pension increase. For 1991 , it was Order-in-Council No. 317. I will give my honourable friend this copy because I do not need it anymore. Ms. Wasylycla-Lels: I would like to thank the minister for that information . That certainly helps clarify, for me, the process around per diem rates for personal care homes.

Okay, now, I was just going to refe rence the second issue I had raised for the minister, if the minister could provide us with a list of the drugs that are now no longer covered as a result of the change in the Decem ber31 , or December something, 1991 , Order-in-Council which basically removed coverage of drugs previously covered under the Emergency Release Program out of Ott awa. Mr. Orchard: Mr. Deputy Chairperson, I will have that informatio n, for sure, when we get into the Pharmacare line. If I can have it before that, I will. * (1 530) Ms.

Wasylycla-Lels: The minister knows my concern with respect particularly to clarythromycin. I am just wondering if the minister can give us any more information now around the number of people who are using and need clarythromycin in Manitoba, what the savings will be for this government by not covering it under Pharmacare, and if there is any reconsideration at all with the committee that the minister has refe renced in the past around setting of rates and regulations under the Pharmacare program to reinstate clarythromycin. Mr.

Orchard: We know of one individual who currently was receiving the clarythromycin as a benefit under the Pharmacare program, but I am not aware of whether there is more than one. I know of one. That individual has communicated directly with my office. Here is the issue. I have explained this time and time again but-the issue is not this individual's circumstance. The issue is the principle behind drug companies, and these are the name brand manufactu rers. They go through a process of

2524 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 23, 1992 clinical trials, et cetera, and after the drug is approved in effective ness, it is safe, et cetera, they apply for a notice of compliance which then through federal Food and Drug certifies that the drug is eligible for use, that it is safe , that it meets medical needs. It is at that stage of the game that govern ments, and I will just deal with this government, makes the decision as to whether to include it as a pharmaceutical for which Pharmacare coverage is available.

The issue has been in the past that until notice of compliance had been achieved, the name brand ma nufactur e rs would conti nue to mak e the pharmaceutical available free of charge until the notice of compliance came in and they start charging for it.

It is my understanding that, historically, that has always been sort of the practice pattern of the drug companies, because bear in mind that, with the exception of Canada, the world has off ered them, what is It, 15 years or 20 years patent protection on new pharmaceutical releases, so to introduce the drug, it was not a major financial inhibition to these companies to provide it free of charge to those people who were, say, on the clinical trials, fo und to be benefitting from it, and for a chronic disease would continue the provision until It was insured. That changed with the disease AIDS.

AIDS, being a terminal disease, there being a lot of compassion around AIDS and the utilization of AZT as a drug of treatment for AIDS, there was a signHicant demand for that because many people suffering from AIDS, from the final stages of HIV infection, were being prescribed the drug. The manufac turer charged for the drug and depending on where in Canada, governments may or may not have picked up the cost. Some provinces did not pick up the cost of AZT because it was not licensed. We made the decision to pick up the cost of AZT .

This year, when we passed our regula tion effective January 1 for the yearly changes to the Pharmacare program of eligible and drugs that were taken off the eligibili ty list for a numb er of reasons-this process, I reiterate to you, Mr. Deputy Chairperson, is undertaken by the pharmacy review com mittee; in other words, pharmacists on a volunteer basis review the list and suggest additions and deletions, et cetera. But the policy was esta blis hed this year that until a notice of compliance has been granted to the new drug, we would not cover that new dr ug un der the Pharmacare program.

There were a number of those drugs currently being prescribed, and I cannot tell my honourable friend how many, but clarythromycin was one that before the notice of compliance, compassionate grounds again in terms of the individual suffering from AIDS, we did pick up the cost of that drug. We changed the policy because we are on a wave of a signHicant number of new drugs.

There Is concurrence across Canada for people operating similar drug plans that we should try to consistently make the decision not to pay for a pharmaceutical until the notice of compliance has been granted, the reason being that with a plethora of new drugs coming in, some of them at $5 and $6 and $7 and $1 0 and $1 8 and $25 per tablet, we will be overwhelmed with costs for drugs for which there is no notice of compliance and for which the tradition has been that the supplier, the manufacture r, would supply them free of charge until that was granted.

This change of policy Is a dHficult one for this individual. I will fully admit that.

I have every compassion for him, but the principle is what we are trying to establish so that the brand name man ufactu rers, the mult in ationals In the pharmaceutical business know the rules of the game hopefu lly right across Canada so that they will not start using the compassion that all of us have for individuals suffe ring from chronic disease to begin charging for a pharmaceutical for which they are going to have 15 and 20 years of exclusive patent protection and substantial profits therefrom before the notice of compliance comes through.

It was the principle that I think was very appropriate that we established. That principle has not been applied in the past 15, 18 years since Pharmacare came in because the issue had not emerged, and the potential for numbers of new pharmaceuticals for which that policy would have application would not seem to be a problem. It was not a problem until AZT and AIDS, and that was the watershed pharmaceutical, the watershed disease condition.

We intend to be firm on this because we believe that the name brand manufacturer can provide that pharmaceutical, which costs, I am told, from $1 80 to $380 per month, free of charge until notice of compliance comes in later on this year. No doubt we are going to have a wrestling match with the company in between.

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MAN ITOBA 2525 My honourable friend will counter and say, well, just for this one case, make the excepti on. I agree. I have every compassion to want to do that, but the difficulty in doing that is, if you make a policy decision and then the first time that is questioned because of compassionate grounds and you back away from it, no name brand manuf acturer is going to take you seriously.

If they see that government is going to cave in to the political pressure put on them by opposition parties, they are not going to supply them free of charge as, I submit, they should until their notice of compliance comes in.

I accept my honourable friend's concern over this individual, this condition and this drug, but I simply caution my honourable friend, it is the principle that we have to adhere to because I do not want to be using taxpayer dollars to fatten the bank accounts of brand name pharmaceutical manufacturers in advance of the granting of notice of compliance for which they will have 15 and plus years of exclusive supply at substantial profit of that pharmaceutical. It is the principle that I am enunciating, and I think It is well founded.

I think my honourable friend, were she in government, would never change that principle. • (1 540) Ms. Wasylycla-Lels: I am not at all disagreeing with the principle that the minister enunciates, but the fact of the matter is that with respect to this one drug, and there may be others , I do not know, with respect to clarythromycin, we are dealing with a drug that was never provided free by the company, Abbott Drugs, that this government was paying for until the change by Order-in-Council, so it had been covered. So in fact what we are dealing with is a change in practice, a change in policy.

I think that constitutes unique circumstances that require a different approach. Thirdly, it is a drug that had been approved through the emergency drug release program from Ott awa for AIDS. We are not talking about every new drug that comes on the market. We are talking about drugs that have gone through some process, some steps to prove effec tiveness. I would assume Ott awa does not put every new drug that comes out that a company claims is going to be useful for AIDS or whatever term inal disease.

I am sure they do not put it on the list without some sort of test in place to determ ine some help, some benefit, some effectiveness, for the benefit of those people. I would ask the minister on the basis of those three criteria or th ose three developme nts tha t clarythromycin was never provided free, period;that the government had in fact been paying for this drug; and, three, that some effecti veness had been demonstr ated and therefore it had been released under the emergency release program through Ott awa. Mr. Orchard: Mr.

Deputy Chairperson, all of those circumstances were known around this particular pharmaceutical and will be the circumstances around future ones. Again, the emergency release statu s by the federal government was narrowed to AIDS, a terminal disease. Where the thought patterns are, I think I can say this is what the thought pattern is, that because it is a term inal disease, there is no cure for AIDS, that you provide drugs on an emergency release basis, because how can you make the person's medical condition worse? I mean, it is a term inal condition.

That is the whole genesis of this issue where it started with AZT. Now in this case, my understanding is that the expectation is that clarythr omycin will be granted a notice of compliance later this year. It is not as if it is not in the very near future to be there . AZf does not enjoy that same kind of status, and we continue to pay AZf, but claryt hromycin has a notice of compl iance coming up. Now, if we use my honourable friend's argument, I want to tell you that you will be in the same ar gumen t with chemotherapy, new chemotherapy pharmaceu ticals for terminally ill people suffering from cancer.

You will have the same compassionate argument. The principle then becomes, sir, that do you, because you have a terminal condition and compassion for the individual, compromise a policy whereby you have the taxpayers pick up the costs before notice of compliance to very, very wealthy multi nationals.

Now I am no doggone socialist, but I cannot understand somebody from the New Democratic Party wanting to have the taxpayers bail out and provide the compassion of the taxpayers to the majo r name brand pharm aceutical manufacturers who are using human suffering to charge for drugs before notice of compliance is there. My stand is that those multinationals have sufficient resources when notice of compliance is in place. They have 15 years of unbelievable profits from these new releases. The least they can do in human compassion is have those drugs supplied

2526 LEGISLATIVE ASSEMBLY OF MAN ITOBA April 23, 1992 free of charge to appropriate recipients until notice of compliance comes in, and I intend to be firm on that. I know my honourable friend, her heart is in the right place, but, by golly, I cannot understand the philosophical attac hment which appears to be emanating from that of wanting to replace taxpayer compassion with multinational compassion. I mean, they have more money than the government of Manitoba, eve ry individua l one of these multinational firms.

Probably their sales are higher than the entire tax revenues per year of the Province of Manitoba, and I do not think it is unreasonable to ask them to provide free of charge an appropriate amount of the drug until notice of compliance comes in. That is the policy. I realize the circumstance my honourable friend puts on these preconditions, but I will tell you, you are going to make the same argument for any number of drugs.

When you make that argument on new released drugs, just remember you are arguin g to enhance the financial position of mul tina tional phar maceutical name brand manufacturers, and you are asking the taxpayers of Manitoba who I submit will offer from time to time that they pay quite enough taxes for quite few enough services, you are asking them to bail out multinationals. That is not a policy that I agree to. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, I think the minister is missing some of the points that I have been trying to raise around this Issue.

In my mind, If the government had been paying for coverage of certain drugs, where there was definite effectiveness and some clinical tests to prove help In these cases, then I think It Is only a question of fai rness and justice and decency for the government to continue providing coverage for those drugs.

I am not arguing that for all the new drugs coming out that the minister not put in place some mechanism to acknowledge the fact that there are so many new drugs coming out, and that we cannot afford to simply, every time a company comes along and suggests It is effective in the case of a term inal disease, to cover it, but we are talking about some drugs, I presume, I do not know how many, some drugs that the government had been covering, where there was some effective ness and some demon strated clinical benefit. Clarythromycin clearly fa lls in that cate gory.

So it is not a question of supporting drug companies, and it is not a question of fa vouring multinational corporations or the profit margins of multinational drug companies. It is a question-In fact, what we are saying is we do not believe that terminal patients, people dying from AIDS or cancer or any othe r disease, should be charity cases of multi national drug companies, that In fact the government has a role to play there In ensuring that they live out their lives with some decency and dignity.

Rather than pursue the argument, let me just simply perhaps ask if I think we can deal with this Issue on a more intelligent basis.

H the minister is willing to provide the list of drugs that had been previously covered under Pharmacare, that are now not covered under Pharmacare because of that change in regulati on, and if the minister could provide the list with as much information as he can about those drugs, for example, perhaps the number of people covered, if possible, or the amount of money expended before the change was made, I think that would help us put this all in some context and debate It on a more reasoned basis. Mr. Orchard: Mr.

Deputy Chairperson, I indicated to my honourable friend that I would attempt to provide that as soon as possible, and for certain we will have it by the time we get to the Pharmacare line. My honourable friend does not have a monopoly on compassion. Let me tell you that when you deal with the major business entities that develop name-brand drugs, you are dealing with people who are in the profit- making business, and they do very, very well at it. My honourable friend Is allying herseH on the basis of one individual circumstance by saying that, you know, government should give this consideration.

Well, that is a compassionate argument, but in doing that you are opening yourself to allowing multina tionals in the development of drugs with lifesaving or quality of life mitigating qualities for terminally ill individuals, be it AIDS today or cancer tomorrow or some other terminal disease, you are saying to the m, Manitoba is wide open to provide this drug and the NDP in oppositi on, on a compassionate basis, will insist government pay for it. This is a lucrative market, this Manitoba.

I say to you that despite the obvious concern all of us have about enhancing the quality of life of any individual suffering from terminal illness, we have obligations also to assure that the policies we put in place force some of that compassion on those who

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 2527 also can afford it, i.e., the bran d name pharmaceutical manufac turers. This would not compromise the bottom line of Abbott Laboratories one iota. I mean this would not do anything to affect their international performance profit- wise.

I do not kno w what th eir cos t of ma nufac turing clarythromycin is, but if the retail is $1 80, it could be $10. • (1 550) I mean that is what we are talking about, and until that receives a notice of compliance, I have to say to you that as difficult as it Is when you introduce that principle, because you are going to catch some people main str eam, if you bow to the compassionate argument on that one, you do not stand a hope in staying your ground and making multinationals stop the policy that they appear to be going on of charging for these drugs prior to notice of compliance.

I simply say to my honourable friend, she has no monopoly on compassion, but I suggest to you that I do not have any compassion for multinational pharmaceutical manufacturers in wanting the taxpayers of Manitoba to assist them in their drive for profits with drugs that do not have notices of compliance. We agree to disagree on it.

I do not think that my honourable friend-and I will just say this straight out-if government was to change tomorrow, I think the New Democrats would agree with this policy and stick to their guns and try to get the money out of Abbott Laboratories in this case rather than the taxpayers of Manitoba. I am convinced of that, because it is the right thing to do. Ms. Wasylycla-Lels: Mr.

Deputy Chairperson, I do not believe for one moment that a New Democratic Party government today would-without having first made that arrangement with a company like Abbott drug company for providing that drug free-have cut people off, people dying with AIDS, would have cut people off a drug that has clearly made a difference in their lives. This is not a question of having a monopoly on human compassion. It is a question of a policy that was in place and was benefitti ng some people and making a differ ence.

I am suggesting to the minister that it would only make sense from a policy point of view, and from a fairness point of view, to say, okay, here is the new policy. From here on in, this is how it is going to work, but we are not going to go back in time and cut off people who have received some benefit from a particular drug and who now may not be able to receive that benefit.

Let me ask, I guess we are on, as part of Health Promotion, Prot ection, and Disease Prevention , the whole area of AIDS, and the minister has, I believe, an advisory committee on AIDS, if he could provide us with the names of that committee and tell us a bit about what advice he is getting generally on the whole area of AID S and what activities are underway. Mr. Orchard: The chair of the committee is Mr. Bill Gar dner, Jr. We have as memb er s of the committee Dr. Chapman-Smith, Ms. Joan Anderton, Mr. Fabian, Mr. Peel, Ms. Bodner, Mr. Landry, Ms. Lorraine Thompson and Rev. lan MacDonald.

I am not certain but I think there is a new Individual on the committee who attended her first meeting last week. There is one more individual on the committ ee, and I am lost for the name right n ow. Ms. Wasylycla-Lels: Could the minister indicate how often the committee meets and what the general purpose of the committee is, what kind of information or advice the minister has requested, and what the plans are in the future for the committe e? Mr. Orchard: Mr. Deputy Chairperson, yes, the committee meets, I think, bimonthly. I forgot, the secretary to the committee is Pat Matusko from Health.

Basically, the committee is reviewing AIDS and the relevant reports, research and information that is available from other provinces, other jurisdictions, other countr ies, to sort of be a window on the AIDS situation nationally and internationally and to provide guidance to government in te rms of where we can change or undertake different approaches in work with staff.

Most of the thoughts of the committee are implemented as matter of, I suppose, policy or activity by staff, and they are not the kind of thing-although maybe we should-they are not the kind of recommendations , or they are not the kind of sugges tions that lea d to public announcement around the suggestions they make. The biggest stre ngth, I think, in terms of the AIDS Committee, is in its diversity of membership. We have both rural and urban people on the committee , and we have people from a diversity of approach to the AIDS issue.

Joan Andert on, of course, is the chief public health nurse for the City of Winnipeg and highly involved with their nursing initiatives, because the City of Winnip eg has cer tain

2528 LEGISLATIVE ASSEM BLY OF MANITOBA April 23, 19 92 undertakings-an educator. Brian Peel is with Village Clinic, and so we have got quite a diversity. We have the Hemophilia Society represented, and they bring toget her a great deal of diversity of knowledge and expertise around the AIDS issue. I think with our approach to AIDS we are probably positioned as well, with as good advice as any pro vince, for trying to manage information around and progr ams dedicated to AIDS. We have not un dertaken an advertising program now for over-two years, I guess, was the last one.

That advertising program was successful, but it was general, and what we have attempted to do, I think it is fair to say, over the last two years is target some of ou r information and some of our program initiatives to high-risk groups. We think that is probably a more important use of scarce resource than the across-the -board televisi on-ra dio advertising that we undertook in the last major advertising campaign. I will let my honourable friend ask questions. Ms. Wasylycla-Lels: I just have one more before-1 know that the member for The Maples (Mr. Cheema) would like to ask some questions.

I just want to comment really. I believe the other person that the minister was trying to think of in terms of the commi ttee is Lara Laramee, if I am not mistaken, an aboriginal woman who I know quite well. I think she has an excellent contri bution. I would just end at this point by saying that I hope that the minister uses this committee on an active basis and addresses the growing and serious nature of this whole issue of AIDS. Mr. Orchard: I take my honourable friend's advice seriously, and the Individual identified, that is correct.

Her first meeting was the most recent one that the comm ittee met, and the chairman indicated to me that he is very enthused, that he believes that she is going to be a very, very good member on the comm ittee because she is bringing a unique perspective of knowledge. Also, the aboriginal communi ty is one of the target areas. We have participated in a conference in The Pas. So we have valued in the past, and we will value the advice of this individual. Mr. Cheema: Mr.

Deputy Chairperson, I was listening to some extent to the comment about the AIDS campaign, and so I want to take care of some of the questions and things which were done in the last year of the campaign has been quite successfu l. I just want not to repeat those things that the member for St. Johns (Ms. Wasylycia-Leis) has already said. • (1 600) My question here is on page 83 of the book, that the External Agencies' funding was reduced by $1 ,000. Can the minister tell us why that funding was decreased and in what areas the funding was reduced? Mr.

Orchard: We reduced our fundin g commitment to funded agencies this year by a total of $207,000 year over year. We reduced our funding by $207,000 year over year. I will give you the areas where we have reduced, rather than taking across-the-board slight reduction, we targeted our reductions. They are arguable naturally as to whether they are appropriate, but we reduced our annual contribution to the Manitoba Society for Seniors by $10, 000. We reduced our prov incial contribution to the Canadian Council on Smoking and Health by $4,400. We reduced a contribution to the Winnipeg School Division No. 1 by $45,000.

We reduced our support grant to the Manitoba Association for Childbirth and Family Education by $23,500. We reduced our grant support to St. John Ambulance Council by $35,300. We reduced our-okay, we did not reduce, we had a two-year funding comm itment in conj unction with the City of Winnipeg Health Department for Street LINKS. That was $1 00,000 per year. The funding for that will termin ate mid-year, I think August. The Canadian Diabetes Association is reduced by$1 ,200 in terms of support that we have given them in the past.

The largest decrease is our decision to not continue funding In conjunction with City of Winnipeg Street LINKS proj ects, $1 00,000. An evaluation is ongoing to see the value to the program of that. I will tell my honourable friend where we are coming from on this because it appea rs-and I do not want to prejudge the evaluation-as if this operation was reasonably successful in reaching a very specific, high-risk target grou p, those involved in sex trade. Recently we have received a report from the Social Planning Council of Winnipeg.

Their observa tion, and they made this observation I guess 1 0 or 12 years ago to go vernment, that we are not provid ing a consistent approach in go vernment to services to highly at-risk kids, street kids in particular. The Social Planning Council made the obser vati on, they made it to the previous

April 23, 19 92 LEGISLATIVE ASSEMBLY OF MAN ITOBA 2529 administration and it is legitimate, that, for instance, an organization will commence a project and they will seek start-up funding, let us say, from Winnipeg Foundation or the United Way or maybe Core Area Initiative or the City of Winnipeg or maybe directly from the provincial government or the federal gove rnment. It is temporary funding. The project gets underway, the project may or may not be a valuable one or a good one because there has been no evaluation generally In the past attached to some of these initiatives.

The point the Social Planning Council makes is that some of the progr ams that were good were terminated because no one picked up the funding afte r the temporary introduction of funding. I will tell you this go vernment is perplexed with that, because again-and we are part of it this year with a two-year funding commitment with the City of Winnipeg on Street LINKS. We are discon tinuing that fun ding. Again, it is a stop-and-start kind of a program . The member for St. Johns (Ms. Wasylycia-Leis) asked what kinds of questions are we going to ask of the AIDS Advisory Committee. Well, a pertinent question.

The City of Winnipeg is con tinuing to operate with remaining funding until about August or September, I think, the Street LINKS project. Evaluation is going to be ongoing. We have identified-is it 97 agencies in the core area?-delivering in excess of 150-some programs with a whole range of funding from different ministries in the pro vincial gove rnment, federal gove rnment, the Core Area Initiative, funding of which is terminating, from Winnipeg Founda tion, United Way. I mean, there is a whole plethora of sources of funding for a whole series of programs in the core area.

I find that frustrating, because I tend to be-maybe pragmatic is the word , I do not know; but I ask myself, do we need 90-plus agencies delivering often what can be certainly, to a degree, unique progr amming, but certainly often cases some parallel program delivery? Government does not have a handle on that. This is not a new phenomenon; this has been going on-every gove rnment has probably been challenged with this kind of a circumstance.

With the Street LINKS, and particularly with the high-risk, sex-trade youth who are involved with this, my sense of it-and I have discussed this with the chairman of the AIDS commi ttee-is to turn over to them this issue, based on the Social Planning Council's observation and try to narrow it, because you are not going to deal with the whole range of program s provided to youth and children from the agencies-but to try to narrow their focus to assess what other agencies may well be providing some service.

We are funding POWER through Mount Carmel, again targeting not this specific group but a similar grou p, I think it is fair to say. So we have to get our minds around the global funding. I submit that, if we take and develop an inventory of how much funding is going into those areas through 90-plus organiza tions, from three levels of gove rnment, volunteer fundr alslng, some oth er free-standing organizati ons, I do not think we will come to the conclusion that resource Is the probl em. Utilization of resource and co-ordination of resource are the prob lems.

I talked over that challenge with the chairman of the AIDS Advisory Committee and gave him the background. Again, as I me ntioned to my honourable friend from St. Johns, we have individuals in many disciplines on that comm ittee who have hands-on experience with some of these agencies and certainly the delivery environment In the area we are talking about. The chairman thought that would be a very appropria te project for the advisory comm ittee to take on because of the diversity of their membership and to provide us with some recommen dations.

Those recommendations may well be that gove rnment curtail the funding to several organizations and amalgamate itto one with expertise. I would welcome a recom mendation like that, because I think you can see potentially a significant advantage to the target recipient. If we are fundi ng several admini strations in several different organizations, that money is not reaching the individual in need. In general, we recognize the difficulty this curtailment of support to Street LINKS is going to cau se, but that it is not the end of the issue is what I am saying.

It is a funding issue that we have made a decision on today, but the program and the approach to the policy is very much in the development stage, I think it is fair to say. * (161 0) Mr. Cheema: Mr. Deputy Chairperson, the minister knows that I have been advocating for the evaluation process as of '88, and I think it is very essential that you do not have the services supplied by fo ur different individual organizations for the same purpose . First of all, they are competing for

2530 LEGISLATIVE ASSEMBLY OF MANITOBA April 23, 19 92 the same dollar, an d, second ly, there is disorganization at certain levels. Basically, whether clients get the services, that still remains unknown. That is why I have diffi cu lty sometimes understanding why sometimes the City of Winnipeg is Involved in some projects, some with the provincial gove rnment, some funding is coming from the federal government. So, when the program s end, then the organizati ons have no place to go.

They will say, well, I will go to the city, I will go to the pro vince, and that exactly happened with the cro ss-cultural unit at Mount Carmel Clinic. I was just saying that similar situations arise when people are getting funding from three sources . When the sources run out, then they have no place to go, because somebody will say, go to person A or B or C. By that time it is too late, and that is the exampl e with the Mount Carmel Clinic, the cros s-cultural unit. The program was started initially on a volun tary basis.

They did a good job, they were saving money, they got the funding on the basis from the Core Area progr am. Now the program is in place, but right now they do not have a funding process. It is very frustrating for them, but certainly because they raised the expectation of the comm unity, they have put their own family-structure based on what kind of jobs they are going to have, it Is very compl icated for them. It is diffi cult for the go vernments, because you do not have a clear-cut policy in terms of whether you fund any prog ram.

There should be clear-cut guidelines on what is going to happen and who is going to do it in one or two or three years. There has to be some perman ency and ongoin g evaluation. That had been lacking. That is why it is so tragic to see that we are spending so much money, but there is so much disorganiza tion. When we see cuts here and there, it gives us and other people the wrong impression that something is going to fall apart, but in essence that may or may not be true.

Once you examine the whole thing, you come to a conclusion that probably that should have been done from Day One so that the co-ordination is taking place. That is why when I look at the Orders-in-Council and how the external agencies are getting funding, I always raise the issue in my own mind, is there anybody co-ordi nating all the funding through the various departments, at what level the funding is being provid ed, what services they are pro viding, what is the outcome and, ultimately, how many actual dollars are being spent in the service delivery? Is it simply to put in an office?

I am just giving a hypothetical example. I think we have to make sure the services are delivered to the needy patients and the other people who will need the services. I would like to know whether we have a process in the Department of Health. Who is taking care of those things? Mr. Orchard: Mr. Deputy Chairperson, I am going to shock my staff. Sue Hicks and Tammy Mattern were supposed to do this for me two years ago, and they did not deliver. I say that in jest. This issue is one that I have talked to Sue Hicks about because, I mean, I share a frustratio n.

Every time one of these organizations has their funding run out from United Way or wherever, they end up on the govern ment's doorste p, often mine, and I am justifying not giving funding to something I have never funded before. I cannot respond as to the effective ness, to the relative placement of how this organizatio n, the service they are provid ing is different or parallels or is the same as another organization .

So I say to my honourable friend that we are att emp ting to un der stand, because within gove rnment we know of organizations that access funding from two to three, maybe even four different ministries. All of us get sort of played one against the other, I think it is fair to say. It Is a task which I would like to have comp leted but, at the same time, we have staff very much comm itted to delivery of program and service and reform of the health care system, and we have not been able, and I say this quite hone

Document details

Collection	Manitoba — Debates (Hansard)
Citation	35-3-51
Type	hansard
Volume / chapter	35th 3rd hansardpdf 51.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	99005455381cdd0ab549d1bce7cb8aec33687cdf

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