Social Services Committee — Department of Health and Community Services — 4 June 2005

2005-06-04

Newfoundland and Labrador — Committees

April 5, 2006 SOCIAL SERVICES COMMITTEE

Pursuant to Standing Order 68, Minister John Hickey, MHA for

Lake Melville, replaces Terry French, MHA for Conception Bay South; Minister

Kevin O'Brien, MHA for Gander, replaces Kathy Goudie, MHA for Humber Valley;

and Wallace Young, MHA for St. Barbe, replaces Felix Collins, MHA for Placentia

& St. Mary's.

The Committee met at 9:00 a.m. in the Assembly Chamber.

CHAIR (Mr. Ridgley): Order, please!

First of all, welcome to everybody this morning. I ask the members of the

Committee to introduce themselves, please.

MR. JOYCE: Eddie Joyce, MHA for the Bay of Islands.

MS JONES: Yvonne Jones, MHA for the District of Cartwright-L'Anse au

Clair.

MR. BUTLER: Roland Butler, MHA for the District of Port de Grave.

MR. R. COLLINS: Randy Collins, MHA for the District of Labrador West.

MR. YOUNG: Wally Young, MHA for the District of St. Barbe sitting in for

Felix Collins.

MR. FRENCH: Terry French, MHA for the District of Conception Bay South

and Holyrood.

MR. O'BRIEN: Kevin O'Brien, MHA for the District of Gander.

MR. T. OSBORNE: Tom Osborne, Minister of Health and Community Services.

MR. JOHN ABBOTT: John Abbott, Deputy Minister, Department of Health and

Community Services.

MR. JIM STRONG: Jim Strong, Assistant Deputy Minister of Corporate

Services, Department of Health and Community Services.

MS KAREN LEGGE: Karen Legge, Acting Director of Financial Services.

MS MOIRA HENNESSY: Moira Hennessy, Assistant Deputy Minister for Regional

Health Operations.

MS LYNN VIVIAN-BOOK: Lynn Vivian-Book, Assistant Deputy Minister of

Public Health, Wellness, and Children and Youth Services.

CHAIR: Thank you all.

We will follow basically the same format as we have in the past. We will

allow the minister a few minutes for introductory comments. What we have found

is that we have started the questioning - now, if a person wants to make

introductory comments before the questioning starts, that is fine as well. Other

than that, we will allow each member of the Committee about ten minutes for

questioning, and then according to the wish of the Committee that member can

either finish his or her questioning or we can pass to another and revert back

to that person.

We will begin then with the minister, please.

MR. T. OSBORNE: Thank you.

I guess there is no need to introduce the officials from the department as

they have already introduced themselves. First of all, it is a pleasure to be

here as Minister of Health and Community Services. Officially I am here three

weeks now, so I will ask the Committee to be a little bit easier on me than you

would normally be.

Health and Community Services is a department, I think, that touches the

lives of everybody in the Province. It has the largest expenditure of any

department with almost half of the provincial Budget. More than any other

department, I think it is a department that each and every individual in the

Province has a heavy reliance on.

Over the last year, there have been a number of investments made in the area

of health care, and some of them more significant announcements. Under Minister

Ottenheimer, who was the previous minister, there was the release of the

Gambling Prevalence Study; the launch of the mental health and addictions

framework; the first announcement on wait times progress - and there will be

another wait times update within the next couple of weeks; the enhancement of

medical transportation assistance; key investments in diagnostic equipment -

there was over $23 million including the third MRI for St. John's which is set

to open next month; the expansion of the Picture Archiving and Communications

System throughout all regions of the Province; we are proceeding with the new

primary health clinic in Grand Bank, with renovations to Blue Crest and a new CT

scanner for Burin; investments in new cancer clinics in Gander and Grand

Falls-Windsor; expansion of dialysis services in Carbonear; implementation of

the new Smoke-Free Act in the Province; and the launch of the Provincial

Wellness Plan. We hope to build on these investments and to continue with the

foundation that has been laid.

There have been some significant investments in Budget 2006 and some of the

priorities there include: the continuation of major capital projects including

long-term care facilities in Clarenville, Corner Brook and Happy Valley-Goose

Bay; the new health facility in Labrador West; continued investment in mental

health and addictions including the new Provincial Addictions Treatment Centre

for Corner Brook and the introduction of new mental health and treatment

legislation - the act will be introduced into the House this year; continuation

of ongoing consultations toward the development of a new healthy aging strategy;

further rollout of the Provincial Wellness Plan; continued focus on improving

wait times for the Province; continued focus on cancer prevention and treatment;

the implementation of expansions to the Newfoundland and Labrador Prescription

Program, including the coverage for drugs related to Alzheimer's and the

expanded coverage for low income families and seniors; development of new

dialysis satellite units in Burin, Happy Valley-Goose Bay and St. Anthony; and

strengthening the public health capacity for the Province.

These are just some of the highlights in our ongoing commitments through the

department and the many boards, agencies and community partners that are working

together to improve the health and well-being of Newfoundlanders and

Labradorians.

At this point, we will open it up for comments and questions and certainly be

pleased to take any questions from the Committee.

CHAIR: Thank you, Minister.

I need to just go back a little bit, because I neglected to fire the official

starting gun which is to ask the Clerk to call subhead 1.1.01.

CLERK (Elizabeth Murphy): 1.1.01.

CHAIR: Shall 1.1.01 carry?

That allows the debate to begin, so we can start questions now officially.

MR. JOYCE: I was going to ask just a few questions.

I thank Yvonne, as the critic, for giving me the opportunity. I will not go

through the Budget, the highlights of it. I will just be asking some general

questions.

First of all, Minister, to you and your staff, I agree that the Department of

Health and Community Services touches everybody. It is a hard portfolio. I

understand the struggles that every person in your department has to go through,

because it is a very sensitive and emotional department. At the outset, it is

very difficult. Sometimes when we raise issues - and myself, raising issues on

the West Coast - I am sure you appreciate the reasons why we do have to raise

issues, but I do understand the dilemma that anybody in the Department of Health

and Community Services must face.

First, the long-term care facility in Corner Brook. In the Budget, I think,

there was $16 million allocated for the long-term care facility. What was the

total money needed to finish the long-term care facility? There have been no

tenders called yet.

MR. T. OSBORNE: I think we are estimating - and again, being here three

weeks, if I make a mistake I will ask my officials to correct it so that it is

correct for the record - I believe the estimated cost of completion on that

facility is in the range of about $47 million. That is correct, isn't it,

John?

MR. ABBOTT: Yes.

MR. JOYCE: Do you have an expected date for the completion of that?

MR. T. OSBORNE: The anticipated completion date at this particular time

is in 2009.

MR. JOYCE: In 2009?

MR. T. OSBORNE: Yes.

MR. JOYCE: How many beds, Minister? Because there is some discussion in

Corner Brook that once the facility is completed there are going to be forty

beds less than what are currently available.

MR. T. OSBORNE: There are188 beds in the long-term care facility in the

new project. In the existing project, there are 225 beds. Some of those beds

that are in the three existing sites are housing light to moderate dementia

patients now.

Having said that, I have heard the concerns that have been raised. I know

there was a Licensed Practical Nurse in Corner Brook who raised some concerns,

as well as other individuals in the Corner Brook region who have raised concerns

about the numbers. What I can undertake, and what we are doing, and I will

undertake for the Member for Bay of Islands, I am doing a review of the numbers.

If we are going to put a $47 million investment in Corner Brook, I want to make

sure that we do it right, so we are doing a review of those numbers to ensure

that the numbers are accurate.

MR. JOYCE: These are general questions about the Interfaith Home. Will it

remain open once the long-term care facility and dementia unit is up and

running?

MR. T. OSBORNE: Those decisions have not yet been finalized. We will

continue discussions with the Western Regional Health Authority to make a final

decision on that, but I think there are a number of things that have to be

looked at in order to come to a final decision on that. That decision has not

yet been reached.

MR. JOYCE: Mr. Minister, I mentioned respite beds in Corner Brook. I am

sure it is in the media, but I have not put it in the media yet because I was

trying to get a solution to it. In Corner Brook, they closed down the two

respite beds for the people who need to put their loved ones in there for a day

or for a week. The reason why they said it was done was because it was

underutilized, but I guess it is hard to say to somebody who is trying to keep

their loved ones home for, say, fifty-one weeks of the year and need a week

break, that you should have used it more - and put someone in an institution.

Is there any solution or is there any possibility that the department can

help out in some way to find a solution for that, because I am getting a lot of

calls. I guess a lot of people do not want to go public that they need the use

of this bed, but there is a need for it in the Corner Brook area.

MR. T. OSBORNE: I respect the concerns that the residents in the area are

rasing as well. I became aware of this particular issue after the decision was

made. Since becoming aware of the decision, which was late last week, we have

started dialogue with the Western Health Authority and we have asked them to try

and identify solutions, and I feel confident that we are going to find a

solution. I believe that it probably should not have gotten to the stage that it

did, where the families were contacted prior to looking for solutions, but I

feel fairly confident that a solution will be found for those families.

MR. JOYCE: There is one lady, Mrs. Sharp, who wanted to know if you would

give here a call. This is not a confrontational call. Her name is Gertrude

Shape, 632-2432. Mrs. Sharpe would just like to explain to you, personally, the

trials and tribulations that she has to go through with her husband, as she is

the only care giver at home with him, just so you know personally that she could

use the facility more but she would rather keep him at home. It is just that a

scattered day, a month, or a week a year, she just needs a break from taking

care of her husband. It is just more to pass the personal side of it. Thank you

for that, because she would definitely -

MR. T. OSBORNE: I will certainly give her a call and I will indicate to

her, as well, that the issue is not finalized, that I believe we are close to

finding a solution for the families.

MR. JOYCE: Excellent.

MR. T. OSBORNE: I believe there were five families booked in for respite

care this summer, and I believe we are close to getting a solution for that.

Moira, are we...?

MS HENNESSEY: Yes.

MR. T. OSBORNE: Yes, we are just about there on a solution for them.

MR. JOYCE: Excellent. Thank you.

The other big issue in the Western Health Care Corporation is the debt that

the Health Care Corporation has as we speak. In this Budget, were there any

funds there for the debt for the Health Care Corporation?

MR. T. OSBORNE: In this Budget, we have allocated an additional $60

million, and that is over and above the - we have allocated additional funds to

the four health authorities under the 2006-2007 Budget, over and above the money

that was originally budgeted in the Estimates. We have provided additional

funding to them to try and eliminate their deficits. This year there is an

additional $60 million that is being provided to the four regional authorities

to try and help them reach their mandate of providing quality care within

available resources, because obviously they face challenges as well. I guess

that additional $60 million will help them to reach -

MR. JOYCE: In this Budget, 2006-2007?

MR. T. OSBORNE: Yes, in the 2006-2007 Budget there is an additional $60

million.

MR. JOYCE: What I am hearing out in Corner Brook, from a few of the

people who are involved with the board, is that they have such a high debt that

they have to find some way to pay it down. That is a major burden that they do

have.

MR. T. OSBORNE: There are debt servicing costs to the regional health

authorities. Obviously that is a challenge as well. I think the four authorities

now combined carry a significant debt, so between government and the authorities

we are working together to try and help them deal with that particular

situation. That is, I think, part of the reason there was an additional

allocation of $60 million this year between the four authorities, to try and

meet their operating costs and try and help to prevent them from going into

deficit for sure.

MR. JOYCE: Minister, I brought up in the House of Assembly, not with you

as the minister, the Hay report in Corner Brook. Is your department moving ahead

with the recommendations of the Hay report or is that dead?

MR. T. OSBORNE: I think it is fair to say that some of the

recommendations in the Hay report have been adopted by Western Health. Others

have been completely disregarded, as you know, and the others recommendations

that are there, I believe, will be assessed on a case-by-case basis. Western

Health, again, they have a responsibility to deliver quality care within the

resources available. We have increased those resources in this year's Budget,

but it is incumbent upon them, within their mandate of delivering quality care,

to look at each and every recommendation, to make a determination as to what

recommendations will best suit their operations and the delivery of quality

care.

MR. JOYCE: Is there any way of getting - because most of the people that

I deal with out in Corner Brook and the Bay of Islands area are not sure which

ones are being recommended and which ones are not, because we are getting some

taken off the table and some not. When you ask the health care authority, they

say, well, we are not implementing the Hay report. We don't know. We, as the

general public, don't know.

I know the Department of Health and Community Services has the final say, but

is there any way that someone like myself, or the general public, can find out

which ones are being recommended? If you come out with a Hay report and you make

it public, and then, with all due respect, you get a minister of the government

standing up and cancelling two outright - everybody in the Corner Brook Western

Region realizes that the Hay report is dead. I will give you my example:

Recommendation 172, moving seniors from Corner Brook to Port aux Basques, I just

think that is cruel.

MR. T. OSBORNE: As far as recommendation 172 is concerned, that

recommendation, I do not think, has been adopted.

MR. JOYCE: Oh, no, you are absolutely, categorically, positively wrong.

MR. T. OSBORNE: I do not think that is has been adopted as a policy,

Eddie. I think what is happening there is, we have announced a long-term care

facility for Corner Brook which hopefully will expand the number of beds - and

again I am reviewing those numbers - and, as well, the AD dementia units that

are going to be in Corner Brook. Some of the surgeons in Corner Brook have

expressed great frustration with having to cancel surgeries and there have been

cases where there have been surgeries scheduled and they just did not have the

bed space to carry out those surgeries.

I will ask John or Moira to elaborated on that, but I think I can say that

172 has not been adopted as a policy, as a short-term measure, until the

long-term care facility is built. The priority to perform surgeries and to look

at acute care patients is obviously there. If a patient is medically released

but waiting for a long-term care bed, obviously I have great sympathy for those

patients who are medically released, and for their families, but I think we also

have to place the proper priority on acute care patients and surgeries that are

scheduled, and unfortunately it is a situation of space availability right now.

We have made the commitment for the long-term care facility and for the

duplexes. There is a long-term solution. It is a matter of bridging the gap

between now and the time the long-term care facility and the duplexes are built.

Beyond that, I do not think 172 is on the books as a policy that is there to

stay. It is a short-term measure.

John, can you elaborate on that above what I have?

MR. ABBOTT: Minister, I guess that is -

CHAIR: Could you introduce yourself?

MR. ABBOTT: I am sorry. I am John Abbott, Deputy Minister.

What the minister said is, I guess, exactly the situation in which they are

finding themselves. It is a capacity issue, so we are working with them. Only as

a last resort will they move any patient or resident to a facility outside their

immediate area. As soon as we get the new facilities in place, we are optimistic

that really should go by the wayside.

I guess, as the minister explains it, the hospital and the senior management

are faced each period with the emergency rooms being blocked, surgeries not

being able to be performed, and we have to move some of the patients to another

facility, and there is a lot of consultation with the families. From time to

time there is a case or cases where the family obviously prefers to stay - in

this case in Corner Brook - but they are only done, literally, as a last resort.

MR. T. OSBORNE: As well, I think it is fair to say, first of all, this is

only going to happen on a case-by-case basis when there is a demand for the

availability of the bed for acute care or surgeries. I think in Central

Newfoundland we are currently looking at a pilot project out there with the

personal care homes and the category of patient that is going into the personal

care homes. If that works well between now and the time the long-term care

facility and the duplexes are built, we may be able to look at extending that

pilot into Corner Brook. That is something that we are looking at and reviewing,

simply as a short-term measure, to get us to the point that we don't have to

remove patients from Corner Brook, which is where they want to be, into

Stephenville or Port aux Basques, or wherever.

MR. JOYCE: That was going to be my suggestion to the department. There

are one, two, three, four, five homes in the Corner Brook area, and I know all

the beds are not utilized. If you could get two or three beds, or three or four

beds, one in each home, even if you have to pay the homes extra, whatever it

costs for the beds and the appropriate services.

John was aware of the situation there two weeks ago. I was just totally

amazed. This eighty-year-old woman, who could not even speak, was told she is

being moved to Port aux Basques, and no family member. Only because the Minister

of Justice -

MR. T. OSBORNE: Yes, and that is highly regrettable. It is.

MR. JOYCE: I know it is a personal thing, and I know no one over there

wants to do it, and I understand that everybody is trying, but there has to be

some way, with four or five personal care homes, to say: Boys, it is going to

cost us a few dollars but can we set one or two beds aside for this? Because it

is hard on the families. It is hard -

MR. T. OSBORNE: Absolutely.

MR. JOYCE: - and I know the families. In this particular case, this poor

old lady, eighty-years old, couldn't even speak, and she is going to Port aux

Basques.

MR. T. OSBORNE: Well, I can give you the assurance that is something we

are looking at. Again, there is a pilot project in Central. There are some

issues we are dealing with between the boards and the personal care homes. If we

can iron those issues out, that is something that we are looking at.

MR. JOYCE: Is there any way to initiate a pilot project for Corner Brook?

This is just a suggestion.

MR. T. OSBORNE: Well, I will certainly have a look at that and I will -

MR. JOYCE: Because this is where the big issue - I am going back a month

now, and I am sure John and the other staff are aware of it. There was a move

there. They were moving eight or nine, and they were all.... I know everybody

feels for these people, and I know that no one really wants to put these people

through this stress. One lady got a call. Her husband came in at 10:00 o'clock,

and she said: You know, they are moving me now to Port aux Basques. They said:

No, no, we are not doing that now. He went home and he got a call. By the time

he got back to the hospital she was gone - that quick. He never even got to say

goodbye to her.

MR. T. OSBORNE: Like I say, it is very regrettable that happens, but I

will give you that assurance, Eddie, that we will - and I will further consult

with you on it, after consulting with the officials in the department, on the

pilot project in Corner Brook as well.

MR. JOYCE: Because I feel that if you put one or two beds aside, and I

don't know how to do it, the experts out in Corner Brook, but I am sure there

may be, in the few home care facilities, if you put one or two beds aside and

then had the appropriate.... According to the hospital, they are saying some are

maybe just for forty-eight to seventy-two hours. By then, I am sure we could set

up the appropriate sources somewhere. If you could consider that, it would be a

great stress off a lot of families in Corner Brook. Just consideration is a

start.

MR. T. OSBORNE: Definitely, we will have a look at that. If we are doing

a pilot in Central, we will look at expanding that into Corner Brook. I am not

sure at this point what the logistics of doing that are, but if we can do it we

will.

MR. JOYCE: Excellent.

CHAIR: At this point I just want to ask the Committee, is it their wish

for Mr. Joyce to wrap up or to switch speakers?

MS JONES: No, he will continue on.

MR. JOYCE: I have about three more questions, Mr. Chair.

CHAIR: Okay.

MR. JOYCE: The dementia unit in Corner Brook -

MR. T. OSBORNE: The duplexes, you mean?

MR. JOYCE: The dementia unit.

MR. T. OSBORNE: The existing dementia unit or the -

MR. JOYCE: No, the new one that is going to be built.

MR. T. OSBORNE: The eighty units within the duplexes?

MR. JOYCE: Yes.

MR. T. OSBORNE: Okay.

MR. JOYCE: Is there any money in this year's Budget for that? I could

not find any money in this year's Budget for it.

MR. T. OSBORNE: Yes, we are moving ahead with the long-term care facility

and the dementia units.

John, did you want to elaborate on that a little bit?

MR. ABBOTT: There are no actual dollars allocated because, depending on

how that project proceeds, the intent is that the successful bidder, if we

proceed down that road, would do the financing and then the payments for that

would be based in their operating grant on a go-forward basis.

MR. JOYCE: So, what was in the Western Star for the tenders was

looking for the P3, public-private partnership. Is the department continuing on

with that, with the P3?

MR. T. OSBORNE: We have received four Expressions of Interest for the

duplexes. All of them were private businesses. We did ask for community groups

and non-profit groups as well.

I guess, similar to Agnes Pratt and St. Luke's which are in my district,

they are not-for-profit groups that operate those long-term care facilities.

They are publicly funded, to a large degree, but they are operated by the

not-for-profit sector. It is something that is currently happening, and that is

a road that I guess the Province had gone down several years ago with those

particular institutions as well as others in the Province.

We are looking at, internally - obviously, my preference here, Eddie, would

be to look at a publicly funded, publicly operated facility. Having said that, I

think it is incumbent upon government to look at all available options and to

choose the best available option for the residents who are going to be utilizing

those duplexes.

MR. JOYCE: When is the expected start date for that unit, and completion

date? Is that too early to calculate?

MR. ABBOTT: It is probably too early to say. We are expecting the

detailed proposals on, or before, April 17. We would evaluate those and make a

recommendation from the department to the minister and then, I guess, to

Cabinet.

Because the intent and the design to build those would be similar to a

housing construction, we would see that they could start this year. We would not

necessarily do all units all at the one time. We would phase them in over the

next year or two or three, depending on demand, and we would start construction

this year and we could see occupancy as early as next spring.

MR. JOYCE: The Gambling Prevalence Study that was done by the department,

is there any money allocated? Because in the meetings that we had with the

Public Accounts, this was the first study that was done in the Province. Are

there any funds allocated to continue on or follow up on the study?

MR. T. OSBORNE: Yes, in this year's Budget - out in Corner Brook, for

example, there is $1.1 million allocated towards the total cost of a $3 million

treatment facility in Corner Brook. That is for a number of addictions,

obviously. There is a $1 million allocation - and, again, I will ask my

officials to correct me if I am wrong - in this year's Budget to continue on

with addictions, including some of the recommendations that were in that study,

including an awareness program. There are nine new addictions counsellors. There

is training for the addictions counsellors. There were five addictions

counsellors put in place under last year's Budget. There are twenty offices

throughout the Province that deal with addictions, so there is ongoing training

for all of those, as well as resources internally within the department.

I am not sure if that answers your question.

MR. JOYCE: It is just because, in the Public Accounts hearings that we

had, when the Gambling Prevalence Study was done, that was the first one done in

the Province. The question raised, of course, was: Will there be a follow-up

study done, and the information - because I would assume there would be just

base information on the study. Will there be another follow-up study, or an

update on this prevalence study, so that at least you can see if the gambling is

rising or lowering, or the need for addiction services is rising or lowering?

MR. T. OSBORNE: In just speaking with my deputy, there is nothing set out

yet. We have not given any thought to another study, or an extension of the

existing study, but that is certainly something that I am prepared to look at.

It is something that, certainly, based on your suggestion, we can bring back and

discuss within the department.

MR. JOYCE: The treatment facility in Corner Brook, is the total amount of

money allocated in this year's Budget to finish that, or just enough to start

it?

MR. T. OSBORNE: It is $1.1 million allocated in this year's Budget. The

total cost of that facility is $3 million.

MR. JOYCE: It is $3 million?

MR. T. OSBORNE: Yes.

MR. JOYCE: When is the expected completion date?

MR. T. OSBORNE: Two years, I believe, on that, is it, John?

MR. ABBOTT: Yes.

MR. T. OSBORNE: Yes, two years on that.

MR. JOYCE: Two years. So, 2008?

MR. T. OSBORNE: Yes.

MR. JOYCE: Okay, I am finished.

Minister, thank you for that respite bed. I will be conveying it on, that you

will be contacting Ms Sharpe, if I am speaking with her. Thank you, because it

is a big concern. Thanks for your support on that.

MR. T. OSBORNE: No problem. You are kindly welcome.

Thank you for the questions.

CHAIR: I am going to pass it to Ms Jones, I think, at this point. I just

want to make note that Ms Jones is not a member of the Committee but sitting in.

Would that be correct?

MS JONES: Yes, I am the critic for the department.

CHAIR: Yes.

MS JONES: Thank you, Mr. Chairman.

Good morning, Minister and officials. I am pleased that you came this morning

to answer our questions. I am going to probably be until about 10:15, if you don't

mind, Mr. Chairman?

CHAIR: Carry on.

Then you are going to pass to Mr. Butler?

MS JONES: Then I am going to pass, because I have to leave.

CHAIR: Is that okay with you, Mr. Collins, or did you want to get some

time in between?

MR. R. COLLINS: I would like some time in between, but Yvonne can go now.

That is not a problem, but when -

CHAIR: I will give ten minutes to Ms Jones and then pass, and then -

MS JONES: Okay.

MR. R. COLLINS: Yvonne can go now, and I will go after Yvonne.

CHAIR: I am just trying to be fair to everybody.

MR. R. COLLINS: If not, I can go now.

MS JONES: Okay, I will continue and whenever Randy wants to intervene

that will be fine.

MR. R. COLLINS: (Inaudible).

MS JONES: Okay, thank you.

CHAIR: Okay, as long as we are all happy.

MS JONES: All right.

I want to start with the merging of the health boards, which was an

initiative of your government. I am just wondering what the accumulated savings

have been from doing that. Yes, maybe I will start there.

MR. T. OSBORNE: Okay.

First of all, I think that the boards themselves, the merging of the boards

has gone extremely smoothly. I had a meeting with the four boards just last

week, and I think they have expressed their satisfaction with how the process

has gone.

As far as the accumulated savings, I will ask the deputy to respond to that.

MR. ABBOTT: In terms of how we structured that, we have identified, for

the first year, approximately $7.5 million in administrative savings.

MS JONES: How much was that?

MR. ABBOTT: It was $7.5 million.

MS JONES: Okay.

MR. ABBOTT: We are pretty well on track on that, and basically what we

are looking at here are administrative positions, management positions,

executive positions, some operating savings, to avoid any impact on patient or

client services, and we have identified that number. As I said, they are pretty

well on track. We should achieve that full saving in this fiscal year.

MS JONES: What is the current debt of the boards now?

MR. T. OSBORNE: About $120 million, I believe.

MS JONES: Minus the sixty that you - is the sixty taken off that figure

that you just announced in the Budget?

MR. T. OSBORNE: No, I think the sixty will go into operations of the four

boards. They can expand on services provided as well as eliminating - or helping

to eliminate, at least - the possibility of deficits.

MS JONES: So there was no money to pay down the long-term debt that they

have?

MR. T. OSBORNE: No.

MS JONES: I misunderstood when you responded to my colleague then.

MR. ABBOTT: Ms Jones, if I may for a second, I said $7.5 million. It

should be $7 million.

MS JONES: Seven.

Did any of the boards run a deficit this year in their boards?

MR. T. OSBORNE: I am waiting on the final numbers to come in. There was

additional funding provided to the boards on two occasions. I think there was

$14.7 million provided to them earlier, or I was going to say in the last fiscal

year, but earlier in the last fiscal year there was $14.7 million to try and

help them meet their budgets. In addition to that, we have just allocated an

additional amount to the boards. I think it was $6 million?

MR. ABBOTT: Yes.

MR. T. OSBORNE: Yes, $6 million we have just given again to the boards.

That should bring them at or near a balanced budget for this year. We are

waiting on the final numbers to come in from them. I have not yet seen them but,

if you wish, I can report back to you once I receive that.

MS JONES: Yes, I would like to know because I know they are trying to

tackle the accumulated debt that they have. If they are doing that just on

savings within their corporation and they are still running a deficit, I am....

MR. T. OSBORNE: They will be pretty close to balance, I think, this year,

based on the additional funding provided. Again, the $60 million should bring

them at or near balance, for sure, in this fiscal year.

MS JONES: The government did a review of the Labrador Health Corporation.

That was before the merger with the Grenfell Corporation, but one of the things

that was identified there was the excessive spending on the community health

side. When I say excessive I mean in excess of what their budgeted amount was,

not necessarily wasted money, so let me clarify that. I know that the demand for

them was very much in the northern region of Labrador. I am wondering if

government has increased their budget to reflect what that report showed and to

give them additional resources that they needed there.

MR. T. OSBORNE: I can honestly say to my critic - I hope this doesn't

happen in the House, but - I honestly don't know the answer so I am going to

ask my deputy to answer that.

MS JONES: Okay.

You have only been there a short time. I don't expect you to know all of

that.

MR. ABBOTT: I will be sure not to (inaudible)

MS JONES: I do expect John to know.

MR. ABBOTT: There are two, I guess, parts to the answer. One issue was

around the need for additional social workers and community support workers,

particularly in the Aboriginal communities, the Inuit communities in particular.

We have, and continue to add each year, additional social workers, which we will

do this year. The other component is for services, particularly for, at this

point, sending children out of their communities and, in many cases, out of the

Province. Unfortunately, that number continues to rise, given the social issues

in the communities.

What we are doing, and one of the reasons why their budget had increased this

past year, we provide additional funding, and we will for the coming year

provide additional funding, to meet that need.

The simple answer combined is, yes, as the service demands increase we are

funding those increases. We still have a challenge of recruitment in the coastal

communities for social workers but we are working very diligently on that with

the board, and part of that solution, obviously, is working with the leadership

in the communities. That is improving. There are still some challenges, but we

are seeing some significant improvements over the past year or two, certainly in

Sheshatshiu, and we are moving towards working closer with Natuashish once

things sort of settle with the leadership there.

MS JONES: I know there is a challenge with recruitment. Are all the

social worker positions filled, that the government allocated for that area?

OFFICIAL: There are still a couple of vacancies. I know, because we were

in Labrador just two or two-and-a-half weeks ago meeting with the senior

executive there, and they are trying hard to recruit.

MS JONES: The children who are going out of the Province for care - and I

know there are probably about twenty children now, aren't there, in Labrador,

who are outside the Province getting care?

OFFICIAL: I am going to ask Lynn Vivian-Book. Lynn may be able to....

MS VIVIAN-BOOK: In Labrador we have a total of, out-of-Province or

individual living arrangements, twenty-two Innu children and youth, and six

others from Labrador are in out-of-Province placements, so it is twenty-eight.

MS JONES: It is twenty-eight.

Can you tell me what kind of care they are getting at these centres? I am

familiar with a couple of them, but I have never visited them.

MS VIVIAN-BOOK: Many are out-of-Province due to solvent abuse or an FASD

related condition, behavioural conditions. Some are in Alberta and some are in

Ontario, primarily Ontario. The treatment facilities often are therapeutic

foster placements connected to counselling and so on.

What we are looking at is trying to figure out residential options where many

of these youth will be able to come back to the Province and have a similar kind

of residential option here in the Province because, for many of these youth, it

is not true treatment. It is long-term supports that they will require.

We are working with some of the facilities in Ontario, and working with the

staff at the Labrador-Grenfell board to come up with some residential models.

One of the positions that we are putting in place this year is a psychologist

position to help us with coming up with some of those options that will meet the

needs to be able to bring some of those youth back to the Province.

MS JONES: All of these children are under the age of eighteen, I

understand, is it?

MS VIVIAN-BOOK: All in this grouping that I just mentioned are, yes.

MS JONES: I have been led to believe, and maybe I am wrong, that most of

these are living in commercially operated homes.

MS VIVIAN-BOOK: Privately operated, yes.

MS JONES: Not family homes, it is a commercial business, and that there

is no resident social worker, there are no resident counsellors, but rather they

are set up with a neighbourhood social worker, counsellor or whatever, that is

assigned to them and they deal with for the duration that they are there. I

guess my question is: Why aren't we offering that service in Labrador? Why are

we sending our children to Ontario and to Alberta?

MS VIVIAN-BOOK: That is the question we are trying to work through in

terms of those options for Labrador.

Residential placements, we will never be able to provide placement for all

options but we are hoping to be able to expand the residential options in

Labrador, particularly in Happy Valley-Goose Bay, to be able to accommodate more

of the needs of these children and youth.

MS JONES: I am not entirely sure that Happy Valley-Goose Bay is the right

place, because most of these kids are coming from that area, from Sheshatshiu

area, as I understand, but I would like to see something done in Labrador to

house these children. I think that any region of Labrador would be appropriate,

whether it is in the west, the South Coast, the Straits or whatever. It does not

necessarily have to be next door to their community, because I understood from

health care professionals that the reason they were relocating them out of the

immediate area in the first place is so that they would not have that direct

connection with their home community, or their family, or the people who have

been abusers to them, or whatever the case may be. If you are going to look at

it, I would seriously like to ask you to look at all of the regions of Labrador

and not just Happy Valley-Goose Bay.

MS VIVIAN-BOOK: We would need to put in place a continuum of supports.

One of the bases that has not been well developed in this Province is

therapeutic foster care, which is a family home within a community, with

additional wraparound services for that home. We would need a continuum, so

those homes could be anywhere in the Province. That would be the first step.

Then, only when that is not a suitable placement, would you move into a

placement that would have more supports around it.

You are absolutely right. The continuum that we need starts in the community,

in the home first, then outside of that home in a supportive environment that is

therapeutic, and then into something more, where more services can be wrapped

around it. That continuum does not exist right now.

MS JONES: Who makes the decision on the placement of these children? Is

that done by the Labrador-Grenfell health board or is it done through your

Department of Health directly?

MS VIVIAN-BOOK: It is done in collaboration with the Director of Child

Youth and Family Services, because 99 per cent of these children and youth are

in the care of the Regional Director, and that, as the parent of that child,

makes that decision. However, if it is an out-of-province placement that is done

in consultation with the Province as well.

MS JONES: How much do you pay this group home in Ontario every month to

house one of those children?

MS VIVIAN-BOOK: That varies each month, it can be a year up to $250,000,

in that range, depending on the child, but $10,000 to $12,000 a month is not

uncommon. I can give you more exact figures, but in that range is not uncommon.

MS JONES: I have heard it has been up to $20,000 a month.

MS VIVIAN-BOOK: For some placements.

MS JONES: Yes.

MS VIVIAN-BOOK: The average would be $10,000 to $12,000.

MS JONES: Do you guys have a detailed list of the wait times for

different tests that you have done in the Province, like MRIs and all the rest

of it?

MR. T. OSBORNE: We did put out an update almost three months ago, I

guess, which was our first report on wait times, and we are scheduled to come

out with an update on that. There has been some improvement. Obviously, there is

significant investment in this year's Budget to try and reduce wait times.

Unfortunately, some of the investments that are being made in this year's

Budget will take some time to get up and running, such as dialysis units,

different breast screening or cervical cancer screening units, CT scanners, that

type of thing. Some of those investments that are in this year's Budget will

take some time to get up and running. You will see a bit of a lag time between

now and the time they are up and running before they have a real impact on wait

times, but it is an issue that we are taking very seriously.

We are at or near the national benchmarks in most areas now for wait times.

There are areas that we have to, you know, put a stronger focus on, and those

are some of the areas that we have put additional investment in this year's

budget for.

MS JONES: Do you guys keep stats on that on a regular basis?

MR. ABBOTT: Yes, Ms Jones, we do. We are just updating that and that

information will be available within the next two weeks.

MS JONES: So you do not have it available today then?

MR. ABBOTT: No. Well, it is in draft. I do not have it here, but we will

be releasing it within two weeks.

MS JONES: Will that be released to the public then?

MR. ABBOTT: Yes.

MS JONES: Because I know in the Budget you guys approved some money to

add some new radiation equipment or machines at the Health Sciences Centre.

MR. T. OSBORNE: Yes. There was over $3 million in this year's budget

and that is to do the renovations and construction at the Health Sciences

Complex. The new radiation machines are larger and more powerful than the

radiation machines that are currently at the centre. In addition, it is

government's intention to continue to operate the two existing machines as

well, so we had to construct new space for the two additional machines. Those

machines should be up and running within eighteen months, which will then give

the Province four machines. With the two additional machines we will have,

perhaps, the most modern radiation services in all of the country.

MS JONES: Once you order a radiation machine, how long does it take for a

delivery?

MR. T. OSBORNE: The companies that provide those machines do not keep

them in stock. They are a special order item, so by the time the space is

constructed for those units and the units are installed and up and running we

are looking at about eighteen months. Now, if we can do it sooner than that, we

will. We did not budget for the two machines in this year's budget because of

the fact we do not anticipate the purchase of those machines in this year's

Budget. We do not anticipate those machines would be ready to be installed in

this year's Budget, but certainly if it can be done sooner, that would be to

everybody's benefit. There are patients now who are traveling to Ontario for

treatment. If it is at all possible to do it sooner than the eighteen months, it

will be done.

MS JONES: So you do not have to pay for them until they are delivered?

MR. T. OSBORNE: No.

MS JONES: I want to talk about long-term care for a minute. My colleague

raised a number of issues around long-term care. We had an issue in Labrador

last week as it related to Ms Saunders, Doris Saunders. She was living at the

Paddon Home and was transferred here to the Hoyles-Escasoni Complex at great

stress from her family and from her. I enquired about the situation and from

what I understood is that often Alzheimer's patients go through different

stages and she was at a stage where they felt that they did not have the proper

space to be able to ensure her safety. The only option they could suggest to me

is if they had more personnel they could have probably had her stay there but

she would have had to be supervised on a twenty-four-hour basis. I do not know

if that is something that the department has considered or if the board even

approached the department on it. I know that the family has been very upset by

this. Ms Saunders has been, I guess, an historian of Labrador society for a long

time. She has documented most of the history that has been done there. She is

very passionate about where she comes from. It was very difficult for them to

have to bring their mom here.

Is it possible that there could be arrangements made in situations like that?

I have no medical experience whatsoever, but as I understand it this is quite

often a short-term phase that these patients will go through. It is also about

being able to provide for their safety at a time like that, and the only way,

they felt, was with twenty-four-hour supervised care. I do not know if the

request even came to your department for it or not.

MR. T. OSBORNE: I am not aware of that request, and certainly I will ask.

I want to address it to some degree, but then I will ask one of my officials to

elaborate on that particular request.

It is unfortunate that patients, as is the case in Corner Brook, have to be

moved away from family and other support networks within their region. Having

said that, in this year's Budget we have made the announcement of a long-term

care facility for Happy Valley-Goose Bay. In addition, there is a health centre

in Labrador City. The health center in Labrador City will have some space

available for long-term care. The primary focus, I guess, on long-term care will

be at the facility that is going to be constructed in Happy Valley-Goose Bay.

Outside of your suggestion - and again I will ask one of the officials to

elaborate on that - but currently I do not think the facilities or the resources

are in Labrador. Once a patient goes through that phase where they are high

risk, that they have high risk behaviors, the preferred choice is in an

environment where the best possible care can be provided for the patient as well

as the resources that are required to attend to the patient. It is a difficult

decision for a health board or for the department to see a patient, such as the

one you are referencing, be moved from the area in which they live. The

long-term solution is there in the facilities that have been announced. Whether

or not the suggestion you are making on additional staff, whether or not that

would suffice as far as the requirements to meet the particular needs of the

individual you are talking about, and the stage of dementia that particular

individual is going through, I will ask - I am not sure - Moira or John.

MR. ABBOTT: In terms of Alzheimer's and those with early dementia,

again it is the stage that a patient, or resident in this case, may be at. For

those who are at a wandering or roaming stage, the physical layout is critical.

Obviously Paddon Home is not designed to accommodate that type of resident. A

suggestion to have additional staff, really we do not think - and I do not think

the board believes - would be a solution, because the issue here is: Can the

individual in his or her environment, room or

section of a home wander or walk

about? That is why many of these units are secured units. There are locked

doors, control entry and exit, those kinds of things. We had a physical space

issue. Right now the home did not have the people in place to manage it. It is

not the numbers, it is just the training for the staff to manage.

We reluctantly - and I say reluctantly in the sense that we too prefer,

obviously, to have the residents stay in Happy Valley-Goose Bay, but the

collective view was that in this case we needed to find a more appropriate

facility, and consequently come into St. John's.

MS JONES: My question is more about - I was told that with twenty-four

hour supervision, that means staff that would be with her all the time, they

could control the environment. That would be the only way under the present

circumstances. I was also told that they did not have the financial resources to

be able to provide that kind of staffing. I am wondering if a request was made

to your department for any funds to be able to do that?

MR. ABBOTT: As the minister said, I do not recall getting any requests.

We are very clear with the boards, that if a solution needs to be found for a

particular case that the financial resources will be provided. We don't think

the suggested solution would be the right one.

MS JONES: You guys had a study commissioned on long-term care and

personal care for Labrador. Is that completed?

MR. ABBOTT: Yes, that was done by the board. That assessment, Moira, has

it been completed?

MS HENNESSEY: We have received the final draft report from the

consultants on the long-term care needs assessment in Labrador. We are expecting

the final report this month.

MS JONES: Is that going to be released to the public?

MR. ABBOTT: There would be no reason why that wouldn't be.

MS JONES: How long have you guys had the report then?

MR. ABBOTT: I'm sorry?

MS JONES: How long has the report been completed? I wasn't aware that

it was completed, that is why I am asking.

MR. ABBOTT: The draft we have seen probably in the past month because it

helped us in coming up with some numbers for our budget for the facilities. We

have asked the consultant to finalize the numbers and the report and submit it

to the department and to the board. We will assess it and then it will be

released.

MS JONES: We did have some discussion about adding some long-term care

beds to a personal care home in Southern Labrador. I do not know where that

ended up in the report or even if it did, but I did meet with the consultant a

couple of times and with the CEO and some of the senior people with the

Labrador-Grenfell health corporation. I am interested in knowing what the pilot

project is that you are doing with personal care homes in Grand Falls. It is

probably similar to what we recommended, but I wasn't aware of this pilot so I

would like to know what it is about.

MR. T. OSBORNE: Actually, I am aware of the pilot project in Central. It

is a pilot project and I think there are issues again with the health

authorities on the classifications, whether the individual is classified as a

Level II or a Level III. There are some issues that have to be ironed out there

before we are able to move into this type of program on a provincial basis. I

guess the pilot project will answer a number of questions for both the

department and for the health care authorities regarding the classifications.

As far as the particular pilot project, the numbers involved and so on -

John, are you familiar with that?

MR. ABBOTT: The challenge that both the board and the department is

facing is we have a number of residents, as was mentioned earlier, who are

either in their own home or medically discharged from the hospital, and the

question is: Is a nursing home the only solution for these residents? Central

Health, as one board, came to us and said: Look, can we explore other options

and alternatives, because we think that some of these residents can be placed in

the community in a personal care home? We said, yes, we agree in principle, the

question is: What type of resident in terms of their care needs would be best

accommodated? The personal care homes built, are they physically capable of

providing the care that is needed?

What we have asked Central Health to do is work with us in terms of defining

the criteria, defining the physical criteria for the buildings, work with the

Fire Commissioner's Office and others, to make sure that if we can accommodate

more residents who are at a higher level of care but not nursing care - it would

be more attendant and personal care - that we look at expanding the use of

personal care homes. Everybody is trying to work through this together, and we

are hoping over the next year to be able to use a couple of personal care homes,

try out the model, do an evaluation, report to the minister to say yes we can or

no we can't, and then extend that to the other regions.

In terms of Mary's Harbour, we need to look, obviously, at some

alternatives for the home there. Once we have the assessment done as to what is

needed in terms of long-term care placements, we will look at how we can use the

home more effectively, and that may be one of the solutions there.

MR. T. OSBORNE: I think it is difficult, Yvonne, to do this on a

Province-wide basis until we have a better idea of exactly, first of all, I

guess, how to implement the change if there is to be a change. Secondly, the

issues regarding the structures, the availability of personal care homes within

certain areas, how that fits into how patients are categorized, the different

levels at which they are going to be categorized, and it is very difficult to do

this, as I say, on a Province-wide basis until we know how it is going to work,

whether or not it can work, how all of the pieces fit together.

MS JONES: The issue I have is that I think there has to be a different

model for delivery of both personal care and long-term care in different regions

of the Province. One of the biggest issues -

MR. T. OSBORNE: You mean different models in different regions, or

different models -

MS JONES: Different models for different regions because, you know, the

institutional style of care is not going to work in the smaller areas around the

Province, and it is not even going to be feasible to provide that kind of

service. When you can have the same staff doing the work for twenty patients as

you are going to have for five, yes, it becomes an affordable issue for

government, but I think there has to be a different model. In the sessions that

I had with the Labrador-Grenfell corporation and the consultant, I tried to

explain that but it was just like talking to the desk, because they were locked

into a concept of: This is the way it is, these are the regulations, and we are

not prepared to look at anything else - which was really unfortunate. So, I do

not know if anything ended up in the study or if it did not, but I really do

think that there is good quality care that can be provided to long-term care

patients in rural areas of this Province without it having to meet all the

staffing requirements that are presently there, and Mary's Harbour is the

perfect example.

You have a twenty-bed personal care home that meets all the standards in

terms of the building code and all the things that they need to meet for both a

long-term care and a personal care home. They live next door to a clinic that is

about maybe a couple of thousand feet away from them, which is staffed with

three nurses and a public health nurse, visiting physicians, and a social

worker. All of these people are right there, a few feet away, but they would not

be able to take, under our present regulations, a long-term care resident into

that home without having a full-time nurse on that floor every day, although

there are three next door that are on call twenty-four hours a day if you need

them.

MR. T. OSBORNE: I appreciate what you are saying. In fact, Yvonne, I

agree with a lot of what you have just said. I have had some discussion with

officials over the past week in regards to some of the very same issues that you

have just raised. Perhaps if I could extend an invitation to you to come over,

to sit down with myself and maybe some of the executive, and the same

suggestions, the same issues that you have raised, that you felt were not

listened to at the board level, if we can enter into some dialogue with you and

get a better understanding of what your suggestions were.

I agree with a lot of what you just said, and if there is a better model -

obviously you can't use a cookie-cutter approach throughout the Province

because there are different regions, there are different issues.

I like what you are saying there. Let's sit down and talk about what some

of your ideas are for Southern Labrador, for example. If we can bring those

ideas, in addition to some of the discussions that I have had with officials,

have a very close analysis of that, probably at some point I will bring the

boards in and review this further.

Let me give you some assurance and some level of comfort that the suggestions

that you are making, I do not disagree with all of them for sure.

MS JONES: I would be happy to do that, and I will do that. I just wanted

to make the point that I think there is a more affordable way, and a way to

provide the services in rural areas of our Province, and it does not compromise

the quality of care that these patients are going to get.

MR. T. OSBORNE: That is my only concern. If we are going to change

certain models, or if we are going to explore new ideas, first and foremost for

government, first and foremost for the boards, is to ensure that the quality of

care for people in the Province is not compromised. If we can do something

different, if we can do something better, if we can do it in a more efficient

manner as far as resources are concerned, those things should be explored

provided the quality of care is not compromised.

CHAIR: At this point I am going to interject.

I believe it has gone past 10:15 a.m., and by agreement we were going to go

to that time.

MS JONES: Yes. I just wanted to say I have to step out for about a half

hour but I will come back because I have other questions that I didn't get to.

MR. CHAIR: Thank you, Ms Jones.

We are going to pass the baton, I believe, to Mr. Collins.

MR. R. COLLINS: Thank you, Mr. Chairman.

Good morning, Minister and officials.

Let me begin by just saying that we are very, very happy, extremely pleased,

to hear the announcement of a new health care facility for Labrador West. The

people in Labrador West are very excited about that. It is long overdue and we

certainly look forward to having a new facility where people, when they need to

be in hospital, will have more pleasant surroundings than they do now. They won't

have to keep worrying about plaster falling on their beds and on their backs and

stuffing windows with toilet paper and paper towels to keep the draft out. It is

long overdue and the people there certainly appreciate it.

I would also like to ask the minister or John to pass on our, I guess,

gratitude to the people involved with the air ambulance program and the air

ambulance crews. Many times we rely heavily on the air ambulance team when we

have difficult medical situations. I can tell you that they need to be

commended, because they flew in at times to pick up passengers where I am glad I

wasn't the patient going back out. They certainly fulfill their duties to the

highest degree, and I have had nothing but positive feedback from any patient

who has been transported by them. The professionalism that they display and the

care that they show is certainly to a degree that they need to be singled out

for commendation.

I would like to just talk about another thing for a minute. It is not really

a question, it is a concern that we have. Many times people from Labrador have

great expense, even with the subsidies in place, when they travel out for a

treatment. I don't know if there is any answer to this, but I think it is

something that should be explored. It is not uncommon for people to go see a

doctor about a medical condition and are told to come back in ten days or two

weeks. That causes a lot of difficulty for people. It is not like you can even

get aboard your vehicle and drive for ten or twelve hours and get there. It

involved a $1,000 airfare plus accommodations. Lots of times somebody has to

travel with the person, and there is the time off work and everything else that

is experienced. I don't know if, when a person comes out if there is more

input from the local doctors as to what the problem could be or the specialist

they are going to see, if there is any way of coordinating that between other

doctors from here to try and minimize that as much as possible.

MR. T. OSBORNE: Randy, on that - and your point is well taken - I think

one of the things we are trying in areas like Bonne Bay where it is working is

the primary health care, where an individual will see the specialist whether it

is a social worker or a nurse or a doctor or whatever the case may be as opposed

to going and being referred somewhere else and then being referred somewhere

else again. I will ask John again to elaborate on the primary health are, but

that I think will alleviate some of the concerns that you are raising.

One of the other things that I think is being looked at and being explored,

and that is providing some services. Whether it addresses the issues - because I

know that with the geography and some of the concerns that you are raising in

Labrador probably some of the areas wouldn't be affected. Some of the areas

could be if there is a smaller clinic as opposed to the larger hospital.

Eventually, as we get Broadband services in throughout the Province, one of the

things that perhaps we can look at is providing some services where people don't

have to travel the great distances at great expense, you know consultation

services and so on. Then if there is a need for them to go to a larger centre,

they can.

I will ask John if he can maybe elaborate on both of those things.

MR. ABBOTT: In terms of primary health care, one of the things,

obviously, we are trying to do is to coordinate more services at the local level

and make sure that our residents know which health care provider they should be

seeing at any point in time. That is evolving throughout the Province.

I think, if I understand your main question around coordinating visits to

specialists, certainly out of region, that one is tricky at best and we really

haven't focused on it, it would be fair to say. What we talked about in some

areas, what we refer to, is sort of patient navigators, so in fact we start

coordinating services. One of the things I can undertake to do here today is

talk to both the CEO in Labrador as well as the others, and talk about how we

can put a process in place. In one sense it is easy enough to track referrals,

and we can see how we can co-ordinate those better. We may have to put a

resource in place to do that.

Mr. Collins, I will take that suggestion forward and we will get back to you

to see what we could do, what the problems are, and how we can improve on that,

but it is a fair enough question.

MR. R. COLLINS: Okay.

On the (inaudible) transportation, air transportation medical subsidy

program, under the new changes, I am running into a lot of problems. I have had

discussions with some people in the Department of Health on this already,

through the former minister. It is not resolved but it is something that still

needs to be resolved.

When people travel now, for the first time in the year, they get $500

deductible from their travel expenses. Mostly it involves airfare. One of the

problems that we are running into is that a lot of people who are just above

minimum wage levels, or single parents who are working in Labrador, do not have

the means to buy the ticket. Because it is a reimbursement system, you have to

pay up front and get reimbursed. A lot of people are having difficulty coming up

with the money to purchase the ticket.

What I suggested - and I still, for the life of me, don't understand why it

cannot be done - is, say a medical ticket from my area of Labrador to St. John's

is $850, of which $500 will be reimbursed, which leaves a balance - well, more

than $500. It will be $500 and half of $350, $175, so $675 of that will be

reimbursed, but the $500 deductible comes right off the top. Why can't the

department, in certain cases where the request is made, pay the first $500 to

the airline so that the person who needs medical travel only has to come up with

the $375 or the $350?

I have had meetings with the former minister and officials on that, and they

are saying it can't be done because of - really, I didn't understand their

reasons why. It seems to me it is just a matter of the paperwork that may be

involved, but it is a big problem for a lot of people. Not everybody works with

the mining companies, and not everybody has insurance plans that cover it, and a

lot of people have difficulty. We are still finding now we have to go to, like,

the ministerial association, to the RNC. They have a charitable golf thing every

year. We have to go to the Lions Clubs, Kinsmen Clubs, all of these places, to

try and come up with the money so the person can go. It is a serious problem.

MR. STRONG: I think the basic issue is one of administration. To do what

you suggest would be a lot more complex.

MR. R. COLLINS: I can't hear you much.

MR. STRONG: It is the administrative complexity -

MR. R. COLLINS: Just a second now. I have to play the role of Speaker

here. I can't hear him.

CHAIR: You can't hear him? Oh, I am sorry.

MR. STRONG: The issue is primarily one of how to administer, and people

present themselves to the program in different circumstances. As you indicated,

some people have an insurance program that only reimburses people after the

insurance is considered in the calculation. People's circumstances are changed

in terms of their requirements for travel. Their appointment dates may change.

Their air trips may change. It is more administratively complex. We can look at

it again, and I will commit to do that for you, but that is the issue basically.

MR. R. COLLINS: It is done on a case-by-case basis. I mean, there are

many people who will never require that. They have the ability to either pay for

it or put it on a credit card or something like that, but there are many others

who do not have that ability.

MR. STRONG: Low-income individuals -

MR. R. COLLINS: It causes a big problem, even if it is set up through one

of the government offices in Lab West that they would put in a request through

there or whatever. I don't think that the administrative difficulty should put

undue stress on people who need health care, if there is a way of getting around

that.

MR. STRONG: Individuals can also apply through the Department of Human

Resources and Employment. They can provide medical transportation assistance as

well.

MR. R. COLLINS: If you meet the criteria.

MR. STRONG: If they meet the criteria.

MR. R. COLLINS: Which again goes to that group of people who have been

referred to as the working, struggling poor who do not qualify for that but do

not have the means to do the other thing either.

If they qualified through that it would not be a problem, they would go there

and do that, but the people I am talking about do not qualify for either and are

stuck in the middle, and still do not have the means to provide.

It is a serious problem. It is one that I run into not real, real often, but

often enough to know that it is a problem. You say you will revisit -

MR. STRONG: We will revisit our policies in that area and get back to

you.

MR. R. COLLINS: Okay.

The orthodontic services: we have been without orthodontic services now in

Labrador West for about two years. What happens is that they used to have a

visiting orthodontist come into the area on a monthly basis.

MR. T. OSBORNE: Is that because that is a fee-for-service?

MR. R. COLLINS: Yes.

MR. T. OSBORNE: Yes, okay.

MR. R. COLLINS: Now the practice is, with a lack of orthodontists, they

come as far as Happy Valley-Goose Bay.

In the local media not too long ago there was a case of one parent whose son

needed orthodontic treatment and, for her to go to Happy Valley-Goose Bay and

have her son receive the treatment that he needs, over the course of that

treatment the cost would have been in excess of $31,000.

MR. T. OSBORNE: That is a difficult one to solve, I think, because it is

fee-for-service.

MR. R. COLLINS: Well, I have an answer for it. I can solve it for you.

MR. T. OSBORNE: Okay.

MR. R. COLLINS: Since the service cannot be available, allow the people

who require that service to travel where the orthodontist is, in Happy

Valley-Goose Bay, under the medical subsidy program there.

MR. T. OSBORNE: What I will do on that, Randy, because that is -

MR. R. COLLINS: I know that the health board has been trying very hard to

attract an orthodontist to the area. I know they have been working hard at that,

and there are also orthodontists who come into Quebec, into Fermont. There are

two who come in on a regular basis, but they won't accept any patients from

Labrador West.

MR. T. OSBORNE: I will have a look at that. I am not aware of all of the

complexities of doing something like that, and what that would mean on a

Province-wide basis, if there are special circumstances in Labrador City that

may give us some leverage in looking at something like that for that particular

area, but we will have a look at that for you.

MR. R. COLLINS: Okay.

Another area that I would like to -

MR. T. OSBORNE: If you could give us a just couple of minutes, I need to

speak to John for a second.

MR. R. COLLINS: Okay.

MR. T. OSBORNE: Sorry about that. Go ahead.

MR. R. COLLINS: Another area that I would like to talk to you about is

the med school. I know the Department of Education plays a role there, too, but

it appears to me that we have a shortage of doctors in this Province while at

the same time we have a number of very bright young people who have difficultly

getting into med school even though they are straight A students with great

resumes in terms of volunteer services, athletic abilities, and all of these

things. There are a number of people who have difficulty getting into med school

even though they would agree and sign anything that was put in front of them to

serve in the Province upon graduation, because they do not want to leave here

and they are willing to go to any part of the Province that the health boards

may want them to serve in.

I am just wondering why more things like that are not done. I know we have a

number of foreign students in our med program, and I understand there is quite a

bit of money being taken in from that, but I think we are doing ourselves an

injustice by not allowing more of our young people into med school, who meet the

qualifications, and who in turn are committed to staying in the Province and

providing the service that we are desperately lacking at the present time. I am

just wondering what your thoughts are on that.

MR. T. OSBORNE: I received, I guess, an inquiry. I think the person who

had written had copied the Premier, the Member for St. John's North, as well

as yourself, that particular individual, but it does speak to more than that one

particular individual.

MR. R. COLLINS: Yes.

MR. T. OSBORNE: Obviously, there are others who are asking the same

question.

It is difficult for the minister to interfere in the selection process at the

Faculty of Medicine. I have asked John Abbott, the deputy - I have given him

that particular inquiry and asked him to contact the Faculty of Medicine just to

make sure that, for some reason, that individual was not being overlooked

unfairly.

You do raise an issue around recruitment and retention. I am not sure if it

warrants further investigation, but it is something that we can look at;

because, you are right, if there are more students who apply and get into the

Faculty from this Province, they are probably more likely to stay than an

international student. I think that is the overlying premise of the question or

the issue that you have raised.

MR. R. COLLINS: It is.

MR. T. OSBORNE: It is something that myself and the Minister of Education

- my officials and her officials can probably sit down and look at the number of

seats available within the Faculty of Medicine, the number of students they

bring in locally versus the number internationally, and what those reasons are,

whether or not there is any ability to move the ratios, whether they are

justified in doing what they are doing or whether it is time to revisit the

policies that they have laid out. That is a discussion that I can have with the

Minister of Education, and maybe with Axel Meisen as well at the university.

At this particular point, I honestly cannot say if their policies are just or

not. Obviously, we trust that they are. Unfortunately, there are individuals who

fall through the cracks, and those individuals obviously feel that, unfairly,

they have been overlooked. Whether that is the case or not, and it may very well

not, it does warrant having a discussion for sure.

MR. R. COLLINS: In the Budget, you have announced thirty-nine new public

health nurses. Where will they be assigned and when will that take place?

MR. T. OSBORNE: Well, it is the first year of a three-year plan to put

those thirty-nine nurses in place. Over the next three years we will have the

thirty-nine nurses. They will be throughout the Province. I guess, what will

happen is we will probably look at the needs basis throughout the Province. I

wouldn't be able to tell you today if there is one going in Labrador West and

one going in Happy Valley-Goose Bay, for example, but they will be placed where

they are most needed.

MR. R. COLLINS: That will be thirteen a year over the next three years?

MR. T. OSBORNE: I don't have the breakdown as to what is going in this

year. There is $1.5 million, I believe, allocated to the hiring of the nurses

this year. I will ask now one of the officials the numbers that specifically

breaks down to. In Eastern Health there are nineteen, in Central there are ten,

Western, five, Labrador-Grenfell, five, and that adds up to the thirty-nine.

Now, where they will be placed in Eastern or in Central, for example, I don't

know, but those are the numbers allocated and they will look at where they are

most needed, I guess, within those regions.

This year, John, the numbers for this year?

MR. ABBOTT: We will start recruitment right away. We will authorize

authorities to proceed to recruit as many as they can. Roughly, we are planning

that they will have a little over half of those in place this year and the rest

will be recruited near the end of the year or the beginning of next year. By

this time next year, we hope to have them pretty well all recruited.

MR. R. COLLINS: There are also nine new addictions counselors. When will

they be hired and where would they be placed?

MR. T. OSBORNE: Again, those addictions counselors will be across the

Province. There were five addictions counselors last year. We saw the need for

nine additional addictions counselors. They will be hired this year, and they

will be within the four regional health authorities.

MR. R. COLLINS: Do you have any information on the wait times now for

addictions counseling, particularly as it related to the gambling addictions?

MR. T. OSBORNE: I don't on gambling. John may be able to elaborate on

that. I know that, for example, in St. John's we did have the addictions

clinic open last year. I guess the number of people utilizing that clinic were

probably beyond what was anticipated. The nine new addictions counselors, some

of the focus we are placing on that will help alleviate some of the pressures

that are there. Unfortunately we are beyond what we had anticipated. I feel that

we will meet the challenges that are there by putting the additional resources

for addictions throughout the Province for consultation with the patients as

well as followup after treatment and so on.

As far as gambling itself, we do not have any specific information on whether

or not there are wait times on that.

MR. R. COLLINS: Do you have any information on persons with addictions in

the Province, where the rapid growth has been?

MR. T. OSBORNE: Sorry? Where the growth has been?

MR. R. COLLINS: Yes, for people with addictions, the number of people

with addictions. Have addictions with alcohol, for example, increased

dramatically or have persons with addictions from gambling increased

dramatically over the past number of years, versus drug addictions or things of

that nature?

MR. T. OSBORNE: I do not know. I will ask one of the officials to respond

in greater detail. Obviously new substances are introduced to the market and the

availability of some of the substances, outside of alcohol - for example

OxyContin which spiked about a year or a year-and-one-half ago, the Province has

worked to get that under control. We are out ahead of the crystal meth issue.

Crystal meth has not become a real problem in this Province yet. Obviously there

are people using it, but in Western Provinces and in Ontario addictions to

crystal meth have already spiked. We are not taking measures and we are trying

to get out ahead of that so that we are not faced with the same challenges we

did with OxyContin. The unfortunate thing is there are new substances being

introduced and I guess the substance of choice for people is somewhat expanded

as new substances are introduced and people experiment and so on. We are aware

of that and we are trying to stay ahead of new substances such as the crystal

meth issue. As far as increases or decreases in particular substances such as

alcohol, I am not aware of that at this point.

MR. ABBOTT: Mr. Collins, we do not have any statistical data on that.

What we are finding, obviously, is that addictions, in terms of numbers, are,

shall we say, consistent in proportion to the population by region, and the

different areas are sort of spiking on different things. Certainly in St. John's

we were seeing, obviously, that OxyContin was a major factor. What we expect to

see happen now, as we have added more counselors, is that we will be able to,

one, promote - and that is one of the things we want to do, promote our services

so that, in fact, we draw more people out of their homes and what have you to

seek services and seek treatment. We expect, actually, the numbers will probably

start to increase based on, shall we say, self-reporting, people coming in for

service. That is the intent here, to collect more data to support, if need be,

more services and more staff throughout the Province. For us, we are still in

the early stages of trying to deal with this.

MR. R. COLLINS: Gambling addictions have certainly increased in the last

few years.

MR. ABBOTT: Yes.

MR. R. COLLINS: The difference, I guess, between persons with gambling

addictions and persons with addictions to what you mentioned, OxyContin, is that

one is supplied by criminals and the other is supplied by government. Don't

you find that ironic from a Department of Health perspective?

MR. T. OSBORNE: Yes. Well, I know the gambling issue is an issue that the

department is taking very seriously and it is an issue that government is taking

very seriously. You have taken a very strong interest in this and you have been

very outspoken and have been a very public advocate to a reduction in addictions

to gambling, and I commend you for that, actually.

As far as gambling addictions, I know that we removed, I think it was,

nineteen machines last week or early this week from service in the Province. The

stop buttons are going to be removed from the VLT machines. We are putting in

place a very focused awareness campaign this year from my department around

addictions, and we will be making further announcements on that within the next

number of weeks for certain. You know, some of the addictions counselors and the

addictions training - obviously, there will be a need for ongoing training as we

see a spike or a rise in particular addictions, whether they are gambling

addictions or substance addictions. I think there is a focus within the

department, not only on issues such as crystal meth, but there is a focus on

gambling, a very strong focus on gambling, within the department.

Myself and Minister Sullivan and officials from both departments are going to

sit down. I think up to this point the Department of Finance were doing what

they had to do regarding gambling and the Department of Health were doing what

we had to do regarding gambling, but we are going to get together and put

together a joint committee of both departments so that we are working together

and bringing, I guess, a more fluid approach to gambling itself.

We have reduced the number by ninety this year, and over the next four years

the total reduction in the number of VLT machines will be ninety. I think that

combined with the awareness program, combined with the training - I know there

is a 1-800 number that is posted on the machines. I think we are looking at a

more localized addictions number for the VLTs. What progress we make on that, I

cannot report on the progress on that particular number at this point because

that is very preliminary at this stage, but we are looking at a more localized

1-800 number. I think as well, with the removal of the stop buttons and so on -

it is probably not as far as you would like to see it go, because I know that

you would like to see the machines unplugged today and removed today. I think we

are headed in that direction. Obviously, some of the establishments that have

these machines - the reason the reduction in the number of machines from last

year to this year did not happen immediately is we had to allow some of the

establishments with the machines time to adjust to the new numbers, and that is

the reason it is phased in over five years to a certain degree.

Having said that, it is not so much about revenues to government. Obviously

that is a focus as well. Government would have to adjust to revenues, but that

is not the focus. It is a focus on how this has affected different

establishments as well and allowing them some time to adjust to the reduction of

15 per cent in the number of machines. Some of these establishments have fifteen

machines, and at the end of the five years they are going to be reduced to five.

You just cannot go in and unplug five machines and say sink or swim type of

thing.

I can give you the assurance that the Department of Health and Community

Services is dedicated, we are committed, to addressing the issue of gambling

addictions.

MR. R. COLLINS: Just a suggestion that I have made before, and it is

something for you to bring up, I guess, in Cabinet: that the representatives on

the Atlantic Lotto Corporation currently are from, I think, the Department of

Finance and the Department of Tourism. I would appreciate it if you would have a

discussion about that in Cabinet and replace one of them and put in an official

from the Department of Health, so that with new initiatives by the Atlantic

Lotto Corporation, when it comes to gambling, at least there is someone with a

health background who can at least have some input into the discussions that

take place before implementation of new products, and can report back.

MR. T. OSBORNE: You are absolutely correct, and that is a discussion that

I have already had with Minister Sullivan. I think measures are being taken to

address that issue, because that is a gap. Now that you have reminded me, I will

ask my deputy to follow through on that and ensure that we do get a seat on that

committee, because I think it is needed.

MR. R. COLLINS: The subsidies for seniors' homes in the Province, you

announced new money to increase the subsidy amounts.

MR. T. OSBORNE: Personal care homes?

MR. R. COLLINS: Yes.

The money that was announced, will that take care of the backlog or will it

also provide for new initiatives?

MR. T. OSBORNE: It will look after the backlog. We are increasing the

subsidy from $1,138 to $1,500. I think in addition to that there is a focus on

the old age security and the guaranteed income supplement, on top of that $1,500

increase.

There are 150 people, I think, wait listed right now for personal care homes.

There is additional funding to allow subsidies for those individuals as well.

That will look after a great deal of the backlog.

MR. R. COLLINS: But it won't cover monies for new people?

MR. T. OSBORNE: There are 150 people, I think - I believe that is the

number, John?

MR. ABBOTT: Yes.

MR. T. OSBORNE: There are 150 people right now who are on the wait list

who aren't in the personal care homes who are waiting to get in. In addition

to there, there are a number of people who are in the personal care homes who

are currently not subsidized because of the $1,138 rate. It puts them under the

bar of being subsidized. There are several hundred people who are currently

within the system who are currently at personal care homes as well who will now

qualify for subsidies because they are now over the bar as opposed to being

under the bar, and they will be subsidized as well. There are several hundred

new people who will be subsidized as a result of the increase in the fee.

MR. R. COLLINS: That is it for me, Mr. Chairman.

Thank you very much.

CHAIR: Thank you, Mr. Collins.

We will pass the questioning to Mr. Butler.

MR. BUTLER: Thank you very much, Mr. Chair.

I would like to welcome the minister and his staff.

I guess when you listen to someone else, other questions come in your mind.

Just to elaborate a little on the one with regard to the increase from 1,138 to

the 1,500, the 150 people who you said are on a wait list or existing there,

does that mean that this will be able to get them into the homes that much

faster? I know it increases and brings the other people who are in there now

below the level that you mentioned up to a standard where they would be

subsidized, but you are saying 150 people would be able to move into -

MR. T. OSBORNE: There are 150 brand new subsidies, yes.

MR. BUTLER: Okay.

The other one with the VLTs, I guess you have to be very careful how you say

things when it comes to VLTs. I guess I have my own personal opinions on them,

and that is not necessarily always the right way to be. I have my personal

opinions on smoking and alcohol and the full bit. I understand and I appreciate

where Randy comes from all the time, saying they should be totally eliminated,

and then I can look at your side of it because there are businesses out there,

if they were taken away totally from them, they would have to adjust over a

period of time.

I happened to be talking to a couple of individuals and I thought they came

up with some good ideas, and it is not what Randy is looking for, but I know you

said about the stop buttons. One of the things they were saying to me was that

maybe they should be closed totally on Sundays. They have heard people who have

come into their establishments say: I would be in church today, only I had to

come here. Then, the other thing they said, like on weekends - and I can be

corrected.

MR. R. COLLINS: The hours of operation.

MR. BUTLER: Yes, the hours of operation.

I was told - and I don't know if this is accurate or not - that this is all

controlled through Moncton, that they are all automatically switched on at 9:00

or 9:30 in the morning and they are turned off at 2:30 in the morning.

Like you said, it is a very easy thing that you could control a bit better

probably during the weekdays. Sundays they would be closed, and during the

weekdays from 9:00 to 12:00. If anyone has to stay in the building from 12:00 to

2:30 to play those machines, no doubt they are addicted to it for sure. You

would think you would be home with your family. Maybe on a Friday night, the

suggestion was, well, it's a long weekend, maybe they could be open until

2:30.

I was just wondering if any of those ideas in the interim would help to cut

back. The way I look at the VLTs is, if I can afford to go in there and my

enjoyment is to go in and I can afford to play the machines, that is fine, and I

can see through that, but there are many people who go there from 12:00 to 2:30

who cannot afford to be there.

I know where you are coming from, and I know where Randy is coming from. I am

just wondering if some of those ideas - they are not mine, they were passed

along to me - could be implemented to help the cause as we go along the way. I

am just wondering if any of those came up in any discussions.

MR. T. OSBORNE: Obviously my focus, in particular as Minister of Health

and Community Services, is to find ways of reducing addictions, find ways of

reducing a reliance. There are people who are lined up waiting to utilize these

machines as soon as they come on. These machines suck the life out of some

people. They literally destroy homes, families.

I share in the concerns that Randy has, obviously, in finding solutions here.

That is an excellent suggestion. I know that has been talked about when we have

talked about other ways and means in dealing with the issue. That is something

that I will commit to you, that we will look further at that particular

suggestion, especially when we get the two departments together to talk about

other measures that can be taken and other ways in which we can reduce some

people's reliance.

The thing is here, not everybody controls the game, not everybody plays the

game for enjoyment. There are people who are seriously addicted, where the

machines are controlling their lives. It is taking food off the table for their

children and, in some cases, it is taking a home away from families. I can say

that I am personally committed to reducing the reliance on these machines.

MR. BUTLER: No doubt, there are homes that are destroyed and that is why

I mentioned liquor previously. The same thing with me, I know many families

whose lives have been destroyed through alcohol. I know cases, I won't say in

what area of the Province, but one particular case with those machines, where a

gentleman passed away and his daughter kept his Old Age Pension cheque coming,

didn't cut it off, because she was addicted to those machines.

It can go pretty deep. I can understand where Randy is coming from, but then

I look at the clubs and the establishments that are in my area and many of them

are dependent very heavily on some of the revenue they get from them. I can

understand where the balance has to come in.

MR. T. OSBORNE: I think that is the balance, because obviously within the

ranks of opposition there are varying opinions on this, and likewise within

government. Government recognizes the problem that is out there, but there has

to be a balance where you try to reduce the reliance, you try to deal with the

addiction, while at the same time not going into communities and completely

shutting down a business within the community.

There is a balance, and that is why government are moving forward here

carefully and strategically. Is it fast enough? Well, that is something that

maybe we should review. Is there more that can be done? That is something that

we are looking at, but you have to weigh both sides of the issue here.

I know one of the things that Minister Sullivan said in the House, I think

last week or a couple of weeks ago, in response to this, is that there is

on-line gambling as well that people engage in at home. How do you approach

that? How do you attack that? If you remove one form of the addiction, do you

lose control by people simply going on-line and using their credit cards or

whatever the case may be?

It is a complex issue. It is more than just the easy solution of simply

unplugging all of the VLTs. It is a complex issue and it is an issue that I

think government in general, and in particular myself, are striving to find the

answers to.

MR. BUTLER: The other question I want to ask, and maybe it is only when I

visit the hospital that I notice this, because my wife has to go periodically

either for a CAT scan or an MRI or some other testing. We always hear talk about

the long lineups, and you have to wait six to eight months to get to one of

those pieces of equipment; however, I have been there several times at the

Health Sciences - and I am not saying this as anything against any staff member

or anything else at the Health Sciences - but if we go there and if we have an

appointment for, say, 9:00 a.m., and you get there by 8:30 a.m., there is nobody

in there using the machine. There is nobody in the waiting area to go in there.

My wife goes in there, and whether she is in there for twenty, thirty, forty or

forty-five minutes, when she comes out I am sitting in the wait room and nobody

else shows up - and I can vouch for this - and an hour-and-a-half, two hours,

two-and-a-half hours go by. I am just wondering, are they utilized to their

fullest extend?

If you have to wait seven months to get there, and it is in use for forty or

forty-five minutes, and an hour-and-a-half has gone by before you go in there,

or after you come out, and people are out there crying to get into those, and I

know doctors are trying to get them in, I am just wondering, has that ever been

looked at? Again, are they only used from 9:00 a.m. to 5:00 p.m.? I know doctors

are on later than that, and nurses are on later than that, and if we have a big

backlog like that can the hours be extended for some technician to -

MR. T. OSBORNE: I think they are, Roland. Now, I don't want to say that

as simply a blanket statement because there may be some instances where some

machines are not used to their full capacity, but I know that there are machines

in the Province - for example, the radiation machines at the Health Sciences

Complex - where they have been overtaxed. They have been used so many hours a

day that they have had downtime because the machines needed repairs. So, there

is a point that you can use the machines and there is a point that you can

overtax the machines. You have to be careful of that as well, because if one of

the machines goes down and requires repairs, then that can really put a spin

into the whole system and create further wait times and so on.

I want to be cautious by saying I don't think it is an issue because there

may be machines that are not utilized to capacity, or are not utilized enough,

but I think in general and overall the machines are used.

MR. BUTLER: The only reason I brought that up was because it is not a

story that I was told - I witnessed it first-hand - but if you go to Carbonear

or come to St. John's for a chest X-ray or any other kind of X-ray, once you

are in there, while you are putting your shirt back on, someone else is going

back in there. I thought that maybe this equipment could operate - and maybe you

are right; maybe it can't operate the same way and there has to be a long

period of time in between for whatever reason, I don't know, but it seems like

where people have to wait six to eight months to get there and, when they get

there, there is no one else, but I understand where you are coming from.

The other one, Minister, like staffing levels, I will just give you an

example - and this was passed along to me by staff at the Carbonear Hospital -

on a floor with thirty-one patients, there are three nurses and one nursing

assistant. I understand, I have seen it from visiting constituents in both

hospitals in here, how busy the nurses are. They are running around, they are

run ragged. For there to be only four people on that floor with thirty-one

patients - and they are not people just sitting up in bed waiting for someone to

bring them a lunch; they are sick individuals. There are buzzers going, and so

on. Then, I have also been told that if an emergency comes in - this is at the

Carbonear Hospital - the most senior nurse on that floor has to leave then and

go down to emergency. This leaves two people up there now with them.

I was just wondering, has this issue ever been brought forward? Maybe it is

appropriate. Maybe that is the ratio. We always talk about ratios with teachers

and students, but for thirty-one people who are sick and in hospital, it seems

to me - and, like this lady told me, somewhere through the night you have to

have your little break, or your lunch or whatever, and possibly there are times

it is only one on one. Maybe they are all asleep by this time, I don't know.

The other thing I was told - and I can understand why, because they are run

ragged, and due to injuries and everything else - is that the average age of a

nurse today in the hospitals, a senior nurse, is somewhere in the vicinity of

age thirty-five. That, to me, was frightening, to know that, whether we are

losing them outside the Province or whether there are injuries or whatever. I

was just wondering if you could make a comment on that, Minister.

MR. T. OSBORNE: I can. I had a meeting, actually, just yesterday with

Debbie Forward, the head of the Nurses' Union. Overall and in general I think

this Province is doing very well with nurse retention. In fact, during the

meeting yesterday it was discussed how lucky we are that we are one of the areas

of Canada that is in really good shape nurse wise. The nurse population, you are

right, is much younger here than it is in a lot of other jurisdictions.

Unfortunately, a lot of the other jurisdictions, when they are looking to

recruit nurses, not only in Canada but in the United States, come to this

Province to recruit nurses. That does create some challenges but, having said

that, I think it is recognized by government and by the Nurses' Union, as was

evident by the discussions yesterday, that this Province is in very good shape

as far as the number of nurses.

There are some challenges in some geographic locations, obviously, and

government and the Nurses' Union and the regional health authorities strive to

reach and meet those challenges. Overall, I think both the Province and the

Nurses' Union are quite pleased with the level of nurses in the Province. The

average age of the nurse population, I think, is very positive for the Province.

Again, there are some geographic locations where we would like to see a stronger

focus. There are, as well, maybe some specialized nursing areas that need some

attention, but overall we are in very good shape in this Province.

MR. BUTLER: Where I mentioned the thirty-one patients and the number of

nurses, maybe that is the standard, I don't know. I am just asking.

MR. T. OSBORNE: That particular situation has not been brought to my

attention. The regional health authorities, in consultation with the hospitals,

would make the decision on the appropriate number of nursing units per floor and

per hospital per shift. It has not been brought to my attention that there is a

concern out there. John, are you - I am not aware of a concern.

MR. BUTLER: My next question - I had another one over here but the two of

them tie in together. The emergency unit at Carbonear hospital - I am just

speaking to that hospital because it is in my own area - has tremendous lineups,

and I can understand that; people go there. Over Christmas it was just blocked

and so on. I think where the problem is coming from is from our general

practitioners. Just take in my district alone, we have a clinic in Spaniards

Bay, we have two in Bay Roberts and there is another one up in Minister

Hedderson's area, in Clarke's Beach, plus the Carbonear area. I guess my

first question is: Those general practitioners, are they monitored by anybody,

the schedules they work or the amount of time they spend in their clinics?

Because you can call, in my area, on a given weekend and you will get three

message managers: Sorry we are closed, call this number. You call that clinic

that is closed. You call the third one, the last one, and the message is: Go to

emergency at Carbonear. This is why there are so many people there. I am just

wondering: How are those clinics monitored? Maybe it is right what they are

doing, but if it is it is causing a major problem for the people down in

emergency at the Carbonear hospital. I am just wondering: The general

practitioners, their clinic hours, do they have set standards or anything when

they should be open and so on?

MR. T. OSBORNE: Do you know something, I cannot answer that.

MR. BUTLER: You only have one more strike.

MR. ABBOTT: Obviously, I failed in my briefing with the minister for that

question.

MR. T. OSBORNE: I wouldn't say that. I have to commend the staff

because, as I said when I started this morning, this is officially my third week

here today. I am officially on the job within the department three weeks, and

there are a heck of a whole lot of briefings, there is a heck of a whole lot of

reading and there are a heck of a whole lot of issues.

MR. BUTLER: I would think so.

MR. T. OSBORNE: I am not going to give anybody the illusion that I know

all of the answers, at least not yet, you know.

MR. BUTLER: That's right.

MR. T. OSBORNE: Come and see me at a later date.

MR. BUTLER: Another two or three week.

MR. T. OSBORNE: They have been working overtime to ensure that I am

briefed and up to date on the issues. I am not going to set out to blame you

yet, John.

MR. ABBOTT: Thank you.

Mr. Butler, in terms of the fee-for-service private clinics, there are no,

shall we say, controls or management systems in place that will say that they

have to be open at any particular hours. They are left to do that on their own.

That then causes some of the problems and some of the issues that you have

identified. What we have tried to do, in working with the Medical Association is

to, obviously, one, encourage them to stay open. In the recent agreements, both

the last agreement with the Medical Association and the current agreement, we

have put in some incentives for the physicians to stay in their offices longer,

have on-call, those kinds of things.

One of the solutions we see for some of those issues is, again, around

primary health care, in that we have more teams in place, doctors, nurses,

psychologists and social workers working together to cover off many of the

issues when people come to the emergency room. What we find, on average, with

people who go to the emergency rooms, is there would be roughly 30 per cent who

do not need to go to an emergency room, and that would be because they cannot

see their doctors.

We are working with the Medical Association and the doctors to minimize that.

We will be looking at call centres and those kinds of things, again to minimize

people having to go to their doctor's offices, and in this case the emergency.

What we have also found is the more services you put in the emergency room, the

more people will come. Those problems do not go away, so it is trying to find

the right balance here.

MR. BUTLER: Like I said, a lot of the people go there because the message

manager said, if you think it is an emergency, then if something happens and

they think it is an emergency they are gone like a shot to Carbonear hospital.

The other thing that comes from that, and I have seen this -

MR. T. OSBORNE: Roland, I have to give you a warning though. I mean Bob

was telling me you guys were talking about Bianca's. We are almost down to A

& W.

MR. BUTLER: What is it, suppertime? Is it time for supper?

MR. T. OSBORNE: Lots of time.

MR. BUTLER: I have to go back to the district, so that is why I am

ignoring it, but I did not know it was Bianca's.

What I see coming from that - and like I said it leads from the clinics to

the emergency. I have seen cases - thank God nobody has died through it - where

they are so busy in emergency they will just check them out and say, well you

can go back home, and they are only landed home when they have to head back.

They are emergency cases. I mean, I can understand that. That is not blaming a

doctor or a nurse for anything. If you have fifty or sixty people out in the

lobby waiting to get in and you are going through them, maybe you do not detect

something. I am fearful that one of those days someone will say, boy, you can go

back home, you are okay, and they are not going to get back to the hospital. It

is from people going in there who really shouldn't be going there, but they

are being advised to go there. Anyway, I appreciate that is been looked into.

I touched on this earlier. With regard to the clinics, I will give you an

example. There is a clinic in Spaniards Bay, usually there are two doctors there

and there is where I go. There is one lady doctor there now. She is the only

one. In the past three years, I have had five different general practitioners. I

will tell you what it is like, Minister, and I do not mean to be funny about

this. It is almost like the people who are coming there are coming to serve an

apprenticeship. When they are finished, they are gone out of our Province and

probably out of our country. I feel strongly about that.

I will give you a prime example. Many people have to wait six to eight weeks

to get in to see their general practitioner even to get their medication

prescribed again. If you are on regular medication, it is still six to eight

weeks to get in to see someone so you can continue on with your medication. I

had an instance myself where I called the clinic two weeks in advance - and I

can understand where they are coming from. There is one lady down there by

herself and you call up and they say: No, your doctor has left again. The next

time you go down - I had a doctor who was in emergency here at the Health

Sciences who just came out, out of courtesy, to give them a couple of days to

try to get the backlog cleared up. You have to go to your pharmacist and say:

Can you give me enough medication to put me over the weekend? Really they cannot

do it. They know you are on this medication for the last five or six years and

they cannot fill you prescription because you have to get in to see your doctor.

It is becoming a major problem in that area.

I am just wondering if there are any plans, or maybe you have not heard of it

before, anyone saying we have a problem out here. I am getting calls more often

now and we are soon going to heard it more in the media. A lady called me the

other night and said she has to wait eight weeks to get in and see her

practitioner. I know there are problems and people are going, probably, for

minor things, but when it gets to that stage, I am just wondering, are there any

plans in place for more medical people, and if there are, if new doctors are

coming in, in some way could they be tied to the Province for awhile rather than

serving this short period of time. As I said, that is what it seems like to me,

they are serving an apprenticeship and then they are gone.

MR. T. OSBORNE: Recruitment and retention has been a problem in the

Province for decades really. I hear what you are saying and it is a valid point.

Government has tried a number of initiatives. All of the health authorities are

dealing with recruitment and retention issues. For the most part, when a

regional authority goes looking they are successful in recruiting specialists or

recruiting doctors. In your area I think that is a fee-for-service. We do have

bursaries that government pays to the students at the Faculty of Medicine. In

return for the bursaries they are required to stay in the Province and provide a

service back to the Province for a certain period of time. Obviously, that has

helped with some of the recruitment issues. Sometimes they stay. They develop

roots or they develop an attachment and some of those doctors stay. Sometimes we

have success with the retention of those doctors because they have served here

as opposed to finishing the degree and moving on. Some of them stay and some of

the doctors move on. Once they serve the required time here they move on and go

elsewhere.

At current, I think we are over 950 physicians within the Province. That is

not bad. Obviously, there are some areas, based on geography and so on, where we

need to get that number up. There is a turnover in some areas as you have

indicated. Those challenges are there and they may always be there. It is not

only this Province, there are a number of provinces that deal with issues of

recruitment and retention really.

John, is there anything that you can add to that?

MR. ABBOTT: Mr. Butler, just in terms of the last part of your question:

We just signed an agreement with the federal government to help us maintain many

of the international medical graduate doctors who come to the Province to stay

here. What we find is there are a whole series of issues. One is cultural

issues. People come, and it is just that they want a way to get into Canada and

then they can go to Quebec or Ontario. Interesting enough, 40 per cent of the

doctors in the Province are from other countries usually. That is 20 per cent

throughout the rest of Canada. In that sense we attract more and we rely on them

more, because a lot of our graduates go elsewhere. We are trying to keep them as

well. We are trying to pull all of that together.

What we see happening is it is going to be more competitive, because Ontario

just changed their rules for international medical graduates to make it easier

for them to practice in Ontario, based on some of the things we have done here

in Newfoundland and elsewhere. The problem may get worse before it gets better,

but we have money this year in the Budget to try to work harder to keep them in

place.

MR. BUTLER: Back to, not to the same question I suppose but in relation

to that: This same clinic, the one that I go to in Spaniard's Bay - and I do

not mean to be picking on that clinic. By the way, the doctors that come there

for their apprenticeship, as I call it, they are all fine and wonderful doctors.

I am not complaining about it in that way, it is just that we cannot hang on to

them. In that particular clinic alone, what people are being told now is that:

Look, I am sorry, we cannot take you here. There are files there now for two

doctors on a full daily basis in that clinic, and they are being told now: The

only thing I can suggest to you is take your file and go somewhere else, and

there is nowhere else to go in our area.

When one of our doctors left he moved to Mount Pearl and his patients have to

come in here if they want to see him. He moved to town for whatever reasons, and

they are traveling back and forth to Mount Pearl to see a general practitioner.

God love him, he has relatives out there and when he comes out he will do home

visits sometimes because some of the people he knows do not have the

transportation to get in. It is becoming a major problem, let me assure you,

when you go into a clinic and there are maybe 1,000 or 1,500 or 2,000 files

there and someone is telling you, you have to take your file and go elsewhere,

and there is nowhere else to go. I know it is a serious problem, but like you

said hopefully something can be done about it.

The same thing with regard to the Carbonear hospital. I brought it up, I

think it was last year or a year and a half ago, that there were two or three

doctors going to leave Carbonear hospital, and I was accused of fearmongering

and spreading rumors. Those three doctors are gone. Today, I have been told, at

the Carbonear hospital there are two more specialists down there who have their

papers in to move on this year. I mean, you take five doctors gone out of the

Carbonear hospital; that is concerning to me. I know where you are coming from

and I appreciate that you are working with the federal government trying to do

things about it, but it is becoming a major problem.

I just have two or three more and then I will turn it back to the critic. I

know, Minister, you were asked this question in the House last week with regards

to the Alzheimer's unit at the Harbour Lodge, and I just want to say to you,

that I think there are three or four constituents of mine who have residents

there or family members there. One of them is a gentleman who is, I think,

seventy or seventy-one years old. He was asking me where they were going to be

moved, whether it was Placentia or St. John's. I think your response last week

was that it would be to St. John's. I am just wondering: Can that be

revisited? Do they really have to be totally moved out of it or can some set-up

be there for some of the residents? I can understand if some of the residents

get to a certain level and maybe the service cannot be offered there. I know

some of them have spread them out to other floors at the Harbour Lodge and they

are staying in the area, but a lot of those older people.... He is really

concerned. His wife recognizes him, but probably not other members of the

family, and now she is going to be moved into St. John's. I know Mr. Joyce

brought up similar situations earlier. I am just wondering if it can be

revisited with regard to the Harbour Lodge. The facility is there, and just to

close it down cold turkey, I am just wondering if something can be looked at in

the future.

MR. T. OSBORNE: The facility itself is not going to close.

MR. BUTLER: No, no, it is that full floor.

MR. T. OSBORNE: Yes, that wing is.

There were five families affected by the decision, and I think the decision

was made primarily based on the fact that there were a limited number of

patients utilizing that floor. There will still be services for dementia

patients at Harbour Lodge, but the patients who have behavioural risk issues -

they are at that stage of dementia where they are at risk to themselves and

others - obviously they cannot be housed in the same units as the other dementia

patients. You need specialized services and a specialized environment for those

particular patients.

Because of the low number, the low utilization out there, it just was not a

good decision to have the resources, both the infrastructure resources as well

as the human resources, there for such a low utilization. They can be cared for

much better in a preferred site where the environment and the resources are

there to look after them.

Those same patients, it does not mean that they cannot go back to Harbour

Lodge when they enter into a different stage of dementia, because there will be

services at Harbour Lodge. The situation is, though, for those who have

high-risk behaviour, they are better served in a preferred site.

MR. BUTLER: The other one, and I am wondering if you are aware of this or

could make a comment on it - I don't know how widespread it is - I have had

two calls with regard to people who have applied for positions at the management

level and, after they accepted the position, within a matter of two or three

weeks they received a letter - and my understanding is that it was from the

department, the board or whatever - saying that, beginning in 2007, your salary

is going to be reduced. One of them told me her letter was for $7,000, there was

going to be a reduction, and another told me $10,000. I am just wondering what

is causing this. Is it only at the Carbonear Hospital? Is it widespread at all

management positions throughout the Province? I am wondering why that is

happening.

MR. ABBOTT: Mr. Butler, not knowing the specifics, but, as part of this

bringing the boards together, there has been a reduction, both a change in

duties and a reduction in management positions. If a person applied and was not

successful on - for instance, if there were three program managers applying for

one new position, the other two would then apply for other jobs and would

probably be at a lower classification and consequently would have a lower

salary. The policy has been that, if they accept the job, they have to accept

the lower salary as well.

MR. BUTLER: Would the lower salary have been noted to them before they

applied for this position?

MR. ABBOTT: Yes.

MR. BUTLER: It would have?

MR. ABBOTT: Yes.

MR. BUTLER: That is the thing I have to go back and check, because I wasn't

told that way.

The second-last question: With regard to ambulance operators, what is the

status? Because I am hearing rumblings that there may be some discontent coming

down the road very shortly - or is everything fine with regard to the department

and ambulance operators?

MR. T. OSBORNE: I have heard, in particular last week or the week before

last, I think there were a number of calls to Open Line and Night Line where

some of these issues were addressed or raised.

I will ask John if he call elaborate on where we are with the ambulance

operators as well.

MR. ABBOTT: We have signed agreements pretty well with all the operators

for the last fiscal year in terms of providing additional funding up to $1

million in total to address cost increases that they are facing, particularly

with fuel.

We have money allocated in the budget this year to address some of their

other ongoing issues. We will be commencing negotiations. We have sort of

started that in a preliminary way, but we will be doing that now, soon, to reach

an agreement to deal with some of their outstanding issues.

One of the complaints we hear, obviously, is that, for many operators to meet

the program standards, it imposes an additional cost on them. That is one that

we constantly talk back and forth on. Obviously, to run a safe ambulance

service, we will want them to make sure they meet all our standards, and we are

recognizing some of those costs in the next round of negotiations.

MR. BUTLER: Very good.

I said that was my second-last one, but there is one other little short one,

and I asked this at all our levels.

In the Budget, and it is under public buildings, it says: We will invest $8.5

million to maintain public buildings, another $8 million to remediate or remove

buildings as required.

I am just wondering, the ones they are referring to here, removing, are there

are any buildings in the system that are covered by the Department of Health and

Community Services that you can advise me will be removed this year?

MR. T. OSBORNE: I guess there is one that I am aware of, and that is the

old Grace Hospital site. I think they are still working on that. I am not sure

if there are other buildings that are former hospitals or clinics or whatever

that w

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Citation	2005-06-04
Type	committee
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