Manitoba Hansard — 13 June 1991 (Sitting 64, 35th Legislature, 2nd Session)

35-2-64

Manitoba — Debates (Hansard)

MG-8048 Second Session - Thirty-Fifth Legislature of the Legislative Assembly of Manitoba DEBATES and PROCEEDINGS (HANSARD) 40 Elizabeth II Published under the authority of The Honourable Denis C. Rocan Speaker VOL. XL No. 64-1:30 p.m., THU RSDAY, JUNE 13, 1991 Printed by the Office of the Queens Printer. Province of Manitoba ISSN 0542-5492

MANITOBA LEGISLATIVE ASSEMBLY Thirty-Fifth Legislature LIB - Liberal; ND - New Democrat; PC - Progressive Conservative NAME ALCOCK, Reg ASHTON, Steve BARRETT, Becky CARR, James 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. DUCHARME, Gerry, Hon. EDWARDS, Paul ENNS, Harry, Hon. ERNST, Jim, Hon. EVANS, Clif EVANS, Leonard S. FILMON, Gary, Hon. FINDLAY, Glen, Hon. FRIESEN, Jean GAUDRY, Neil GILLESHAMMER, Harold, Hon. HARPER, Elijah HEL WER, Edward R.

HICKES, George LAMOUREUX, Kevin LATHLIN, Oscar LAURENDEAU, Marcel MALOWAY, Jim MANNESS , Clayton, Hon. MARTINDALE, Doug McALPINE, Gerry McCRAE, James, Hon. MclNTOSH, Linda, Hon. MITCHELSON, Bonnie, Hon. NEUFELD, Harold, Hon. ORCHARD, Donald, Hon. PENNER, Jack PLOHMAN, John PRAZNIK, Darren, Hon. REID, Daryl REIMER, Jack RENDER, Shirley ROGAN, Denis, Hon. ROSE, Bob SANTOS, Conrad STEFANSON, Eric, Hon. STOR IE, Jerry SVEINSON, Ben VODREY, Rosemary WASYL YCIA-LEIS, Judy WOWCHUK, Rosann CONSTITUENCY Osborne Thompson Wellington Crescentwood River Heights Radisson The Maples Kildonan Portage la Prairie Ste.

Rose Seine River Roblin-Russell Selkirk Concordia Arthur-Virden Steinbach Riel St. James Lakeside Charleswood Interlake Brandon East Tuxedo Spri ngfield Wolseley St. Boniface Minnedosa Rupertsland Gimli Point Douglas lnkster The Pas St. Norbert Elm wood Morris Burr ows Sturgeon Creek Brandon West Assiniboia River East Rossmere Pembina Emerson Dauphin Lac du Bonnet Transcona Niakwa St. Vital Gladstone Turtle Mountain Broadway Kirkfield Park Flin Flon La Verendrye Fort Garry St.

Johns Swan River PARTY LIB ND ND LIB LIB ND LIB ND PC PC PC PC ND ND PC PC PC LIB PC PC ND ND PC PC ND LIB PC ND PC ND LIB ND PC ND PC ND PC PC PC PC PC PC PC ND PC ND PC PC PC PC ND PC ND PC PC ND ND

3284 LEGISLATIVE ASSEMBLY OF MANITOBA Thursday, June 13, 1991 The House met at 1 :30 p.m. PRAYERS ROUTINE PROCEEDINGS TABLING OF REPORTS Hon. Bonnie Mltchelson (Minister of Culture, Heritage and Citizenship) : It is my pleasure to table the Annua l Report for 19 89-90 for the Manitoba lntercultural Council. Introduction of Guests Mr. Speaker: Prior to Oral Questions, may I direct the attention of honourable memb ers to the Speaker's Gallery, where we have with us this aft ernoon His Excellency Ramon Diaz, the Ambassador of the Philippines. On behalf of all honourable members, I welcome you here this afternoon.

Je tiens a vous signaler la presence, dans la galerie publique, de cinquante-deux etudiants de la 6ieme annee de I' Ecole Bannatyne sous la direction de Sylvia Allard, Monique Renaud et M. Mollot. Cetta institution est situee dans la circonscri ption du depute de Sturgeon Creek (M. McAlpine). (I would like to indicate the presence in the public gallery of fifty-two pupils of the sixth grade from Bannatyne School under the direction of Sylvie Allard, Monique Renaud and Mr. Mollot.

This school is located in the constituency of the Member for Sturgeon Creek.) Also, we have in the public gallery this afternoon, from the St. Gerard School, eighteen Grade 5 students, and t!1ey are under the direction of Cheryl Unryn. This school is located in the constituency of the honourable member for Concordia (Mr. Doer). On behalf of all honourable members, I welcome you here this afternoon. ORAL QUESTION PERIOD Free Trade Agreement - Mexico Government Position Mr.

Gary Doer (Leader of the Opposition): I am sure Manitobans watching television last night had chills running down their spine when they saw Michael Wilson sitting there with Carla Hills and the Ambassador of Trade for Mexico talking about the continental trade agreement being proposed with Mexico, Mr. Speaker. This is the man and the person in Canada who gave us the GST, the high dollar and the high interest ra tes , the high unem ploym ent, the made-i n-Ca nada recession and everything that goes along with it, Mr. Speaker.

Now, he is, of course, the point person and his last hurrah in government to negotiate the corporate trade agenda with Mexico. During the election, we asked the Premier what his position with free trade with Mexico was, and he said during the televised debate, he was opposed to it. We have asked him since, in his own Estimates and other Estimates, about his position on free trade, how has Manitoba expressed that opposition and what action has Manitoba taken on the proposed free trade agreement with Canada, United States and Mexico? * (1 335) Hon. Gary Fllmon (Premier): Mr.

Speaker, seeing Carla Hills, Mike Wilson and the Mexican Trade Ambassador called to mind when Howard Pawley signed the comm unique at the Western Premiers' Conference some four or five years ago, in which he agreed to a North American economic union, and that went well beyond, as mo st observers understood it, free trade but rather economic union with Mexico and the United States. Certainly these subjects and these proposals and ideas have been before us for quite some time. Mr.

Speaker, as we have talked about before, we have indicated that we have a good deal of concern about free trade with United States and Mexico. The Minister of Industry, Trade and Tourism (Mr. Stefanson) has comm issioned analyses and studies of the various areas of the Manitoba economy to try and assess what the potential effects might be, where there might be gains, where there might be losses, where there might be problems, where there might be opportunities. Under those circumstances, we continue to review that and be

- 3285 LEGISL ATIVE ASSEMBL Y OF MAN ITOBA June 13, 199 1 very cautious, very skeptical and concerned as to areas of such an agreement that might not be in our best interests. Essentially, we have in the past asked the Canadian government to ensure that we were kept fully informed as to progress, as to their intentions, and we continue to be of that mind, that Manitoba's concerns have to be taken into consideration and that we have to repres ent the Manitoba economy whenever any decision is taken. Publlc Consultations Mr. Gary Doer (Leader of the Opposition): Mr.

Speaker, as the Premier well knows, Michael Wilson is not receiving and taking any input from the provinces in the country. He did not before on GST, he did not before on the high dollar, he did not before on high interest rates, he did not before on the made-i n-Canada recession, so perhaps the Premier has more faith in Michael Wilson than we do on this side. Mr . Speaker, the question is: How are the provinces going to take action on this trade agreement with the federal governme nt, and in turn, how is this government going to take action to consult the people of Manitoba?

I note that the Premier mentioned the survey being done by his Minister of Industry, Trade and Tourism (Mr. Stefanson). Well, that survey included 16 5 businesses. We know from Frank Stronach the position of business on the free trade agreement. He said yesterday, profit means money, money has no heart, no soul, no conscience and no homeland. We on this side have a different view of trade and sovereignty of decision making than some of the business people In our country. My question to the Premier is: How are the factor y workers going to have any input into the say?

How are the farmers going to have any input into this decision? How are the public going to have any input into this decision, or are we just going to go the same way as what the federal government is going and having a few business people give us advice rather than opening it up to all the people of Canada and all the people of Manitoba about the implications of this very important trade agreement? Hon. Gar y Fllmon (Pre mier ) : Mr. Speaker, clearly, there are a number of issues here.

When the member opposite talks about areas in which Michael Wilson did not listen to the public, he was acting in areas of federal jur isdiction where he had the total authority. The fact of the matter is that the federal go ver nm ent does have authority con stitutionally over international tra de. Regardless of what we may or may not say to Michael Wilson or the federal government, they will still be under their own jur isdiction and authority in making decisions that they make. It is like a lot of things, that governm ents do not listen necessarily to what other governments tell them.

When they have the authority to make decisions, they do that. When Howard Pawley was in government and he decided to raise the sales tax in Manitoba from 5 percent to 7 percent, he did not listen to the public, because the public did not want that sales tax increased from 5 percent to 7 percent. When he imposed a payroll tax that caused the loss of tens of thousands of jobs and investment in Manitoba, he did not listen to the public or to the businesses of Manitoba when he brought in that. When he put in the 2 percent tax on net income, he did not listen to the public at all.

The New Democrats do not have a monopoly on consultation, and when they consult, they do not necessarily listen. I do not think we need to have any advice or suggestions from the Leader of the New Democratic Party. The fact of the matter is, Mr. Speaker, that we are consulting in the areas of the economy that may indeed be affected, that may affect the jobs in our factories, that may affect the jobs in our farms, that may affect the jobs in a variety of areas of the economy.

If indeed those areas of the economy say that they are not going to be affected negatively and are going to be affected positively, I think that is information that is important to us when we discuss free trade, because I do not think we should discuss free trade with Mexico just as a reflex response. We should do it based on knowledge. • (1 340) Subsidy Definition Mr. Gary Doer (Leader of the Opposition): Mr. Spea ker, I am sure the 16 5 corporations that are included in the consultations will sleep better tonight.

I am sure the other one million Manitobans who have not been consulted yet will not sleep well tonight with the Premier's answer. Howard Pawley had meetings all across the province on free trade with the United States, so let the record show about the discussions.

June 13, 1991 LEGISLATIVE ASSEMBL Y OF MANITOBA 3286 Mr. Speaker, this is a very important subject for Manitobans across all political lines, so let us deal with this, hopefully, on the high road. Mr. Speaker, there are six tables established by the Wilson trade negotiations with the United States and Mexico. One of those tables does not preclude any negotiations on cultural sovereignty in Canada, an issue that is very important for us and, I am sure, for all Canadians . Another table deals with a number of other issues, including trade rules dealing with subsidies. Mr.

Speaker, in the last set of free trade negotiations with the United States, subsidies were not defined, and the whole issue of whether medicare would be included as a subsidy or excluded as a subsidy was left dangling for the next five years, which is three years ago. My question to the Premier is: What is our position on the subsidy issue dealing with the United States and Mexico? Are we taking a strong position ? Have we written the Prime Minister saying that we do not want medicare to be considered a subsidy in any trade negotiations?

Are we going to have a made-in-C anada social policy, or are we going to have a continental corporate policy of social programs in this country based on the next free trade agreement with the- Mr. Speaker: Order, please. Hon. Gary Fllmon {Premier) : I might say for the edification of the Leader of the Opposition that, through the Minister of Industry, Trade and Tourism, his department has held a series of meetings with various sectoral organizations, such as agriculture, such as the manufacturing sector, the service sector and so on.

They have included labour organizations within those consultations to ensure that labour did have their input and did have their ability to comment. I might say that they are represented in this Legislature. Each and every one of the individuals in Manitoba is repr esented in this Legislature by repres entatives who obviously are going to be interested in putting their viewpoint forward. I might say further to that, that Mr. Wilson has requested a meeting in early July with the trade ministers, including our own Minister of Industry, Trade and Tourism (Mr . Stefanson).

With respect to the whole area of subsidies, there has to be an ability to consider everything by way of subsidy. We have a concern, of course, that environ men tal standards and environme ntal pollution control ought not to be considered to be an unfair subsidy. The fact of the matter is that we have to have comparative standards. We have some concern on the part of agriculture producers that the cost of infrast ru cture, for instance, for irrigation systems has to be on the table when you consider that kind of thing, all sorts of things. Mr.

Speaker, the whole issue of subsidies is a very complex matter, and suffice it to say that we will not allow for anything to happen that will in any way damage our medicare system in this country, that will in any way damage our standards in medicare, that we want to have the highest quality of medicare and that we reserve the right to do that under any circumstances. • (1 345) Health Care Facllltles Bed Closure Study Ms. Judy Wasylycla-Lels {St. Joh ns) : Mr. Speaker, on November 5, 1987, the Minister of Health said a Tory government would not close a single Manitoba hospital bed.

Well, we know that the minister has not lived up to that promise, and now we know he is planning to extend summer and Christmas bed closures. The three-month time frame on the study doing that very thing is up. We would like to know from the minister if he can tell us the results of that study. Which hospitals will have extended bed closures, for how long and how he is going to explain these cutbacks to the growing number of Manitobans on waiting lists? Hon. Donald Orchard {Minister of Health): Mr. Speaker, again my honourable friend is asking for information that I do not have.

My honourable friend is bringing an issue for ward that is currently before the Urban Hospital Council as one of the options that they wish to discuss amon gst the health care system in the city of Winnipeg, inclusive of the Brandon General Hospital. I cannot indicate to my honourable friend an answer to the question, because I simply have rece ived no recomme ndation fr om the Urban Hospital Council on the issue of summer bed closures, which are a reality in the system and have been for a number of years. Second, to my honourable friend's question about acute care bed closures, my statement was made

3287 LEGISLATIVE ASSEMBL Y OF MANITOBA June 13, 1991 very re alistically basis the process that her governmen t went through in 1987, Wilson Parasiuk, Minister of Health, where with no consultation they mandated the closure of 111 acute care beds in several hospitals in Manitoba with no consultation, purely as a budgetary measure. We have chosen not to do that. Ms. Wasylycla-Lels: The minister has asked for summer bed closures to be studied-the extension of bed closures to be studied-so he can tell us the basis for making such a request.

Could the minister tell us, give us information about the waiting lists for each facility? Will he table that information? Will he tell us the number of patients in hospital corridors, the number of patients in holding rooms, so that we and all Manitobans can underst an d the im pact of this gov ernmen t's cutbacks on quality patient care ? Mr. Orchard: Mr. Speaker, I know you must get bored with my constantly correcting my honourable fr iend in her use of cutback as language when the budget for health care has increased by 5.3 percent.

More money is being spent in health care in the hospitals in Manitoba than last year. That is not a cutback, but I know my honourable friend will attempt to use that narrowed political rhetoric to try and establish her case. Mr . Sp eak er, let me again clarify for my honourable friend, it is not gover nment that is suggesting the consideration of summe r bed closure extension. That was one of the issues that came forward in asking the Urban Hospital Council for issues to be studied. Gover nment did not put that on the agenda- Mr. Speaker: Order, please.

I would remind the honourable minister that answers to questions should be as brief as possible. Ms. Wasylycla-Lels: The people of Manitoba know that waiting lists are growing and that this government is closing beds. Extended Care Conversion Ms. Judy Wasylycla-Lels (St. Johns): I want to ask the minister about another one of his studies.

Since time is also up on this working group to consider the conversion of one of our hospitals into a long-term care facility, could the minister tell us which hospital has been selected and how the people in that hospital surrounding comm unity will have access to commu nity-based quality patient care? * (1 350) Hon. Donald Orchard (Minister of Health): Mr. Speaker, again, I simply point out to my honourable friend, that is one of over 40 issues being considered at the Urban Hospital Council. No decision has been made, no recom mendation has been made.

I cannot provide to my honourable friend that issue, but let me tell my honourable friend one simple fact that I hope she will bring to Estimates debate this aft ernoon. Would she inform the people of Manitoba that this government, through reductions in budgets in other departments, has provided 5.3 percent increase in funding to health care in Manitoba, inclusive of hospitals, personal care homes, physicians. With that budget of 5.3 percent increase, we expect that we will be able to deliver quality health care to improve the health status of Manitobans.

Surely my honourable friend as a health critic will agree to that- Mr. Speaker: Order, please. Min ister of Native Affairs Resignation Request Mrs. Sharon Carstalrs (Leader of the Second Opposition): Mr. Speaker, since this government took office in 1988, they have talked about an urban Native strategy. We have had talk, but we have not had action. On May 27, 1991 , in the Estimates process, the Minister of Native Affairs (Mr. Downey) gave evidence of what his action would be, and I would like to quote.

The minister said: • ... the enhancem en t of job oppo rtu nities an d encouragement for those job opportunities outside of the city of Winnipeg or outside of our urban ce ntr es, to give a meani ngful, produc tive opportunity in life, would be the most successful urban Native strategy that we could develop. " Mr. Speaker, the Minister of Native Affairs (Mr. Downey) is suggesting that we banish urban Natives from the city of Winnipeg and other urban communities. Would the First Minister immediately request this minister's resignation? Hon. Gary Fllmon (Premier): Mr.

Speaker, I am not sure whether in the heat of the debate and the rhetoric the member for Arthur (Mr. Downey) said that or did not say that, and I will take that question as notice so that I may discuss it with him more fully and understand the intent of the statement that he

June 13, 1991 LEGISLATIVE ASS EM BLY OF MANITOBA 3288 is reputed to have made by the member for River Heights. Mrs. Carstalrs: Mr. Speaker, this is a very serious issue. This is a quotation, page 2575, May 27, 1991 , in this Chamber. The Minister of Native Affairs (Mr. Downey) is talking about, I guess the best and most productive solutions and then goes ahead and suggests that solution is to move our aboriginal people from our urban centres. The Premier certainly does not need notice on this question.

On the basis of this evidence, and I am quite prepared to table the page from Hansard, why will this First Minister not disassociate himself from this Minister's comm ents and ask for that minister's resignation? Mr. Fllmon: Mr. Speaker, I have seen comments in Hansard that oftentimes are said inadvertently where they -(i nterjection)- We have the member for River Heights who stood up in Minnedosa two years ago and said that she would turf out 40 percent of the residents who are in personal care homes in Manitoba, turf them out of personal care homes onto the street.

That was her policy statement, and she has never refuted-- Mr. Speaker: Order, please; order, please. Point of Order Mrs. Carstalrs: The Premier is deliberately putting information on the record, which he knows is not correct. There is no quotation in any newspaper, in any article, in any Hansard which ever said I would turf people out of nursing homes. Mr. Speaker: The honourable member did not have a point of order. It is clearly a dispute over the facts. *** A (1 355) Mr. Fllmon: Mr.

Sp ea ker, the quo te in the Minnedosa Tribune says that 40 percent of those who are in personal care homes in Manitoba should not be there. That is what she said, 40 percent of them should not be there . That is the most outrageous thing I have ever heard in my life. She said it in Minnedosa, and she has never been able to refute that. Secondly, she said that she would immediately Some Honourable Members: Oh, oh. Mr. Speaker: Order, please. Mr. Fllmon: She said that she would immediately sell McKenzie Seeds in the midst of an election campaign.

She said that she would get rid of 40 percent of the middle management at MPIC. All of these things-- Some Honourable Members: Oh, oh. Mr. Speaker: Order, please. Mr. Fllmon: Mr. Speaker, I will ascertain what the circumstances were under which the member for Arthur (Mr. Downey) made those remarks. I will discuss it with him, and I will be glad to discuss it further with the member for River Heights (Mrs. Carstairs), but I say to her that we are intent upon developing an urban Native strategy to meet the needs of our aboriginal people in our urban settings in Manitoba.

We regard it as a very high priority; we regard it as a long-term need that will involve all three levels of government, because it is a large challenge for us and one that must be addressed. Mrs. Carstalrs: Mr. Speaker, when souther n whites said that the solution to the black problem was to send black people back to Africa, everybody recognized that as a rac ist statement. Mr. Speaker, will the Premier tell us in this House today why it is not a racist statement to tell urban Natives to go find jobs outside of urban centres? Mr. Fllmon: Mr.

Speaker, I think that the member for River Heights is getting into pretty desperate circumstances when she would try and trump up that kind of allegation. I think it is despicable for her to raise that kind of issue in this foru m, in this Legislature. Mr. Speaker, one has to wonder why she took two weeks to raise this issue, why she would come and trump up this issue in the Legislature two weeks later. Point of Order Mrs. Carstalrs: Point of order, Mr. Speaker. Again the min ister is imputing motives. I read the quotation for the first time today and raised it immediately. Mr. Speaker: Order, please.

The honourable member did not have a point of order. *** Mr. Fllmon: Mr. Speaker, one has to wonder why her critic, having heard that comment, took no issue

3289 LEGISL ATIVE AS SEMBL Y OF MANITOBA June 13, 1991 with it at the time, why her researchers, having read Hansard, took no issue with it at the time, why anyone took no issue at the time and, two weeks later, she decides that this is going to be an issue that she trump s up in Question Period. I said to her that oftentimes things that are contained within Hansard are a misrepresentation of what was said, or in fact the individual makes a statement that is not quite what they thought they were saying.

I will ask the minister to clarify what he said, and when I have done that, I will be happy to discuss it with you. Urban Aborlglnal Strategy Government Commitment Ms. Jean Friesen (Wolseley): My question is also for the Premier. In 1988, the government announced it would introduce an urban Native strategy. The Premier again said today it is a priority of his government. We have asked numer ous questions in Estimates, in Question Period, from this side of the House, on the fate of this strategy, but we have seen only evasion, at the best, on this question. Mr.

Speaker, I would like to give the minister another chance today to commit himself to a date when he will present an urban aboriginal strategy to this House. •

(1400) Hon. Gary Fllmon (Premier): Mr. Speaker, of course, it is ironic to have that question come from an individual in the New Democratic Party when, for six and a half years in the '80s, they were in government and they did not even think about an urban Native strategy, did not even think about it, took absolutely no action whatsoever on it. At that time, we had a minister responsible for Native Affairs who was an aboriginal from northern Manitoba, but they got nowhere. They did absolutely nothing with respect to an urban Native strategy. Mr.

Speaker, this government believes that an ur ban Na tive strate gy is im portant. This government has been in the midst of a consultation process with respect to the urban Native strategy and will continue to consult with the various organizations and individuals who would be affected by this so that they can have an urban Native strategy for the future needs of our population in Winnipeg and Manitoba. Ms. Friesen: Mr. Speaker, I heard more rhetoric but no date and no comm itment. Interim Report Ms.

Jean Friesen (Wolseley): I am asking this to the Premier: The Minister of Northern Affairs has earlier indicated that at least $400,000 has been spent in the last two budgets on the development of this strategy. It has resulted so far, that I can tell from the record, in one meeting with aboriginal people and two so-called conversations with the city and the federal government. Could the minister indicate for us what else has been accomplished? Could he table a list of any contracts awarded?

Could he tell us the number of employees involved in this progr am , and would he present an interim re port on what has been accomplished with this $400,000? Hon. GaryFllmon(Premler): Mr. Speaker, I would have thought that all of those questions would have been asked of the minister during the Estimates debate. That is the purpose for Estimates, is to have all those kinds of complex answers and questions discussed. I do not know if the member opposite was here for that Estimates debate, whether or not she took any interest in it at the time.

I will take those questions as notice on behalf of the minister and have him bring those responses back to her . Ms. Friesen: Mr. Speaker, I was in the Urban Affairs Estimates asking exactly the same question of the minister at the time. My colleague the member for The Pas (Mr. Lathlin) did indeed ask these questions. The minister responded that he would table them, and we have not heard. Government Commitment Ms. Jean Friesen (Wolseley): My final question for the Premier, Mr. Speaker, is that I want to emphasize for him the urgency of this issue.

Since 1988, and since we have had a majority government in this province, the single aboriginal parents in my constituency have lost their parent-child centres, they have seen the Abinochi kindergarten ended, they have seen the core area programs abandoned. They have lost Native communication programs, their student bursaries-- Mr. Speaker: Order, please. The honourable member for Wolseley, kindly put your question now please.

June 13, 1991 LEGISLATIVE ASS EMBLY OF MANITOBA 3290 Ms. Friesen: My question for the Premier is: What advice does he have to those aboriginal families in my constituency? Hon. Gary Fllmon (Premier): Mr. Speaker, we continue to believe that it is imp ortant for us to develop an urban Native strategy, one that meets the needs that have been expressed by the member for Wolseley and many other needs. I am sure she knows that it is projected that, by the year 2000, one in every four people entering the work force in the city of Winnipeg will be of aboriginal descent. That is a very large challenge for us.

We have said that, in the course of a new tri-level urban renewal agreement, we believe that an urban Native strategy ought to be incorporated as part of that, that it is a fundamental cornerstone. We have indeed included discussions on the CP station, as the member for Crescentwood (Mr. Carr) points out. All of these matters are matters of long-term need. They are not short-term need. If they had been short-te rm need, they would have been addressed long ago by this government or the previous NOP government, but they were not, Mr.

Speaker, because they are long-term challenges that are growing in complexity and growing in terms of the resource allocations that will be needed. Under those circum stances, I think it is important to have a proper plan as opposed to ad hoe responses to problems. Ecologlcal Reserves Advisory Comm ittee Staff Replacements Ms. Marianne Cerllll (Radlsson): Mr. Speaker, some of us are preparing for a long day today as we begin the comm ittee hearings for The Wildlife Amendment Act. Many leading ecologists and environm entalists will be in opposition to this govern ment's proposed legislation.

One presenter opposed to this ·legislation and to the real issue, the Ducks Unlimited building at Oak Hammock Marsh, was recently replaced by the minister with new appointments to the Ecological Reserves Advisory Committee. My question for the Minister of Natural Resources is: Given that the work of the Ecological Reserves Advisory Committee is so vital to the identification and protection of ecological reserves, why were credible, impartial, recognized experts in the field replaced by, for one, the curr ent curator for the D.U. building and, two, an election worker from the last campaign for a Tory campaign?

Hon. Harr y Enns (Min ister of Na tural Resources): Mr. Speaker, firstly, I am only too pleased to acknowledge the credentials and the excellent work done by members of the Ecological Reserves. In Manitoba, we have established some 17 ecological reserves, and that is an important aspe_ct of our concern for the natural environment. The board memb ers that she speaks of have, I believe, served for a good number of years, several reappointments for a period of 10 years. It is natural that these boards get rotated from time to time.

I tru st she is not questioning the professional credentials of the persons who are being replaced. Ms. Cerllll: Mr. Speaker, these are blatant political appointments, and the concern is that there is no longer any continuity in the research on this important board. I ask the minister: How can he justify appointing pro-Tory, pro-dev elopment people to an ecological reserves board? Mr. Enns: Mr. Speaker, let me deal with the issue of political appointments. Every member who was appointed by the previous administration was, of course, a political appointment. That is the nature of the beast.

Every person appointed by an Or de r-i n-Council is, by natu re , a politica l appointment. I say without any contradiction that the past board served this province well, as I am sure the incoming board will serve. Ramsare lnternatlonal Letter Tabllng Request Ms. Marianne Cerllll (Radlsson): Mr. Speaker, my final supplementary is for the same minister. In the Estimates on Monday night, this minister said that he had received a letter from the Ramsare institute, which has recognized Oak Hammo ck Marsh as an international wetland, that praised the Ducks Unlimited building on that marsh.

I ask the minister to please table that letter for the House. Hon. Harr y Enns (Min ister of Natural Resources): Mr . Speaker, I do that with a considerable amount of pleasure because I am aware , of course, that first of all it is indeed a compliment to Manitoba and to the Oak Hammo ck

3291 LEGISL ATIVE ASS EM BLY OF MANITOBA June 13, 1991 Marsh that that international organization, which is a watchdog, if you like, of important wetlands throughout the world-that to be recognized by that organization is an honour. They have indeed sent a copy to me of the letter that they sent to one Duncan Stewart, chairman of the Sierra Club, just recently indicating that they have reviewed the plans for Oak Hammock. They take no issue with those plans. They are satisfied with the reporting proceeds established, and I would be more than happy, Mr. Speaker, to table that letter.

I do not have it with me, but I will do so at my earliest opportunity. Immigration Consultants Premier's Involvement Mr. Kevin Lamoureux (lnkster): This government has failed to recognize the seri ousnes s of exploitation of innocent families and immigr ants or would-be immigra nts. We have seen that in the lack of actions taken by this government. My question to the Premier is: Has he or his principal secretary ever met with Claro Paqueo or Seech Gajadharsingh in the Premier's office or any other gover nment office for the purpose of discussing immigration, investment or any political appointments? Hon.

Gary Fllmon (Premier) : With respect to Claro Paqueo, the answer is no, unequivocally no, Mr. Speaker. I have not met with Mr. Paqueo in my office or in this building, and from my principal secretary I understand that he has only met with Mr. Paqueo with respect to outside interests in working on campaigns, which have been identified in this House previously, and not with respect to any of the items that he listed. With respect to Mr.

Gajadharsingh, he worked in this building as a special advisor to the minister, and I had met with him on occasion with respect to his responsibilities in that particular position, not on any of the items which he referred to in his questions. Mr. Lamoureux: I thank the First Minister for the answer, Mr. Speaker. Seech Gajadharslngh Appointment Recommendations Mr. Kevin Lamoureux (lnkster): Mr. Speaker, my supplementary question is to the First Minister. On two separate occasions, concerns have risen about appointments within the Department of Family Ser vices.

Has thi s go ver nment made any appointments based on recommendations given, either by Seech or Claro, and if he has, will the First Minister table those appointments? • (141 0) Hon. Gary Fllmon (Premier): Mr. Speaker, that is a matter that is the subject of the review at the present time by the Civil Service Commission. I migh t say that we are investigating as well where-because I would be unaware at cabinet where recommendations would originate for people wh o are being put for war d. Under those circumstances, we are having to dig deeper than in respect to anything that would come to cabinet.

It would not have necessarily, nor would it have had a recommendation signed or presented by the individual whom he has named. Certainly with respect to Mr. Paqueo, he had no involvement with this government. In terms of any recommendations, they would not have come to cabinet or to ministers from him. Whether they came through any other source, I could not say. Immigration Consultants Publlc Inquiry Mr.

Kevin Lamoureux (lnkster): Once again, would repeat that the Civil Service Commission and the RCMP investigation is very limited in terms of what it is they can investigate, and the Premier nods his head indicating that is in fact the case. Mr. Speaker, would the Premier agree with us then that, if that is the case, then he would agree to have a public inquiry into it? Hon. Gary Fllmon (Premier): Firstly, I said before that we are doing all investigations necessary under the matter, and that the other investigations that he is speaking of are clearly as independent as they can possibly be.

That is, there is the total independence of the RCMP, and I am sure that not the member for lnkster nor any other member of this Legislature would su ggest they are not independent. I have also clearly indicated to him and to the members opposite before that there is the total independence of the Civil Service Commission. If he is suggesting that there should be an inquiry as to how we make our political appointments, Mr. Speaker, the political appointments are made with respect to the authority that is vested in government to make political appointments, that recognizes

June 13, 1991 LEGISLATIVE ASSEMBL Y OF MANITOBA 3292 political appointments. If he has any allegations of particular influence or particular appointments, I will be glad to investigate them. Curriculum Development Branch Review Mr. Dave Chomlak (Klldonan): Mr. Speaker, the Minister of Education and Tr aining has gutted the Curriculum Development Department by getting rid of staff, cancelling the curriculum policy review council, the curr iculum review comm ittee and the joint committee.

In light of the effect that this will have on education in the province and the future of education in this province, will this minister undertake to reverse his decision and meet with the interested groups like MTS, MAST, the superintendents and the parents and teachers in order to at least review this decision prior to gutting the Curricu lum Development Branch? Hon. Leonard Derkach (Minister of Education and Training): Mr. Speaker, once again, the member should know that I meet with the various organiza tions, the Teachers' Society, MAST, MASS, MASBO, the parents organizations on a regular basis.

Indeed, we try on a monthly basis to meet with the chairs of those organizations to ensure that there is some continuity in terms of the liaison between the organizations. Mr. Speaker, I have to indicate very clearly that, in terms of curriculum development and the writing of curriculum, we are changing the way in which we are ap proac hing the inservicing and the development of curriculum, but we are moving ahead with revising curriculum, with putting new curriculum in place.

The new program as an example, Skills for Independent Living, will be made available to schools in the next few weeks, and it has been written-- Mr. Speaker: Order, please. Education System Funding Formula Mr. Dave Chomlak (Klldonan): Mr. Speaker, in light of that, maybe the minister will respond to the May 8 letter from MTS asking for a meeting to deal with these issues. Mr. Speaker, this summer, within several weeks, the minister will be putting in place a funding for mula that will be the single most important thing he can do as a minister, that will deal with education funding for the next five years.

In light of that, will the minister undertake to bring before this House this funding form ula prior to its unilateral implementation? Hon. Leonard Derkach (Minister of Education and Training): Mr. Speaker, it is not a unilateral implementation. For the last year and some, we have been meeting actively with the organizations, the interest groups with regard to a new funding form ula.

As a matter of fact, we reinstituted the finance advisory comm ittee that was abolished by the form er adminis tration- they wer e never activated-so that they would give advice on financial matters, especially on a new education finance formula. Some 16 meetings have been held with that comm ittee, which has representation from the various interest groups, the educational groups to talk about and to deal with the specific issue of the Ed finance formula. We are now going to move to the interorganizational committee that will have access to the information on the Ed finance form ula. There has been a- Mr.

Speaker: Order, please. The time for Oral Questions has expired. Speaker's Ruling Mr. Speaker: On Wednesday, May 29, 1991, the Leader of the second opposition party raised a matter of privilege: "That the Minister of Education and Training's (Mr.

Derkach) conduct in providing information to government memb ers and then refu sing to provide the same information to opposition mem bers by denying its availability be referred to the Standing Committee on Privileges and Elections to determine whether the minister misled the House and whether he is competent to remain in his position as the Minister of Education." To summarize her points, on May 21 in the Comm ittee of Supply she asked the minister for a list of schools that would be constructed in the 1991-92 fiscal year.

The minister responded that the list was not finalized, but that as soon as it was he would send a copy to her. On May 27 during Question Period she asked why she still had not received the list, because three government MLAs had sent letters on April 17 and 18 to constituents indicating that certain school projects would be constructed.

3293 LEGISLATIVE ASS EM BLY OF MANITOBA June 13, 1991 On May 28, during Question Period, the minister admitted he had provided some information to the three government MLAs and that the information was inadvertently made public, adding that the action was done in innocence and not to pre-empt the usual process of public announcements.

Later, during Question Period that day, the minister reiterated that the list had not been finalized, and that he would make public all decisions relating to construction in one announcement and would give the Education critics of the two opposition parties the list when he made the announcement. The second opposition party Leader stated that May 29 was the first opportunity for her to raise a matter of privilege as she was awaiting Hansard from May 28 to verify what the minister said.

When a matter of privilege is raised there are two conditions to be met in order for the Speaker to rule it in order; first, was the matter raised at the earliest opportunity? I am satisfied that it was. Second, is there a prima facie case of a matter of privilege? "A prima facie case of privilege in the parliamentary sense is one where the evidence on its face as outlined by the member is sufficiently strong for the House to be asked to send it to a comm ittee to investigate whether the privileges of the House have been breached or a contempt has occurred and report to the House. " That comes from Maingot.

A matter of privilege is a very serious business, and I would like to paraphrase the Speaker of the House of Commons to clarify what my role on a matter of privilege is: In ruling on a question of privilege the Speaker does not decide on the matter; all the Speaker can do is to judge whether on the basis of the material presented to the House it appears likely that there has been a breach of privilege, which is so grievous that we set aside all other business before the House to consider the alleged breach. I have reviewed the rulings of Manitoba Speakers and have not found a case identical to this one.

However, the procedural autho rity of Joseph Maingot in Parliamentary Privilege in Canada is very clear on this point at page 191 : "A complaint that a Minister of the Crown has made a statement outside the House rather than in the House or that the gove rnmen t provides info rma tion only to its supporters in the House may well amount to a grievance against the government but in the absence of an order of the House forbidding such activity, there is no personal or corporate privilege that has been breached in the doing and neither does it constitute a contempt of the House in the 'privilege' sense.

" The second point in the argu ment of the Leader of the second opposition party is that the minister misled the House. Here I would refer the House to a ruling of Speaker Phillips of August 21 , 1986, where she very precisely states: "To allege that a Member has misled the House is a matter of order rather than privilege, " that is, a motion of privilege should be worded in such a way that another memb er is alleged to have deliber ately or intentionally mislead the House.

Speaker Phillips then goes on to say, "A Member rising on a matter of privilege which charges that another member has deliberately misled the House must support his or her charge with proof of intent. " While the Minister of Education (Mr. Derkach) himself indicated that the incident in question was a situation wherein he did provide some information to three MLAs that was inadvertently made public, and the Leader of the second opposition party (Mrs.

Carstairs) may well have a grievance against the government, I must rule, based on the parliamentary authorities and past rulings of Manitoba Speakers that a prima facie case of privilege has not been established. ORDERS OF THE DAY Hon. James Mccrae (Acting Government House Leader): Mr. Speaker, I wonder if there is a disposition amongst honourable members to waive private members' hour. Mr. Speaker: Is it the will of the House to waive private members' hour? Some Honourable Members: No. Mr. Speaker: Leave is denied. Order, please. * (1 420) Mr. Mccrae: I move, seconded by the honourable Minister of Labour (Mr.

Prazn ik), that Mr. Speaker now do leave the Chair and the House resolve itself 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 comm ittee 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 Agriculture.

June 13, 1991 LEGISLATIVE ASSEM BLY OF MANITOBA 3294 CONCURRENT COMMITTEES OF SUP PLY SUP PLY-HEALTH The Acting Chairman (Mr. Reimer): Will the Committee of Supply please come to order. This afternoon, the

section of the Committee of Supply, meeting in Room 255, will resume consideration of the Estimates of the Department of Health. When the comm ittee last sat, it was considering item 1 .(

b) Executive Support: (1 ) Salaries $499,700 on page 83 of the Estimates book and on pages 23 and 24 of the Supplementary Information book. Shall the item pass? Ms. Judy Wasylycla-Lels (St. Johns) : Mr. Acting Chairperson, I would just like to carry on with where we left off on Tuesday, a few more questions on the whole area of psychoanalysis. The minister suggested that this area was not now insured, that it was being allowed under the psychotherapy series, and that he was having consultations with the MMA and the psychiatrists of Manitoba.

Having looked into this issue further, it is my understanding that psychoanalysis is very much a part of psychotherapy. In fact, the research suggests that psychoanalysis is psychotherapy, although a more intensive form of therapy. It would appear, therefore, that the only way the minister can accomplish what he is pursuing is, in fact, to reduce the number of visits that are allowed under the fee schedule. I am wondering if that is exactly what the minister is considering doing. Is he considering capping a service now covered under our medicare progr am? Hon. Donald Orchard (Min ister of Health): Mr.

Acting Chairman, I really appreciate my honourable friend's questions, but my honourable friend now understands, I believe, from the way she posed the questi on, that the information that she had yesterday that psychoanalysis was a billing procedure was inaccurate. It is not a billing procedure, and I indicated to her clearly yesterday that it was not. Now she appears to understand that, and in fact that- Point of Order Ms.

Wasylycla-Lels: I pointed out the opposite to the Minister of Health, that in fact all information and research on this item suggests that psychoanalysis is a form of psychotherapy, and therefore for the minister to single out psychoanalysis is to deinsure a service. The Acting Chairman (Mr. Reimer): I would thank the member for her comments, but the comme nts are a dispute of fact. *** Mr. Orchard: Mr. Acting Chairman, how do I put this genteelly so that I do not get into a big discreP, with my honourable friend the New Democratic Party Health critic?

Clearly the impression was left, whether it was deliberate or not, that psychoanalysis is an insured service. That was the impression that certainly members of the media who had interest in this ques tion were left, the im pression that psychoanalysis was billed as psychoanalysis. I indicated to my honourable friend yesterday, in Question Period, I indicated to those in the media who inquired, that was not the case. You know, whether my honourable friend meant to leave that impression, did leave that impression, is irrelevant. It simply is not an issue of deinsure because it is not an insured service.

So, again, I do not want to be argume ntative, but my honourable friend uses words like cu tbacks and dei nsurance inappropria tely. You cannotdeinsure, something is not insured. So that is the point I am trying to make today and again reinfor cing what I said yesterday. *

(1440) Now, under the billing process that is allowed, there are billings, we un de rsta nd, of psychoanalysis. Now I want to bring my honourable friend back to something that the New Democrats attempted to achieve with the MMA and, certainly, we are close to achieving with the MMA, and that is the whole issue of fee

schedule reform. We have a fee

schedule manual that is that thick, a very, very thick, a very complex document. It has within it billing practices. Some of them have been unaltered for a number of years. Health care is an industry which is subject to more rapid change in tech nology probably than mo st others that government is involved in, in terms of purchase of service. We legitima tely ma ke the ar gumen t, and physicians have written to me on this issue, so that physicians who are thoughtful about the system are concerned about the fee

schedule and its structure. They believe the fee

schedule has led to the kind-and let me tell my honourable friend the

- 3295 LEG ISLATIVE AS SEMBL Y OF MANITOBA June 13, 1991 distribution of tariffs and establishment of tariffs has been within the MMA's exclusive purview up until the last few years. So some of the idiosyncrasies of the fee

schedule system that are currently there, like anesthesiology, have not been created by government. They have been created by internal allocations in the past with MMA doing the internal reallocation of monies provided by government through the fee

schedule negotiation. There are other issues in the fee

schedule where technology, me thodology, new techniques, because the whole delivery of medicine is a changing dynamic, where a fee

schedule established a num ber of years ago today is inappropria te. It either provides too much of a fee

schedule today with changing technology because the time commitment today is less to undertake that procedure than it was when the procedure first came in. Now, we are intent with the MMA and that was part of the agreement to analyze the fee schedule. We are trying to seek an independent third party analyst, expert analyst, to undertake that, to guide us on where we ought to be addressing inequities within the fee schedule. Who do those inequities impact upon? They impact upon, first and foremost, the patient.

If you are paying too much for a given procedure than its relative value com pared to other procedures, patients lose, because you are using resource inapp ropriate ly. Physicians lose if within the com petition for a block of monies to pay fee

schedule there are ina dequacies where some are overrewa rded ver sus oth er s who are underrewar ded. That is not fair to the physicians. That can distort and alter practice of delivery. Such is the case with psychoanalysis. It has been recognized for probably 10 years that it ought to be addressed.

We are attempting to address the issue of psychoanalysis again from the standpoint that in the changing context of mental health service delivery there we believe is a more appropriate, there may well be a more appropriate use of those resources that are going to pay for psychoanalysis under the psychotherapy fee schedule. That is what we are looking at. That is what we are hoping to achieve a resolution of co-operative ly with the MMA, co-oper ati vely with the Psych iatric Association of Manitoba.

Let me tell you, it is not an easy thing to do, because there are individuals whose practice styles are built around that practice. Of course, they do not want to give that up. That is just a given, but in terms of prioritization of limited resource to get the best value to im prove the health status of Manitobans in the greatest possible way, we believe it is an appropriate issue to address, not a new issue. I have indicated to my honourable friend the New Democratic Health critic that she ought to consult with her Leader, the member for Concordia (Mr.

Doer), who was just here giving her the advice about his thoughts on this, because he has some pretty strong thoughts on this issue. We are trying to achieve the best use of the fee

schedule dollar in terms of its use towards billing for psychoanalysis. Ms. Wasylycla-Lels: I can assure the Minister of Health that we are all united in our concern about this minister's moves to deinsure important services for Manitobans. The minister, in his long rambly answer, did not alleviate any concerns or fears with respect to his attempt not to allow psychoanalysis to be covered as an insurable service. If the mi nister wa nts to en sure that psychoanalysis is not covered under psychotherapy, then it appears that he has only two choices to make.

Either he has to cap a service and restrict a service to a certain number of visits, which in our view is a very dangerous precedent, and we wonder about what will be next. We know that there are many kinds of treatments that require repeat visits, require often visits, and we wonder if this means the minister is setting the stage, and then he or someone might consider capping a number of dialysis treatments, and the list goes on. The other option he has is to target the two psychoanalysts we have in this province.

He can go after them and say what they are doing is not allowed and not covered, and drive those two psychoanalysts out of the province of Manitoba. I think that would be an absolute shame to the people of Manitoba who would like to have available to them a continuum of service as is available in just about every other province in this country. One of those psychoanalysts is a Barry Miller who has been through commu nity medicine, has a very valuable expertise to offer this province and has spent years furthering his skills in terms of psychotherapy and psychoanalysis.

June 13, 1991 LEGISL ATIVE ASSEMBL Y OF MANITOBA 3296 I want to know which of those two options the minister is looking at because either one is dangerous and not appropria te to the needs of Manitobans. Mr. Orchard: You know, I do not have the knowledge of the individuals that my honourable friend has because I do not know the names of individuals who are practising psychoanalysis, and I am pleased my honourable friend does.

The issue that we are trying to arr ive at a consensus on is whether this process is meeting the needs of a large number of Manitobans who require the services of acute psychiat ric care, because we do not have- this is maybe a difficult concept for my honourable friend and the New Democrats to understand-the resources to carry on with the delivery of the health ca re system without attempting to analyze the value of health status improvement we get for the various expenditures throughout the $1 .75 billion we spend. This concern does make us ask some very serious questions. Those are not new questions.

They are not questions that are stimulated narrowly by a Progressive Conservative government. They are the same questions posed by my predecessor to whom I enjoyed several years of critic-min isterial relationship, the Honourable Larry Desjardins. Larry Desjardins was forewa rning Manitobans five and six years ago that this expenditure treadmill we were on could not continue, that we had to start taking measures to contain the cost in the health care syste m. That was spoken as a New Democratic Party Health minister.

His replacement in the New Democratic Party, Wilson Parasiuk, announced the closure of 111 acute care beds in hospitals in Brandon and Winnipeg, not because he wanted to, but because he saw that as the New Democratic Party approach to containing costs in the health care system. We have chosen somewhat of a different route. We have tried to analyze and determine what the system does for 1 million Manitobans and whether the practice of medical delivery within the health care system for the service provided is improving the health status of Manitobans. *

(1450) That crosses a wide range of issues including mental health, and in the mental health field, one of the issues that has come up is the issue of psychoanalysis and whether that is an appropr iate intervention in helping the grea test number of Manitobans with the resourc e it cons umes. Although you probably will not hear from them, there ar e those pro fessionals who are saying to government that it ought to be looked at, because in their opinion, as professionals, it is not delivering as much improvement to health status as other uses of that resource within the billing

schedule for psychiatrists in the system. We want to know, we want to find out, and that is the issue that we have put before both MMA and the Manitoba Psychiatric Association to try and seek out a resolution to this. I do not know what the resolution will be. I do not know what the decision will be that government ultimately might accede to, because I have not received recomme ndations on how we proceed.

This is opposition's perfect prerogative, is raising the very worst of scenarios with everything government does, but my honourable friend does not raise the scenario of saving upwards of several million dollars a year on lab tests because we changed the ways doctors order lab tests. She is not saying today that Manitobans are dying by the hundreds because we changed that order process, because she cannot. It did not happe n.

My honourable friend is not saying that the triplicate prescription that we brought in is killing Manitobans because we are denying $700,000 of improper prescr iption of nar cotic pha r ma ceuticals to Manitobans, of course not, because she knows that health status is being impro ved with those measures, but if we took that issue back, we could have my honourable friend saying exactly what she is saying today, raising fears which are unfounded about an analysis of an issue to assure that we are receiving value for health care dollars.

I cannot tell my honourable friend what the conclusion of that will be, but I am telling my honourable friend we are exercising an investigation in the hopes of resolving the issue so that dollars are more appropriately spent to serve those suffering from mental illness in the province of Manitoba. I call that reform of the health care system, and it is for the betterment of patient care, not the predicted calamity my honourable friend from the New Democratic Party would put on the record today. Mr. Guizar Cheema (The Maples): Mr. Acting Chairperson, I just want to add our views on the issue.

I think the issue is not only one aspect of

3297 LEGISLATIVE AS SEMBL Y OF MANITOBA June 13, 1991 psychoanalysis, it is a larger issue. As the minister will recall and everyone knows in Manitoba, in 1990, last year, when there was a sort of war going on between the MMA and the minister for binding arbitration, one of the agreeme nts was that there will be a study done.

There will be a consultation done and then the MMA and the minister will look at the various aspects of some of the tariffs and some of the fees and how the disparity would be made more equitable. ·1 think that issue still has not been resolved, and I do not think that there is a committee which has provided the final report. The minister has given the argument that is why one of the things they are going to look at is psychoanalysis. Simply, I think the minister should ma ke it very clear, because basically what we are seeing here is whether the government is going to follow up their own promise, No. 1 .

Second, is the deinsuring of services. There are two issues I would like the minister to clarify. The first issue is, are they following up on their own promise to wait for the consultation report? Mr. Orchard: No, I do not believe we are. There are some services that we deinsured. The issue of fee

schedule reform is to analyze within the fee

schedule an appropriate-and probably would end up-redistribution of the fee schedule, but we have chosen in some of the issues that my honourable friend has brought up in the House, such as tattoo remo val, to simply not pay for that anymore on behalf of the taxpayers. Mr. Cheema: Mr. Acting Chairperson, with due respect then, the minister has said that they are not following their promise and they are looking at these services on a separate basis. Is that true? Mr. Orchard: That is correct. Mr.

Cheema: Then can the minister tell us, other than psychoanalysis, what other services are they looking at present to deinsure? Mr. Orchard: The ones were tattoo removal, reversal of vasectomy, the fitting of cosmetic contact lenses, varicose veins and certain cosmetic surgeries. Mr. Cheema: Mr. Acting Chairperson, I think the minister is probably digging himself more and mor e in to tro uble, because psychoanal ysis and psychotherap y-you tried to explain that the psychoanalysis as such was not a listed item under the tariffs. I have checked the tariffs; it is not there.

It was under the sort of a vague statement under the tariffs of psychotherapy. Even though the minister would have all the arguments to restrict that, still the psychotherapy is available. Is the minister going to allow the psychoanalysis to be carried and the psychotherapy? My question is, is that going to be used? Mr. Orchard: Mr. Acting Chairman, that is what is happening. Mr. Cheema: That me ans the minister would restrict the psychotherapy services. Mr. Orchard: Are you sure that psychotherapy is what is being billed is the issue? Mr. Cheema: Mr. Acting Chairman, I am lost with this issue.

I would like the minister to clarify when the psychoanalysis is not listed in the tariffs and physicians are billing under the psychotherapy. Th e min ister is saying we will not pay for psychoanalysis. That means they will not pay for psychotherapy. The issue is that the basic necessity of psychotherapy, which is very much a fundamental part of the mental health refor ms, is to give more services other than the acute psychiatry care.

If he is going to stop the psychotherapy services, one way or the other, whether it is going to limit the numbers or how many times the patient can visit their physician or the hospitals. Ultimately, I think, that is a very dangerous move. I would like him again to clarify, because I think somebody in the department has not really dug up the whole research on the area, how the physicians are billing even tho ugh there are two psychoanalysts, as the member for St. Johns (Ms.

Wasylycia-Leis) has said, but the other physicians are still billing under the psychotherapy, so how are you going to differentiate the whole thing? It does not make sense to me at all-absolutely zero. Mr. Orchard: I cannot explain it any more clearly to my honourable friend than I have over the last two days. Mr. Cheema: Mr. Acting Chairperson, then I will leave it up to the people who are going to suffer, the MMA, the minister's own department and us to, and analyse what the minister has said. Basically that means the minister is exposing himself to further questioning-absolute ly.

The second thing, the minister has said the varicose veins are going to be included for the deinsuring services. Can the minister tell me how on earth he could include the varicose veins for deinsuring of services? This is one of the necessary services

June 13, 1991 LEGISLATIVE ASSE MBLY OF MANITOBA 3298 under the surgical procedures done very commonly. There is a medical reason, there are surgical reasons, many reasons. I do not have to go through all the reasons but simply, if they are going to restrict the varicose veins, what is going to come next? Appendectomy? I mean, this has to stop. Some body is not advising the minister right. I had a lot of respect for the minister's judgement, but somebody is trying to derail the minister here and giving him the wrong advice.

Varicose veins are a necessary surgical procedure, and tomorrow, when the people are going to find it out, the minister will get a lot of calls and a lot of questioning. Certainly, I am very much disturbed that the minister would include a procedure which is done so commonly and which is a necessity. Can he explain to me what is the rationale, what is the basis, what evidence he has and who gave him such stupid advice? *

(1500) Mr. Orchard: My honourable friend asks some pretty interesting questions. I understand where my honourable friend is coming fr om. My honourable friend practises medicine, and so I understand that everything he does is considered to be medically necessary. Okay? I will accept that from my honourable friend as a given. Let me indicate to you that varicose veins, in many instances, are surgically treated, and it is not related to any particular or specific medical condition, but it is prim arily for cosmetic purposes.

Now, let me-before my honourable friend jumps in with his medical arguments, the surgical trea tment of varicose veins will only be covered when the physician ma kes the determination that it is medically required, as it is occasionally. We recognize that. Let me tell my honourable friend a little something that a physician shared with me. A physician shared with me that this will not work because, he said, we will always have medically necessary remo val of varicose veins whether they are medically necessary to be removed or not. Okay? A physician told me that.

I just want to point out to my honourable friend that-my honourable friend indicated to me that he very much supported the centre for health, policy and evaluation. Okay. Absolutely, my honourable friend says. You know, they do an analysis of what we are paying for in our health care system. One of the things that their analysis determined five years ago was that Manitoba children were much unhealthier than children in Ontario and in Saskatchewan. An Honourable Member: We have heard this one. You did this in last year's Estimates, Don. Mr.

Orchard: Well, if you do not want to hear this, then leave, because this is important to determining what is delivered as medically necessary. We in government do not determine what procedure is done, a physician does. In Manitoba, physicians determined that children were unhealthier than Ontario and Saskatchewan because they removed their tonsils at a higher rate than either of those provinces. When that issue was drawn to their attention as a result of research by the Roos and published in the College of Physicians and Surgeons, do you know what happened within a year?

Our children in Manitoba were as healthy as the children in Ontario and Saskatchewan because we did not take tonsils out as much. Do you want to be blunt about what was happening with tonsillectomy? Children were being used to create income, not to cure a medical condition, because children are not more unhealthy today than they were when tonsils were being taken out just as a matter of procedure. Mr. Cheema: Sure. Mr. Orchard: My honourable friend for The Maples (Mr. Cheema) just said "suren and says that is right. Well, that is right. The same thing exists with varicose veins now.

I tell my honourable friend we have a problem because a physician has told me face to face, you have a prob lem, we are going to say everything is medically necessary. Well, okay, then that means that the system needs some real soul-searching as to what motivates the billing for procedures. Is it cosmetic, is it income driven, or is it medically driven? I want to have a system and my honourable friend wants to have a system that is medical-needs driven, with health status impr ovement in terms of outcome.

I was in Victoria and I had a discussion with a physician, a very leading physician, and he made an interesting observation to me. This physician is a very, very excellent physician. He said to me that physicians drive the costs in the health care system because physicians undertake the procedures and they admi t people to ho spitals. Tha t is approximately $1 .25 billion of our expenditures.

3299 LEGISL ATIVE ASSEM BLY OF MANITOBA June 13, 1991 The physician told me, he said, you want to find out who your outriders are. I had never heard the term "outrider " before . Do you know what an outrider is? Someone who practises beyond the norm of his professional colleagues and peers, in other words, does mor e hy stere cto mi es on wom en, does mor e tonsillectomies on children, etcetera, et cetera than is the normal pr actice stand ar d of oth er professionals making medical judgment.

He said, if you want to control your medical costs, develop a method of identifying the outriders because no physician want s to be an outr ider and will immediately come in within the practice standard. You know, that is one of the things that the Centre for Health Policy and Evaluation is going to help us to establish, and do you know what? Manitobans will not suffer from that because I recalled in the House, before the 1988 Election, or maybe it was- no, it was before the 1990 Election when Maureen Hemphill used to make the observation that, you know, there is too much surgery done, period and paragraph.

Well, I do not know whetherth at is right or wrong. I cannot make that judgment as a Minister of Health, but one group of professionals that can help make that judgment is the Centre for Health Policy and Evaluation. That is why we are funding them to the tune of $3.5 million a year to try to give us that guidance for policy formulation. Mr. Cheema: Mr.

Acting Chairperson, I think, when the minister last year had a full discussion, and as I said, it was ongoing for weeks and months with the MMA and the other professional organizations, everyone came to a conclusion that we spend a lot of money and we have to control cost, but they never, never even once, inside the House or outside the House or during the campaign, minister-and with due respect, they have their own philosophy. The question here: Is the philosophy they are going to follow to dismantle some of the services? (Mr.

Marcel Laurendeau, Deputy Chairman, in the Chair) The minister has given the argu ment from his point of view on varicose veins. Whether they are correct or not, I think still the jury is out because, you know, this is one of the very commonly needed procedures for working individuals who work or workers who work the whole day standing. It is very common for people who have to work six to eight hours a day, the varicose veins come. It is not for cosmetic purposes. It is very commonly done on the elderly population. That is true; that is a fact.

If that is kind of service the minister's office is going to take away, the fundamental question the minister has to answer-we are going to disagree with that absolutely, whether that is the intent to deinsure services and have the user fees, because the user fees, the minister cannot do it because it is not possible within the Canada Health Act. He under stands more than anyone else. So that means that by deinsuring services, basically, you are getting away with murder, and this is from the policy point of view.

From the minister's point of view, from their philosophy, that may be right; from the universal health care system, that is not right. Mr. Orchard: Mr. Deputy Chairman, I am intrigued with my hono urable friend's arg umen t. My honourable friend says thatthe universal health care system was designed to do what? To do cosmetic procedures? I am saying to my honourable friend when I read to him the answer on varicose veins, where medically needed, they are an insured service. Where they are undertaken for cosmetic reasons, no. That is the difference.

Medical need will be achieved, and we are asking prof essionals to make that decision of where medical needs arise. That is what they are trained to do. I do not think that is asking too much, to pay for medically needed services because, unless I have a misconception of the Canada Health Act, I believe that is what we were originally designing a system to do, to meet medical needs.

Now, if you are not meeting medical needs with a procedure, is my honourable friend saying the Liberal Party, and I know the New Democratic Party is there because they have argued against any deinsurance, even though they were not exactly without their cases, but nevertheless, you are saying that every procedure we do today has to be there, otherwise it is a violation of the Canada Health Act? That is not right. You will not carry that policy should you ever be in government, because you will analyze, when you are in government, procedures to assure that they are needed medically.

That is what we are doing here, and no one can tell me, for instance, the removal of a tattoo is a medically necessary insured service the taxpayer should pay for, but it has been, and there are other procedures like that.

June 13, 1991 LEGIS LATIVE ASSEMBL Y OF MANITOBA 3300 In 19 -w hat was the yea r when the big controversy over plastic surgery took place? We were not governm ent. It was in the last 20 years, and if we were not government there was only one other party that was gov ernment. Was that stimulated as a violation of the Canada Health Act by the NOP? Of course not. You know, I want to tell you, we did not participate in that controversy because it was not meeting a medical need. Ms. Wasylycla-Lels: Mr.

Deputy Chairperson, the minister likes to refer , whenever we get into this topic, to tattoo remo val because it is a good way to deflect from some of the serious issues that are part of this deinsurance package of the minister. There are some very serious issues here in terms of services that Manitobans need, and as a result of this system and these moves to ensure by the Minister of Health, he is clearly, this government is clearly, setting up a two-ti ered system. One that I have mentioned in the House before is the reversal of sterilization. * (1 510) Now, Mr.

Deputy Chairp erson , under this minister's new policy, clearly, this government is not considering the fact that family circumstances change, and not clearly reflecting the fact that we should be providing the same kind of service across the board regardless of one's wealth or position in life. My question to the minister is, and this goes back to what I asked on Tuesday-I do not want to have to beg for all of these items under deinsurance. He has now dribbled out one more item, varicose veins.

I asked him for a list of all of the services being deinsured on Tuesday, that come to this total of $2 million in savings as outlined in the Budget Address. The minister has said he could not provide it until we get to the Manitoba Health Services Comm ission line. He has the material in front of him. He has just read from that li.st. I would like him to table that list so that we could have a serious and intelligent discussion about this matter. Mr. Orchard: You have just heard them. Ms.

Wasylycla-Lels: So the minister is saying the only one he left off this press release was varicose veins, and that he is getting $2 million in savings by deinsuring tattoo remo val, contact lens fitting, reversal of sterilization and varicose veins. Mr. Orchard: Psychoanalysis and reversal of sterilization. Ms. Wasylycla-Lels: Mr.

Deputy Chairperson, the minister is now confirming that psychoanalysis, contrary to what he said on Tuesday, has been determined that that service will be deinsured contrar y to his statements on Tuesday that he was studying this matter and consulting with the MMA and the psychiatrists of Manitoba. Mr. Orchar d : When you ma ke budg etary decisions, you set targets for those budgetary decisions. That is not an unusual budgeting process. Within the services that are deinsured, a target saving is $2 million. They are as I have indicated. Psychoanalysis was never an insured service .

Listen to my honourable fr iend, the member for The Maples (Mr. Cheema), who just said he went to the fee

schedule and determined that. Point of Order Ms. Wasylycla-Lels: The minister is not being straig htforward with this com mittee. He just finished saying, when I asked him what was on the list of deinsured medical services and I went so far as to add varicose veins, he himself, on his own, added psychoanalysis. Mr. Dep uty Cha irman : Order, please. The honourable member does not have a point of order. It is clearly a dispute over the facts. *** Mr. Orchard : Mr.

Dep uty Chair man, psychoanalysis has been billed as psychotherapy and I will go through this any number of times my honourable friend wants because we still have 58 hours to go here. Now I just want-I told my honourable friend the New Democratic health critic to consult with her esteemed leader because on April 8, 1988, during the election campaign when he was a fresh- faced new New Democratic Party leader, he was in Brandon. Mr. Doer said he wants to give a raise to psychiatrists in mental hospitals who are paid about $80,000 a year .

Doer said yesterday that hospital patients suffering from the most serious mental illnesses have less access to psychiatric services than well-to-do neurotics in Tuxedo. Well, you know, I am taking this issue a little more seriously than Mr. Doer did when he said that hospital patients, meaning mental health patients in psychiatric facilities, suffering from the most serious

3301 LEGISLATIVE ASSEM BLY OF MANITOBA June 13, 1991 mental illnesses, have less access to psychiatric services than well-to-do neurotics in Tuxedo. Now my honourable friend, the member for Flin Flon (Mr. Stor ie), is nodding his head. Maybe he can explain the policy that Mr. Doer announced in 1988 as to who these well-to-do neurotics in Tuxedo were and what services they were receiving. Ms. Wasylycla-Lels: Mr. Deputy Chairman, the minister is deliberately avoiding this issue.

He said on Tuesday, June 11, thatthe psychoanalysis issue is one that is in discussion right now with the MMA and the psychiatrists association of Manitoba. I am sure they will find it quite interesting to know that this is already a fait accom pli by this government and has been included in this government's budget as a significant cost saving.

I would like to ask the minister, since he likes to talk about evaluation and utilization reviews and scientific evidence and all of that, which we do not disagree with, if he will table for us the evaluation, the scientific analysis, the data for each one of these services that this government is in the process of deinsuring so that we can better understand the objective basis for making this kind of a decision on the part of this government. Mr. Orchard: Mr. Deputy Chairman, I do not think one needs to have a whole lot of scientific evidence around a number of these procedures.

Sterilization voluntarily undertaken is paid for under The Health Services Insurance Act, a lifestyle choice to reverse that will not be. Recall I said "lifestyle choice to reverse that will not be. " That is not a small price to ask when my honourable friend asks of me almost every day for more money in the health care system. Where does it come from ? Well, if you are an NOP, you would raise taxes or borrow money. We chose to do neither. We wish to -(interjec tion)- Well, my honourable friend the member for Flin Flon (Mr.

Stor ie) says, take it out of pr ivate schools, the same private school system that his Leader received his high school education at; the same pr iv ate school system that the for mer Attorney-General, now Dean of the University of Manitoba, sends his child to. I mean, let us not be bloody hypocrites in the NOP about private schools. You send your children to pr ivate schools and stand in the House and complain about it. Put your principle where your students go and your children go. Now, Mr.

Deputy Chairman, I just want to tell my honourable friend, because she just said that she has no disagreement with making sure that health dollars are ap pro pr iately serving Manitobans-okay, let us rhetorically deal with that issue and see how serious my honourable friend is. Bearing in min d that the Leader of the New Democratic Party in 1988 said, we have to improve the salaries of psychiatrists working in our mental institutions, because they are paid at $80,000 while-and because they are only paid $80,000, he believed their salary should go up. I want to tell you that is one of the things we did.

We did that in 1988. I mean, we recognized that was a problem, and we enhanced the salary of psychiatrists employed by the government of Manitoba. I do not know what my honourable friend the Leader of the New Democratic Party, Mr. Doer , meant in 1988 when he said that patients suffering the most serious mental illnesses in the mental hospitals have less access to psychiatric services than well-to-do neurotics in Tuxedo. It might be interesting for him to explain that.

Maybe his critic could explain it, or maybe some of the members of his party who are here listening in astonishment could explain it, because the member for Flin Flon (Mr. Storie) nodded his head when I said this, because I guess this is shop talk in the New Democratic Party caucus. Mr. Jerry Storie (Flln Flon): How many patients do they have? Mr. Orchard: Okay, let us deal-my honourable friend the member for Flin Flon asked, how many patients do they have? Mr. Deputy Chairman, I will give you not just some hypothetical- Mr. Deputy Chairman : Order, please. Point of Order Ms.

Wasylycla-Lels: The minister is responding to a question that has been yelled from the floor and not recognized by the Deputy Chairperson, so I assume I can proceed to ask my next question. Mr. Orchard: Well, I am not finished answering the question. Mr. Dep uty Chai rman : Order , please. The honourable memb er for St. Johns did not have a point of order. It is a dispute over the facts. *** Mr. Orchard: Mr. Deputy Chairman-

June 13, 1991 LEGISLATIVE ASS EM BLY OF MA NITOBA 3302 Some Honourable Members: Oh, oh. Mr. Dep uty Chair man : Order, please. The honourable minister is attempting to answer a question. I would appreciate a little bit of decorum. Mr. Orchard: The member for Flin Flon (Mr. Storie) asked the question that his critic should have asked. How many patients do some of these psychiatrists see, who, I presu me, are dealing with these neurotics in Tuxedo?

Well, I am led to believe, one psychiatrist sees 40 patients, that costs us in excess of $1 10,000; another one sees 23 patients, that costs us in excess of $1 26,000; another sees 44 patients and that costs us in excess of $140,000.

Now, I think that deserves some analysis, some discussion with the psychiatric association and with the MMA to ascertain whether those 40, 23 and 44 patients are appropriately consuming scarce dollars in the health care system and whether, in fact, a greater number of Manitobans might receive service if that money was repr io ritiz ed within the system-very inter esting, a very interesting question. I am glad the member for Flin Ron posed the question that ought to have been posed by his Health critic, because I think it might shed more light on the Tuxedo neurotics that the NOP talks about. * (1 520) Ms.

Wasylycla-lels: If, in consultation with the MMA and the psychiatrists association of Manitoba, those two organizations expressed their opposition to the remo val of psychoanalysis from the current billing arrang ement, will the minister then throw out this idea and give us the actuals in terms of savings from his list of deinsured services? Mr. Orchard: Mr. Deputy Chairman, as I indicated to my honourable friend, anytime one prepares a budget, those are your best estimates that you have. I cannot presuppose a decision, a position or a recomme ndation from the MMA or the Psychiatric Association of Manitoba.

That is why we have had some discussions already with those two groups around the issue. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, the minister made quite a lengthy comment in dealing with this issue, general issue of deinsured medical services, in terms of evaluation and the role of the Centre for Health Policy and Evaluation. I do not think in that context then it is too much to ask for the minister to table to this comm ittee the scientific evidence and the objective evaluations that are the basis for deinsuring the five services that the minister has mentioned. Mr. Orchard: Mr.

Deputy Chairman, I think the issue becomes, what is a medically needed and required service? That was an issue, to some degree, that my honourable friend the member for The Maples and I discussed just about five or 1 0 minutes ago. We pay for the removal of a tattoo. The tattoo placement in the first place was a service paid for by the individual, not insured. We do not believe that it is a wrong decision to not have taxpayers pay for re moval of tattoos.

There is no detailed analytical study which shows that this is going to compromise the individual's health if the taxpayers do not pay for the removal of his or her tattoo. Now maybe what we should do is find out whether that is one my honourable friend believes should be reinsured. Is that the New Dem ocratic Par ty position? We can deal with that tattoo first and then I will deal with the rest. Ms. Wasylycla-Lels: Mr.

Deputy Chairperson, since we are getting no answers on this question, even though the minister likes to talk about evaluation and scientific approaches, I would like to move on to his Urban Hospital Council, which we have been dealing with in the House for the last couple of days and his 48 new studies in addition to the- Mr. Deputy Chairman: Order, please. Point of Order Mr. Cheema: Mr. Deputy Chairperson, if we are going to move into another section, I have a couple of questions on the deinsuring services, if it is possible, with the permission from the member for St.

Johns, so that we do not have to go back and forth. Mr. Deputy Chairman: I would like to remind the honourable memb ers that we are dealing line by line. The minister had noted that there were a number of areas we could go yesterday. I will have to refer back to those ones and see what they were, but let us try and keep within where we are with the staff that is present. *** Mr. Cheema: Mr. Deputy Chairperson, can the Minister of Hea lth tell us if the re ver sal of sterilization, as he has indicated they have included

3303 LEGIS LATIVE ASS EM BLY OF MANITOBA June 13 , 1991 in the budget, will not be insured, and if there are unforeseen circumstances, somebody has had an accident or somebody dies and remarries. What are you going to do then? I think there is an issue that has to be qualified that if the minister is so insistent that they want to proceed in that direction, then he should tell us what will be the answer to that individual or that family if they want to have a new family and something has happened, a tragic situation. There are so many things that happen.

There are so many people having trouble in their family lives. They make a decision at an early age, and they may change their mind. That decision may be very much in the interest of a family. How those people will proceed and how the minister can justify and maybe if any provision or provisions can be made in the present circumstances to make sure that those individuals are at least covered. Mr. Orchard: Mr.

Deputy Chairman, there are always difficult circumstances around any decision like that, but the one circumstance, to put it this way, that we would insure and pay for the reversal procedure is when the or iginal sterilizati on procedure was done because of a birth defect, disease or injury. We would pay for the reversal in those circumstances, but others we would not. Mr. Cheema: The minister said initially that any procedure done for a family lifestyle will not be paid. That means that all the visits-if somebody is going for birth control pills, are they going to be deinsured, too? Mr.

Orchard : In ter ms of the Pharma care program ? Mr. Cheema: No, in terms of the visit to the doctor or the gynecologist or a special clinic where they go for a family planning visit which is covered now under the tariffs. It is covered that you can go and get advice and get your birth control pills, and a physician can bill it. That is true Is the minister going to deinsure those services as well? Mr. Orchard: No. Mr. Cheema: The minister is confused again, because he said initially that they will not pay for any reversal of sterilization which was initially done for the purpose of family life.

At the same time, they are paying services on a daily basis for hundreds of people who go to their doctors, get family planning advice. It is paid. Mr. Orchard: Surely my honourable friend is not suggesting that we do not pay for those? Mr. Cheema: No. Mr. Orchard: We are not suggesting that. Mr. Cheema : I am simply telling the minister and giving him a valid argumen t for him to understand that is the case there. We are not asking him to do the same thing that he has done with the reversal of sterilization, but I will ask him to do at least one thing on a compassionate ground. There should be a

section in the reversal of sterilization that should clarify that anybody who has an accident or somebody dies or rema rries for some other reason, if they want to have a reversal of sterilization, it should be paid. Mr. Orchard: I hear what my honourable friend is saying. I will give that consideration and ask the individuals within the ministry responsible whether that is a reasonable suggestion. I appreciate that suggestion. Ms. Wasylycla-Lels: On that again, we have very real concerns that these kinds of decisions are being made on the basis of subjective feelings about a particular service.

The minister is using the term "lifestyle issue " when it comes to de insuring reversal of sterilization, ignoring the fact that, as my colleague the mem ber for The Maples (Mr. Cheema) and I have both sa id, fam ily circumstances change. A member of a family unit may decide to have the sterilization procedure. Then a member of that family may die or the family may split up, and new circumstances are posed to that individual, and the wish to have a family is reopened, but the minister is saying now, only if you are wealthy and you could afford this kind of service is that option available to you.

If you are low income and you cannot afford to pay for reversal of ster ilization, even though your family circumstances have changed and you have a wish to have a child, then you cannot be accomm odated. Sorr y-too bad for you. Mr. Deputy Chairperson, that kind of subjective decision making is not appropria te for the field of health care, and that is why we repeatedly ask for the minister to follow his own advice and come forward with scientific evidence and evaluation data that provides the basis for deinsuring any service. Otherwise, we are on a very dangerous treadmill.

I fear for wh at can come in this kind of decision-making mode.

June 13, 1991 LEGISL ATIVE ASSEMBLY OF MANITOBA 3304 * (1 530) Mr. Orchard: My honourable friend makes an interesting point, but I just want all here to note that my honourable friend did not answer the question as to whether the NDP wants to insure, for instance, re mo val of tattoos. Sh e is into re versal of sterilization-v oluntarily undertaken sterilization. There is not a medical reason to pay for that, and my honourable friend-I would like to hear her argume nts around the medical grou nd. My honourable friend the member for The Maples (Mr.

Cheema) drew a certain circumstance together, and I am prepared to take a look and see whether that can be accommo dated because that is a som ewhat ex te nuating circu mstance . I am prepared to take a look atthat but, in terms of making an argu ment that this is a medically needed procedure under the Canada Health Act, I do not think my honourable friend can demonstrate scientific data research basis to make that case, and she has not answered whether she would reinsure tattoo removal as a New Democratic Party policy. Ms. Wasylycla-Lels: Mr.

Deputy Chairperson, the minister has the responsibility for clarifying to the people of Manitoba the basis for his decisions. He has failed to do so at every turn, and I think he has a responsibility to account for each and every service that he deinsures. Let me go on to the Urban Hospital authority. Mr. Deputy Chairman: Is that going to be under another department? Ms. Wasylycla-Lels: This is part of the overall structuring of the department that the minister said we should talk about under this line, and I think it fits quite appropriately in this section. Mr. Deputy Chairman: Carry on. Ms.

Wasylycla-Lels: The minister, as we have talked about earlier, has set up 48 studies, in addition to his· 14 task forces under the Health Advisory Network, in addition to the dozens, perhaps hundr eds of other studies that he is responsible for since becoming minister. I guess, actually, we are down to 47, since after Tuesday's exchange in the House, I assumed that the study group on user fees has been disbanded. I would like to ask the minister on what basis he and his deputy minister made a decision to set up these 48 working groups and what he hopes to accomplish by this elaborate study session. Mr.

Orchard: I want to take and do two things. First of all, I want to have my two honourable friends have a copy of the terms of reference of the Urban Hospital Council, so that my honourable friend does not fly off on her little tangents of rhetoric where she ha s to end up losing creditab ility for no t understanding the issue. My honourable friend says, why did I and my deputy minister put these issues before the Urban Hospital Council? I want to explain the process to my honourable friend of how we got around to establishing the Urban Hospital Council.

Over the past number of months and, indeed, for some time, I have attempted-and not in isolation. My senior management within the department and my deputy minister, the executive director of the comm ission, my assistant deputy ministers and other senior people within the ministry who have working relationships with the major hospitals have developed a good working relationship. We have attempted within government to try and reach consensus on issues so that we can plan health care reform in a strategic manner. I gave the example Tuesday to my honourable friend about a decision that was made.

My honourable friend needs to have a little bit of a refr esher course in policy, bec ause the New Democ ratic Party established a policy for the hospitals of Manitoba that they should not operate in a deficit basis. That was a policy that came out of the mid 1980s when hospital deficits were approaching $23 million, ranging from $400,000 in one to 5.6, 5.7 in another major hospital. They made the decision that hospitals must operate within their global budget with no deficits. We have carried on with that policy of the New Democratic Party.

Since I became minister, one of the hospitals, and there is no point in naming the hospital because I am using this as an example, midway through the year looked like they were going to run up a fairly significant deficit. In terms of coming to grips with their budget problem, they met with the ministry and the comm ission and with myself even. One of the areas of cost containment within their hospital that they were going to undertake was to discontinue the chemotherapy outreach program from their facility.

That would have saved them some considerable dollars in staffing and in pharm aceutical and operating costs. That, as one might readily understand, was not accepted by

3305 LEGISLATIVE ASS EM BLY OF MANITOBA June 13, 1991 government because those people still need chemotherapy. So all you did was transfer the budgetary problem with the patient to the next facility which would provide the service. What I am indicating to my honourable friend is that you cannot make budgetary decisions all the time in isolation of the health care system. Much to the benefit of Manitobans, our senior executives in the health care system in Manitoba recognize that and wish to work together through the form of the Urban Hospital Council to come to grips with the budgetary issue.

Their increased request this year was in the neighbourhood of $70 million. We are not providing that large an increase. We are providing less than that. That is the $19 million cutback that my honourable friend the New Democrat keeps talking about. An Honourable Member: I am glad you finally admitted it. Mr. Orchard: My honourable friend says I am glad I am finally admitting it. My honourable friend still cannot make increased funding into a cutback despite how hard she tries.

At any rate, in coming around the issue of how they are going to get by with their budgets this year, based on past co-operation with government. They wanted to make this effort a partnership effort because governmen t has the responsibility of setting what the hospital global budgets are going to be. We do that because we are elected to do that. Then we expect the boards and the management of our health care facilities to operate within those budgets and no deficit. That means some decisions have to be made. They are not going to be made in isolation.

They are going to be made within the context of Urban Hospital Council to deal with system issues. Each facility, individually, is going to make decisions internally on operations strictly internal to their own facility.

Now, in establishing the Urban Hospital Council, the CEOs from all the major hospitals in Winnipeg and the CEO from Brandon General Hospital and the MHO executive director, my deputy minister and my associate deputy minister are on that, and it is not the director of Winnipeg Regional Services on the Urban Hospital Council as well, for the reason that she is the co-ordinator of community-based services, so that any decisions within the hospitals that may require enhanced community services, she should be there and part of the planning process.

So that is why that individual is there, although not directly attached to hospital funding. Now, the concept was agreed to, that we would form a partnership arrangement with the CEOs and the ministry of Health and MHO involved. The next step was to determine what issues ought we to look at. We suggested some issues. We suggested several issues and the Urban Hospital Council member ship suggested a whole range of issues.

What my honourable friend tabled in the House the other day was probably the first list of issues that was put together, suggested from all areas of the health care, all the CEOs and the department. • (1 540) Ours was not the suggestion. The ministry's suggestion was not the user fees that my honourable friend went on her little tirade on. When we prioritized and decided on a final list of issues to be discussed, we said, that is not one that is on the table. This government has said, we do not believe that user fees are the answer to the health care problems.

User fees are yet another form of taxation and, if extra money to the health care system was going to solve all the problems, then we ought not to have any problems, because we have done nothing but put money at the health care system for the last 20 years. That is why, in terms of publicly funded health care systems in the world, we spend more per capita than any other. We spend more money per capita than any other publicly funded health care system in the world. So we said user fees are not on the table for discussion.

A number of the other issues that were suggested both from government and from CEOs are being discussed. The process is that an individual chair and a small committee has been established to a number of these issues so that they can seek advice from a little wider range of advice and attempt to come to a recomme ndation which will be considered by the Urban Hospital Council membership.

Those recom mendations will then, after having received the approval there, be passed on to myself as minister, because the council will be reporting to me, and then government will have to weigh all aspects of that recomm endation to see whether it has applicability to the health care system. There are a lot of issues being discussed on the Urban Hospital Council. I am not afraid of that kind of open discussion.

June 13, 1991 LEGIS LATIVE ASSEMBL Y OF MANITOBA 3306 I realize that there is a substantial amount of political risk to under taking that, because my honourable friend, as she has tried to do already, will attempt to paint the very worst possible outcome of decisions that have not even been advised to government, of each topic that could be discussed. I recognize that, but I simply say to my honourable friend that the process is very, very, very healthy. The process is very, very unique to Manitoba.

There is no other province, and my deputy will correct me if I am wrong, there is no other province that has the opportunity to have the chief executive officers of all of their major hospitals sitting down with government and strategically planning reform and change in the health care system.

I want to tell you that every other province, including NOP Ontario and many Liberal provinces across Canada, would love to have the kind of co-operation and opportunity for intelligent decision making to be of their avail in determining budgetary policies in their respective provinces because, without excep tion, all pro vinces are facing constrained funding. The only exception is Ontario, where the same advisers who drove the deficit through the roof in Manitoba are now providing advice to Premier Bob, Premier Bob and borrow.

Th ey are the same advisers who now are recom mending a $9 billion deficit in Ontario, so that they are deferring to yet unborn Ontarians and Canadians the opportunity to pay for today's consumption. Every other governmen t is Canada has chosen not to do that, Liberal, Conservative, Social Credit, even New Dem ocrat in other provinces or other territories. Now we have an opportunity here in Manitoba with our Urban Hospital Council to discuss the issues, to seek advice and try to come to a reasoned decision making. I think that makes for healthy public policy.

I think that makes for a healthy mana gemen t environ ment in the health care system. I think "that is good for the system. If that is good for the system, there are only two groups of people who will benefit, the patients and the taxpayers. I say two groups of people when, in fact, they are one and the same. That is why I said yesterday in Question Period that the decision made at Seven Oaks has every opportun ity to be a win-win, a win for the taxpayer and a win for the patient. Now my honour able friend objects to that because she is into job protection, she is into no layoffs.

She is into having the health care system, not as a system to provide care to people in need of health services, but rather as an em ployment vehicle for unions. Oh, I am sorry. That is not the reality of today. That is NOP reality. It is discredited reality. Now I also indicated to my honourable friend that decisions that emanate as Seven Oaks' decision has emanated, will be done within the context of the collective bargai ning agreement and all other agreements that are in place. It will be worked through with as much co-operat ion as is possible to achieve when you have those kinds of decisions to make.

That is the genesis behind the Hospital Council. The issues, my honourable friend said, that were provided to the council by myself and my deputy minister-I simply want to indicate to her that we did not provide a number of the issues for discussion. We agreed to their discussion; they were not our suggestion. So I hope my honourable friend might contain her phraseology and reflect accurately the genesis of some of the comm ittee questions being considered, that they are not government's agenda. They are the Urban Hospital Council's agenda. Ms.

Wasylycla-Lels: Well, that certainly appears to be coming as news to members of the Urban Hospital Council, given the CEO's comments from the Health Sciences Centre yesterday. I am wondering if the minister is commun icating and there is that kind of dialogue happening. I am wondering if the minister would simply table his new list. Mr. Orchard: Well, first of all, would my honourable friend be able to clarify what comm ents the CEO at the Health Sciences Centre made yesterday, which would confirm what she is trying to put on the record thatthose are all our issues?

Would my honourable friend care to indicate what the commen ts were of the CEO from the Health Sciences Centre? Ms. Wasylycla-Lels: I would be happy to, Mr. Deputy Chairperson. It was quite interesting to read Jim Rodger's comments in the Free Press when asked about this study group on user fees. It was reported to him that the minister had disassociated himself from that study group. He said, well, if that is the case, then we will not have it on our list. So it is clear that it had been on the list until yesterday.

I am wondering, given all of this-and the minister says that so he can clear up the air and simply table

3307 LEGISL ATIVE ASSEMBL Y OF MANITOBA June 13, 1991 his new list of working groups under the Urban Council authority. Mr. Orchard: Mr. Deputy Chairman, I know that this is nitpicking, but Mr. Rodger is not the CEO at the Health Sciences Centre and Mr. Rodger has not been at the Urban Hospital Council meetings. It has been Mr. Thorfinnson; Mr. Thorfinnson is the CEO. Government removed the user fee question at one of the first meetings of the Urban Hospital Council, so you know I cannot change anything. What I put on the hospital has to be accurate.

What my honourable friend puts on the record does not matter, but my honourable friend just has to please accept what I am saying about user fees. We did not suggest it; we took it off the list; it is not on the list. Ms. Wasylycla-Lels: Would the minister table the list? Mr. Orchard: I certainly will. Yes, I will give my honourable friend a list, but before I do, I want to count up the num ber of issues so that she understands. Unless I have made a mistake, it is about 26 issues that are being discussed now. Ms.

Wasylycla-Lels: While we are waiting for that list, I do know that on the original list his deputy minister was studying the issue of cancelling-or was chairing the study group to cancel projects from the Health Services Development Fund and put those monies into other areas given the financial crisis. I found that very curious, given that the Health Services Development Fund was such a major initiative of this government, of this minister, when he first came into government. There were big prono uncemen ts about the Hea lth Ser vices Development Fund.

Now we see, we believe, understood at one time anyway, it is under study in terms of complete annihilation, but notwithstanding that issue, we also know that there has been a significant reduction in this whole area. What has caused the minister to change his thinking with regard to the significance of the Health Services Development Fund? Mr. Orchard : Nothing. That issue has been discussed with the CEOs. The Health Services Development Fund will remain in its mandate of providing a window and bridge funding on reform of the health care system.

The monies in the Health Services Development Fund will not be diverted, as suggested by some on the Urban Hospital Council, to current care delivery. * (1 550) It is still a topic at the Urban Hospital Council because that is a fund which they have an ability to give us projects which may meet the criteria of the deciding group, of the decision-making body to help in areas that we are dealing within the Urban Hospital Council. It is still there as a topic of discussion under the original purpose and mandate and envisioned utility of the Health Services Development Fund with no change as suggested. Ms.

Wasylycla-Lels: The minister, in comments around the budget, in terms of the reduction in the Health Servi ces Development Fund, said that the reduction was the result of less uptake than originally expected. I am wondering if the minister could tell us how many applications there were, what each of them-if he could give us a list of each one and how many were finally approved. Mr. Orchard: I do not know whether we have-because we are bouncing all over the place, Mr. Deputy Chairman.

The last count I have is there were approximately 122 applications before the Health Services Development Fund, 13 of which received approval, a number of which are now actively undergoing. A number of the contracts are being finalized so that the project can be undertaken. There have been no recent approvals of projects to the Health Services Development Fund. Mr. Cheema: Could we go back to the Urban Hospital proposed working groups? I have a few questions and maybe the minister can clarify.

The minister has made a statement and given us a copy of the objectives of this grou p, and he has said that the group is an independent group and has its own mandate, and they have decided on their own which area they want to study. Can the minister clarify that there were no directions given from his department to this group on who should be on the committees, who is going to be part of the comm ittee structure of all the groups, and what are the areas they should be looking at? Mr. Orchard: Mr.

Deputy Chairman, first of all, the Urban Hospital Council, before we even got to the issues to be decided, agreed to the terms of refere nce that I have given to my honourable friend, guided by Attachment A, The Goals for Health and Health Care, which are goals that I think are quite

June 13, 1991 LEGISLATIVE ASSEMBL Y OF MANITOBA 3308 reasonable in their intent and the principle regar ding the chief executive officer's participation in the Urban Hospital Council. The membership was deliberately decided to be of CEOs and very few other staff, i.e., my deputy, my associate deputy minister, my regional director for Winnipeg services and the executive director of MHO. So we have a small committee.

In determining the number of issues that my honourable friend has just received from a number suggested, 50 or so suggested at one time, we have agreed that these are the issues that we ought to deal with at the council level. Mr. Cheema: Mr. Deputy Chairperson, so the minister is well aware of the issues they are going to look at. Is that true? Mr. Orchard: I am familiar with the issues, the 26 or 27 issues that have been brought forward in terms of, generally, what each issue is supposed to be in terms of an issue for the health care system.

It might be worthwhile this afternoon for us to go through them and talk about each one and find out. It might be an ideal opportunity for both my critics to pr ovide advice on whe ther they think it is appropria te for the Urban Hospital Council, the health care system, to be dealing with each of these issues, and to provide some of their comm ents and advice and suggestions on how these issues could or could not be investigated. Yes, in a general term, I am familiar with the issues that are being investigated here. Mr. Cheema: Mr.

Deputy Chairperson, I would be very willing to go through the whole list and I am sure the member for St. Johns (Ms. Wasylycia-Leis) also, but I just want to start with the one copy I have, and I am sure the minister has a copy. If you look at No. 3, A Review of the Emer gency Departments, this clearly shows that the group has met four times and have prepared the data, and they are in the process of preparing the original draft. By this, I was told and I have the impression that there will be decision making probably by the end of June.

I have given the mini ster, the other day, argu ments, and I will again give the minister my argume nts why we are opposed to the closing of any emergency room in Winnipeg, and I will give him all of the rationales why I think, on behalf of my party, the emer gency units either partially or totally should not be closed. The other day, the minister was saying, first of all, that they are basing information on one month's strike and that is not enough data to be collected. There were a lot of problems in the strike.

People did not go to the hospitals and after the strike was over, there were definitely more services utilized in the emergency departments. Secondly, the role of the emer gency department in any given hospital is very essential. It is basically a gateway to any given hospital, especially the community hospital. Can you imagine any commu nity hospital without an emergency room? If the admissions are done, some of them done through the emergency room , the physicians work through the emergency room. Patients and their families know that is the one route to go.

Even the walk-in clinics and the other physician services do not deal with some of the problems, so they have to go thro ugh the emer gencies. (Mr. Jack Reimer, Acting Chairman, in the Chair) * (1 600) Each and every hospital has a catchment area and it is very well established that people do associate themselves with their given hospital. A community has developed a relationship with the hospital and the development of a commu nity and the development of a hospital very much go hand in hand.

Especially in the areas of north Winnipeg and the areas downtown, there is a need like any place else that the emer gency services should be kept, but that area should not be based solely on the financial aspec ts because emer gency care, sometimes you can see 10 patients which are very serious. At times you may not see more than one or two, so to base any decision on financial incentive is not going to be a very rational one.

I am sure the minister would not do that because we know that he has more understanding of the issue than he is sometimes given credit, but that is why I will warn him-maybe "warnn is not the proper word to use in the English language but I will caution him that closing any emer gency unit in any hospital will be the death of a particular hospital eventually, and that has happened in the past. Look at on Selkirk Avenue, St. Joseph's hospital. I gave you the example of what has happened eventually when the emergency was closed, then it was converted into a personal care home.

Eventually that result may come to any of the other hospitals.

3309 LEGISL ATIVE ASS EMB LY OF MANITOBA June 13, 1991 Here I have to cr iticize the previous admin istra tion, also, when they closed the obstetrical floor, and I am sure there were a lot of NOP caucus members who did not like that but they were unable to stop the minister at that time, and by taking that unit away, the hospital still has not recovered. Any further insult by the way of partially or fully closing a unit will not be in the interest of the public at all, and I would like the minister to give us the argument why that item was even kept in the Urban Hospital Council group.

That is something you should have just kept away. That is the part and parcel of a given hospital, and I would like to hear what the minister has to say about this. Mr. Orchard: Mr. Acting Chairman, I appreciate my honourable friend's comm ents and observations, but there are hours in which emergencies are closed in hospitals across Ca nada. When that is happening elsewhere, one ought to analyze how they are able to cope, why they are able to shorten the hours of emergency service. The strike was one issue that I mentioned to my honourable friend the other day.

We had an experience last summer right about this time of the year with one of our commu nity hospitals in terms of difficulties retaining adequate numbers of emergency physicians. That operation was curtailed for evening and late night hours and Health Sciences Centre was utilized. Mr. Acting Chairman, I cannot prejudge a recommen dation out of this committee. It is one of the issues that they have met on a number of times. They are also taking a look at a number of issues around use of the emergencies.

I guess one of the things that I found interesting to ponder was that we had during the eight-hour period, midnight until 8 a.m .- apparently, the average calls at our emergency in all of our community hospitals in Winnipeg, the five of them, averaged 51 in that eight-hour period of time amongst five hospitals. Of the 51, there is an average of four admissions. I do not know what that means in medical terms, but I think that means that there ma ybe was no t a life-th rea tening circu mstanc e is probably an appr opr iate conclusion. That information is being considered by the Urban Hospital Council.

Let me indicate to my hon our able friend something that I know he already knows. The emergency department of our hospitals are our most expensive point of entry into the health care system. I guess one has to start to question, when we do not have unlimited dollars, when we are making throughout government and throughout the whole health care system in Canada difficult decisions and choices on how we fund needed services in health care. You have to look at where your high cost areas of generation are. Emergency departments clearly are a major high cost generating centre in our health care system.

All of that discussion is taking place at the Urban Hospital Council. I cannot give you any more information. I cannot give you a-g ov ernment does not have a preconceived agenda here. If that is what my honourable friend's concern and fear is, we do not. We are asking that the issue be considered-and this is one of the topics that we put on as government into the Urban Hospital Council in terms of the Urban Hospital Council's ability to analyze the system as to whether there are any changes to the operation of emerg ency departments that would adhere to the terms of reference of the Urban Hospital Council.

They are studying that issue, given experience in other provinces, given the data that is available to them in the Manitoba experience, and are trying to conclude a reasonable approach that they would recommend through the Urban Hospital Council to go vernment. I do no t kno w wha t that rec om men dation mi ght be. I appr eciate my honourable friend's concerns. Mr. Cheema: Mr. Acting Chairperson, I want to put some more comments on the issue, because I think that this is one of the issues we feel very strongly because of the commu nity hospitals.

One point I think they should take into consideration through the deputy minister, who is probably in constant touch with these individuals. When the admissions are done in any given hospital, you have to have a physician. That means physicians have to have a privilege in more than one hospital. The second thing, transferrin

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Collection	Manitoba — Debates (Hansard)
Citation	35-2-64
Type	hansard
Volume / chapter	35th 2nd hansardpdf 64.pdf
Language	en
Format	pdf
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