1974 Legislative Session: 4th Session, 30th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, MARCH 25, 1974

Night Sitting

[ Page

1605 ]

CONTENTS

Night sitting

Routine proceedings

Committee of Supply: Department of Health estimates

On vote 75.

Mrs. Jordan — 1605

Hon. Mr. Cocke — 1611

Mr. Gardom — 1612

Mr. Curtis — 1612

Hon. Mr. Cocke — 1613

Mr. L.A. Williams — 1613

Hon. Mr. Cocke — 1614

Mr. L.A. Williams — 1615

Mr. Wallace — 1616

Hon. Mr. Cocke — 1618

Mr. Phillips — 1618

Hon. Mr. Cocke — 1619

Mr. Phillips — 1619

Hon. Mr. Cocke — 1620

Mr. Phillips — 1620

Mr. Smith — 1620

Mr. Gardom — 1622

Hon. Mr. Cocke — 1623

Mr. Gardom — 1623

Mr. McClelland — 1624

Mr. Curtis — 1627

Hon. Mr. Cocke — 1627

Ms. Sanford — 1627

Hon. Mr. Barrett — 1628

Motions No. 22.

Hon. Mr. Barrett — 1629

Mr. Chabot — 1629

MONDAY, MARCH 25, 1974

The House met at 8 p.m.

Introduction of bills.

Orders of the day.

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

ESTIMATES: DEPARTMENT OF HEALTH

(continued)

On Vote 75: Minister's office $82,898.

MRS. P.J. JORDAN (North Okanagan): Mr. Chairman, I certainly

listened with great interest to the Hon. Minister of Health

today, and I'd like to just compliment him on his health

programmes for, hopefully, healthy people. I did hear a rumour

that once he'd taken his test he'd given up jogging. I didn't

know whether that was the result of the test or the result of

the jogging.

I did also listen with interest to his figures on the

motorcycle accidents in British Columbia, and his reasons for

defending the high insurance rates of ICBC. Unfortunately, I

didn't copy them all down and Hansard isn't ready, but I

thought he might also like to be made aware of what the bicycle

accident rate is in British Columbia.

In 1971, there were 17 people killed in bicycle accidents

and in 1972, 18 cyclists killed. There was only one property

damage. The non-fatal rate was 680 cyclists, making a total,

including the deaths, in 1972 of 699; in 1971, 706. So there is

certainly a rising incidence of bicycle accidents in British

Columbia.

It might interest the Premier, who is nodding with great

wisdom, to know that of this total of 710 injured in 1972, 179

were female and 531 were male, so perhaps he might want to look

at that. The age incidence is quite interesting: in the zero to

four years of age, seven accidents; in the 5 to 14 years of

age, 416; 15 to 19, 166; and 20 to 29, 81; 30 to 39, 15

accidents; 40 to 49, 8 accidents; 50 to 64, 7 accidents; and 65

years and older, 10. I would like to know, along with these

figures which parallel quite closely the motorcycle accidents,

if the Minister of Health is going to persuade these cyclists

off the road by high insurance rates. Perhaps he would

comment.

My suggestion would be — and it's not exactly under this

Minister's vote but I'm sure a strong opinion from him would be

helpful — that in light of the increasing accident rate for

cyclists, rather than rule them off the road with high

insurance rates, we'd be far better to consider cyclists'

routes on all our major areas where people tend to cycle.

Interjection.

MRS. JORDAN: We'll go into those under the Minister of

Transport's estimates, for obvious reasons. (Laughter.)

But of a more serious nature — although I do feel seriously

about this; I recognize the problem in providing cyclists'

paths because I myself was very keen on this when on the other

side of the House, and did a study. It is going to cost

something like $50 million to build them just in the major

areas of inter-communities, such as between Nelson and Trail,

from Vernon to Penticton, down the Fraser Canyon, in areas

where it would be more obvious to put them, and on Vancouver

Island. But I do believe it's something that should be

considered in preference to high insurance rates.

MR. CHAIRMAN: Order, please! I would ask the Hon. Member to

relate her remarks to the Health Minister's

responsibilities.

MRS. JORDAN: Yes, thank you, Mr. Chairman; I just hope

you'll put in a positive voice rather than high insurance

rates. It's time we faced this problem and did something about

it.

What is of considerable concern to me as well, Mr. Chairman,

is the matter of the registered nurses and B.C. Hospital

Association stalemate that's happened in British Columbia. The

Minister said this afternoon "my group," and I want to

make it very clear that I resigned a long time ago from the

Registered Nurses' Association, in 1966 to be exact, when I

first went into government.

I have steadfastly resisted discussing this subject in this

House, but in all those years, Mr. Chairman, regardless of

situations in Which the RNs have found themselves — and I have

long maintained that the nurses of British Columbia have

carried the bed pans of British Columbia in relation to other

professions — but never have they been in such a difficult

plight as they are now. This situation is different because, in

fact, it's not the result of natural bargaining processes; it's

the result of unprecedented interference by a Minister of the

Crown.

I'd also like to make it very clear that in interceding on

behalf of the licensed practical nurse, his objectives, I'm

sure, were most worthy, and the results of bringing them up to

a reasonable level of pay is commendable. I'm sure, and I can

speak with confidence for the registered nurses in British

Columbia, that there is no way in the current negotiations, or

in their current attitude which is very strong, that they wish

to detract from the licensed practical nurse and their position

and their salary increase. Registered nurses fully support

this.

What they do condemn is that in trying to correct one

discrimination, the Minister has created another.

[ Page 1606 ]

In creating this other discrimination, he's really made no

effort to follow through with the precedent that he set in

trying to assist this group that have been grossly

discriminated against. He had every opportunity when he was

interceding on behalf of the LPN to make it very clear to the

hospital boards that he was aware of the increased cost to the

Treasury of British Columbia, and in making his recommendation

that he was aware this would not only be reflected within the

LPN salaries but also would be reflected in other salaries

coming up for negotiation. That includes the registered nurses,

but it also includes the administrative staff in hospitals, who

by tradition have their salary increases set by the precedent

that has been set in the union negotiation area and the

professional negotiating area.

What one asks is whether in fact the Minister, as he stated

today, interceded really not on the basis of a full

understanding of what he was doing and the cost involved, but

if he succumbed to pressure.

As he said, there have been a lot of letters to the Human

Rights Commission, and I'm sure this is true. But, Mr.

Minister, does this mean that every time you are pressured by a

group in relation to human rights, you will use this as a means

of upsetting the balance of other people's rights, and in fact

that you will create a series of discriminatory actions and a

series of discriminatory results?

There's some considerable concern that by backing the

registered nurses into the corner as the Minister has, there

may well be a serious question if, in fact, there is a strong

desire on the part of this government to see that they are

officially and formally unionized.

The government is in a difficult position with their fair

employment practices Act where they've made it very clear that

anyone working and receiving public moneys should in fact be a

member of a union. The professional nurses have stayed away

from union organizations since 1952. They have tried extremely

hard to maintain a professional attitude in their work and in

their position in the public's mind, and they should be

commended for this.

Is the government in an embarrassing position where they

have a group of professional people within the health sector

who are not unionized and who are creating embarrassment for

them? And rather than come out and enforce the Public Works

Fair Employment Act , trying to take the back-step in

forcing the nurses to unionize.

There used to be in the Vancouver General Hospital a member of the union —

this was a matter which I experienced myself, when I was a member of the association

when it fought very hard to regain a professional status. They have lived up

to this not only in their conduct within their work, but perhaps also as an

outstanding example of a professional group who have done more than their share

to promote professionalism within the health world by making actual cash grants

to the University of British Columbia for extra studies in the area of the nursing

field.

They have one of the most active post-graduate in-service

and extra-service training programmes in the country. And they

have always been looked upon as individuals who are true to

their ideals, and who carry their traditional role with great

seriousness and almost a heavy mantle.

I suggest, Mr. Chairman, that the situation they find

themselves in is intolerable. For your information, they feel

that the interference by the Minister in the specific instances

of the LPN in relation to the arbitration awards — particularly

four that were made in British Columbia: in Penticton, Trail,

Kimberley and Royal Jubilee Hospital — were such that in light

of the decision that was forced by the Minister they are in a

position where the LPN, worthy as she is of this increase, has

a minimum requirement of 10 years of training in the high

school, grade 10, and a 10-month training programme. And they

can meet parity within two years of service within the

hospital.

It's a fact that registered nurses are required by law,

within the legislation of this province, to supervise all LPN

activities and orderly activities, and, by tradition, this is

their role. By the nature of the work that's outlined in the

hospitals, this is their role. They must be in a position which

is supervisory to the LPN.

Yet today in British Columbia they find...the registered

nurse finds herself in a position where she is, as I mention,

by law, responsibility and training, required to supervise

those who are receiving more money than she is.

They rightfully resent this, Mr. Chairman.

I think that it was well documented in the Sun the other day

by George Dobey where he said, "RNs Face a Practical Problem."

I'll read just a little bit for your information. He says:

"The facts are the RNs are militant and determined. They've had two widely approved strike votes at

Royal Jubilee in Victoria and Royal Columbia in New Westminster

and expect to get similar results next Wednesday and Thursday

in voting at Vancouver General Hospital."

I don't recall in my lifetime in British Columbia ever

hearing registered nurses described as being militant. Yet

today they find themselves backed into a situation where they

must adopt a militant stand or succumb to Ministerially imposed

discrimination. Mr. Dobey goes on to say:

"The issue that has riled the RNs is the disruption of what

they say is their rightful differential between rates of RNs

and registered practical nurses. Deeply involved is what the

RNs describe as the unusual interference of the

[ Page 1607 ]

provincial government through Health Minister Dennis Cocke

in the collective bargaining in the industry.

"The interference came in the form of an agreement between the government and the hospital employees'

union giving special adjustments to practical nurses to end

discrimination against them in relation to male orderlies doing

similar work."

Mr. Chairman, the Minister said this afternoon that he

encouraged the hospital boards to enter into this agreement.

And if his words in the contract that were signed are

encouragement, I'd hate to see what he has to say when he's

forcing his powers upon them. Along with the 58 per cent

increase that he awarded the LPNs and other dictums he says

right on page 1of the agreement under 1 (C):

"The parties agreed that all such discrimination of wage rates, job description, promotions

and any other shall have ended by January 1, 1976. If progress

towards this goal is deemed unsatisfactory, the Minister of

Health Services and Hospital Insurance shall undertake suitable

measures to ensure that that goal is achieved."

That, Mr. Chairman, is what the Minister of Health describes

as gentle persuasion to the hospital association of British

Columbia. Gentle persuasion, Mr. Chairman.

I thought perhaps in his thoughts of gentle persuasion the

Minister might like to know some of the other discrepancies

that he's brought about in trying to correct one discrimination

and creating so many others.

Maids in miscellaneous services at the YMCA, doing

ostensibly the same work as the maids in the hospital, only get

$3.85 an hour, Mr. Chairman. We don't hear the Minister

standing up and speaking about this discriminatory action or

this differential.

A truck driver, Mr. Chairman, for Indalex Ltd. gets $5.60 an

hour, and the registered nurse is asking only for $5.61 an

hour. Surely, Mr. Chairman, a registered nurse, with her

training, her responsibility and the law under which she must

operate, is entitled to the same wage as a truck driver.

But even more interesting is the first-aid attendant working

for Kaiser Resources — that terrible, terrible enterprise

corporation. A first-aid attendant as of January 1, 1975, will

get $5.50 an hour. Surely, in light of the discriminatory

situation that the Minister has created, and in light of the

traditional differential that the registered nurse has had,

their request for $5.60 an hour as a base rate is not

unreasonable. Surely they are worth a little bit more in terms

of responsibility and training than a first-aid attendant. And

surely they are worth as much as a truck driver for a small

company.

It is interesting that there is some considerable concern on the part of the

B.C. Hospital Association, who have traditionally had a very good relationship

with the in-staff at the hospitals. And their relationship with the registered

nurses has always been one of the best. The bargaining climate has generally

been carried out in the best of humour and the best of intent — for fairness

to the hospital and fairness to the registered nurses and, above all, fairness

to the patient.

Mr. Minister, we have precedent in this province by your

government when it campaigned in the last election campaign and

decided that the ills of education fell on the fact that the

teachers needed a much greater salary increase than what was a

matter of judgment on the part of the former administration.

The government, to its credit, carried this out. But then they

turned around and smacked down the school boards and told them

they had to cut back their budgets.

What we ask here is whether this isn't, in fact, a repeat of

that pattern, that the Minister of Health has, in fact,

interfered and arbitrarily ordered the hospital boards to take

action which has created this discriminatory situation, and if,

in fact, now he isn't turning around and interfering with the

hospital boards and letting the message get through to them

that they must cut their costs. Is this, Mr. Minister, a

parallel to what's happened in education? Is this the practice

that you're starting in the health field now?

Mr. Minister, there has been a philosophy imposed by your

government that there should be an effort to cut down on

salaries in certain areas. I don't quibble with this if the

salaries are unreasonable. But I think if that is your

intention, then you, through you, Mr. Chairman, should come out

publicly and say so — not use the hospital association

negotiating units and not use the registered nurses as whipping

boys because of your interference and the precedence you set

and for an objective that you're not ready to bring out to the

public notice.

I would ask the Minister, in light of the fact that when he

appointed the mediator for the UNs he appointed Mr. Blair, who

is a very fine mediator, I'm sure, but who also is known to be

very strong on this side of labour and that's fine.... But I

would hope that the mediator that he appoints in this situation

will be as favourably disposed to remove the discriminatory

situation that the nurses find themselves in now, and which

has been created by the government, and that the Minister in

turn will give the hospital association....

MR. CHAIRMAN: Order, please! I would just request that the

Hon. Member not stray too far into the responsibilities of the

Minister of Labour (Hon. Mr. King).

MRS. JORDAN: Thank you, Mr. Chairman. I am

[ Page 1608 ]

trying to relate this to an order that I have here — an

agreement which was dictated by the Minister of Health and is

signed by Mr. W.J. Lyle, Deputy Minister of Hospital Insurance,

on behalf of the Minister of Health…

MR. CHAIRMAN: On the point of order....

MRS. JORDAN: ...and Mr. Clay Perry, his Executive

Assistant. I would feel that if you would like to examine this

you'll recognize it.

MR. CHAIRMAN: The point is that the Hon. Member may discuss

the past action of the Minister in this regard and things

pertaining to it, but rather not to stray into other possible

things that are now the responsibility of the Minister of

Labour.

MRS. JORDAN: Well, thank you, Mr. Chairman. I appreciate

your point of view and I suspect you've had strong indication,

which I'm sure you would ignore, from the Minister of Health to

get the heat off him because he has no intention of assuming

the responsibilities that he should. Mr. Minister, you stabbed

those nurses in the drawsheet. You're relying on the fact that

they are idealistic people, that they have carried the lamp of

health in this province and within the North American continent

in spite of any of their personal concerns or feelings. I

assure you, Mr. Minister, that they'll carry that lamp. They

recognize they must have a basic wage increase with annual

adjustments based on responsibility, training and loss. It is

your action that has interfered with their legitimate right to

achieve this.

I hope the Minister will stand up and suggest that he

recognizes that at the core of all health service is the nurse

and the patient, the patient and the nurse. Everything else

radiates from there: the specialist in terms of doctors,

general practice and specialists, the laboratory, the LPN, the

orderly, the administrative staff in the hospitals, the people

who keep the hospitals clean, the voluntary areas. Everything,

Mr. Minister, must plug into the patient. Beside the patient is

the nurse because she is the one who most directly has to be

responsible for that patient's daily care and who most directly

must practise the art of medicine that comes only through their

own particular personality and sensitivity and the type of

training they take, which is not only academic but is in itself

a sensitivity programme; to be able to differentiate between

the norm and the abnorm; to be able to use a sixth sense that

indicates for some reason or another that this patient is in

need, needs special attention or needs the physician.

As the Minister of Education said about education, "If the teacher is unhappy

about his or her salary, the children are going to get a poor education." Those

are her comments. I would just say to the Minister of Health that for the first

time in history really, the registered nurse in British Columbia is unhappy

about her salary position, not on the basis of greed for money or perhaps even

need for money, but by the law, her or his responsibilities, training and the

role they play in the health picture. Will the Minister bring together these

parties and assure the B.C. Hospitals Association that the government is willing

to meet the commitments financially that will be necessary if the proper wage

settlement is to be made?

There's another matter I'd like to go on in relation to

nurses: B.C. has experienced the continuing shortage of

registered nurses this year. Usually by the fall, the seasonal

summer shortage has eased but this year the shortage of RN

staff in B.C. hospitals, public health and schools of nursing

which began developing in early spring has continued into the

winter. In late fall, with more than 300 vacancies still listed

with the RNABC placement service, the RNABC on its own began

preparing recruitment advertisements. The ads were published in

eight newspapers in eastern Canada in January. They only drew

32 responses from RNs who made inquiries.

HON. D. BARRETT (Premier): On a point of order.

MR. CHAIRMAN: On a point of order?

HON. MR. BARRETT: With respect, this particular item I think

is more appropriate for vote 92. I think the Member is quite

right in pursuing it, but if you'll check vote 91 — training in

the expanded role of nurses — it will be appropriate, I think,

for a good discussion at that time.

MRS. JORDAN: I'll be pleased to bring it up then, Mr.

Chairman, but I would like to speak in principle now because

I'm most interested to know how the Minister can equate his

position in the present dispute with the nursing situation in

this province.

MR. CHAIRMAN: Order, please. Order! I just want to comment

on this....

MRS. JORDAN: It's his administrative ability, Mr.

Chairman.

MR. CHAIRMAN: Order, please. I would like to comment on the

point of order, Hon. Member. The point is well taken in this

respect: a general discussion is in order for the Minister's

salary but if a detailed discussion is going to take place

which is more appropriate to a particular vote, that is the

time to do it. It's up to the Minister, though, whether he

wishes to discuss it at that point or under the vote. The Hon.

Member may proceed.

[ Page 1609 ]

MRS. JORDAN: Thank you, Mr. Chairman. I am aware of where

the vote is, but I'd like to speak in principle. If it's your

wish that I do not, I would ask that I be given fair leeway

when that vote comes up in order to pursue this. I think we

have a schizophrenic position on registered nursing in this

province which has been in

part contributed to by the Minister

of Health. I feel that one is at liberty to discuss anything

under the Minister's salary that relates to his

administration.

I would like to go on to prosthesis and a subject that came

up this afternoon brought up by the Hon. Member for Oak Bay

(Mr. Wallace) in a manner which I don't approach it. He brought

it up in terms of the Foulkes report where it was implied that

a physician for the want of money would choose to do a radical

mastectomy on a woman rather than a simple mastectomy or a

biopsy.

Just on that point, I would suggest that in British Columbia

there's never a radical mastectomy done without a frozen

section or a biopsy examination of the offending problem which

is usually a lump in the breast. Traditionally in most

operating rooms they do a frozen

section or biopsy of the lump

and, if it is suggested to be malignant at the time, they then

with consent of the patient proceed to do either a simple

mastectomy or a radical mastectomy depending on the choice of

the doctor.

For anyone to suggest that a doctor would undertake a

mastectomy of any type for money, I think, is an utter

disgrace. I frankly would stand by 99 per cent of the

practitioners in British Columbia and believe that that's a

cruel, vicious and unthought-out statement.

Just on the subject, I think every woman reads the pros and

cons of a radical mastectomy and a simple mastectomy. For my

money as a woman right now, with what little I know — and it

isn't much — it may be mutilating but I'd gamble on the radical

mastectomy because it appears that the results, though never

terribly good, are certainly much better in that instance.

I would like to bring up the fact that this is a psychologically extremely

difficult operation for women, regardless of their age. Unless the situation

has changed, there are no funds available really for counseling for these women.

There is a group of women in Vancouver who have got together and set up a counseling

programme for women who have to have mastectomies. This is on a voluntary basis,

and I wouldn't really suggest that they want to be paid or it's necessary that

they be paid. But I would like to suggest to the Minister that he make funds

available so that some of these women who have activated this programme and

who have had a lot of experience in it on a voluntary basis would be allowed

to go around the province to set up other such counseling services in smaller

hospitals in British Columbia where they do this surgery. It really wouldn't

be a massive undertaking because this type of surgery is not done in small hospitals;

it's done basically in regional hospitals.

I'm sure all Members of this House have had an opportunity

to speak to a woman, whether she's in her 70s or in her 20s,

who has had a mastectomy. It doesn't matter whether they've

been a nurse or a doctor or well-acquainted with the process;

there are great psychological problems. This is a service which

is badly needed. I hope, as I mentioned, the Minister would

make funds available so that this type of counseling could be

available around the province.

Also, under B.C. Hospital Insurance and the Medical Plan

there is very limited provision for payment for cosmetic

surgery.

MR. CHAIRMAN: Order! Point of order.

HON. MR. BARRETT: I'm sorry, Mr. Chairman, but I must bring

to the attention of the House that there is a separate vote on

Hospital Insurance and cosmetic surgery. I think if we get into

all these details, we won't get on with the general debate.

SOME HON. MEMBERS: Oh, oh!

MR. CHAIRMAN: On the point of order, I would rule that the

Hon. Member may refer to the matters in general terms,

providing she doesn't go into great detail on each one. I would

ask the Hon. Member to continue.

MRS. JORDAN: Thank you, Mr. Chairman. I accept your rule and I will continue. I would caution the Premier that my patience

is being tried. If he's impatient to get out of the House, then

go.

If he's not interested in debating the matter of health in

British Columbia, then go. If you want to get on your bicycle

or get in your sauna, then go. We are interested in staying

here and discussing some of the problems of health care in

British Columbia. Furthermore, Mr. Premier, if you don't tone

down, I'll get into the Foulkes report and then you'll really

be sorry.

MR. CHAIRMAN: Order, please! I would ask the Hon. Member to

return to the administrative responsibilities of the Minister

of Health.

MRS. JORDAN: To continue...and this subject may be very

uncomfortable for the Premier to listen to, I don't know. But

there is minimal provision for cosmetic surgery and this has

its merits; but also in that minimal provision is a lack of

funds for cosmetic surgery for women who have had mastectomies.

I would hope that the Minister of Health would consider

inclusion of this, recognizing that it would

[ Page 1610 ]

have to be a medical decision whether it was in the best

interest of the patient and whether the patient was in fact

able to withstand this type of surgery. I would hope that it

would apply right across the board, from simple biopsies to

simple mastectomies to radical mastectomies.

I notice the Minister of Finance discussing it. Maybe we've

already got the money for it, have we?

I'd also like to bring to the Minister's attention the

matter of the home-care service. This, as the Minster

mentioned, was started as a pilot project in British Columbia

some four to five years ago in the area of Kamloops, as one

example, with a view to deciding whether or not this had a

useful place in the medical programme in British Columbia.

Quite obviously, by the response of those who received the

care, by the releasing of some of the load on hospitals, and by

the response of those involved in giving the care, it is a very

useful programme and should in fact become very much a part of

the medical-care programme in British Columbia.

But I hope the Minister doesn't look at this as solely a

cost-cutting feature, because I would predict at this time that

this type of home-care programme is going to prove very costly

if it's gone into in an extensive way, and should be

adjudicated on the basis of whether or not it serves the

patient's needs, rather than whether or not it's cutting costs.

Certainly there's a lot of evidence in British Columbia to

suggest that the physicians are moving ever more carefully and

cautiously but, hopefully, wisely into the area of day care or

day surgery.

But let's not get carried away and start shunting patients

in and out of the day care on the basis of numbers rather than

on the basis of possible complication and the fact that they

might well need to be in the hospital. I hope that in the

programme of day care, day surgery, the Minister will leave

enough latitude that the physician has the option to adjudicate

the home situation. There may be a small amount of surgery

needing to be done but, in fact, that mother may well need one

or two days in the hospital in terms of adjusting to her

surgery and adjusting to the home situation. I hope that that

latitude would remain.

I also hope, Mr. Chairman, while it didn't take the Foulkes report to bring

forth the need for the continual expansion of this programme, that the Minister

won't become over-zealous in developing this programme and let it become academically

top heavy. As we went around the province on the health committee — and it was

an interesting committee from this point of view — it became very clear that

the majority of women involved in this programme were working because of a desire

to serve; they were working because they were having a learning situation. And

much to the surprise of many of them, they had developed within themselves capabilities

they never thought they would have.

One lady in Castlegar who had had a grade 10 education, who

worked in a store before she was married, and married very

young — she was in her late 20s — said, "If you had told me I

would be sitting before you at this time in my life, telling

you about this programme, and that I could look back and feel

that I'd been the spearhead of it, I would have just laughed

you right out of the room." This woman doesn't have any specific academic training, Mr. Chairman, but she has more

sensitivity, more ability and more nursing expertise that is

needed in this field than many with Master's degrees in some

areas.

We began to see a tendency, as the programme became more

successful and more popular, that with all due respect, the

academics that came before us emphasized that it needed to

expand, and in the expansion of service was more the expansion

of the administration — that we needed at least baccalaureates

at the head of it, or preferably Masters of Social Work or

Masters of Nursing, with executive assistants and secretaries

and all the paraphernalia that go with it.

I would suggest, Mr. Chairman, that to structure too tightly

the development of this home-care service in British Columbia

would be a costly mistake in terms of patient care and in terms

of dollars to the whole medical programme.

We have the Meals-on-Wheels programme, and while there's

certainly a need in some areas for some financial assistance,

again it's essentially run by volunteers. I would hope that we

will continue to emphasize the work of the volunteer in the

health programme rather than de-emphasize it.

MR. CHAIRMAN: Order, please! I would point out to the Hon.

Member that vote 79 specifically deals with that area and I

would ask her to keep her remarks brief and on general

comments.

MRS. JORDAN: Thank you, Mr. Chairman; when we get to vote 79

I'll go into it in great detail.

MR. CHAIRMAN: Order, please. In the general comments, I

would ask the Hon. Member just to touch on subjects in general

terms but not to deal with them in detail until we get to the

vote.

MRS. JORDAN: Perhaps, Mr. Chairman, you might tell me what

subject you consider acceptable under this vote?

MR. CHAIRMAN: Order! The administrative responsibility and

the actions of the Minister of Health.

MRS. JORDAN: That's precisely what I'm discussing, Mr.

Chairman.

[ Page 1611 ]

MR. CHAIRMAN: Hon. Member, it's a case of appropriateness — the most appropriate place to discuss things.

MRS. JORDAN: Well, Mr. Chairman, I think we'd better send

you to nursing school because if you don't think that home care

of patients is appropriate to the Minister's salary, you've got

an awful lot to learn. Would you like to enrol?

MR. CHAIRMAN: Order, please! It's the case, Hon. Member,

that the whole programme may be discussed in detail under vote

MRS. JORDAN: Well, Mr. Chairman, as you know, I'm a neophyte

on this side of the House. I took six years of training on that

side of the House watching the then Leader of the Opposition

discuss this under the Minister's votes, and I'm sure it's in

the archives....

Interjection.

MRS. JORDAN: Yes, Mr. Member, he did ask a question 76

times. I assure you, Mr. Chairman, I won't go over these

subjects 76 times. In fact, I'm just touching on them once. So I hope that I will have your fair ruling on this matter.

Anyway, Mr. Chairman, there is a very sensitive area in

relation to volunteers in hospital, paid personnel of the

professional nature and of the general staff, and the volunteer

who's paid through LIP grants and other federal financing. You

can go around British Columbia and find incident after incident

where there has been a well-thought-out, useful,

patient-oriented programme evolved by volunteers.

Someone gets the idea that they should get a LIP grant to

organize this, and someone's friend who knows the beneficiary

of the LIP grant tends to get their friends in, and we have a

layer of paid volunteers coming in.

While the programmes are entered into with good intent, what

is happening is that you're creating two levels of volunteers.

The paid volunteer is getting to be a problem in relation to

the voluntary volunteer, or the non-paid volunteer.

I would urge the Minister to not let this level creep in to

any degree because I believe that in the long run the patient

is going to suffer and that we will lose a lot of competent

volunteer people in the health service in British Columbia

because of very small friction which need never have been there

over money.

I recognize that the Minister doesn't have too much control over what the feds

do in terms of these grants, but I hope that this department would take the

time to become familiar with some of the programmes in B.C. and that where it's

more of a job creation for someone's friend, they would take a strong attitude

against it and leave the programmes in the hands of the volunteers.

I don't wish to transgress, Mr. Chairman, but I hope that

the Minister will raise his voice and offer his opinion when it

comes to the efforts to accredit women with volunteer service

and that there should be in British Columbia a certificate

programme where a number of years of competent volunteer

service would in fact be credited to a lady who might want to

re-enter the work force. In fact, such a volunteer programme in

certain areas might even be a benefit to them if in later years

they chose to enter into registered nurses training or licensed

practical nurses training. That same should apply to men should

they wish to enter this field.

Well, I have a number of other things I'd like to bring up

under the Minister's salary vote, but I'll just leave

them for the moment and hope that he will answer some of these

questions and give the House the benefit of his views.

HON. D.G. COCKE (Minister of Health): Mr. Chairman, I was

delighted to hear the Member for North Okanagan discussing

health care in her inimitable fashion, not taking sides, being

fair.

MRS. JORDAN: No, I'm taking the nurse's side. I don't make

any bones about it.

HON. MR. COCKE: Not a member of RNABC any longer. But, Madam

Member, Mr. Chairman, it strikes me that when there are

negotiations going on, it's rather out of character for any of

us to be discussing the negotiations that are going on right

now, in fact, with a mediator.

HON. A.B. MACDONALD (Attorney-General): It's a negation of

collective bargaining.

HON. MR. COCKE: It is a negation of collective bargaining.

That Member indicated, as did her colleague the member for

Langley (Mr. McClelland), that I interfered earlier in another

set of negotiations.

MR. J.R. CHABOT (Columbia River): You did.

HON. MR. COCKE: There weren't negotiations! How many times

do I have to say that to this House?

MRS. JORDAN: Stop playing with semantics.

HON. MR. COCKE: They just don't want to know, and that's

unfortunate. Let me suggest again that that was part of a

settlement that came down from the old Social Credit mediation

commission which said that anomalies could be questioned

during

[ Page 1612 ]

the life of a contract, and that's what happened.

Then do you know what happened? We brought about orderly

change as opposed to chaos. Yes, that's right, because as the

hospitals were going to arbitration one by one, and the human

rights applications were coming in hundreds by hundreds, there

was nothing but chaos. But once we asked both sides.... And

you will notice that this is a proposed agreement, not signed

by me. It's a suggestion to me, a recommendation from my staff

and from the hospital employees.

But that brought about an opportunity for everybody to sit

back and say, "Okay, now how do we get there, and let's stage

it." It is being staged, Mr. Chairman. What is being staged in

the whole picture is that ultimate parity, male and female wage

parity, will be brought about by 1975-76. Reasonable

objectives. How that Member across the way can suggest that

this parity should have been maintained.... For an example, in

1973 the orderlies were only making $3 less than an RN. There

were no questions asked over there at that point. Now they're

going to be getting $65 less.

MRS. JORDAN: Oh, you're skating all around!

HON. MR. COCKE: You see, under our recommendation....

Interjection.

HON. MR. COCKE: So you just don't want to listen, Madam

Member! That's it. I've dealt with the subject as far as I'm

concerned. It's finished. I don't think we should be discussing

any longer a question that is now being mediated and a question

that's now being negotiated.

Mr. Chairman, one other word just before I sit down, and

that is: day-care surgery is at the physician's request, as it

has always been and as always will be.

MRS. JORDAN: What about home care?

MR. G.B. GARDOM (Vancouver–Point Grey): Mr. Chairman, I'd

like to draw one topic to the attention of the Hon. Minister

and that is dealing with the situation of emergency wards. I

think we all appreciate that they have to be clinical and

precise and indeed, hopefully, quick. But they do not have to

be dispassionate.

I tend to think that the forms the patients are required to

complete should be very much secondary to the relief that they

may require. I would suggest very strongly that there be some

paramedical solace offered — sort of a good neighbourly kind of

help and assistance to all of those people who in most cases

are very frightened and afraid, lonely and alone.

There's no question that the prime and first job of an

emergency team is to take immediate care of the critically ill

and the very seriously injured. That does not mean that the

remainder of the less serious cases should be treated somewhat

in an insignificant manner, perhaps not from the very finite

medical point of view, but certainly from an attention point of

view.

Why not see that they have a proper place to lay down, a

reassuring hand, readily available bathrooms and basins, and a

cup of tea or coffee, or something along that line — help in

telephoning, in notifying their relatives, and assistance in

departing. What we need to have there is assurance, reassurance

and a helping hand.

I say as much as possible eliminate the high degree of

impersonality and coldness out of the emergency ward.

There's no question that perhaps the very highly technically

trained personnel may be too busy and their priority should be

other priorities, but that doesn't mean for one second that

there should not be made available also those kind of people

who will be able to contribute the time and offer the skills

that I've mentioned.

MR. H.A. CURTIS (Saanich and the Islands): Mr. Chairman,

when would the Minister like to discuss ambulance service?

Under this vote or another one?

Interjection.

MR. CURTIS: Under hospitals? Okay.

The other point which I think might be appropriate at this

time concerns pituitary glands. It's a medical area into which

I realize laymen such as I should probably fear to tread.

Nevertheless, I think it's a subject that requires some

discussion and publicity.

There's a teenage lad in my constituency who, as I

understand it, had a tumor in the vicinity of his pituitary

gland. This was discovered in June of last year and he was

operated on in September. The operation was a success, but the

boy has not recorded growth for some 18 to 20 months, by

today.

I believe it's correct to say that there are approximately

10 children in B.C. right now awaiting some sort of treatment

which is not readily available to them.

I have been given by the parents of this lad a statement by

the Canadian therapeutic trial of human growth hormone, which

points out that there is a shortage across the country.

Apparently growth hormones are available in some other

countries in larger quantity than here, notably Sweden. But it

points out in this statement that the current national

collection programme has fallen below 10,000 pituitary glands.

Double this amount

[ Page 1613 ]

would be needed to enable children in the programme to be

treated continuously instead of only for six months of the year

as they're now treated due to the hormone shortage. A threefold

increase in collection would enable all children now on a

lengthy waiting list to begin treatment which at present cannot

be offered to them.

My colleague, who obviously knows a great deal more about

this than most Members of this House, indicates that this is a

rare situation. Yet I think it would be unfortunate if we let

these estimates go by without hearing from the Minister as to

the British Columbia position in this regard.

The organization, which is centered in Montreal, has pointed

out that the problem should be publicized to relatives, to

friends, to neighbours — that willingness to donate pituitary

glands at death should be enlisted; and to contact a physician

coordinator — I think there are three in British Columbia — as

to how the citizen can help that coordinator in collecting and

forwarding pituitaries.

I realize it's a very clinical subject, and I really don't

wish to pursue it further, but I would appreciate hearing from

the Minister at some appropriate point as to, as I say, what

British Columbia is doing in this connection. I think that's

the least we can do for one, two, or 10 youngsters who are

experiencing this really traumatic problem.

HON. MR. COCKE: Mr. Chairman, we know about that specific

case and we know about the other situations around the

province. It is, as you say, rare. We have been in touch with

Ottawa and there is a coordinating programme, but unfortunately

there are insufficient glands available at the present time. We

hope that it can improve.

I'd like to thank the Second Member for Vancouver–Point Grey

(Mr. Gardom) for his suggestions regarding emergency wards,

too.

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

I'll only be a few moments dealing with a matter which has been

raised a number of times before: the question of the

negotiations going on with the nurses.

I don't have anything against the practical nurses, male or female, or the

registered nurses. But under the previous administration the difficulty with

respect to negotiations between the hospitals and the hospital unions came down

simply to this. The former Minister of Health (Mr. Loffmark) had made some pronouncements

as to the extent to which the government, which provides all of the moneys to

run the hospitals, was prepared to go with regard to salary increases. This

apparently placed constraints upon the Hospitals Association and the various

boards of hospitals in their negotiations with the hospital employees unions.

We had the confrontations which we faced here in the spring of 1972, which were

very serious.

The situation with respect to the financing of hospital care

in B.C. has not changed one bit. The Minister of Health, for

reasons which he considers to be valid — and I don't quarrel

with that — has seen fit to intercede to ensure there is no

improper disparity between male and female employees covered by

the union contracts. So be it.

However, we now have the registered nurses believing that

their status in British Columbia is somewhat demeaned by the

offers made by the Hospitals Association. I would just like the

Minister of Health to indicate to us whether or not the policy

of the Government of British Columbia with respect to this

matter is such that if collective bargaining takes place

between the administrators of our various hospitals and the

representatives of the registered nurses, and if as a

consequence of those negotiations certain salary levels are

established for registered nurses or for other categories of

employees in hospitals, then is the Province of British

Columbia prepared to make available to the hospitals the moneys

necessary to meet those wage settlements?

HON. MR. COCKE: With a great deal of respect, my learned

friend across the way still persists in indicating that we

interfered with negotiations. There were no negotiations at

that time at all, so I won't run through that one again.

The policy, as you know, enunciated by the previous

government in 1971 was that they would only meet 70 per cent of

the wage increases. We restored the full wage increase and our

payments to hospitals reflected that. That's our policy: to

meet the hospital per diem costs.

We're trying our very best normally to keep out of these

negotiations. I hate to be forced into them tonight.

MR. CHAIRMAN: I would make the point of order that

discussions are presently going on. I would ask you to keep

your remarks brief.

MR. L.A. WILLIAMS: Mr. Chairman, I thank you very much for

that admonition. Certainly we in this House committee are not

to be constrained by what may perhaps be going on outside

unless it happens to be in the courts of this land. I wish the

committee to understand that I'm not indicating any motives

with respect to what the Minister of Health did; I'm not saying

he interfered improperly or in any other way.

I just want to get it clearly established that at long last

the people who are charged with the responsibility of

administering the hospitals in the Province of British Columbia

have been set free by the government to carry on free

collective bargaining with their staffs, whether they happen to

be members

[ Page 1614 ]

of the hospital employees union, whether they happen to be

nurses, or whether they happen to fall into any of the other

categories of health delivery personnel in those hospitals. The

government has now said to them: "We expect you to now do your

job in negotiations and administration of the hospitals. If you

come to proper terms with the nurses in this particular case,

the government will make these funds available." I gather from

what the Minister says that this is now the policy.

Therefore I don't think that we in this House — as you

indicated, Mr. Chairman — should make any remarks which might

interfere with the responsibilities of our hospital

administrators, with the proper representations of the

registered nurses, and with the job which the mediator is

attempting to do between these two groups.

It has already been suggested by some people that nurses are

going to withdraw their services from hospitals. I don't think

we should do anything which might encourage them to take steps

which a day or two days or a week of further responsible

discussions could perhaps avoid. We in this group are not going

to say anything more about this subject because it is far too

serious to the people who are in the beds in the hospitals for

us to be playing around with as politicians on the floor of

this House.

AN HON. MEMBER: Hear, hear!

MR. L.A. WILLIAMS: I have a couple of other questions to the

Minister. I'm not going to talk about pituitary glands because

that's not my bag.

Interjection.

MR. L.A. WILLIAMS: Well, there are some people who are older

than I am and they understand the problem more than I do.

(Laughter.)

We've had the Foulkes report. I've attempted to wade through

it as a layman. I frankly hope that something will come out of

it for the people of British Columbia, but I seriously

wonder.

I'm concerned that in my few years in this House we've

argued year after year after year about health delivery in B.C.

I would just like the Minister of Health to tell me, following

the Foulkes report and the job he is doing — I've got a lot of

respect for the Minister of Health and his staff — where we are

going. We know there are still shortages of beds and facilities

in all of the categories. We're not too bad off as far as acute

care is concerned, but in the intermediate levels and in the

chronic-care levels we seem to be facing the identical

situation that I heard discussed here in 1967 and 1968, and

then when I began to learn what it was all about, in 1969 and

1970, the same questions were being asked all the time.

I know that in the rural area of my constituency the same problems exist in

the spring of 1974 as existed in the spring of 1967. We have not yet taken the

health care delivery services to the people who are in need — that is, the sick

and the injured.

I know this is a tremendously costly responsibility of

government. All governments complain about it. The amount of

money that we are considering in these votes for the Minister

of health is colossal, and it's not getting any cheaper. But by

the same token, Mr. Chairman, we don't seem to be delivering

much better care to the citizens. I would like the Minister to

indicate, if he can, the extent to which he believes progress

is being made under his department, particularly in those rural

areas which don't have the large hospitals, don't have the

large numbers of physicians and surgeons, general

practitioners, specialists, nurses, physiotherapists, and all

the supportive medical personnel that is available to us in the

City of Victoria, in metropolitan Vancouver, and the other

major centres in this province.

When are we going to do it, Mr. Chairman? When will we get

outside into those communities of this province where people

get just as sick, where a broken arm or a broken leg or a

ruptured appendix is just as serious as it is in the urban

centres, and where public health and the public health nurse is

a far more important issue and a far more important person than

they are in the metropolitan areas? It seems to me that with

the moneys that are available to government we should be making

some significant progress in those rural areas.

In the City of Vancouver if you increase the number of

hospital beds by 100, that's a drop in the bucket. It really

makes little or no difference to the demand in that

metropolitan area. But I can assure you that if you're in some

of the rural areas and you suddenly provide 10 beds or even 5

beds, and if you provide a nurse-doctor combination where there

never was one before, then the step forward is a momentous one

for that community.

I'd like to hear the Minister tell us tonight just what it

is that he and his department are accomplishing in this field

where such a little bit of help makes such a fantastic

difference.

HON. MR. COCKE: The Member for West Vancouver–Howe Sound

(Mr. L.A. Williams) brought up, I think, a particularly

important subject. One of the directions that we felt was very,

very necessary to go was the direction of, "What do we do for

these people in the rural areas?" It wouldn't do very much for

a rural area if we brought into service 5 or 10 beds and there

was no medical attention. That's one of the big problems of the

rural areas.

So one of the reasons we're bringing in an emergency service.... You know, our ambulance service.... As a matter of fact,

you'll all have an opportunity to vote on that Act very

shortly. I didn't

[ Page 1615 ]

bring it in before my estimates, naturally, but our

ambulance Act is going to be an emergency service Act, and that

emergency service is going to make just that available in the

rural areas.

We're really afraid of providing facilities that (1) are

inadequate and (2) can't be staffed full time. That's just one

of the things we're very wary of.

I will say that in the last two years we've vastly increased

the number of staff we have in public health and that's really

healthy. Some of the areas now have nurses that never had them

before. We even have a few doctors that are going to outback

areas and working. Some are salaried because of the fact that

the area wouldn't pay a general practitioner on a

fee-for-service basis; there just isn't enough business, so

that's happening.

We're aware of those problems, but, Mr. Member, there are

also problems in the urban setting, real problems in the urban

setting and problems which the Member for Oak Bay (Mr. Wallace)

discussed this afternoon. That was the chronic care and so

on.

We're very much aware of this and we hope that the emergency

service and the other areas of service that we're providing

will give us the kind of leverage that is going to produce for

us in these areas. Our only problem is that we just can't get

professionals into some of the areas very readily. We're trying

to work on that.

MR. L.A. WILLIAMS: Well, Mr. Chairman, I don't want to.... Yes, I do want to carry on this debate a little longer.

AN HON. MEMBER: Pity.

MR. L.A. WILLIAMS: You know, I faced this same response from

the former Minister of Health. I think maybe we're getting down

to some of the things that are bothering the people of the

Province of British Columbia with respect to medical care. I

know I can be criticized by some people in the medical

fraternity for what I'm about to say, but I'd like to know why

it is that we can't get doctors out into some of the rural

areas. The rural areas of British Columbia aren't that bad. As

a matter of fact, some people are moving to our rural areas

because they think that there are advantages there which the

cities don't offer.

MR. D.M. PHILLIPS (South Peace River): We need a lawyer up

north.

MR. L.A. WILLIAMS: If I could have your account I just might

go. (Laughter.)

Interjections.

MR. L.A. WILLIAMS: That's providing I could be on the other side from

you. (Laughter.) I'd win every time.

Interjections.

MR. L.A. WILLIAMS: You see, Mr. Chairman, how serious it

really is. They all want to joke about it, and those are all

Members from the rural areas.

AN HON. MEMBER: Oh, yes.

MR. L.A. WILLIAMS: But I'll tell you what it's like. In the

vast constituency of West Vancouver–Howe Sound, which is 120

miles long, we have exactly this problem. In West Vancouver,

you know, where all the fat cats live, there are lots of

doctors, but at the top end of the riding, Pemberton Valley,

until about 1968 there were no doctors at all and that's where

it was tough.

Finally a doctor moved in and did a fantastic job. Oh, he

gets a lot of complaints from the local citizens but that's

always to be understood. But the doctor moved in and all he had

was an ordinary little black bag, no clinical facilities, no

diagnostic facilities. Somebody broke their arm and they went

to his house and it was on the kitchen table, you know, and he

put on a plaster cast; but he had to buy the plaster used for

the cast.

There was no hospital that provides all these services and

no nurse to help him make the cast. It was all done by the

doctor out of his black bag.

Now this is a problem that the government has to help to

resolve. Somehow or other the government and the medical

profession have got to attack the problem of how to get doctors

to go out into these outlying communities. Some of them have

gone out on salary, and I'm certain the Member for Cariboo (Mr.

Fraser) is going to have some comments about some of the

consequences of that. But that's a special situation, and I

don't want to get involved in that.

It seems to me that somehow or other, with the amount of

money that the people of British Columbia are paying to sponsor

and support our medical school, we should be able to encourage

some of the graduates of that medical school to go out into the

rural areas for a period of time at least. I understand that

it's not as convenient to practise in a rural area without all

the stainless steel and all the equipment and staffing that

goes on in the urban areas. But somehow or other we've got to

break through and get medical service, competent medical

service, into those areas.

The Member for Skeena (Mr. Dent) throughout his constituency

has a need for this kind of help. Whether it's on some basis

where they spend a period of two or three years, or whatever

the case may be, serving in our outlying communities before

they receive their general right to practise throughout all

[ Page 1616 ]

of British Columbia, I don't know. But I really can't

believe, in 1974, with the funds that are made available by the

taxpayers of this country to support our full health system,

which includes the payment to doctors, that we aren't in a

position to give some direction to where those doctors are

going to practise.

It's very easy to come into urban areas. I'm not sure that

some of the doctors who come into urban areas necessarily do

that well financially, but they're with their professional

peers where all the facilities are. If there's a problem they

can communicate easily with someone who can give them

assistance. I know this is one of the areas and one of the

problems in the outlying areas.

The Minister, I'm sure, would be the first to agree that one

of the difficulties is how you get some of that back-up

assistance. This may be one of the problems: this communication

between the doctor who's on the scene of the accident, or

dealing with a particular problem, who needs to have some

assistance from a specialist who's going to give him

advice.

Whatever it is that's required, I think we've got to make

this breakthrough and begin to move our professional people,

doctors and nurses, and the other paramedical staff that are

found in considerable abundance in the urban areas, out to

where the need really exists.

The Members in the earlier debate talked about northern

development. Northern development means new communities in

parts of this province that are scarcely touched by humans

today. A lot of the people who will go to those communities — whether they're going to work in the mills or whether they're

going to work in the plants that are built there or whether

they're going to be in the service industries necessary to

support those primary workers; whether they're going to be

drycleaners or whether they're going to work in the bank or

whether they're going to work in the grocery store or whatever

the case may be — when they go to those northern communities

they'll be going, in many cases, with their wives and their

families, and they'll be coming from areas of this province

which at the moment have a lot of facilities available to

them.

It's a big problem for a young man to say to his wife,

"We're going to go north where the opportunity is." And the

wife says, "That's fine, but what about our young child? Are

there going to be the medical facilities there if we have a

problem?"

It's all very well for the Minister to talk about the

increased ambulance services — and that's fine again in close

proximity to our urban centres — but I'm talking about places

where if a real problem arises we have to depend upon the

services of the Minister of Transport and Communications (Hon.

Mr. Strachan) to send a jet airplane to bring some youngster or

some woman to immediate medical care.

Now the closer we can bring that medical care to those

communities, the more acceptable those communities will be to

the people whom we will want to travel and take up residence

and live in those communities. I think that this is a

responsibility which faces government and a responsibility

which faces all of the citizens of this province, but in this

particular area, a responsibility which faces the medical

profession.

We'll have the same thing with regard to teachers and

everybody else. We've got to take that whole infrastructure of

a community into those northern areas. Difficult as it may be,

expensive as it may be, and challenging as it may be, it falls

on the shoulders, unfortunately, of the Minister of Health, to

provide that leadership which will get this thing done.

MR. G.S. WALLACE (Oak Bay): I would like to add a few

comments on the subject raised by the member for West

Vancouver–Howe Sound. I think it would be naive if we

overlooked the fact that a doctor is just a human being like

everybody else. I really don't see that there's so much

difference in a doctor going to a remote community than a

welder or a miner or a teacher or an accountant or a lawyer or

a bank clerk or anybody else. The fact is that many people

don't like to live in remote communities, and that's no news to

anybody in this House.

Interjection.

MR. WALLACE: The Member for South Peace River (Mr. Phillips)

interjects, and I know from talking to his predecessor in this

House (Mr. Marshall) that there's great difficulty in obtaining

skilled personnel in the Peace River area. The wages are high,

security of occupation is good in many cases, and yet I just

know that there is great difficulty in obtaining skilled

personnel in northern communities.

I would admit and accept that in the case of health

services, there is an urgency and a necessity. People can't

choose whether or not they get ill. They maybe can choose

whether or not they employ certain other types of personnel.

The only holdup in these cases would be the development of

industry or northern development, as the Member for West

Vancouver–Howe Sound (Mr. L.A. Williams) has pointed out. So

there has to be a somewhat different attitude in the case of

health services and I recognize that.

But I think it would be wrong to take a simplistic view and

look across the floor at the Minister of Health and tell him

that somehow he has to solve a problem. I just don't happen to

think that it's that simple. Or is the Member for West

Vancouver–Howe Sound suggesting compulsion such as some

measures of conditional granting of a doctor's licence? Should

certain doctors or graduating doctors only be given

[ Page 1617 ]

the licence to practise medicine after they have served X

number of years in the north country? I don't know, but I don't

think we should skate around the subject, because it has to be

done either on the basis of certain incentives or it has to be

done by compulsion. There's no other way.

The Member asked the question, without putting himself on

record, as to what his answer to the problem was. I don't think

any of us should put forward such difficult social and moral

and legal questions in this House without at least taking our

stand as to what our solution would be if we were

government.

I think some of the points which the Member for West

Vancouver–Howe Sound raised were very valid. A doctor generally

has a wife and children, and it benefits nobody very much if

the doctor takes his family to a remote area and his wife has a

nervous breakdown. That really doesn't help anybody, and it

certainly doesn't help a doctor to dispense good medical

care.

So I think we'd better just keep our feet on the ground and

look at this very coldly and realistically in a practical way.

As far as that goes, I served in a northern community for four

years and I know what I'm talking about. I served four years in

a community in northern Ontario. I enjoyed it, but I'm not so

sure that my wife enjoyed it, and I'm not so sure that as a

doctor I have to make some complete commitment medically and

dedicate my time and services forever and a day when my wife's

unhappy.

Interjection.

MR. WALLACE: Oh, Roy, for God's sake, go back to sleep.

We're on a serious matter for once. (Laughter.)

These are some of the issues, Mr. Chairman, that this House

must consider. Beyond that, from the doctor's point of view, it

is not easy for a doctor to serve in a northern community and

remain abreast of his subject and keep in touch with the

demands that are made on him. I'll tell you more than that, Mr.

Chairman — a doctor in a northern community finishes up doing

many medical and surgical — particularly surgical — procedures

for which he is really not competent or properly trained. Now,

that's just the fact of the matter. But when you get some

youngster broken in 100 pieces in a highway accident with

fractures and a head injury and internal bleeding, you just do

the best you can. You do the best you can and it's not

easy.

I think it's time, and I think the Minister's on this direction, that maybe

we'll have to start and look at bringing the patient to the medical care instead

of all this heroic pioneer approach that some young doctor who hardly knows

what it's all about should perhaps be the one who might be compelled or directed

to serve in remote communities.

I've looked at that and I've often thought that perhaps

young doctors could receive financial assistance in their

education and the condition for that financial assistance would

be that they would serve in the north country when they

graduate. But, I have looked at that a second time, and I just

wonder if the youngest, most inexperienced medical man is the

person who should really inflict himself upon people in a

remote community who have no other medical care.

So this, Mr. Chairman, is a very difficult problem. There

are many people always coming out with bright ideas as to how

it can be solved, but it's very complex and it involves human

relationships far beyond the mere content of the medical

service.

As the Minister knows, some efforts have been made where

doctors in the urban areas have given one month or two months

of their time to go to some of these areas and give medical

service, and this is particularly useful for some of the more

highly trained specialists in the field of ear, nose and throat

and eye surgery, who may at least be able to go and consult

with the patient for several days in some of the northern areas

and then arrange for the patient to be brought down to the

appropriate facilities for the surgical care.

I know we've only started, but the start has been made. I

feel that while from a simple conscience point of view, it

might look good to send young doctors out to these areas, I

think the quality of care which the patient receives surely has

to be of primary consideration. This old-fashioned attitude

that any doctor is better than no doctor at all, I just don't buy. A young, inexperienced, doctor can make some pretty

serious mistakes, even with the best of intentions. I just feel

that this whole matter has to be tackled in the most

conscientious way by cooperation with the Minister and the

government, the medical profession and the College of

Physicians and Surgeons who grant the licences.

As one particular, positive suggestion, as the Minister

knows, at a recent conference it was decided that we should try

to educate our own sons and daughters to become doctors, we

would expand our medical training facilities and there was a

real possibility that if immigration of doctors continued at

the rate it's been occurring, in fact there would be an excess

of doctors or at least there would be an increase in the

maldistribution of doctors.

I think that the Minister would be well-justified in

considering some direction of doctors who immigrate to Canada.

In other words, there are many very well experienced physicians

and surgeons coming into Canada every year, and they tend to

settle in the urban areas. If there is to be any compulsion at

all — we always approach that word with some reservation — I

would suggest that this is the area to start.

[ Page 1618 ]

I was a doctor who came to this country by my choice and

received as much as anyone could expect coming into a new

country. I chose to go to the north country, and certainly the

experience I'll never regret in any way. The experience was

tremendous, but there were times when I don't think the patient

received the best treatment, and that was just because of my

inexperience.

If we have experienced people immigrating to this country

and wish to settle in this province or any other province, it

would not be unreasonable, in my view, to direct these people

in their particular specialty or in general practice to the

areas where there's greatest need for a period of perhaps two

or three years. It's a possibility that should be

considered.

But this other aspect of the really remote areas: I think

the principle has to be to provide the vehicle whereby the

seriously ill or the fairly ill patient can be brought from the

place where they live to the skilled medical attention. I think

the third possible measure I would like to suggest is to

provide various incentives encouraging the urban physician and

surgeon to make his services available for a month or two

months — or for a group of doctors to rotate.

I know it isn't as satisfactory as having a resident person

at the place of need, but for the various reasons that both the

Member for West Vancouver–Howe Sound (Mr. L.A. Williams) has

pointed out, and the reasons I've tried to point out, I think

you'll try forever and a day to encourage people to go and

practise in these areas. But for the various reasons I've

mentioned it is not likely to succeed.

I think these other positive proposals I've made are the

ones that should be followed up by the Minister.

HON. MR. COCKE: Mr. Chairman, I'm pleased with these

positive contributions.

I agree that it's a mixture of a number of things that have

to be done in order to bring about better care for those people

in remote areas. We have right now, for example, under contract

with the United Church of Canada, I think, about 11 doctors in

B.C. in remote areas that are salaried doctors. And we have

others, as you know, that we're getting into areas where they

can be fairly easily reached.

There are other people who can never be close to a doctor. We can be unkind

and say it's their choice. But, you know, if you're living in a community of

10 people, you can't possibly attract a doctor — and it's very difficult to

attract any professional person at all in that kind of isolation. But we do

I certainly agree that there has to be a better way of doing that now because

the Member for West Vancouver–Howe Sound indicated quite rightly that there

aren't even doctors in areas where there should be.

I hope that we can, by cooperating with the college of

physicians.... I don't think we could give direction even to

new immigrants. I don't think we could give that kind of

direction without assistance from the college. I mean, if the

college licenses a person to practise medicine in an unlimited

way, and then you say to that person, "You must go first to

Pouce Coupe" — is it possible to do it that way? I think it's

possibly something between the college and the Health Ministry

to get something like that off the ground.

Anyway, we'll see where we go. All I know is that I'm

directed in the same way as both of you are, and that is to try

to get more care to more people in the rural areas because it

is a priority. I hope that emergency service does at least

provide us with the first step.

MR. PHILLIPS: Mr. Chairman, I'd like to add a few comments

to this debate, because I've discussed in this House before the

matter of professional services to the north. I'm not going to

call it the rural area because in the north there are many

towns of 5,000, 6,000, 12,000, 20,000 population, which I don't

consider a remote area. But it is difficult in many of these

instances to attract professional people into these areas.

I have made this suggestion in this House before and I will

make it again tonight: I think we have to come up and take the

long-range view, particularly in view of the economic

development that is being proposed for the northern part of the

province — both northeast and the northwest. Certainly I think,

Mr. Chairman, through you to the Minister of Health, he'll have

to agree that that area in the province is going to be

developed, it's going to be opened up and, if the present DREE

agreements are signed, then within the next few years there's

going to be a tremendous influx of population.

I have suggested in this House before and I discussed it

during the estimates of the Minister of Education (Hon. Mrs.

Dailly): I think we have to come up with some sort of a

long-range plan where we assist young students who have the

mental capacity and the inclination to enter the professional

services. We have to assist them with some type of financial

aid because it's a long spell to spend at the lower mainland in

a university taking either a doctor's degree or a dentistry

degree or a law degree.

The cost of transportation back and forth puts a severe

burden not only on the individual, but the individual's

parents. As I've said before, it's only those students who come

from a good financial background that can afford to spend this

amount of time in a university in the lower mainland. I think if we

had some plan whereby these students could be assisted

financially, and even if

[ Page

1619 ]

they had to sign an agreement that they would go back for a

period of 5 to 10 years.... But I think the experience you

will find, if you want to check it out, is that students from

that particular climate who have been brought up in it, who are

used to the ruggedness of the north, who are used to the severe

climatic conditions, will generally go back. They are

accustomed to it. As a matter of fact, I think you will find

they really don't like urban living and they have a tendency to

go back.

I can speak of this from experience. For instance, in the

Peace River area we really haven't got that much of a problem

with doctors. I think we have some of the finest doctors in the

province. But where do they come from? They certainly don't

come from the lower mainland of British Columbia; they come

from the Prairies and they come from Alberta, where they are

climatized.

They are not used to this tulips-in-March type of climate.

So if you get people who are climatized, who are used to that

kind of life, they will go back. I would like to see some type

of system, either through the Department of Education or

through the Department of Health, instituted where some

positive measures are taken immediately.

With regard to the remote, remote areas such as — well, I

won't say Fort Nelson at the present time — Fort Nelson a few

years ago when there was a smaller population, now with the

demands made on the medical profession, the specialties, the

one-man hospital is sort of out the window. In the older days

when you didn't have to have a doctor to administer the

anesthetic, you could have a one-man hospital. We didn't run

into the problems we have today.

It seems to me that outpost hospitals with a general

practitioner would certainly be a far better area in which to

provide medical service than it would be to take that patient

and fly him out of his area.

When they're sick physically, and you take them out of their

atmosphere, particularly people from remote areas, they're in

strange surroundings, they're away from their loved ones, and I

don't think that's the answer.

I realize we've made great advances, but certainly I would

think that general practitioners in those remote areas might

not be specialists, but they can diagnose; then if they realize

that the treatment needs a specialized care you can use your

air ambulance service and move them out where they can provide

proper care.

This is happening today. Anywhere in the north country

outside the lower mainland where a patient needs a specialized

lung operation or open-heart surgery then the doctor diagnoses

it and brings him down to the facilities that are here — the

more specialized facilities. This is going on today.

I'd like to leave that suggestion with the Minister, Mr. Chairman. I think

it's valid. It won't solve the problem immediately, but in the long range I

think that we would solve a lot of the problems that exist.

I'd like to, for just a moment, Mr. Chairman, speak on

another subject. I feel in British Columbia we've done an

excellent job with our acute hospital facilities. I think we've

made a lot of progress in that area. I think probably in

British Columbia, it's one of the best anywhere in Canada.

There's one area, though, that I feel we have made no

progress whatsoever. I'm not sure what our plans are and I'd

like the Minister to advise me what he intends to do in this

area, and that is the intermediate care facilities.

I was just noticing, Mr. Chairman, that in the annual report

of the Department of Health there are just three short

paragraphs devoted to intermediate care in British

Columbia.

MR. CHAIRMAN: Order, please! There is a vote that covers

intermediate care and I would request, if you're considering

specific programmes, that you bring them up under the

appropriate vote number.

MR. PHILLIPS: Well, I want to ask the Minister a specific

question while I'm on it and it's under his.... It's been

discussed here before, Mr. Chairman.

The report states that the government has accepted the

principle that there is an unfulfilled need in the health care

facilities of the province. I would like to ask the Minister

before I question him further what the plans are in the

province, if they accept the principle of this unfulfilled

need, to fulfill these needs?

HON. MR. COCKE: Mr. Chairman, I think we've discussed

intermediate care at some length. Maybe that Member was out of

the House, but our plans are to expand extended care, we've

expanded intermediate care and now we're just moving in the

direction of cooperating with those non-profit societies that

are going into intermediate-care and we ourselves are naturally

moving in the same direction of setting up our own. As you

know, there'll be an intermediate-care hospital on a trial

situation in Cumberland in the not-too-distant future.

MR. PHILLIPS: Mr. Chairman, on the same subject, my

information is that in May, 1973, the federal government made

an offer to British Columbia to pay 50 per cent of the cost of

construction...

HON. MR. COCKE: You may as well sit down, Mr. Member.

MR. PHILLIPS: ...of facilities for intermediate care in the

Province of British Columbia.

[ Page 1620 ]

Interjection.

MR. PHILLIPS: Well, this is the information I have. I have

it on good authority.

HON. MR. COCKE: Your authority is no good because I have

been down there negotiating that very thing and we're not even

close. We would like to have some help on chronic care of any

kind, and outside of extended care there is no help forthcoming

from the federal government on intermediate care, personal care

or, for that matter, even mental health which has been going on

for years and years. Your government, the former government and

this government have continually asked for assistance in this

area but have not....

MRS. JORDAN: You said you know how to get it.

HON. MR. COCKE: Yes, I know how to get it. Vote for the

mining bill, Bill 31.

SOME HON. MEMBERS: Oh, oh!

MR. CHAIRMAN: Order, please! I would point out to the Hon.

Member for South Peace River that under vote 97, code 035,

there is...

MR. PHILLIPS: Mr. Chairman, we've been discussing this and I

don't have any intention of delaying the House, but I'm sorry I

hit a sore spot with the Minister because this information was

relayed to me. If the information is wrong, I'll go back to the

sources I got it from, but I'm told this was not made on the

Ministerial level but that it was made on the civil service

level. The information — I'll be quite frank — was relayed to

me that this offer was made in May of 1973 and the federal

government offered to British Columbia to pay 50 per cent of

the cost of construction of facilities for intermediate care.

That information was relayed to me by the Member of Parliament

for Prince George-Peace River (Mr. Oberle) who says these

facilities are badly needed in his area. He did some research

into it and this is the information he relayed on to me. As I

say, if the Member's wrong, I'd like to know where he gets his

information.

Interjection.

MR. PHILLIPS: Well, I've already asked him and I've discussed it and

he told me I could use this on good authority and that he would back it up.

So I think that if the information is wrong it certainly should be discussed

with him, because there is a facility needed in his area which would also assist

the Peace River area. I don't know why he would relay to me in a special phone

call to me from Ottawa to give me this information, if he didn't have it on

good authority.

HON. MR. COCKE: Well, there might be a mix-up here. You

might be talking about personal-care homes that are financed by

CMHC where Ottawa loans money. We grant money, they loan money — but anyway that's neither here nor there. Certainly there has

been no talk.

MR. PHILLIPS: Thank you very much. I just have one further

subject, Mr. Chairman, that I'd like to discuss with the

Minister and I hope it hasn't been discussed while I was out of

the House this afternoon and that is with regard to venereal

disease.

HON. MR. BARRETT: That's a separate vote — vote 86.

MR. PHILLIPS: Vote 86? All right, I'll discuss it under vote

MR. D.E. SMITH (North Peace River): I'd like to pursue with

the Minister for a few minutes this matter of medical help and

professional services in some of the rural areas of the

province. Being an MLA from a predominantly rural area, I think

I understand some of the problems that we face in trying to

attract adequate medical help, but I also think that I have a

few ideas and suggestions that I'd like to throw out to the

Minister with respect to what could be done to relieve some of

the areas where we do not have adequate medical facilities or

doctors at the present time.

MR. CHAIRMAN: Order! I would ask the Hon. Member to keep his

remarks relevant to the present administrative responsibility

of the Minister as contained in these votes, if this is

possible.

MR. SMITH: I'm trying, Mr. Chairman, but please grasp this.

The Hon. Member for Oak Bay (Mr. Wallace) introduced the

subject, the Hon. Member from the Liberal Party indicated some

interest in this, and so did the Member for South Peace River

(Mr. Phillips). We're continuing on a subject that is vital and

important. I think that perhaps this is the best time to

discuss that particular subject.

As I was about to say, Mr. Minister, the thing that I

think you could do through the facility of your department is

conduct a study into the background of the medical people who

are presently practising in predominantly rural areas in

northern British Columbia. I think that if you conducted such a

study, you would find, as suggested by the Member for South

Peace River, that they have a background not particularly in

medicine in the Province of British Columbia, but a background

in medicine which they

[ Page 1621 ]

acquired in some other part of Canada, quite often the

prairie provinces, as a matter of fact, or from overseas.

A lot of these people initially that I have talked to and I

know personally have a great reluctance to locate in an urban

area. They're anti-urban in their thinking. They do not want to

become associated again with the large urban sprawl of a

metropolitan city. I find that a lot of these people are

outdoors people. They like the idea of the wide open spaces.

They're not unaccustomed to wide open spaces; as a matter of

fact, they prefer that to urban areas. You'll find that a lot

of them are sportsmen — they like to get out. This is the type

of medical practitioner that we can best attract into the rural

parts of the province of British Columbia, because they do not

mind practising medicine there.

There is another very serious problem, and that is that when

these people locate in small communities, which they do, they

find themselves locked in, in that once they arrive and set up

their practice they feel duty-bound to stay there and render

the medical care necessary, even to the detriment of their own

health, because there's no one available to relieve them. If we

could do nothing else, at least we should be able to work out a

system whereby doctors who are practising and are quite content

to practise in rural parts of the Province of British Columbia

could take periodic sabbaticals, if you like, away from their

work, because they do get locked in, they're overworked and

it's a seven-day-a-week, 365-day-a-year business. Their

families object to that because they don't get a chance to take

a holiday with their family. Yet because they're dedicated,

medical, professional people they will not desert the people

who are depending on them. They'll stay rather than take a

holiday.

[Mr. G.H. Anderson in the chair.]

There's another thing that I have found, and that is many of

these doctors will stay in a rural community until their

children reach junior high school age and then they want to

make a change for the simple reason that they want to give

their children the advantage of every educational opportunity

possible. Quite often the small communities cannot afford that

type of education; they can't offer it. So many of these people

will come up as young doctors, young married men, some without

families, some with very small families, and they will stay in

an area which is predominantly rural for a number of years and

be quite happy. But when their children get to the age of

junior high, they decide that for the best interests of their

family and their wife they should move. So this has to be taken

into consideration.

I would think, Mr. Minister, that what we should do, rather than try to coerce

doctors from whatever part of Canada or wherever they come from, into going

into a certain direction, is try to provide a basic framework and look for the

doctors that fit into that pattern, because they're the ones who will be the

most content and they're the ones that will actually stay.

We have doctors, for instance, in a community like Fort

Nelson that is growing rapidly. The only complaint that they

have is that they're overworked quite frequently. Fortunately,

we have three or four doctors there now, a far cry from what it

was five years ago. But five years ago we had two doctors and

neither one of them could leave, because if an emergency came

in or they had to perform an operation it took both of them.

One was a general surgeon and the other had to handle the

anesthetic for the operation so neither one of them could take

a holiday. These are the things that we run into in these rural

areas.

I'd like to spend a few minutes talking about ambulance

services. I know that you're moving in this direction. You're

going to try to provide more ambulance service to the rural

areas — as a matter of fact to all of the Province in British

Columbia — and I think it's a desirable goal.

It's going to be costly, no question about that. But in the

meantime before you completely establish the type of service

that you are talking about I think you would be well advised to

look into the emergency air transportation facilities that

would be available to you.

There are many places now in British Columbia where charter

operations are located. They have good aircraft and I'm sure

the department could work out some sort of an arrangement with

them that they would have aircraft available on a stand-by

basis 24 hours a day, every day of the week, provided they knew

that there would be some remuneration for them other than the

odd emergency flight that they have to take on behalf of the

department.

HON. MR. COCKE: In our pilot project that's what we're doing

with Okanagan Helicopters.

MR. SMITH: Right. Well I'm glad to hear that but Okanagan is

only one firm. They're only located in certain areas. But there

are many charter firms scattered throughout the north now. They

are there mainly to cater to the petroleum industry, the mining

industry and so on. They are there as a result of that type of

activity. But aircraft would be available to the

department.

As a matter of fact they are used now quite often and have

been in the past on emergency basis and quite often they're

never even paid for it. They can't bill the individual patient.

But that would be one means of overcoming some of the problems

[ Page 1622 ]

moving people rapidly to the areas where the adequate

medical help is available to them.

There's another area that causes concern in north-eastern

British Columbia, and I'm sure it must have similar

ramifications in other parts of the province, and that is the

matter of operating grants for hospitals.

Many of the hospitals started as a very small institution

built up over a period of years, some of them by private

nursing orders as in the north, others by means of community

organizations and societies that set up to help finance. Each

one of these hospitals is allocated a per-diem rate according

to their actual expenses. But because that per-diem rate covers

no more than the actual operating expense of a hospital they've

never been able to accumulate any amount of operating

capital.

I know the Minister on a number of occasions has done

something to relieve this problem. But it's a problem that

doesn't get any less with many of these institutions. And I

could name for instance four of them in the Peace River country

that have had recurring problems: Fort Nelson, Fort St. John,

Chetwynd, and Pouce Coupe. They've all had these problems and

they all are continually faced with the problem of chronic

shortage of working capital.

Now, I know that we don't want to provide them with excess

dollars. But surely there should be some way to allow them

sufficient working capital that they do not have to continually

go to the bank and depend upon the good graces of the bank

manager, or someone in financial institutions to help them

finance on a month-to-month basis. There should be some working

capital available to them perhaps jointly through the

department and the regional districts which operate the

hospitals now.

This is a very real concern to the administrators of every

one of the hospitals which I have named. I believe that many of

these people are adequate administrators. Some of the hospitals

have had problems, I don't disagree with that, trying to find

good administrators. But don't think it's the fault of the

administrator than it is more the fault of a system where they

were never really assigned any amount of working capital when

they set up and hospitals expanded and have grown like Topsy

and the condition has never to this day been completely

corrected.

I'd like to speak about intermediate care facilities but I

will wait till the proper vote where that comes up, Mr.

Chairman.

I do wish that the Minister would comment on some of the

remarks that I have made.

MR. GARDOM: Mr. Chairman, I'd like to ask the Minister a few questions

on a couple of topics. First of all I'd like to deal rather shortly with the

Foulkes report which I see is bound in interesting fuchsia and perhaps that's

a clear indicator of what's inside it.

I think, Mr. Chairman, one of the surest tests to arrive at

a diagnosis as to whether or not a person is a complete and

utter regulationist or structionist is to ignore him a little

or perhaps be slightly critical of his master plan and sit back

and wait for the shrieks. And such seems to be the case with

the Dr. Foulkes report because he's become pretty shrill in the

Province of British Columbia, and he lashed out against his

medical colleagues not too long ago and no doubt that's soon to

be followed by rather hefty doses of complaint about

governmental inaction on his report.

It seems to me that the creed that Dr. Foulkes is following,

Mr. Chairman, is that the existing structure that we've been

living within the Province of British Columbia in the field of

health care is one that has created all of the ills, and that

his new structure is one that should cure all of the ills.

It seems very, very demonstrative that once again this is an

over-simplistic socialistic concept, that the end-all and the

be-all of all of the problems of man is to make the state the

vehicle almighty, and then that all pestilence and drought and

despair would go ahead and disappear into thin air which is

somewhat, I suppose, the antithesis of the witches in Macbeth.

If I remember them correctly, they said; "Fair is foul, foul

is fair and hovers through the fog and filthy air." But the

socialists always seem to fail to appreciate....

HON. MR. BARRETT: When shall those three meet again?

(Laughter.)

MR. GARDOM: But the socialists always fail to appreciate,

Mr. Chairman, the great differences of mankind in the

heterogeneity of his direction and of his ideas and how

controls really tend never to expand, but they tend to limit

his productive and innovative capacities and certainly limit

local initiative and participation and local interest and

certainly all kinds of useful autonomy.

Now Dr. Foulkes, as I stated at the outset, made the initial

assumption — at least it appears clear from his report — that

the system that we have today is primarily responsible for the

deficiencies. It seems that throughout he often exaggerates or

overstresses the deficiencies to support his premises. As I

said everything seems to him to be sort of authority central.

He's spinning his wheels constantly into planning and

committees and into making horses into camels, and creating

level after level of control and regulation and designation.

And he seems to call that progress.

Well there's a marvelous quotation from a pretty-old timer,

by the name of Petronius Arbiter, and it says this: "We tend to

meet any new situation by reorganizing, and a wonderful method

it can be for creating the illusion of progress while producing

confusion, inefficiency and demoralization."

[ Page 1623 ]

It seems to me that this is the direction of Dr. Foulkes,

and his report is just full, chock-full of socialistic

political overtones. Those seem to be never ending and if

nothing else it's a political treatise in which he's used

health care as an example.

He's discussed the controlling of food supply and the

manipulation of the civil service. He suggests that political

consideration and involvement in the process of selecting

medical students would be a very good thing, and he certainly

blames the medical profession of all of the faults of the

health care system. I would just like to refer to those four

things in specifics by quoting to you, Mr. Chairman, and for

the interest of the Minister when he returns and certainly for

his comment, from some excerpts of the Foulkes report. When he

talks about the need to control food supplies in the market in

the province and comments on the subject of nutrition he says

this, that the object of a good nutrition programme "requires

government regulation of the food supply, its quality, storage,

distribution and cost."

So he's going the total way insofar as the regulating of

food products in the Province of B.C. Then when he refers to

the civil service he says this:

"The best designated system will fail, if those responsible

for implementation and ongoing operation are not sympathetic to

its basic goals and objectives. Unfortunately there will be

senior personnel who cannot identify with these objectives or

who cannot provide the necessary administrative and management

skills.

"As soon as such persons are identified, decisions should be

made either to transfer them to positions where they can

function effectively or if this is not possible, to provide

them with adequate termination and pension arrangements. This

will then make way for personnel who will identify with the

objectives and who will contribute effectively to their

successful implementation."

Well, for all practical purposes there goes the Civil

Service Commission and the concept of civil service that we

have enjoyed in this province for as many years as we have been

a self-governing province.

Now, dealing with the political considerations for the

selecting of students in medical school, he says this — recommendation No. 51:

"That a select committee of the Legislature be formed to

ascertain with the faculty of medicine the possibility of

developing a method of selection of applicants to medical

school as a means of achieving changes in medical school

out-put."

So he's going to leave the selection of medical students up to a committee

of the Legislature. Surely to goodness, isn't that another preposterous extreme?

Dealing with his criticisms of the doctors, when he suggests they don't carry

out the quality of care, surveillance and evaluation and, "It is virtually impossible

for the hospital to exert the effective control over the quality of services

offered in its facilities." That's not true. That's not true because every accredited

hospital in the province must demonstrate effective quality control measures

in order to obtain and certainly maintain its accreditation status. That's just

a little bit of more fuchsia Foulkes.

When we're talking of Parkinsonism and this portfolio, one

would think that it would relate to physical impairment, but

I'll tell you, certainly no. If the concepts of the Foulkes

report were followed, it would just relate to one more classic

example of this government's committed direction to an

inflexible initiative-destroying, overwhelming bureaucracy.

That's not Parkinsonism at all; it would be Parkinson's law

running loose, running at large, and very, very large

indeed.

I'm going to ask the Minister…he skated around this

Foulkes report, left, right and centre — it's a terribly costly

experiment. Are you afraid of it? Are you going to back it, or

are you going to reject it? What portions are you going to

support and what portions are you going to tell the people in

the Province of B.C. that you're going to throw out so they

don't have to be afraid about it?

HON. MR. COCKE: We have discussed the Foulkes report at

great length and that's exactly what it's for; it's for a

discussion paper and it's out right now being discussed. Last

weekend at the university it was discussed by nurses, doctors

and other health professionals, and positive results are coming

from that report.

MR. GARDOM: Are you looking for another report?

HON. MR. COCKE: No, no, no. We're implementing part of that

report right now in the ambulance service — the integration of

carriers, and so on. There are parts of that report that won't

be implemented. The fact of the matter is that report is a

discussion paper, and it's an excellent one. We need help.

MR. GARDOM: The ambulance service concept and so forth,

certainly long preceded the Foulkes report. We've been talking

about that thing in this Legislature ever since I've been

elected, which is coming on to seven years now.

I'd like to ask the Minister a few more questions dealing

with another topic. It's something that I raised last year, and

he said, "By golly, yes, we've increased our staff 400 per

cent." I was talking about nutritionists, and I'd like him to

inform the House: if

[ Page 1624 ]

we do have a nutritional programme in the Province of

British Columbia, what is it? Is it being effective? — and as

to whether or not the people in B.C. can receive independent

advice from the government as to the nutritional value of

foodstuffs, say cereals. If Snap, Crackle and Pop, and

what-have-you is on the shelf, does it actually snap, have some

crackle or could pop? I think the public would be entitled to

know that. So far they've never been able to find out.

HON. MR. COCKE: Yes, Mr. Chairman, we're going up 200 per

cent this year, and that kind of information is available.

MR. GARDOM: In what form?

HON. MR. COCKE: In forms, for instance, of printed material

and also in form of consultations. Basically our nutritional

aspect of health care is to assist the public health units

throughout the province. In other words, our nutritionists go

out, talk to the public health nurses, give them advice. They

in turn give advice to the public. There is a nutritional

service and it will be expanded and will continue to be

expanded.

MR. GARDOM: A propos of that, Mr. Minister, have nutritional values

and nutritional standards been developed? Is it possible for a person to go

into a store in the Province of B.C. today, which I gather it is not, and look

at a specific package of cereal and compare the nutritional value of that package

of cereal with every other packet of cereal on the shelf?

Interjections.

MR. GARDOM: Well, in what form? Will the Minister inform

me?

HON. MR. COCKE: Well it's Food and Drug — it's a federal

Food and Drug programme.

MR. GARDOM: I am aware of that.

HON. MR. COCKE: Okay. Well, then we have no control over it.

As I said, if you want advice, that's precisely what our

department is for.

MR. GARDOM: Is it possible for any individual in British

Columbia to get hold of your department and ask for the

nutritional contents of a food or liquid in the province?

HON. MR. COCKE: Yes. And if they haven't got it, they'll

find it for you.

MR. GARDOM: And they'll receive that information free of

charge? Who do they write to?

You?

HON. MR. COCKE: Yes. The Department of Health.

MR. CHAIRMAN: Shall vote 75 pass?

MR. GARDOM: Well...just hold the phone! (Laughter.)

Interjection.

MR. GARDOM: I'm missing all the action that's going on.

(Laughter.)

HON. MR. BARRETT: Sit down and I'll send you a note.

MR. GARDOM: How many nutritionists have we....

HON. MR. COCKE: You're wanted on the phone. (Laughter.)

MR. GARDOM: The last time I spoke on your estimates, I

remember I dropped a tooth on the floor, and I didn't receive

any compassion from you at all.

However, how many nutritionists have we got now in the

Province of B.C.?

HON. MR. COCKE: Four.

MR. GARDOM: Oh, so they're the same as the.... You just put

in four last year, the same four as last year.

MR. R.H. McCLELLAND (Langley): Just a quick comment about a

couple of the answers that the Minister gave us, and I want to

thank the Minister for responding the way he is. It's the first

Minister we've had....

AN HON. MEMBER: The only one.

MR. McCLELLAND: The only one who really responded to our

questions and we appreciate that very much.

The Minister did say, however, that the Foulkes report was

under discussion, but it really isn't because the Minister

refuses to discuss it. He has suggested, in fact, that it isn't

appropriate that there be discussion of the report on the floor

of this Legislature. I don't know where else it is more

appropriate than on the floor of this Legislature to discuss a

report of this proportion, and of this expense to the people of

British Columbia.

AN HON. MEMBER: It's $270,000.

[ Page 1625 ]

MR. McCLELLAND: The Minister now says at least

half-a-million or a little better — and that's some

discussion.

Mr. Chairman, the Minister also said earlier that they're

looking for ways to solve the alcohol problem, the drug

dependency problem. He said, "If someone comes along with

something we haven't seen yet, we'll look at it." The question

I'd like to ask is: why won't the government look at some

things that have been presented to it for years and years? Why

something that's new? What's wrong with some of the suggestions

that have already been made? I'd suggest that those may be just

as valid as any yet undiscovered magic cure. Let's look at some

of the things that have already been presented to the

government.

I just want to get clarification on this matter of the

interference by the Minister into the bargaining procedure of

the Hospital Employees Union and the Hospitals Association.

It's my understanding that the provisions of the mediation

commission, in the agreement that was signed, were that there

were certain grievances which were as yet unsolved and the

agreement was that those grievances would be settled during the

life of that contract. There's nothing wrong with that. Nothing

wrong at all with that.

It's the same kind of an agreement that the Minister of

Transport and Communications (Hon. Mr. Strachan) made with the

Ferry workers. The only difference is that the Minister of

Transport and Communications didn't keep his word with the

ferry workers, and that's one of the reasons they're upset. But

that's all right; there was nothing wrong with that. No big

deal.

I'm glad the Minister mentioned the Cumberland Hospital.

There is an intermediate unit going in there, and that's

good.

He also suggested the other day in the House that the people

in the Cumberland area are all happy as anything about what's

going on in there. But that's hardly the case. The people in

the Cumberland area are pretty upset about the treatment

they've had from this government with regard to their

acute-care hospital and they'd like some answers about that as

quickly as possible.

Many of them come to me as the health critic on this side of

the House and for help. They want to know what the government

is going to do.

In the last election, the Member for Comox (Ms. Sanford) was

almost going to march on Victoria if they didn't get their

acute-care hospital. I have some clippings here in which the

Member is quoted.

Interjection.

MR. McCLELLAND: All right, I will, if you insist.

On August 23, 1972, the Member for Comox said, "I feel that

Cumberland should retain its hospital."

The Minister of Transport and Communications (Hon. Mr.

Strachan) said on that same date at the same meeting, "You've

got a better chance of a new hospital with Karen than with the

present MLA." Some chance, some change! Then the Member herself

said, in a letter to the editor,

"The following is a letter which I mailed today to the Hon.

Ralph Loffmark, the Minister of Health, in Victoria.

'Dear Mr. Loffmark:

As a provincial NDP candidate for Comox riding, I am particularly

concerned about the future of the hospital in Cumberland. The people of the

area are understandably confused by conflicting statements on the matter. Mr.

Donald Cox, Deputy Minister of Hospital Services, informed Mayor Bill Moncrief

of Cumberland that the hospital would be phased out; Premier Bennett, speaking

in Courtenay on Sunday, said he favoured construction of a new hospital. I urge

you to inform the people of this area just what the plans are for that hospital.'

That isn't all she asks:

"'I personally feel that a new hospital should be

constructed in Cumberland in order to provide adequate hospital

services to the residents of this area.'"

That's a pretty positive statement from an NDPer running for

election in that area. What did the leader of the opposition in

those days say in that area? That's the present Premier of

British Columbia, Mr. Barrett.

MR. PHILLIPS: Trust us, trust us.

MR. McCLELLAND: He doesn't say that any more; he doesn't

bother to say, "Trust us" any more.

Interjections.

MR. McCLELLAND: Mr. Chairman, may I continue?

HON. MR. BARRETT: Oh, certainly.

MR. McCLELLAND: Thank you. He was talking about the staff at

the hospital. The Leader of the Opposition took a tour of the

hospital and was talking all about the facilities and the

staff. He said, "You've got skilled staff here for the

hospital. That's great." And then he said: "We should build on

that rather than abandon it. What you are really threatened

with is the loss of a good staff." Barrett was earlier informed

that Cumberland is fighting not just to save the old buildings

but for a new 75-bed hospital. "The more I see of it, "

Barrett said, "The more it makes sense."

Where is Cumberland's new hospital? The people

[ Page 1626 ]

in Cumberland are terribly upset, so upset, as a matter of

fact, that I came across this headline in the Comox District

Free Press which says, "Non-Confidence Voted in Karen".

HON. MR. BARRETT: There were 15 people at the meeting.

MR. McCLELLAND: There were 500 people at the meeting, Mr.

Chairman, 500 people according to the editorial in this paper.

Do you say 15? Wednesday, March 20, 1974.

HON. MR. BARRETT: How many people at the meeting?

MR. McCLELLAND: Well, let's read and find out. I wasn't

going to read this but I will. We'll read the whole thing.

Interjections.

MR. McCLELLAND: Do you want to read the headline again:

"Non-Confidence Noted in Karen." Karen Sanford, Member for

Comox. Yes, really. Non-confidence.

Mr. Chairman, if I could continue.

MR. PHILLIPS: I voted non-confidence in her years ago.

MR. McCLELLAND: May I continue, Mr. Chairman?

"Sunday's vote of non-confidence in Comox MLA Karen Sanford

by citizens of Cumberland and surrounding area over her lack of

support in saving the Cumberland General Hospital from closure

is not unexpected."

HON. MR. BARRETT: How many people at the meeting?

MR. McCLELLAND: Well, wait, I'll get to that, Mr.

Premier.

"Displeasure over the inaction of the MLA has been simmering

over the past year, and things came to a head with the

announcement a few weeks ago that the hospital was being phased

out. The motion, passed at a meeting Sunday with only one

dissenting vote, came after citizens had openly criticized Ms.

Sanford for her hypocritical and arrogant cold shoulder to the

wishes of those persons directly affected by the NDP

government's decision to close the Cumberland hospital.

"It was quite evident at a public meeting we attended last

December that the majority of the 500 citizens in attendance…"

— 500 citizens.

Interjections.

MR. McCLELLAND:

"…were definitely opposed to the plan to close the

hospital. Several speakers at that meeting reminded their

elected representative of her promise prior to the last

election that she would fight to retain acute-care beds in

Cumberland."

It's not my headline, Mr. Premier.

"What is distressing to many citizens is the manner in which

Ms. Sanford has handled the hospital issue. Citizens are

naturally angered that she has failed to live up to her

pre-election promise, but what they resent even more is Ms.

Sanford's presumption to tell them what will be good for them

in respect to institutions."

This is good stuff. You should listen to this; it's really

good stuff. It says a lot more here.

"The lack of positive action on the part of Ms. Sanford in

attempting to alleviate some of the problems which abound in

this riding is causing concern to many citizens."

They go on to talk about other things which don't relate to

health but, nevertheless, lead the area to say "Non-confidence

Voted in Karen." In that

article on the front page they

say:

"The citizens of Cumberland and the surrounding district

passed a motion of non-confidence in local NDP MLA, Ms. Karen

Sanford, Sunday night for her lack of support in saving

Cumberland General Hospital from the deathblow of Health

Minister Dennis Cocke.

"The committee also noted in the motion Ms. Sanford's

pre-election pamphlet in which she pledged full support to

retain acute-care beds in Cumberland.

'' The committee said they also resented…."

Well, I won't repeat that; I've already said that. But they

also said that, "Ms. Sanford was not representing them but

ruling them."

Well, that's the hospital in Cumberland. Then there was also

a group of people who came into my office the other day and

wanted to know what this government was doing about a hospital

in the Sidney-Saanich Peninsula area.

Interjections.

MR. McCLELLAND: Well, I can't really help it if the people

come to me, but the business of British Columbia is the

business of all of us. We'll treat it as such. There's a

serious question here of a hospital which

[ Page

1627 ]

was promised to the area's residents and is now apparently

being forgotten; that promise is being forgotten by the

government.

The Health Minister on February 12 told the people of that

area that the question of providing acute-care hospital

facilities in that area must be very quickly resolved. Speaking

on acute care for the peninsula, Cocke said, "That's an

argument we must get into very quickly and resolve." The people

still want to have it resolved, and they think all they would

like you to do is live up to the promise that was made for

those people to have a hospital in that area.

I understand that the construction carried out on the

hospital to this date has been carried out in a manner so that

an acute-care hospital could be added. There are facilities

there for an acute-care hospital. The people want an acute-care

hospital; they've already passed a referendum to pay for an

acute-care hospital; all they want now is the Minister to tell

them why they can't have their acute-care hospital. I think

that's a reasonable request of the Minister and I agree with

him that that matter should be resolved very quickly.

MR. CURTIS: I'm sorry the Member for Langley felt it

necessary to raise the matter of the Saanich Peninsula

acute-care hospital this evening. I am aware of the issue, very

much aware of the issue. I have discussed it with the Minister

and I think the Minister knows the matter rests with the

regional hospital district of the Capital Regional District at

the moment. I did not want to raise the matter during the

estimates because the decision is not on his desk at the

present time.

I've attended more than one major meeting with more than 15

people present, with more than 500 people present. In fact, I

attended one in Sidney in Sanscha Hall earlier this year with

something over 800 people present. The people of that peninsula

want that hospital. But until the Minister suggests, "You can't

have it," I am prepared to work quietly with the

Minister and with his department to secure the hospital.

Interjection.

MR. CURTIS: Yes, I have one in both cars, Mr. Member. I am

very much aware of the strong desire on the part of the

residents.

Interjection.

MR. CURTIS: Well, as I say, I am sorry the Member felt it necessary

to raise this tonight. The Minister knows how I feel; the Minister knows how

the people on the peninsula feel. We want the hospital, but I felt it was a

matter that did not need to be raised in political debate at this time.

HON. MR. COCKE: I am not going to deal with the Sidney

hospital but I do want to say something about the Cumberland

hospital and I want to say it very quickly.

The Cumberland hospital was a decision made by the previous

government. I have in my possession a memorandum by the former

government to the Deputy Minister, Donald Cox, telling him not

to announce that they would have to close the Cumberland

hospital because of the decision to open up 70 new beds in

Comox. Not to announce it!

Once that became a fait accompli, there was no other course

but to go the way we did with the Cumberland hospital — unfortunately.

Interjection.

HON. MR. COCKE: Certainly we will. Absolutely. I can't do it

tonight but I will certainly table it tomorrow.

Mr. Chairman, that MLA for Comox is one of the

hardest-working MLAS; I have never had more representations

from anybody in this House. I think I have said enough.

MS. K. SANFORD (Comox): I'm pleased to see the Hon. Member

for Langley is back in the House because I, too, have a copy of

the paper he was referring to. I would agree it is unfortunate

that issues like hospitals have to become political issues as

that Member has chosen to make it this evening. I think that's

unfortunate.

I think the Ministerial responsibility which the Hon.

Minister has to show in cases such as the situation at

Cumberland is one which I wouldn't wish on anybody. I think the

kinds of decisions that a Minister of Health has to make in

this province in order to provide the best possible health care

for the people requires that he make decisions as unpopular as

the one which has required the closure of the oldest hospital

in this province, namely the Cumberland hospital.

In Comox Valley we have two hospitals located nine miles

apart. With the opening of 70 additional beds out at Comox, the

Minister could not justify a surplus of acute-care beds in the

Comox Valley and is therefore closing the old building as an

acute-care facility.

It was not an easy thing for the people of Cumberland to

accept, Mr. Member; it was not an easy decision for them to

accept. The people of Cumberland years ago worked to build that

hospital. The miners in the early days paid $4.25 out of every

monthly cheque, money which they could not afford, in order to

build that hospital. It's not easy for them to accept that

decision; it was not an easy decision

[ Page 1628 ]

for the Minister to make.

MR. CHAIRMAN: Order, please!

MS. SANFORD: In order to soften the blow to the people of

Cumberland, the Minister decided he would leave the building

open as a diagnostic and treatment centre and also as an

intermediate-care unit until we can have built in Cumberland a

brand new diagnostic and treatment centre and a brand new

40-bed intermediate-care unit in Cumberland. I have supported

the Minister's decision in this because I am convinced the

Minister is providing the best possible health care for the

people of the Comox Valley. Not only will we have sufficient

acute-care beds to serve the needs of the valley but we will

have intermediate-care which i