Fifth Session, 42nd Parliament

(2024) OFFICIAL REPORT

OF DEBATES

(HANSARD)

Tuesday, April 23, 2024

Afternoon Sitting

Issue No. 417

ISSN 1499-2175

The HTML transcript is provided for informational purposes only.

The PDF transcript remains the official digital version.

CONTENTS

Orders of the Day

Committee of Supply

Estimates: Ministry of Health (continued)

S. Bond

T. Stone

Hon. A. Dix

L. Doerkson

Reporting of Bills

Bill 19 — Children and Family Development Statutes Amendment Act, 2024

Committee of Supply

Estimates: Ministry of Health (continued)

Hon. A. Dix

L. Doerkson

S. Bond

B. Stewart

T. Shypitka

S. Furstenau

A. Walker

Proceedings in the Douglas Fir Room

Committee of the Whole House

Bill 19 — Children and Family Development Statutes Amendment Act, 2024

A. Olsen

Hon. G. Lore

N. Letnick

E. Ross

Bill 15 — Budget Measures Implementation (Residential Property (Short-Term Holding) Profit Tax) Act, 2024

P. Milobar

Hon. K. Conroy

Proceedings in the Birch Room

Committee of Supply

Estimates: Ministry of Education and Child Care (continued)

E. Sturko

Hon. R. Singh

D. Davies

A. Walker

Hon. M. Dean

A. Olsen

TUESDAY, APRIL 23, 2024

The House met at 1:32 p.m.

[The Speaker in the chair.]

Orders of the Day

Hon. A. Dix: In the main chamber, I call Committee of Supply for the Ministry of

Health.

In the Douglas Fir Committee Room, I call Committee of the Whole for Bill

19, the Children and Family De­velop­ment Statutes Amendment

Act.

In the Birch Committee Room, I call Committee of Supply for the Ministry

of Education and Child Care, followed by the Ministry of Post-Secondary

Education and Future Skills.

Committee of Supply

ESTIMATES: MINISTRY OF

HEALTH

(continued)

The House in Committee of Supply (Section B); J. Tegart in the

chair.

The committee met at 1:35 p.m.

The Chair: I call the Committee of Supply to order. We’re dealing with

the Ministry of Health’s estimates.

On Vote 32: ministry operations, $32,710,062,000

(continued) .

S. Bond: Good afternoon to the minister, staff and the Chair.

I know that we are literally on the clock now. Just as the

minister has binders of answers, I have binders of questions, so I’m

hopeful that we can work through them as expeditiously as possible. In

some cases, I may just read the question into the record. The minister

is…. I would be very happy if he’d provide a response at some point in

the future.

I would like to begin by ceding the floor to my colleague from

Kamloops–South Thompson so that he can ask his questions. I’m sure the

minister will have all the answers that my colleague

requires.

T. Stone: Thank you to my colleague from Prince

George–​Valemount.

I see the minister has a great big smile on his face, so that’s

good.

Interjection.

T. Stone: You and I reunited once again, yeah.

Anyway, I’d like to ask a few questions about the cancer centre in

Kamloops. I will preface this by saying there’s been a lot of

back-and-forth on this over the years. I’m going to spare everyone the

historical assessment of how we are where we are today. I think what

really matters is that with a business plan having been approved

recently, on February 8, and work underway as we chart a path forward

where there will be a cancer centre in Kamloops, it’s on the

horizon.

I think the critical component now is making sure that we get the

cancer centre right and that the components that are part of this

facility actually truly make sense, based on the input and the feedback

of health care professionals that are currently delivering cancer

services in Kamloops.

I just have a series of questions. I’ll try to be as brief as I

can in posing them and would hope that the minister can be concise, as

well, in his responses. First off, the current Kamloops centre facility

is, as the minister knows well, considered a community oncology network

site, so a CON site. It’s under Interior Health administration, although

physicians are paid by PHSA. Regional B.C. cancer sites are under PHSA

administration.

The new Kamloops cancer centre, recently announced, consists of a

four-floor parking lot. There’s a floor for radiation services. This new

site, as I understand it, will be under PHSA administration, while the

systemic side of cancer treatment — so the existing CON site, which is

existing in Royal Inland Hospital today — will remain under IHA

administration. This fragmented cancer care in our community is

represented by putting the medical oncology and the radiation oncology

in two separate geographic and administrative silos.

My understanding is that this type of model is unproven and that

there’s no other small cancer centre in Canada or the United States that

has the medical oncology and the radiation oncology siloed in two

different buildings. I’m also told that this plan was announced without

engagement of the local Kamloops cancer health care providers, and I’m

certainly hearing from a lot of them who are quite concerned.

[1:40 p.m.]

I guess the first question would be this: could the minister

specifically point to where in North America this model of a fragmented

delivery of cancer care, between the systemic on the one side and the

oncology on the other, exists that the minister or the ministry is

basing the plan for the Kamloops cancer centre?

Why would the minister think that it’s a good idea to proceed with

this unproven, sort of fragmented, model that certainly wasn’t advanced

and doesn’t appear to be supported by a good number of the health care

professionals who are delivering the cancer services in the existing

community cancer clinic in Royal Inland Hospital today?

Hon. A. Dix: The answer starts in 2002. I won’t do that, except to say that

this plan and this way that we govern cancer in B.C. comes out of the

reorganization, the creation of health authorities in B.C. in 2002, by

the previous government.

What happened was…. I know that predates the member’s time in the

Legislature by a little bit, although I think he was here. In any event,

he was in town.

What we have is a cancer centre that’s run both by the PHSA and by

regional health authorities — B.C. Cancer, for the PHSA, and regional

health authorities. That’s the structure that’s been in place since that

time. There has been some comment about that over time, but the system

is quite integrated.

What we are doing, and it’s envisioned in our ten-year cancer

plan, is to provide further integration in that. We’re going to be

engaging with oncologists in Kamloops and other communities about this

as well, particularly in Interior Health. It was the decision that was

made at that time to have a provincewide system, but a lot of what is

cancer care is also provided by regional health authorities.

This is a made-in-B.C. system that stems from that time. We are

looking at greater integration, including in Kamloops, but it’s

consistent with what’s happened in the management of cancer care over a

long period of time.

I just wanted to introduce, directly behind me, Dr. Kim Chi, who’s

the leader of B.C. Cancer in B.C.

T. Stone: I think the piece to be really clear on is that the regional

cancer centres…. If we talk about Kelowna, if we talk about the centre

in Prince George, if we talk about the centre in Victoria…. These are

fully integrated cancer centres that have both the oncology and the

medical sides done or the radiation sides done in the same facility.

They’re fully integrated. I think the concern that is being expressed in

Kamloops is that that isn’t the plan, going forward, with the investment

being made. Often radiation is given concurrently with chemotherapy, so

the medical and the radiation oncologists have to work very closely

together.

I’m just expressing the concern that local health care

professionals have brought forward. The question that they’ve asked me

to ask you is: how will this integration actually work? How can we

confidently say it’s going to work as best as possible when the two

different sides of cancer care are working in two different geographic

locations, very much siloed — under the administration, on the one hand,

by PHSA in terms of the radiation side, and Interior Health continuing

to administer the local side? How are they going to be

possible?

How can they best integrate their services when they’re in those

two different locations? They’re under two different administrations,

and even furthermore, they’re using two different electronic medical

records systems.

[1:45 p.m.]

Hon. A. Dix: By working together. That’s the absolute intention to do so, not

just in Kamloops but across the province. There are a lot of aspects of

cancer care, in­cluding surgery, that inevitably will continue to

be done at the health authority level — a lot of support for patients is

done.

Further integration is required, and what we’re going to do in

Kamloops is what we’ll do in other places, which is work with the

oncologists working, in some ways, in both streams and the staff working

in both streams to ensure that that integration occurs, and that work

occurs.

That work starts, really, now, because even though, as the member

will know, the business plan is approved and we’re going forward with

the request for proposal soon and then going on with building the

centre, a huge part of the preparation for that will be the recruitment

of staff and working together to ensure that the centre is all that all

of us who believe in the Kamloops cancer centre want it to

be.

T. Stone: I do appreciate the minister’s comment about working towards

further integration in the future.

I guess the frustration and the concerns that are being expressed

by…. The local health care providers in Kamloops that are delivering

cancer care today are saying it would be better, within the context of a

significant investment being made, for that integration to have been a

feature of the new cancer centre and that it would actually truly be a

regional cancer centre in every way, shape and form, as is the case in

Kelowna and Prince George and Victoria and elsewhere. That’s the

concern.

I’ll move on to my next question, though. This is all tied

together.

If concurrent chemoradiation is provided, I think we all

acknowledge that there will be a corresponding increase in patient care

volume. The current team of health professionals delivering cancer care

in the community has been, I think, making tremendous efforts but

nonetheless has been trying to recruit medical oncologists and general

practitioners in oncology to the Kamloops cancer clinic for years

without a lot of success.

When you compare the existing system, the CON cen­tre that’s

in Kamloops, and you compare the CON centre physicians to regional

centre physicians, the CON physicians see more patients. These are,

again, the physicians that are in the existing cancer clinic in Royal

Inland. They see more patients, they have less protected time, they

manage typically more tumour sites, they have less support, and they’re

not offered paid sabbaticals like the regional cancer centre physicians.

They are paid the same annual salary as regional centre

physicians.

Hence, all new recruits to this point have chosen, when given the

option, to actually go and work in a regional cancer centre, where they

have all of these additional supports. They’re choosing not to go to the

CON centres like the clinic in Kamloops.

The question would be this. Could the minister just outline how

Interior Health, the PHSA, the Ministry of Health…? How do you envision

the Kamloops medical oncology team will deal with this expected

increased volume of patient care, with concurrent chemoradiation, when

the existing Kamloops cancer clinic is already massively overstretched

and having significant challenges at recruitment?

Hon. A. Dix: Dr. Chi has already begun that consultation, with respect to the

member’s first two questions. We expect that work to be happening this

summer, understanding that the new cancer centre will be in place later

on. I know the member wasn’t suggesting we should delay the cancer

centre in order for that to happen, so I’ll leave that aside.

[1:50 p.m.]

As the member can imagine, my desire is to go on these projects,

but part of going is ensuring that we recruit. We’re going to have an

occasion, I’m sure, with the opposition Health critic, to talk about

cancer recruitment. Just to say that since the cancer plan came into

place, 94 new cancer doctors were working for B.C. Cancer across B.C.

That involved a change, in that case, in recruitment and in payment. Our

base rate for oncologists went from $410,000 to $472,000, making us

competitive with everyone else. What we found was that doctors came back

not because of the money but because of the recognition that that

indicated.

Equally, we’ve done the same with RTs on the radiation side. That

has been an important…. We’ve made very significant progress there. This

has been the best year, net, that B.C. Cancer has ever had in terms of

recruiting. We will have a major recruitment plan, including in

hard-to-serve areas. You understand, I think, that there are 42

community oncology network sites. We’re also looking at HHR issues and

at payment issues there in order to ensure recruitment

everywhere.

As the House will know, because we’ve talked about this before,

we’re going to go from in the neighbourhood of 34,000 diagnoses this

year, on a population increase of 575,000 over three years, which is

stunning, in B.C. Just think of the share of that, the share of

population that has cancer. We’re going to go from about 34,000 new

diagnoses of cancer, we expect, this year, which is way up, to about

45,000 in ten years. So what is required in Kamloops is required

everywhere.

One of the areas that we’re really focused on in the plan is also

the community oncology network sites. These new regional centres are

going to be important. Nanaimo and Kamloops and Surrey and Burnaby:

there will be major recruitment efforts there. But we also have to

support the community oncology network sites — I hesitate to use the

acronym — in 42 communities, which are vitally important. I’ve visited

them everywhere, including in places as diverse as Vanderhoof and Trail,

around the province.

Those are important sites. We have to continue to be able to

recruit to those sites. We’re looking specifically at that now because

what you don’t want and what we don’t want is the new cancer centres in

Kamloops and in Nanaimo to affect our community oncology network as

well. So that work is being done. And in hard-to-recruit areas, we’ve

been looking at significant supports for people. I think that sort of

addresses that question.

I think people are going to want to work in Kamloops. I think it’s

going to be exceptional. I think the team is going to be able to find,

working together with B.C. Cancer, the care that’s provided. We’re

certainly open to all of the suggestions to make sure it’s as seamless

for patients as possible.

We have, the member will know, cancer patients in my family.

They’ve gone through both radiation and chemotherapy recently, so we

know on a personal basis. And then collectively, all of us have

constituents and others who’ve been dealing with that and know that

you’re in one system. You want to be treated as if it’s seamless. These

questions that develop, they’ll be questions for the organization but

not for patients.

T. Stone: I completely agree in the sense that I think the minister and, I

would suggest, every member of this House would support the most

seamless and integrated care that we possibly can. We know the

prevalence of cancer is increasing. The rates are going up. People are

living longer. There’s just more overall sheer volume of cases. We know

that in Kamloops, the chemotherapy treatments are projected to increase

significantly.

This, again, all boils back to making sure that the health care

professionals who deliver the cancer care in Kamloops today have a

better, more confident sense that the building blocks that need to be

there in order to successfully deliver on the promise of this seamless

cancer care can actually happen, will actually happen.

The concern around Interior Health continuing to administer the

community oncology site in Kamloops versus PHSA managing the radiation

side…. The recruitment challenges the community, the existing clinic has

faced, and recognizing that unless…. The minister can correct me if I’m

wrong. It doesn’t appear that the community oncology site is going to

disappear anytime.

[1:55 p.m.]

The challenge around the existing site from a recruitment

perspective, which I mentioned in my previous answer, and from a

staffing perspective is that the physicians…. There are benefits and

entitlements and things that the physicians have in a regional cancer

centre that they don’t get with a community centre like the one we have

currently in Kamloops.

I said that the community centre physicians are expected to see

more patients. They have less protected time. They manage more tumour

sites. They have less support. They’re not offered paid sabbaticals.

These are all factors that come into play in a deeply, deeply

competitive labour market where we need a heck of a lot more cancer

professionals across the whole board in communities right across the

whole province.

There is a hopefully not real but at least a perceived

disadvantage being baked into the cancer plan in Kamloops by having IHA

manage the one side that doesn’t offer the same realities that are as

attractive to recruitment and hiring physicians as there are on the

regional centre side. It simply boils down to: if this is truly a

regional cancer centre that’s intended, then why isn’t this integration

just part of, a feature of what Kamloopsians and the region can expect

when the new cancer centre opens its doors on day one?

Another aspect to this, which again just further underpins the

frustration and the concern and the worry that a lot of the health care

professionals delivering cancer care in Kamloops today have, is this:

when the government announced its new ten-year cancer plan with $500

million to improve cancer care, part of that was to hire 400-plus

additional cancer professionals across the province. Again, I stand

corrected if the minister has a different number, but I think around 300

had already been hired.

But the point is that none of those hires were directed towards

these community cancer sites, like the existing clinic in Kamloops —

none of them. That’s against the backdrop of estimates that the CON

sites, like the cancer clinic in Kamloops, provide 50 to 70 percent of

all chemotherapy treatments. Yet because they’re under IHA

administration, they don’t receive any of the additional supports that

have been rolled out to the regional cancer centres. Those additional

supports really matter.

So there’s everything I’ve talked about from a recruitment

perspective that make things more attractive to the doctors, to the

physicians. These other supports include things like having a dedicated

cancer pharmacy. I do appreciate that the existing cancer clinic in

Kamloops is being relocated to the main floor so it’s adjacent to the

pharmacy. That, I’m told by the health care professionals’ accounts, is

not good enough. The Kamloops cancer centre, at the end of the day, will

be the only so-called regional cancer centre that doesn’t have its own

dedicated cancer pharmacy. So that’s number one.

There are a whole bunch of support services that aren’t included

in the plan, such as counselling, psychiatry, drug navigator, clinical

trial navigator, administration support, adequate nursing levels. These

are all concerns that are being expressed to me from these health care

professionals, again, that deliver cancer care today in the existing

Kamloops clinic.

When you look at the differential from a recruitment perspective,

the differential that makes things more attractive for physicians to go

to a regional centre versus a community cancer clinic, and you look at

the types of additional supports that are just inherent with a regional

cancer centre anywhere else that they exist in the province but that

won’t be in place in Kamloops — certainly not when the new cancer centre

opens up and the existing cancer clinic is relocated — I guess the

question that health care professionals would want me to ask the

minister would be: how can the minister and this government refer to

this cancer project as a regional cancer centre?

[2:00 p.m.]

The minister did refer to the Kamloops cancer centre that’s

planned as regional. It will be a regional centre. How can he refer to

it as that when it won’t have many of these features and components that

exist at all the other regional cancer centres — again, a dedicated

cancer pharmacy, support services like counselling, psychiatry, drug

navigator, clinical trial navigator, and so forth? None of those

features will be included in the delivery of cancer services in

Kamloops, even after this project is completed.

Hon. A. Dix: With respect to the community oncology network, just to be clear….

We’re moving from six to ten regional cancer centres, which is great

news for people. We also have 42 community oncology network sites, and

we are on the health human resources issues on those sites.

I know the situation in Kamloops and in Nanaimo is different.

They’re both moving to the regional cancer centres in those

places.

We have a regular working group on the CON sites that’s going to

see to these things and will require that improvements be made. The

increase in demand for chemo­therapy in communities around the

province is significant. So that’s the work that’s taking place

now.

With respect to the Kamloops cancer centre, the work is starting.

We will be doing that work, as we always do, with the health

professionals in the community.

With respect to the pharmacy, just to talk about the proposal for

a little bit…. You’re going to see a significant renovation. Really,

what it means for the pharmacy in Kamloops is that the cancer pharmacy

will be co-located with the rest of the pharmacy, which is not, I think

the member would agree, necessarily, in itself, a bad thing.

Certainly, significant renovations and relocation are going to

happen to the existing CON clinic and to the existing pharmacy. We’re

going to see a significant expansion of both.

I know the member knows this. We won’t talk about parking — he’s

asking really specific questions about cancer — but that’s added

too.

This is going to be a phenomenal regional cancer centre. It’s

going to be phenomenal because of the people who work there now and the

people we’re going to recruit. The work is happening now to make sure

that for patients…. This is a regional cancer centre, and all of these

issues are just something that happened between health

professionals.

I expect it to be just a spectacular success. I know the people

there. I know the member has met with some of the people there. That

work is happening and starting. Some of that work is starting now. We’re

confident that this is going to be a regional cancer centre that

everyone is proud of.

In the meantime, of course, the RFP and building the cancer centre

and all those things are going on. We feel we’re in good shape to do all

that. Dr. Chi and his team will be leading those efforts, starting, I

think, next month, with local doctors, local oncologists.

You can assure them that they’ll be very much part of the process.

It will become and is their centre in every way. You do that by working

with people from the ground up. We’re going to be ready to go. That work

is going to be excellent.

[2:05 p.m.]

On the community oncology network…. Just to be clear, that’s a

very significant part.

I’ll just note this. We’ll be having, again, this debate a little

later. We did, in total, 11 percent more patients and follow-ups this

year than last year. So in one year. That’s an exceptional performance

by our health professionals in cancer. That’s everywhere in B.C. That’s

at our 42 sites around the province.

That gives you a sense of, if you’ve got an 11 percent increase in

one year, the increase in the number of people needing cancer care and

the exceptional response of the system to that need. That’s got to

continue, and that’ll continue in Kamloops.

T. Stone: The health care professionals that deliver cancer care in Kamloops

definitely were excited about the prospect of enhancing the

infrastructure in Kamloops and building it out and the prospect of a

truly regional cancer centre in Kamloops. Again, in every way, shape and

form the same as in Kelowna, Prince George, Victoria and elsewhere. It

is something that definitely has the health care professionals excited

and the community as well.

I come back to my original point. These questions I’m asking today

are coming directly from the doctors and others that are delivering the

cancer care in Royal Inland Hospital today at the community oncology

network.

They’re very concerned, again, about the fragmentation. They’re

very concerned that there doesn’t appear to be a plan to ensure that

there are no differences between, if I can call it, the working

environment of physicians that work in the regional centre, which are

superior in a number of ways that I have outlined in my previous

question, and doctors and physicians in the community oncology network

side.

Those additional support services, which are specifically spelled

out as features of regional cancer centres in these other communities —

Prince George, Kelowna, Victoria — are not part of the initial plan for

Kamloops. That has everyone concerned.

The one final piece that I’ll add to the mix…. I just really want

to understand the plan moving forward.

The current team of health care professionals that are delivering

the best possible cancer care they can in Kamloops, with the resources

they have, are telling me…. Their understanding is that the square

footage of the upgraded cancer clinic is the same as the current

space.

I’ve been advised that Interior Health has actually not sat down

with these health care professionals who currently work at the existing

Kamloops cancer clinic to engage them more fully in the planning

process, despite frequent requests to have an opportunity to provide

their input. That said, if Interior Health did consult these health care

professionals, they would be told that the upgraded space is inadequate

and, in the opinion of these health care professionals, would not

actually improve or benefit their workflow or benefit patient care. This

is looking forward. The reason being….

It was reported recently that the Kamloops cancer clinic saw 4,935

visits for chemotherapy in 2022. That’s projected to increase to 7,187

chemotherapy treatments when the new cancer centre opens. Those are

numbers from Todd Mastel, the executive director of IHA business

operations.

In order to deliver that many more treatments…. These health care

professionals are saying that more space, not the same, is going to be

required. Yet that’s not possible within the footprint of where the

clinic is proposed to be moved in Royal Inland Hospital.

The question would be this. Why is the minister proceeding with a

plan that will not actually provide for the space and capacity needed to

deliver what amounts to a projected 45 percent increase in chemotherapy

treatments at the existing cancer clinic or community oncology network

site in Kamloops?

[2:10 p.m.]

Hon. A. Dix: It is, just to be clear, in total, approxi­mately 1,000 to

2,000 square metres of renovation, 19,000 to 20,000 square metres…. If

it were square feet, it would be more, right? I’m looking to my

colleague from Williams Lake.

So 19,000 to 20,000 square metres of new construction is

anticipated, with 4,000 square metres of that new construction dedicated

to the cancer centre and the rest making up the parkade, which has the

most area, as the member would expect.

The overall project cost for the project is estimated — obviously,

it will be in an RFP process — at $359.04 million. Just by way of

comparison, the one in Nanaimo is $288.76 million. This is, I think, a

significant increase, both to the size and to the services

delivered.

I think the point the member is making is that there’s a need to

engage with local people in the community. That’s exactly what’s going

to happen and exactly what you would expect to happen, to make sure that

this really very significant investment in the hospital, a hospital

that, between the previous government and our government, has received

very significant increases over time….

This is building out. This is going to be, as a hospital site, a

fantastic hospital site. The cancer centre is going to be integrated in

that. We’re going to be preparing and working with those that are

working there now and those that we will be adding to that and will be

coming to work there in the next period.

We have to, at our community oncology networks, respond to both

issues of space but also to issues of hours, not on one site but at 42

sites, if you’re seeing that kind of increase in diagnoses. We’re

expecting that a very significant proportion of those will be

chemotherapy, that some will require radiation and that some, of course,

will require both.

I think what the member is bringing to my attention are some

concerns by local people who provide cancer care. I’m saying we’ll hear

those and engage those concerns. They’ll be part of the process, because

this is their centre. It’s not my centre; it’s our centre, and we want

it to be successful. That means doing the very work together that both I

and he have been talking about.

T. Stone: I do hope that the minister ensures that there is true engagement

with the health care professionals that are delivering cancer care in

Kamloops today, because I can assure the minister that that is not how

most of those health care professionals feel today. Many have indicated

that they’ve written to the minister but haven’t received responses,

They’ve tried to engage the local reps that are involved in advancing

this project and haven’t been able to engage. I think they are raising

some very legitimate concerns.

When I talked about the concern these health care professionals

have around the square footage of the relocation of the community

oncology network site, the existing cancer clinic in Royal Inland

Hospital, the local health care professionals delivering the cancer care

in Kamloops say that their understanding is that that footprint is not

going to be any bigger.

I completely understand that the actual new cancer centre

building, which has been announced, has a floor for radiation services

and some other pieces related to that. Obviously that’s all net new

space; I get that. I know there are four floors of parking, that there’s

much-needed parking at Royal Island Hospital. There, I got it in for the

minister, so he didn’t have to.

That’s not to say that…. The concern that these health care

professionals have expressed is about how the heck they’re supposed to

deliver a 45 percent projected increase in chemotherapy treatments

within the CON clinic in the Royal Inland Hospital, in the relocated

space when it’s all done, when that space is not any larger than the

space that they’re in today. That’s the point.

[2:15 p.m.]

I’m going to end here. I am very appreciative of the time that my

colleague from Prince George–Valemount has provided for me and the

opportunity to have this back-and-forth with the minister.

I want to end on this note. One of these health care professionals

delivering cancer care today asked me to provide this quote to you from

her, on behalf of the department.

It goes as follows: “We owe it to the citizens of Kamloops and the

entire region to ensure a sufficient cancer centre is built in our

community, one that is endorsed by the current team of health care

professionals delivering cancer care in the community, one that will

encourage recruitment of cancer care physicians and one that is

sufficient to service our future community cancer needs. Unfortunately,

the current plan is inadequate and will hinder rather than improve

cancer care in our community. That’s our concern.”

I encourage the minister to please direct the appropriate Interior

Health officials, particularly with respect to the community oncology

network site, the existing cancer clinic, to as soon as possible, reach

out to these health care professionals. They want to be proud of the

investments being made. They want to be proud of the new cancer centre,

but they also have this pretty unique and, I think, valuable and very

pertinent insight into best practices in the delivery of cancer care.

They feel that the project is not on the right track in a number of

respects which we’ve canvassed in this exchange here today.

If the minister could please reach out to them, provide me that

assurance, I know that will go a long way to hopefully, if it’s not too

early in the process, maybe course-correct on some of these things and

incorporate their feedback into the planning. Let’s make sure that we

get this very important regional cancer centre investment and buildout

in Kamloops and for the entire region. Let’s make sure that we get it

right.

Hon. A. Dix: First of all, there will be a meeting that involves, obviously,

the PHSA with B.C. Cancer, IHA, local community teams and local doctors

on May 13. Really, this is the work we’re doing now. We’ve gone through

this stage, and we’ve had discussions over the years. My job, in some

ways, is to set this in motion, to find the resources to deliver a

cancer centre. And it’s our team’s job to make sure that it’s all that

we need it to be.

The only point I would make to the member, and I said this in all

the responses, is that on the community oncology network side, we’ve got

a lot of work to do everywhere, not just in Kamloops. I know he’s

focused on Kamloops. That’s his constituency. What he’s highlighting

there is something that we’ve got to do everywhere. We’ve got to do it

in Williams Lake, we have to do it in Prince George, and we have to do

it everywhere else. Also smaller sites such as Vanderhoof, where they

have community oncology networks that are seeing similar growth and

demand.

I’m really excited. I’m actually excited to have this exchange

with the member about how we’re going to make the cancer centre we’re

all building together a great thing. I would describe that as progress.

The business plan is progress, the moving ahead, the delivering of

service and the work we’re going to do together. Ultimately, it’s the

people of the region who are going to benefit, and we want them to be

involved and, obviously, the health professionals in the

region.

I appreciate the questions. The work is beginning, meetings have

already occurred, and further meetings will be set up starting on May

13. That’s the work now that we’re doing, which is making sure that this

cancer centre is everything we want it to be.

L. Doerkson: Thank you very much to the member for Prince George–Valemount to

ask a couple of questions, which is very valuable time here

today.

I have a couple of questions that will lead to geriatric care, but

I need the answer to a few before we get there. The first one is: what

is the number of residents in Cariboo-Chilcotin that are without a

doctor now?

I’m going to combine a couple of questions in there as well.

There’s a process that has our residents having to pay $145 to retrieve

their records. I want to understand that process a little

bit.

[2:20 p.m.]

Lately I’ve had a number of calls with respect to this,

particularly from senior citizens who find it hard to believe that

records that should belong to them already belong to someone else. I do

want to understand that process and if the ministry or minister has

contemplated any other solutions to that, particularly for low-income

people and seniors.

Maybe I’ll leave it there for now.

Hon. A. Dix: What we’re trying to do to solve this problem…. It’s a problem

that I think also, aside from the cost of it, brings about a little bit

of bad feeling between health practitioners and patients when it

happens. Do these belong to me? There’s the cost of storing records,

when, say, a health professional retires or moves or so on.

Our solution to that is the expansion of the health gateway so

that people will have consistent and constant access to their records

across platforms. This is looking to resolve the fundamental problem of

how to deal with health records that are held for people over long

periods of time. So we’re directly taking action to move on

that.

The member wanted some specific numbers from the central Interior

rural division in terms of the health…. This is Health Match B.C. These

are the people who have contacted us seeking a provider in the region.

The active people are 6,035 who are seeking that within the central

Interior rural division. The member will know 635 of those have been

attached so far.

We’re starting to work through that because of the work that we’ve

done, which we discussed last week in estimates. Further, 635 are

attached, and 381 are pending, so they’re in the process of

attachment.

[2:25 p.m.]

That’s a start. It’s not all of them, and that leaves some people

without, but it’s also the progress we’re making. There are also doctors

taking patients in the area, so there’s a number there as

well.

What that number tells you within that central Inter­ior

division is that approximately 6,000 people are actively in the health

connect registry telling us they need a family doctor. Roughly 1,000 of

those are either attached or pending, so that’s the start. We’ve got

work to do there and everywhere else to respond to people who want a

family doctor. It obviously means that we have to bring more family

doctors to the region, as well, which we’re working hard to do. Maybe

that will be the subject of subsequent questions.

The response on health records is putting together a health

gateway that gives people permanent access to their records so that this

issue of what happens when records go isn’t becoming an issue between

patient and doctor or patient and nurse practitioner.

On the one hand, that was his first question, and the second

question was the numbers I gave.

L. Doerkson: Thank you for that information. I suspect that that number that

hovers around that 6,000 mark is for people that have actually enrolled

and are trying. So there are probably….

Interjection.

L. Doerkson: Yeah, so there probably are many more, I would suspect. Certainly,

in our region, I’ve never seen Cariboo Memorial Hospital closed, and

we’ve had a number of closures in the South Cariboo as well, so I would

suggest that that number is quite low.

What I didn’t hear…. I heard about a potential gateway with

respect to recovering records. It’s my understanding that those records

now…. For someone like myself who does not have a doctor and wanted to

retrieve those records, it would cost me around $145. It’s seniors that

have a challenge paying that fee. I’m just wondering. Has there been

anything contemplated on that front to absorb some of that cost away

from seniors?

Hon. A. Dix: Interestingly, this was an issue I raised when I was Health critic

for the opposition in 2009, I think. The member might want to look back

at those records, which we keep.

But just to say what the portal gives people access to now. It’s

prescription record, lab result record, immunization history, B.C.

cancer cervical screening test results and recalls, special authority

drug request status, hospital visits, health care visits billed to MSP,

organ donor registration status, diagnostic imaging reports. That’s what

we’ve built out now, and we’ll build out more of that.

I think the issue is to answer this question and change it and to

use the building out of health gateway to take this question out

entirely. It has been an issue for governments and for the health system

for a long time. I think the response is that if we’re going to have a

digital system, it has to work for people and it has to give them

control and authority over their records. So that’s the permanent

solution that we’re talking about and talking about

delivering.

With respect to the health connect registry: yes. But I would say

this to the member, that if you see 1,000 people in the central Interior

rural division getting access to a provider, that tells you that that’s

us. We really want to encourage people to sign up as well. That will

deal with that number in between the number of people signed up and the

number of people who don’t have a family doctor, but it’s also the best

way to get involved.

I really encourage…. I know the member’s constituency office is

active. We work with his constituency office in our office quite a bit.

We want to encourage people to do that as well. I know that it doesn’t

necessarily mean there’s a doctor or nurse practitioner suddenly there

right away, but it is an opportunity for them. I think if you’re looking

for a family doctor, and everyone on that list is, then that’s the best

way to do it, and I really encourage people to join that.

Right now, as the member will know, we have significant spaces

that we’ll be able to provide for people across the province. So I

really encourage that part of it, which is separate and apart from the

whole debate we’re having.

L. Doerkson: Thank you, Minister.

Just going to actual doctors now. Central division has done, I

think, pretty good work. They’re very active, and they work hard to

bring doctors, of course, to our community. But frankly, the last time

they announced five doctors, I think the following day or certainly in

the following week, two more had announced that they were

leaving.

[2:30 p.m.]

Specifically to Cariboo-Chilcotin, not referring to rural B.C…. I

know that we hear numbers often from the minister that we’ve hired 700

doctors. I’m wondering what specifically is happening in

Cariboo-Chilcotin to bolster our supply of doctors. Honestly, as I said

before, I’ve never seen Cariboo Memorial closed. I know that that might

have been for different reasons, but frankly, there is an unbelievable

amount of pressure.

When I first started as MLA, I would say that it would be every

week that we would get significant calls about this, but now it’s a

daily occurrence, where people are coming into our office without

doctors, can’t navigate the system, etc. What specifically is the

ministry doing to bolster that number in Cariboo-Chilcotin?

Hon. A. Dix: The core, of course, is something we put in place a number of

years ago called the Central Interior, the primary care network that

came out of the community. It was designed and directed by doctors and

divisions of family practice and First Nations in the

community.

If you look at the PCN, the primary care network, that’s a total

of, and this is hired between that and the All Nations Healing House,

53.9 FTEs to support that. That, at its core, is what we’ve been doing.

That includes physicians; nurse practitioners; nurses; allied health

professionals; pharmacists; administrative support like medical office

assistants, who do an excellent job; and Indigenous resources as

well.

That just gives a sense of the support that’s in place for primary

care. That’s a start. I just wanted to report on that. We can provide

more on that and the details on that because we have regular reports on

that.

We have, as the member noted, five new physicians coming to

Williams Lake this year through the practice-ready assessment and the

UBC internationally trained medical graduate return of service. So when

we have a choice in those programs that we’re doing as a return of

service, Williams Lake is not just at the top of the list; it’s at the

top of the top of the list in terms of the priority we have.

We tripled the size. Last year we’re tripling the size of the

practice-ready assessment program, which is very important, as you can

see, for communities such as Williams Lake. It went from 32 to 41, now

to 96 in that program. That makes a very significant difference not just

to Williams Lake but other parts of the member’s constituency, another

part of the Cariboo-Chilcotin.

Since January 2023, there have been ten physicians hired to work

at CMH. Four of them will join the family practice team, with start

dates between April and September. But as the member has noted,

physicians have also left. That’s a significant issue and why, when we

have any choice in the matter, we are assigning people to Williams

Lake.

Those programs, the PRA, the medically trained ones, are where we

have, against a return of service, an ability to place people. The other

reason we place people in Williams Lake is that our doctors and our

nurse practitioners and nurses in Williams Lake are just outstanding.

I’ve met with them personally in Williams Lake. That’s a good place to

have people establish their medical careers. We’ve got to collectively

do a better job to make sure that they maintain that status.

[2:35 p.m.]

We do a lot of issues around recruitment as well. That involves

Williams Lake as well, relocation assistance, the B.C. loan forgiveness

program, all the work we’ve done with others.

It’s obviously not just doctors, but the member asked about

doctors so I’ll shorten my answer by talking about that. All the

significant measures that we’re putting in place…. We just signed off on

an APP for our hospitalists at Cariboo Memorial, which is an important

question. We signed off on that on April 10. That provides some

supports. In addition to that, we’re advancing virtual care, and our

team was in Williams Lake — Interior Health’s team, I mean — I think the

week of April 8, which is the week before last, working on that issue as

well.

So across the board, incentive, support and where we have a

choice, Williams Lake is at the top of the list of priorities. You can

see that just as evidence. I mean, 41 this year, three to Williams Lake,

is an indication across B.C. of the priority that we give.

The work we’re doing with hospitalists, the work we’re doing in

support, all of those are efforts to attract people to Williams Lake. I

believe we’ll do that because we’ve got outstanding teams of medical

professionals there. It’s a good place for a practice-ready assessment

doctor to go because they’re going to get the support of outstanding

teams of doctors.

L. Doerkson: Thank you, Minister. I aim to help the ministry keep

Cariboo-Chilcotin on top of that list, for sure.

This is where I wanted to end up. The minister would be very aware

of a situation that developed a few months back where we had a senior

citizen that should have been in long-term care but was in the hospital.

I’ll thank the minister for helping us with that.

I was saddened to find out that there was not only one. There were

a few people that were in the hospital. Here’s the problem with that.

One, there was an empty bed waiting for them at a long-term-care

facility. And two, they were, of course, in a bed in the hospital. We

don’t have a lot of beds, obviously.

I want to understand that process and what is holding a resident

from being transferred to the long-term-care facility. Now, I understand

that this only happens when a resident does not have a doctor, and

there’s a need to have somebody available to receive a 24-hour call on

behalf of that patient.

Of course, if we’re talking about 6,000 people without doctors in

the Cariboo-Chilcotin, and we know that number is much bigger than that,

then we have a number of people that might find themselves in this

particular situation. Of course, it’s not a matter of capacity because

there’s an empty bed waiting for them. They’ve actually moved into an

apartment, all their personal belongings are there, but they simply

can’t move over.

The problem becomes even more complex where we had three doctors

taking care of geriatric patients in Williams Lake. One left, leaving

two. The second one left, leaving one. The final one said: “Look, I

can’t take this burden on.” I can absolutely appreciate the horrendous

amount of work that would entail for that final doctor.

I understand that there was a temporary solution. I don’t know the

timeline on that solution, when that ends. But I do want to understand

better how we could have one person that has an empty bed, that’s in a

bed in the hospital, and how this can be fixed.

Hon. A. Dix: I’ll have the answer to that in a minute.

I have to move that the House rise, report progress and ask leave

to sit again. We just have a report to come in, and then I’ll get to the

answer to the very important question from the member.

Motion approved.

The Chair: Thank you, Members. We’ll see you shortly.

The committee rose at 2:39 p.m.

The House resumed; the Speaker in the chair.

Committee of Supply (Section B), having reported progress, was

granted leave to sit again.

[2:40 p.m.]

Reporting of Bills

BILL 19 — CHILDREN AND FAMILY

DEVELOPMENT STATUTES

AMENDMENT ACT, 2024

Bill 19, Children and Family Development Statutes Amendment Act,

2024, reported complete with amendment, to be considered at the next sitting

of the House after today.

Hon. R. Kahlon: In the Douglas Fir Room, I call Committee of the Whole, Bill 15,

Budget Measures Implementation Act.

In the main chamber, I call continued estimates for the Ministry

of Health.

Committee of Supply

ESTIMATES: MINISTRY OF

HEALTH

(continued)

The House in Committee of Supply (Section B);

S. Chandra Herbert in the chair.

The committee met at 2:42 p.m.

On Vote 32: ministry operations, $32,710,062,000

(continued).

Hon. A. Dix: We were discussing transfers out of acute care to long-term care.

I want to express again…. We’ve had this discussion with the member for

Prince George–​Valemount. I want to express my appreciation to the

member’s office and the work that we often do on cases such as this. I

appreciate that work and the working relationship we have. There are

debates in the Legislature, but also, we’re working together, and his

office is working is for his constituents every day.

With respect to the long-term-care thing, there is an interim

solution. Right now we have the team at the Doctors of B.C., the local

division of family practice, the Ministry of Health working together to

look at permanent solutions to the issues that have been raised. The LFP

model, for example, is having long-term care added to it because of an

agreement on June 10, the new model for paying doctors. That’s

important. In the interim, we’ve added nurse practitioners to the model

to support patients in their transfer. That’s important in terms of the

care provided at the long-term-care homes in Williams Lake.

Those are the interim solutions. We’re working together right now

to build a permanent solution. A big part of that will be the

application of the LFP model to long-term care, which is one of the

issues that the member for Prince George–Valemount and I discussed last

week. So those are key elements to do that.

I would say that the general problem…. I refer the member to a

written response we provided about the details of

alternate-level-of-care patients. The issue of patients being in a

hospital bed and not being able to get into long-term care is not the

main issue, with respect to alternative level of care. It’s access to

long-term-care beds. It’s why we’re building so many in B.C., because we

have a rising number of seniors.

[2:45 p.m.]

That issue that he described, which was a real issue, isn’t the

main alternate-level-of-care issue. But that said, change in the LFP

model to include long-term care; specific work being done, including by

the Doctors of B.C. and ourselves on the situation directly in Williams

Lake; the interim support that’s going to carry us through June of this

year from nurse practitioners — those are some of the solutions that

have been put in place, and the advocacy of the member has been part of

that process as well.

L. Doerkson: I only have time for one more question, but I do want to confirm.

I understand that there’s an interim solution till June, so I’ll follow

up a month or two down the road to find out what the solution of that

problem is to be. But I also want to confirm that this is not a

situation where there’s no space. In the cases that we’ve written about,

in those cases, they’ve actually had the available beds. And that’s

concerning, because by way of being in the hospital, the care is

obviously different in the long-term-care facility than in the hospital.

And of course, families were advocating for that move to

happen.

Anyhow, I’m glad to understand that the ministry is working on

this, because I really do think it’s a very serious situation, and we

definitely need to come up with a practical, full-time solution to

it.

Before I ask my question, I just want to thank all of the workers

in this system in Cariboo-Chilcotin and the ministry, because this is

definitely priority 1 in Cariboo-Chilcotin, and it’s very concerning.

Just to note that when a hospital closes in Williams Lake, we are three

hours to another hospital. For folks that are in other areas in the

Cariboo — Tatla, Anahim Lake — they’re three, four hours into Williams

Lake, not to mention another three hours off to Prince George or

Kamloops, noting that, of course, they could potentially stop in 100

Mile as well.

My final question is about Tatla Lake. Tatla Lake is run by an

incredible group, much like the rest of Cariboo-Chilcotin. We have some

of the best folks in the system. I’m sure of that. But in Tatla Lake,

certainly Patrice Gordon, Dr. Rob, nurse Ruth, who is an icon in

medicare, have been advocating for an upgrade to that clinic. It’s been

my understanding that it’s been approved in the past. We really have to

consider an upgrade there. The facility is old. They’re doing the best

they can with it, but they are really in need of some support

there.

I’m just wondering if the minister could comment on what plans

there may be for Tatla Lake. We have had community meetings in Tatla

Lake, where we’ve met with Interior Health, and we have tried to push

this issue forward. For lack of a better term, it’s really just a small

double-wide there with a couple of rooms with paper-thin walls. There’s

not a lot of privacy for patients. There’s older equipment and

such.

I’ll leave it there for today, but I’d like to hear if there’s

anything being contemplated for what could be a very affordable fix in

the scheme of medicare in this province.

R. Russell: I seek leave to make an introduction.

Leave granted.

The Chair: Please proceed.

Introductions by Members

R. Russell: It’s with pleasure…. I see up here a school group. I’m always happy

when the schools show up, especially in this case, and get to see a little

bit of the more respectful back-and-forth dialogue that takes place in this

House.

On behalf of the Minister of Mental Health and Addictions, who I’m

sure would love to be here to welcome you but is busy elsewhere, please

welcome École Glenbrook from New West.

Welcome.

The Chair: Welcome. Bienvenue.

Minister. Monsieur.

Debate Continued

Hon. A. Dix: Bonjour, tout le monde.

What I’ll endeavour to do…. There are a couple of meetings I need

to have in the next week or two with members of the opposition. The

member for Shuswap is one. The member for Vancouver-Langara — I just had

a meeting. I have meetings with a couple of members of the opposition I

need to do, once estimates are passed and then we have a little more

occasion to do that.

[2:50 p.m.]

What I’ll endeavour to do with the hon. member is, perhaps, if we

could get together on a Zoom meeting with people in Tatla Lake so I can

give them a forum. We’ll do that in the next couple of weeks. We’ll

arrange for that before the end of estimates so that meeting happens,

because those issues are critically important.

They’re also important to just recruitment, and the issues are

different in different communities. The member for Shuswap has issues

that he’s raised with me with the hospital there. The member for

Vancouver-Langara was talking about community health centres. These are

really useful meetings as well.

On Tatla Lake, I think we can probably find a time together to sit

down with the folks in the community and talk about those issues for 30

minutes just so I’m fully informed. That involves the inevitable process

of having notes prepared for me about what’s happened and having the

appropriate officials on the line so we’re not just talking at a

political level, but we’re talking with everyone else.

If we could do that together…. I’d be happy to arrange that with

the member. We can just sit down in my office and Zoom in to people in

Tatla Lake in the next three weeks.

L. Doerkson: I’m sure they’ll be very happy to hear that. I think they have an

annual general meeting tomorrow night, actually. They will be excited to

hear that news.

I will just say, again, speaking to rural health care, it’s really

important. I think we forget just how far some of those communities are

apart. I mean, I was just in Anahim Lake. They have a clinic there. They

have amazing service, with a crew that is willing to really go the

distance. We’re seeing that, frankly, all over Cariboo-Chilcotin and all

over rural British Columbia, where the staff are really filling gaps

that honestly are not their fault.

I do appreciate the comment that you made about not just the

willingness to meet but the fact that this can help with retention. It

can help with getting people into rural British Columbia when they have

nice facilities, state-of-the-art facilities. Frankly, that’s really

important in a small community like Tatla Lake.

I’m sure that Tatla will enjoy meeting with us, then, in the next

three weeks. I won’t wait for that call; we’ll send an email right

away.

S. Bond: Thank you to the minister and staff for responding to my

colleagues. It’s a big province, and when it comes to health care and

many other things, it is not one size fits all.

We’re now into the short snapper

section of the estimates, despite

the many hours we’ve spent together, because I still have half a binder

to get through in the next several hours. I’m hoping the minister will

be succinct in his response. I will try to be succinct in my

questions.

I’d like to move to PharmaCare for a bit. I’d like to talk about

the MedAccess B.C. report.

I recently met with a group of representatives from MedAccess B.C.

The minister would know that that is a coalition of 35 patient groups.

They are extremely concerned about the fact that…. I can almost

anticipate the minister’s answer, but I want to be on the record as

sharing the concerns of the people that I met with.

We are currently, in British Columbia…. Our PharmaCare program

actually covers fewer non-oncology medications than any of the other

provincial drug plans in the country. In fact, it continues to decline

as new medications are available almost everywhere else in

Canada.

We are the chair of the pan-Canadian Pharmaceutical Alliance. It’s

fondly known as the pCPA. That organization, that group, actually

completes price negotiations via a letter of agreement. Yet B.C.

patients do not have equitable access to medications.

Can the minister explain to me why patients in British Columbia do

not have access to medications that the vast majority of other Canadians

do?

[2:55 p.m.]

Hon. A. Dix: First of all, with respect to PharmaCare, this is an issue of

considerable interest to me personally. It’s why we’ve made very

significant improvements in our coverage, especially for lower-income

seniors and lower-income people in B.C., since I became Minister of

Health — in our PharmaCare program in B.C.

What happens when a new drug is open for review in B.C.? This is

an area where there has been consistency between governments. The model

that I’m referring to was put in place in part by the NDP government in

the 1990s but significantly added to by the government of which the

member was a part.

We have a process where Health Canada will approve a drug,

essentially, against a placebo. Their approval doesn’t mean a lot in

terms of its coverage decision. There’s a review by an organization

called CADTH, then a review in B.C. by the Drug Benefit Council, which

assesses issues of efficacy against costs and efficacy in general. The

Drug Benefit Council does that work. That was put in place by the

previous government.

Only one drug, to my knowledge — and I think that knowledge is

fairly complete; I think it was Duodopa, which is a multiple sclerosis

drug — was approved against the advice of the Drug Benefit Council in

B.C. It’s consistent, really, with the situation we have now in terms of

approval. Minister Lake did that. But that was a multiple sclerosis

drug, which had not been approved against cost in 2008. It had been

improved in other jurisdictions, and the company essentially didn’t

reapply to have it dealt with here. So the government acted. That’s the

one example. It’s an example that I supported at the time — by Minister

Lake when he was Minister of Health.

That’s the system we have in place. There is, I think, in general

— people will focus on the differences — a high degree of consistency

between provinces. After the approval by the council in that process, we

go through the pCPA, which is a price negotiation process. What B.C. has

done over the last number of years, when people talk about money

involved through the time of the previous government and then added to

during my time, is also get the best possible deal in B.C. That included

the very significant biosimilars initiative, which perhaps the member

will ask about.

Between January 1, 2015 — this is over the time of two governments

— and December 31, 2023, B.C. completed 479 drug reviews. Innovative

Medicines Canada, which is a representative of big pharma — they

wouldn’t like that term — the larger, brand-name pharmaceutical

companies who I meet with regularly and work with on lots of issues, has

stated during that time that 39 of B.C.’s coverage decisions were

inconsistent with other provinces. Those occurred over that period

between 2015 and 2023.

What that also says, as the member will know — both to defend

Minister Lake and myself, I suppose, against the criticisms from

Innovative Medicines Canada — is that in 90 percent of the decisions, we

were aligned with other jurisdictions. We also have outstanding levels

of coverage in our PharmaCare program, better than other jurisdictions.

We’ve been a key part of working with the federal government in their

investment and their discussion of national PharmaCare but also their

expensive drugs for rare diseases.

I appreciate that that’s a long answer. I’ll be shorter now. But I

just want to put the context of where we are and how we are in that

process. Then I’ll try and be shorter. In addition, I’ll say that what I

will set up with the member is a process for written questions where she

gets answers as she would in the speed of estimates over the next

week.

S. Bond: Thank you very much. I’d appreciate that, because that was

certainly not a short snapper.

[3:00 p.m.]

The point I want to make to the minister is that I understand the

process. I understand CADTH. I understand the pCPA. What I do not

understand is how British Columbia declined to provide coverage for 31

new medications, and the list continues to grow. Those recommended

medications all went through that process and a price negotiation.

During that time, Ontario declined two. Alberta declined

three.

We’re not talking about just looking at this because we want to

have a big long list of medications. We are talking about quality of

life for people in British Columbia that is not aligned with

opportunities in other jurisdictions.

I’ll give the minister one example, and I have lists of them:

short bowel syndrome. When we think about what’s happening in British

Columbia, British Columbia denies coverage for the only medicine

approved to treat short bowel syndrome in children and adults. That is

not a small issue. The complications of SBS are significant:

malabsorption, dehydration, malnutrition, fatigue, weight loss. We do

not cover that in British Columbia. The list goes on. That is the only

medication approved to treat SBS.

I would just like to leave with the minister the fact that,

certainly, this is about cost. I know that that has been part of the

decision-making process. But other provinces…. Certainly, they’re not

wrong in their assessment. During the period of time from 2018 to 2023,

they, for example, in Alberta, only declined three. We, in British

Columbia, declined 31 new medications. They cover a wide range. Some of

the most significant ones are things to do with skin, with arthritis,

with schizophrenia, you name it. We do not cover it.

I don’t have time to continue to list those drugs, but I want to

end this

section with one question. In 2022, B.C. allocated $257 a

person for prescription medicines, and that is significantly less than

the Canadian average of $442 per person. I did note in Budget 2024 that

there is an additional $224 million assigned to PharmaCare.

Can the minister, then, tell me whether that additional funding

will actually bring B.C. in alignment and cover access to therapies that

are covered in other Canadian provinces?

Hon. A. Dix: Just to be very specific with the drug raised…. I’ll just be short

with this. The drug is teduglutide, or Revestive, which was a decision

from a previous time, 2017. These decisions are subject for re-review.

Those were conclusions of CADTH from the DBC at that time, in the case

of that drug. I don’t say that because it’s 2017. These are decisions

that say the approach has been consistent under Minister Lake and under

myself in terms of the approval processes.

All drugs on the list that the member describes have either

therapeutic alternatives listed on the B.C. formulary that provide

better value for money or a confidential negotiated price. But the pCPA

did not reach the cost-effective price determined by the CADTH. That’s

the reason why there are some differences.

Those differences have been in place under a number of

governments. Certainly, our approach has been consistent with that taken

by Minister Lake. We believe in evidence-based decision-making, and

that’s what we seek to do equally.

Our biosimilar initiative has saved hundreds of millions of

dollars that we can invest in the coverage of new drugs. I won’t go into

that in greater detail.

Finally, numbers being used there do not include a whole series of

other drugs, I would say. One of the reasons why the biosimilar

initiative was so important was that we were able to

reinvest.

[3:05 p.m.]

I might say, on the biosimilars initiative — supported by the

opposition, I think, importantly in that case — which allowed us to move

together and to save money, then reinvest it…. It doesn’t include a

whole series of drugs, including the use of Avastin and other retinal

drugs that aren’t included on the list, and oncology drugs, which is a

very significant area where we might get to shortly. Not considered, in

that part of the process, are transplant drugs and others.

I’m just saying that I think we have a very robust PharmaCare

program that is income-based. That is the Fair Pharmacare program.

Remember that it was started, in its present form, under the previous

government, and we’ve maintained it, although we’ve improved it in

significant respects. I think that discusses some of those

drugs.

I’d be happy to provide the member with information I have about

the list of drugs — that might be helpful as well — so that I don’t go

through them and have to discuss each one. I know the member would

prefer otherwise, but the information is available, and I’d be happy to

share.

S. Bond: I appreciate the minister’s response.

I don’t want to debate the drugs that are on the list. I want to

talk about the ones that aren’t, and the ones that are impacting quality

of life for British Columbians.

My final question around this…. I might as well link this. I was

going to do it later, but I’ll do it now. An issue that is very

significant for many British Columbians is the issue of migraines.

Without effective treatment options, many people end up in emergency

departments or have an appointment with their family physician. There

are effective treatments to deal with migraines.

Migraine Canada did a recent report card and found that, not

unlike for some of the other drugs that I’ve mentioned, related to short

bowel syndrome — there’s a whole list of them — B.C. has the poorest

coverage of migraine medication in Canada.

A new class of medications, calcitonin gene-related peptide

inhibitors, became available in 2018. However, of the five possible CGRP

inhibitors available in Canada, B.C. provides coverage for only two. Can

the minister tell me if there is an intention to increase coverage for

CGRPs?

Hon. A. Dix: Just to report, we now cover three out of the five. Vyepti was

approved today, actually. What I’ll seek to do, because a lot of this

information is available, is provide this information to the hon.

member, certainly, this week so that she’s up to date. On the issue of

migraines, the decision to list Vyepti is an example of expanding and

addressing the very issue she raised.

S. Bond: Well, there you go. Migraine Canada will be very thrilled with my

advocacy, thinking that we just got another one covered today. That’s

fantastic news.

I want to just do a single question here on behalf of a colleague.

The minister, if he’d prefer…. I don’t want us to have to have staff

shuffling in and out here. I’m wondering if I could read this into the

record. If the minister has the answer, that’s fine. If not, perhaps he

could get back to me later today.

Here is the question from a colleague who’s involved in another

set of estimates. Does the Ministry of Health have any contracts with

Fair Price Pharma? If so, to what date and for the provision of what

pharmaceutical products and quantities, and what is the term of that

contract?

Hon. A. Dix: No.

S. Bond: Now that was a short snapper. I’m very appreciative of that

one.

I want to move on to talk a little bit about ER closures. We know

that that has been a significant issue for British Columbians,

particularly in rural and more remote communities across the province. I

want to just talk for a moment…. Obviously, there are challenges in many

cities, but let’s talk for a moment about Prince Rupert.

[3:10 p.m.]

The minister said that he was frustrated, too, by the situation in

Prince Rupert. Apparently, there are a significant number of vacancies

at the Prince Rupert hospital. If the minister feels frustrated, imagine

how the people of Prince Rupert feel when the nearest hospital is a very

significant drive from Prince Rupert.

I’m wondering if the minister can give me an update on the

timeline, an expectation for those vacancies to be filled, so that the

people of Prince Rupert can have some sense of confidence that if they

go to the ER with an emergency situation, they are not diverted to

Terrace.

Hon. A. Dix: Just on the general issue, then I’ll try and get quickly through

Prince Rupert and just talk about the initiatives that we’re undertaking

there. I was agreeing. In Prince Rupert, talk about frustration, with

the frustration that people felt in the community, especially during the

period of spring break when there were multiple closures. So we’ve been

working very hard with the community — myself directly, the Deputy

Minister of Health, the Assistant Deputy Minister of Health and Northern

Health — to address some of these questions.

More broadly, and I’ll just say this quickly, GoHealth B.C. now

employs about a couple of hundred nurses in Prince Rupert. They

provided, since its creation, 28,624 GoHealth nursing hours. The issue,

though, in Prince Rupert was significantly doctors, so we have been

working together very closely on a new APP contract, which was first

offered in January. We’ve been working closely with them. There are a

couple of issues remaining, and we work on those issues with local

doctors and with the Doctors of B.C.

We’ve put in place an enhanced compensation package for the Prince

Rupert emergency department for April, May and June as we work through

these issues. That has seen the filling of 18 eight-hour shifts, and a

further seven full 12-hour shifts in response to the compensation

package were put in place.

[3:15 p.m.]

We’re working closely with the ministry, with the city of Prince

Rupert and BCEHS for long-term mitigation strategies. As the member will

be aware, BCEHS has been very heavily involved in supporting communities

that do face diversions or temporary closures of their emergency

rooms.

We also have the provincial emergency locum pool, which we’re

building out, to which 186 doctors have signed on. All of these are

measures. Then there’s a list of measures we’ve already discussed, which

I won’t repeat, that are recruitment measures that are available for

doctors in Prince Rupert.

In short, there are two sets of issues with doctors. There are

direct issues that we are engaging with them on at the hospital, and

there’s more broadly an issue of housing in the community for doctors

coming in. That’s a community issue, which the city of Prince Rupert is

being very helpful in working with us on.

S. Bond: Thank you to the minister for that answer. I’m not going to

re-engage in the discussion we had for several hours a few days ago

about the 700 net new, according to the minister, doctors in the

province. When you’re living in a place like Prince Rupert or Clearwater

or Tumbler Ridge — the list goes on — or Elkford, people don’t feel that

when their ER is closed.

I’ll just tell the minister today, for example, hopefully to

goodness the Clearwater ER is open. Once again on a highway, part of

which I represent, there was a tragic accident. Two people were killed

today on Highway 5, and it sparked a wildfire on top of that. If your

emergency room isn’t open when those kinds of things happen, just

imagine what that means for people who live in those communities. The

Prince Rupert situation was devastating for people who were impacted by

that.

Let’s move on to Elkford. The emergency department in Elkford has

been closed for 30 months. The minister last year in estimates said that

he hoped the closure would be over, that the vacancies had been filled

as of July 2023. Can the minister confirm for me and my colleague that

represents this area if the Elkford ER will be fully reopened on a

permanent basis?

Hon. A. Dix: I’ll shorten my answer just by saying I did have a discussion in

detail with the member for Kootenay East on this question last week. I

know he asked about B.C. Hydro and the program, and he did ask about

these questions, and we’re in close contact with him. It’s of course our

intention to continue to provide that service in Elkford and to continue

to do that work there. Not just in Elkford but in Sparwood, as well,

where there’s significant work going on.

I’d refer the member, not to give a long answer to that one, to

the previous response I gave. I’m in regular contact with the member for

Kootenay East on that question.

S. Bond: The Merritt mayor intends to send the Minister of Health a bill

for $90,000 to the province for 19 days of emergency room closures. Will

the minister and the ministry be paying the bill, yes or no?

[3:20 p.m.]

Hon. A. Dix: What we are focused on is filling physician positions in Merritt,

three positions working primarily in community and one international

medical graduate who’s completing a return of service as a part of

completing their residency and beginning practice as a physician in

B.C.

The success of the provincial ED physician contingency locum pool

has ensured urgent and last-minute vacancies at Nicola Valley Hospital

have been covered and that a contract to fund additional physicians in

permanent positions in the ED is being developed with the Ministry of

Health that offers physicians alternative compensation than

fee-for-service. We have had an APP offer on the table for some

time.

We work closely with the mayor of Merritt. The member will know

the mayor of Merritt brought these ideas to the regional hospital

district and was not successful in that. What we will be doing, while we

won’t be paying the bill, is we will be continuing to work with Mayor

Goetz, who I’ve worked regularly with in this process, to continue what

I think has been a successful effort to fill physicians’

positions.

That’s what people want there. They want physicians, and they want

nurses. They understand that the mayor of Merritt is taking steps to

raise the issues of his community. I completely respect his approach and

his advocacy for his community, and I’ve been working with him closely

on these issues.

I would say that, in addition, the mayor of Merritt has offered

temporary accommodation to people and has found some opportunities

there. I’m very appreciative of that as well.

As you can see, the situation has significantly im­proved

since last summer when we raised these issues, but it’s not finished

yet. It’s why we continue to recruit and add physicians to the Merritt

hospital, as well as pursuing the APP agreement that has been helpful at

other hospitals and we believe will be helpful in Merritt. We hope to

have a solution on that soon with the Doctors of B.C. and the doctors in

Merritt.

S. Bond: I certainly agree with the mayor’s approach. I had the opportunity

to meet with him and spend time with nurses in Merritt last week. There

was a significant sense of distress. Nurses, in fact, described for me

the fact that they are experiencing moral distress and burnout. That is

not unique to Merritt, although Merritt has had 22 closures, service

interruptions, over the last two years.

The minister noted that there was funding that was supposed to

stabilize physician staffing in October, but staff at the hospital say

it’s not enough. In fact, nurses said: “Inter­ior Health must

acknowledge the crisis at their work site and address the systemic

staffing challenges that are resulting in untenable working conditions

for nurses and the deterioration of patient care in the

community.”

I guess I just want to emphasize for the minister that it’s one

thing to make an announcement; it’s another thing to actually see those

changes make a difference for the people of Merritt.

Again, if you look at where Merritt is situated in this gigantic

province we live in, whether it’s summer or winter, there is significant

transportation. I don’t know if the minister has driven it recently, but

industrial traffic along the Coquihalla and through those corridors is

extensive. So it’s not enough to be able to say: “Okay, the ER isn’t

open today in the middle of a snowstorm on the Coquihalla.”

I wanted to raise for the minister the fact that there continue to

be systemic staffing challenges at Nicola Valley Hospital and that I

applaud the mayor for actually standing up and speaking up for his

community. I’m disappointed that the minister won’t be paying the bill

for the time that the ER was closed, but I do appreciate the fact that

we have situations like this all over the province. So I appreciate the

time spent on Merritt.

I wanted to also raise, ever so briefly, South Okanagan General

Hospital. The minister described an arrangement that he had made as a

stabilization arrangement. That arrangement was signed on September 29,

2023. In that news release — again a news release…. I will quote from

that release. It said: “With these service contracts, all patients and

nurses will benefit from more regular on-site physician presence, which

will help emergency rooms in these hospitals remain open.”

[3:25 p.m.]

Well, since October, all 18 closures that have occurred at the

South Okanagan General Hospital have been due to limited physician

availability. Clearly, the problem is ongoing, and the solution isn’t

working.

I’m wondering if the minister…. He doesn’t have to provide it to

me now, but if he could provide that to me at some point, the details of

the $7½ million that was announced. How much was allocated to Oliver to

stabilize emergency services there, and how much of that subset has been

spent to date?

R. Russell: May I seek leave to make an introduction?

Leave granted.

The Chair: Please proceed, Member.

Introductions by Members

R. Russell: I see in the gallery we have another group here from École Glenbrook

in New West. If the House would please make them feel very

welcome.

I am ecited that you get to be here to see the back and forth here in

regards to the Ministry of Health.

Welcome.

Debate Continued

Hon. A. Dix: With respect to South Okanagan General Hospital, we’ve been

working closely with doctors in the region and with the mayor of Oliver

to work on these specific issues.

On September 29, as the member stated, we approved an APP contract

application for South Okanagan General Hospital. What’s required at that

point…. We don’t make anyone go off fee-for-service. These are always

negotiated and discussed, a significant discussion with doctors at the

hospital. The funding was approved, the supports were improved, and the

physicians were required to accept a contract offer, which they did on

December 20, 2023.

I think the money in question that the member talks about was

about a number of communities, and this was one of them.

At the time of the signing, ten physicians signed as permanent

contract members. They committed to providing 5.5 FTEs of service. We

also brought in 22 locum physicians. The result has been a significant

improvement in the stabilization of the situation — not perfect yet, but

still a significant improvement as a result of the APP

contract.

Just to explain to people who are listening why APP contracts are

useful in this case, as opposed to, say, a fee-for-service contract.

It’s that in a community such as Oliver or such as Merritt or even such

as Prince Rupert, it ensures shift coverage and people being paid for,

essentially, the time they served and not the number of patients they

see, which is a significant impediment.

Previously in a lot of communities, the group of doctors in the

community would work together to fill ER shifts. That situation is

changing. It’s just not the same as it was. That requires a change in

approach and is why we are pursuing, in a number of places — including

Prince Rupert, including Merritt and, successfully, at South Okanagan

General Hospital — APP contracts.

In addition, we’re recruiting for one additional position for

emergency medicine in South Okanagan General Hospital. The total value

of the APP contract for the FTEs in question is $2.82

million.

Obviously, this is significant work, and I want to thank the

doctors in the community who advocated for this, who wanted this. We

negotiated it. We funded it. We came in place. We went through the

details of it, which took between September 29 and December 10, and it’s

now in place. There have been improvements, and we have to make more

improvements.

S. Bond: Well, thank you to the minister for the response, and I appreciate

the details. But let’s be clear. We see the minister basically around

the province, dealing with one-off situations all over the

place.

I have pages of closures, whether it’s in the Interior Health —

100 Mile, Ashcroft, Barriere, Castlegar, Boundary District Hospital,

south Similkameen, Lillooet; then let’s move into Northern Health —

Chetwynd, Fort St. John, Fraser Lake, Houston, Hudson’s Hope, Kitimat.

The list goes on.

While I appreciate the fact that it’s “Let’s get to this one,”

meanwhile, there are closures all over the place. It has enormous

impacts on people across the province.

[3:30 p.m.]

I don’t have time to go through all of the various locations and

the number of closures. I certainly have a chart.

[J. Tegart in the chair.]

But I do want to point out that in the case…. When you look at

Oliver, Boundary-Similkameen, as an example, the number of service

interruptions in 2022 was four; 2023 was 31. Ten closures after October

18, when the announcement was made, were limited physician availability.

This year, in 2024, we’re already up to eight. Why? Limited physician

availability.

Again, we announce, we roll out the money, we go and say, “it’s

going to be stabilized,” and sure enough, we continue to face the same

issues over and over again across the province. British Columbians who

live in rural and more rural and remote communities deserve quality

health care wherever we live in this province.

With that, I’m going to move on. I do want to go back for just a

moment. The minister…. I’m sure he did not mean to do this

intentionally, but the 400-plus drug review he referenced is not an

apples-to-apples comparison. The list includes generics, biosimilars,

HIV and cancer therapies and, likely, other program spending that

PharmaCare is not responsible for. I was speaking specifically to

PharmaCare.

Between 2018 and 2022, B.C. reviewed 99 drugs that had a CADTH

recommendation and the pCPA letter of intent. They opted out of 31 drugs

during that time, and that is an opt-out rate of 30 percent. That was

the point that I was trying to make when it comes to, again, quality of

life, availability of options for people that are not available in

British Columbia, that are available in other parts of the

country.

I wanted to raise an issue. It’s a nursing issue. I wanted to

raise it because, as the minister well knows, I spent a lot of time on

the road last week and spent some time with nurses throughout the

Interior Health Authority. I actually didn’t believe this was happening,

but apparently it is. I would like the minister and his staff to look

into it and assure me that if it is happening, it’s going to be

fixed.

I have information from two different nurses that have received

bills from MSP for ER visits for first aid within their hospitals after

a workplace safety incident occurred.

Let me give the minister an example. A nurse from a hospital had

to have treatment for blood work pertaining to a safety incident that

occurred at work involving a patient blood–body fluid splash to her

eyes. She received a reminder bill in the mail regarding the first ER

visit for this first-aid visit. The total cost she was being asked to

pay is $521.

I can assure you that if nurses in British Columbia are getting

bodily fluid splashes in their eyes, they should not be paying MSP. I

will happily share the location later with the minister of the two

nurses. Again, in two cases specifically, according to these nurses,

they needed to have first-aid treatment, and they were sent bills in the

mail as a result of that.

It’s really important that if there are body fluid exposures that

actually nurses should be taken care of. Can the minister just confirm

that he will take a look at that situation?

Hon. A. Dix: Of course we’ll take a look at the situation. We resolve issues

with the B.C. Nurses Union all the time and in our workplace. We’ve

talked many times about how there are 230,000 people who work across the

health care system in B.C. The cases seem fairly straightforward, and

I’ll have my staff work with the nurses expeditiously to ensure that the

situation is resolved.

[3:35 p.m.]

S. Bond: Thank you for that.

I want to move on to talk about something that we’re all very

concerned about, and that is, obviously, medical imaging and cancer

treatment in the province. I want to start with that.

Even just today I received another email from a constituent in my

riding. I can barely read through the email, because of the significant

delays that this person is facing. They are dreadfully afraid that

cancer has already spread before they get a chance to have the treatment

and imaging that they deserve.

I’ll remind the minister that I wrote to him regarding medical

imaging wait times last year. I did that in a follow-up to our estimates

discussion. I would like to know the data breakdown of wait times for

diagnostic imaging for priority 1 through 5 examinations per health

authority. Specifically, to the minister and staff — and, again, if

you’d prefer to provide this to me later, that’s fine — what are the

wait times for P1 to P5 examinations by ultrasound, computed tomography

and magnetic resonance imaging in Vancouver Coastal, Fraser Health,

Island Health, Interior Health, Northern Health and the Provincial

Health Services Authority?

I’m wondering if the minister would be prepared to work through

that data and provide it to me. I’d like to know also the vacancies with

respect to medical imaging professionals in B.C. How many radiation

technologists and radiologist vacancies are there currently?

Hon. A. Dix: What I’ll do is provide some comprehensive responses. We have the

information as we’ve prepared it, but it may be different from what the

member wanted, so we’d be happy to provide that.

Just in general, I would say, and she’ll know this from our past

estimates debate, the broad issue of medical imaging is one of

significant importance to me and to the government such that we’ve

increased our per capita rate, for example, for MRI exams in the time

I’ve been Minister of Health from 36 to 58. That means from 174,000 MRIs

to 314,832 in a relatively small period of time and during a pandemic.

With respect to CT, a similar situation. There are, for ’23-24, 983,526

CT scans. That’s a 41 percent increase over what it was in

2016-17.

We’ve seen our wait times broadly in diagnostic imaging improve

against other jurisdictions in the country, in many cases dramatically,

especially at the 90th percentile, such that the MRI wait time in days

at the 90th percentile was 273 in 2016-17, and that was down to 145 by

2022-​2023. What we’ve seen is a very significant investment. I

think people are going to reflect on that.

[3:40 p.m.]

Sometimes we get into the discussion: when did what thing happen

and what not happen? Every one of those MRI scans and every one of those

CT scans involves multiple work by skilled people. So that is a massive

increase in capacity over that time. It was achieved by extending the

working time of MRI and CT machines through the day.

We only had one operating 24-seven when I became the Minister of

Health, but we have, I believe, eight today, and we’ve gone from seven

operating to 19. The number of MRI scanners has increased in my time

from 25 to 43, and the number of CT scanners from 63 to 72. That’s net

new in the public system.

The most significant places where the most significant increases

and improvements have happened have been in the Northern Health

Authority. That doesn’t mean that there are not challenges for people.

It doesn’t mean that when you’re at the 90th percentile, 50th

percentile, and there’s a wait time at all…. When you need an MRI or a

CT scan, you want to have one right away, and I understand that. That’s

why we have built out so much capacity, and there is more to

do.

One of the things we see in hospital, when we go to different

communities — whether it’s Fort Nelson, which is looking for a CT

scanner, or whether it’s Kitimat looking for a CT scanner — is not just

the quantitative but the qualitative response that sometimes can mean a

reduction in hospital stay if you have diagnostic equipment in that

particular place. What we’ve seen is a very dramatic improvement in

diagnostic services around the province.

That doesn’t mean we can’t do more. I don’t disagree with that.

I’ll provide some of the detail and information the member asked,

perhaps by letter, and not a long time from now, but as the session goes

on.

S. Bond: Let me just read a quote for the minister. This was from March 22

this year, 2024. This is from the president of the B.C. Radiological

Society.

“Medical imaging is at an all-time crisis. It’s a lack of resources,

a lack of personnel. It’s just all come together with the post-pandemic

backlogs increasing ages of the population. There’s many factors that

are resulting in these delays, but it’s making it really difficult for

physicians to get the initial imaging that they need for diagnosis or to

screen for workup of cancers, for diagnosis of cancers. Even just

image-guided biopsies are behind as well. So it’s putting a lot of

anxiety both on the clinicians but particularly on the

patients.”

That’s the circumstance that people are facing in British

Columbia. The minister can speak about added capacity on the ground.

That is not what people feel. In fact, the distress that radiologists

and other specialists are feeling has been described to me as moral

trauma, because they can’t do the work they’re called to do. I

appreciate the minister continuously referring — you know, massive

investments and massive increases. Those aren’t my words. Those are the

words of the president of the B.C. Radiological Society.

Let me ask another question, if the minister can provide this

information to me as well. He doesn’t have to do it at this moment. What

are the current wait times for diagnostic mammograms? And again, I’d

like to see that in each health authority.

I’d like to move on to financial pressures facing community

imaging clinics, because I raised this last year and, in fact,

clinicians themselves, specialists, raised the issue. They note that the

pressure has only gotten worse since then. Basically, clinics are

struggling to keep updated equipment, and some aren’t even replacing

mammography equipment specifically. I’m wondering what the minister’s

plans are to specifically address the increased operational cost

pressures.

If you look at what, again, the president of the radiologists has

said: “It’s becoming very difficult for some of these clinics to even

keep updated equipment, so some are even choosing to not replace the

mammography equipment they have once it breaks down because it’s just

not worth it.”

I cannot imagine what we will do with fewer pieces of mammography

equipment when we are facing the crisis that we’re already

facing.

[3:45 p.m.]

Could the minister provide me and, more importantly, British

Columbians, with some hope about the plan that he has to address

increased operational costs for community clinics?

Hon. A. Dix: Okay, just a few things.

Well, we talk about people on the ground: 110 MRI technologists,

FTE technologists, in 2019; 246 today, which is more than double. And

the place where the most significant percentage increase is, is in

Northern Health. In terms of sonographers, 386 in place when I became

Minister of Health; 537 today. Those are the significant increases on

the ground.

The member asked for some questions and details, and I have some

of the answers. But I think what I’ll do is not go through the full list

of answers but rather provide this information and the significant

reductions in significant areas in terms of wait times. I don’t want to

answer…. I didn’t want to give an eight-minute answer on all of that.

But that’s a short version.

In terms of the workers for the HSA, where the bargaining unit is

increased by 26 percent…. It’s a key bargaining unit, and you see the

very significant increases. That is a demonstration in terms of people,

not just machines and exams, of the increases we’ve seen.

We’re working closely on the community imaging clinics. We have a

working clinic with the clinics that involves both Associate Deputy

Minister Mark Armitage, Assistant Deputy Minister Kristy Anderson, that

is dealing with this issue with the B.C. Radiological Society. The

members include health authority staff, the society itself — physicians

— and others to address the key issues that they have raised with us

about their cost pressures. The recommendation…. They will complete

their work and issue a report on or before June 30, 2024. So we are

working actively on the ground with radiologists around community

clinics as well.

We’ve seen the very significant progress against other

jurisdictions that we’ve made in the provincial system on diagnostic

care. But the member is right that community clinics are very important,

and that’s why, in particular, the mandate of the ultrasound working

group to address these key issues, which include clinical placement,

significant cost pressures and health human resources, why that is such

a priority for us and why we are working so closely, again, with those

working in the field.

S. Bond: Thank you to the minister.

I guess I want to reiterate that we can stand in the House all day

and trade numbers and quotes. When people have to wait a year and a half

to get surgery when they have a fist-sized tumour, I don’t think they

think the words mean very much when it’s “we’ve had significant

increases and we’re adding this and we’re doing that.” The fact of the

matter is that may be happening. But what’s also happening is the B.C.

Radiological Society is telling this minister that we are at an all-time

crisis.

Medical imaging is at an all-time crisis. That wasn’t, like, two

years ago or in 2016. March 22, 2024. And people just want to hear, just

once in a while, that there is an acknowledgment of the anxiety, the

distress, not just for patients but for health care professionals who

cannot deliver in a timely way in British Columbia.

Anyway, let me just continue on.

[3:50 p.m.]

In March, there were two separate incidents at Surrey Memorial

Hospital, where the CT scanner at Surrey Memorial was unavailable

overnight, again due to staffing shortages. It’s the busiest ER in the

country, and losing access to a critical piece of equipment for any

period of time is unacceptable. The Medical Staff Association says there

should have been improvements and investments over the past year, and

they are very concerned about the lack of access to critical imaging

resources. They are warning that no access to a CT scan for even a few

hours could lead to catastrophic delays in diagnosing.

Can the minister provide for me a response in terms of what action

he is taking to make sure that the critical piece of equipment at Surrey

Memorial Hospital is staffed at all times?

Hon. A. Dix: I said in the previous answer, for example, on MRI machines, we

didn’t have them open overnight. By definition, I guess they couldn’t be

off on two nights, and that’s frequently the case, plus the problems….

We’ve dramatically increased the numbers and the hours by significantly

increasing the training and the staff, and we’re going to continue to

have to do that, I would argue, in terms of sonographers, in terms of

medical radiation technologists, in terms of laboratory and X-ray

technologists, everyone across the sector. It’s why we’ve increased

training spaces as well, in these areas. These are frequently some of

the biggest challenges you face in health care. A lot of discussion

always of doctors and nurses, and we’ve talked about the remarkable year

we had last year in recruiting both.

It doesn’t mean there aren’t other issues. I don’t avoid that. I

go and meet with people directly and answer their calls and listen to

them all the time. But in areas where we have, in terms of our

technologists, in terms of our allied health workforce that has shown

just exceptional work by post-secondary institutions and health

authorities, in terms of the increase in the number of people involved,

more than doubling MRIs, MRI techs working in the province as we

basically doubled the number of MRIs…. That’s a significant success, and

we need to reflect on that as well.

Part of the reason, the way that, in the medium term, you deal

with these issues is increasing training spaces, and we’re doing that —

for example, the 336 new allied health spaces we put in place in B.C.,

the recruitment we’re making in key areas. We talked about radiation

technologists earlier. All of that work is being done to ensure that

staff such as the staff of Surrey Memorial Hospital are

supported.

We also have to do work, I would say, and this is important work

on the other side of it. When you increase…. The member says people

don’t feel the increase in the number of exams, whether it be the

hundreds of thousands more CT scans, the hundreds of thousands more MRI

scans we’ve done and all of the work by all the health care workers and

specialists involved in that.

[3:55 p.m.]

We also have to, I think, take some action in working together

with the professionals to ensure there’s not either duplication or

unnecessary scans so that people who need the scans get them more

quickly as a result. The results have been good. In the case of Surrey,

I can absolutely and will respond specifically on those two days and

what happened and what we’re doing there.

Basically, across the system, as well, we have to recruit and

train more people. If we’re going to add CT scanners, as we are in many

communities, then we’re going to have to have the people to make those

go, including the radiologists on the MRI and CT side. That means the

significant increases in training that we’re making.

S. Bond: Obviously, because of the timing of this session and the fewer

hours that we have, I am pressed for time. I have an hour left, and I

want to move to cancer care, please.

I’m going to read these out. I don’t expect the minister to have

it today, but I’m hopeful that he’d be prepared to provide the

information for me. What I’m looking for are the number of vacancies for

full-time equivalent positions. I’m wondering if the minister has the

information broken down by health authority.

I’ll list the positions that I’m looking for. Obviously, the

minister has a large army of staff, so I’m sure they’ll be able to get

the list. By health authority, it’s medical oncologists, hematology

oncologists, neurological and gynecologist oncologists, radiation

oncologists, surgical oncologists, radiation therapists, oncology nurses

and medical physicists. Those are the categories I’m interested in, in

terms of the number of vacancies for full-time equivalent positions by

health authority. I’ll just leave that. I’m sure the minister isn’t

going to read them all out one at a time.

I want to look at B.C. Cancer’s data and analytics when it comes

to wait times. As I understand it, B.C. Cancer’s data and analytics

division provides performance bench­mark indicators to the

minister. That was obviously…. It was noted in the Premier’s transition

binder in 2022 and the minister’s 2023 estimates binder. I’m hopeful

that the minister can share, for the most recently reported quarter,

what percentage of patients were treated and seen within benchmark wait

times.

I’ll give the minister the categories. Obviously, the information

is available because we’ve seen it in the Premier’s transition binder

and the minister’s binder. It’s IV chemotherapy treatment, radiation

therapy treatment, radiation oncology consults and medical oncology

consults. Could the minister just confirm that he could provide that

information to me?

Hon. A. Dix: Yes, and what we’ll be doing very shortly is doing a report on the

first year of the ten-year cancer plan. In advance of the public release

of that report, Dr. Chi and Deputy Minister Brown can provide the member

with a full briefing.

We’re assessing the plan over its first year — where we need to do

more, what the successes have been, for example. I’ll just say this.

We’ll get the FTE numbers. I have one of the answers on FTEs that the

member was asking for. We’ve seen a 16.2 percent increase in one year in

physicians. That’s a head-count increase of 92 physicians, of which 71

were oncologists.

An additional 20.9 FTEs have been hired but not yet started. This

leaves a 14.3 FTE vacancy for physicians. That is real progress, and

that makes a difference for people.

Keep in mind something that the member and I discussed last week,

I think, the significant increase in number of people in MSP. It just

brings about more people who require cancer…. So we have to keep doing

this.

Thirty new FTE radiation technologists have been recruited since

April 1, 2023, when wages were increased under the collective agreement.

A further six have been hired but not yet started.

[4:00 p.m.]

Twenty-one further graduating students have accepted conditional

offers of employment, ten recruited nationally and 11 from BCIT, the

entire graduating class. That is great news.

Net 135.7 regional staff FTEs have been added to cancer centres

since the start of the fiscal year. That’s a 10.5 percent increase in

one year. There is, as of P12, a total — this is a reduced total — of

254 FTE vacancies.

That gives some of that as answers. On the specific issues…. We’ll

either provide those to the member in this time, or we’ll provide them

in a specific briefing note that we’ll have for the member in advance of

the release of the report on the first year of the cancer

plan.

S. Bond: Thank you to the minister.

What I would appreciate is…. The more specific the data can be,

the better, so that we can have a good understanding of what the gaps

look like and what progress has been made.

It was interesting to note…. In February of this year, the

minister was actually able to state that the Kelowna cancer centre had

the highest number of people receiving radiation therapy within wait

times. I think that was given as part of the rationale for why fewer

people in the Interior chose not to or did not need to go to Washington

state.

That would make me believe that the minister has the data, broken

down by cancer centre, at the cancer centre level. I am hopeful that I

would also be able to see, by cancer centre and by health authority, the

same descriptions that I’ve provided: IV chemotherapy, radiation

therapy, radiation oncology and medical oncology. Obviously, if the

minister knows Kelowna, he must know the numbers at the cancer centre

level.

I will leave that question on the record for the very specific

data. I look forward to receiving it.

I wanted to just get an update on the Bellingham radiation

therapy. I’m sure the minister can imagine what it’s like for people who

have to leave home to get critical radiation treatment.

Can the minister tell me how many patients in fiscal ’23-24 or

recently — if it’s up to date, fine — have been referred by radiation

oncologists for treatment in Bellingham? How many have started

treatment, and how many have completed treatment?

Hon. A. Dix: The member is quite right. One of the reasons — this is why I said

this in the House — why the Bellingham program wasn’t designed for

Interior Health was that the wait times were in much better shape in

Interior Health than anywhere else. That was the reason. People,

obviously, would rather go to Kelowna than go the long journey just

south of the border to Bellingham.

Let me just take the member through the people who have received

and are eligible. Remember that this is a choice for people. It’s

obvious, I guess, that the largest group of people who have chosen to

get treatment are from the Fraser Health Authority. It’s closer to

Bellingham, it’s a more direct route, and there are a lot of people in

that health authority.

Let me take it through the numbers. So 884 patients are eligible

and agreeable for treatment in the United States. Post-screening

cancellations, 87. This is, by the way, as of April 22. Really, these

referrals started in July, essentially. That’s the period. Patients that

received a U.S. radiation oncologist consult, which is required to begin

with, 739. There were 11 post-consult cancellations, and 703 patients

have started treatment.

Currently this week receiving treatment in the United States, 50.

That is the maximum. We’ve been between 46 and 50. Basically, every

week, except the Christmas weeks, in the last six months, we’ve been at

the maximum contracted amount. The number of patients that have

completed radiation therapy in the U.S. is 654, of which 494 are for

breast cancer and 160 are diagnosed for prostate cancer.

I also have the numbers by health authority. I won’t go through

those now, but I’ll share those with the hon. member. That might be the

easiest path.

[4:05 p.m.]

Generally, the health authority that has had the most

participation is the Fraser Health Authority, partly because of

proximity and the sheer number of people in the Fraser Health Authority.

That’s the disproportionate group. Whenever people get…. We expand the

access to care. Obviously, that helps in addressing issues of waiting

for care. We want to get that right away, which is the reason why we

engage in this initiative.

I would say this. Twenty-seven patients have completed treatment

from the Northern Health Authority and 97 from the Vancouver Island

Health Authority. So it’s not just Fraser Health. Those are the health

authorities involved.

S. Bond: Thank you to the minister.

Could he confirm that he said that the number was 703 people that

have started treatment in total?

Hon. A. Dix: Yes.

S. Bond: When the data is shared, could the minister also ensure that the

numbers are included for people who have declined to actually

participate in the Washington program? If there are those who have

failed screening and may still be waiting for treatment, could he

include that information?

I’m wondering if the minister can tell me if there have been any

updates or extensions to the two contracts since each of them was

originally signed.

Hon. A. Dix: No.

S. Bond: That was a short…. I’m never prepared for a short snapper from the

Minister of Health. That was very good.

I want to move on to something that, actually, the Premier said.

In one of his year-end interviews, he made a commitment to releasing

wait times for chemotherapy and oncologist appointments.

I’m wondering if the minister could provide me with a timeline for

when that data would be made publicly available.

Hon. A. Dix: I’ll be shortly reporting on the first year of the cancer plan. It

will include data such as that. If I have that data in advance of that….

In any event, we commit to giving a pre-briefing to the member. So

she’ll have that on the day. She won’t just be responding immediately at

the conference. She’ll have the information. But if we have it

beforehand, happy to share that as well.

S. Bond: The other thing that the Premier talked about was…. He actually

said that we need to make much faster progress in cancer

care.

I’m wondering if the minister can…. Perhaps this will be included

in his upcoming report. Are there exact and specific targets that have

been set for cancer care improvement? What I would like to know is: are

there those targets set in place? And is there a gap between the targets

and the latest wait times for chemotherapy and oncologist

appointments?

Hon. A. Dix: Those targets are on the record. I’ll be happy to share them with

the member.

I’ll just give the member an example on radiation therapy. We were

talking about that. We can also do that in terms of consults.

In terms of radiation therapy…. This is in P12. The fiscal year is

divided into 13 things. This is probably February to the middle of

March. In that case…. So 83 percent of patients received radiation

therapy within four weeks in P12. And 90.1 percent were treated within

five weeks. So it’s very clear…. Our goal is to achieve 90 percent

within four weeks. That means ensuring…. That shows that we’re close to

that but that we have work to do.

There are targets in every one of those areas in terms of

treatment. It’s those clinical targets that we intend to hit.

S. Bond: Thank you to the minister.

A new expert panel was appointed to advise B.C. Cancer. I’m

wondering if the minister can provide me with the panel’s specific

mandate and their terms of reference. Perhaps tell me whether they’ve

met.

[4:10 p.m.]

Have they submitted recommendations to government? If government

has received recommendations, will those be integrated, and when, into

improving cancer care service?

Hon. A. Dix: There are two committee structures that were put in place. The

first is the executive provincial steering committee. That was formed in

November 2023. It involves the Deputy Minister of Health but also three

prior experts the member will be familiar with: Don Carlow, Susan

O’Reilly, Tom Keane. They meet on a regular basis, I think biweekly, to

oversee immediate actions.

The international committee that we referred to, as well, the

panel, does meet and will be meeting in person next week. That includes

Prof. Mark Britnell from the Global Business School for Health,

University College London — he has other titles, needless to say; Prof.

Dorothy Keefe, who’s the chief executive officer of Cancer Australia;

and Dr. Craig Earle, who’s the chief executive officer of Canadian

Partnership Against Cancer. Their next meeting will be an in-person

meeting in Victoria next week.

S. Bond: I appreciate the information.

As I’ve said numerous times, data is one thing, words that we

share in this House, but any wait, when you have a cancer diagnosis, is

too long. All of us are hearing absolutely terrible stories of people

who are afraid and worried. We have health care professionals who are

finding it devastatingly difficult. There is a lot more work to do. I

look forward to receiving the information from the minister about wait

times and looking at the gaps that exist. I think it’s important to

acknowledge that people are just worried. They’re feeling, often, a lack

of hope in the system.

I want to move on to capital projects. I’m going to start very

quickly. The minister will not be surprised to know how disappointed I

was. Yes, we’re getting a parkade, but I do not see in the budget the

plan for University Hospital of Northern British Columbia. I’ve met with

doctors, nurses, health care professionals, patients on a regular basis.

I don’t think it’s a stretch to say that the situation at UHNBC is dire.

It is not something we can simply continue to push further down the

road.

There was an announcement, more than one, about a new patient

tower, cardiac unit. We continue to see investments being made

elsewhere. The business plan phase was one of the commitments. That

takes 12 to 18 months. When we think about this, we’ve seen those

deadlines move further and further away.

I am deeply concerned for the people of northern British Columbia.

As the minister knows, that hospital serves an enormous geographic

region in British Columbia, two-thirds of the geography of the province,

actually.

I would like the minister to provide me with specific details of

when the people who are served by UHNBC will see shovels in the

ground.

[4:15 p.m.]

Hon. A. Dix: First of all, because I’m talking about Prince George, I’m going

to wait.

The pre-works is really important. I, like the member, want to

proceed with the project. The pre-works, as we’ve seen in other

projects…. You have to do the pre-works on this project. You have to

work on the site to prepare the site for the larger works that come

later.

I pushed forward, obviously, with the pre-works. The contract is

in let, and they’re starting construction soon. That’s part of the

project. So if we had not done that, then everything would be delayed

for the pre-works. That’s not a small project, and it’s not just a

concept plan approval in the ten-year capital plan and not just a

business plan approval, but a proof contract, and we’re proceeding to

break ground. That is part of a broader project.

With respect to the University Hospital project, we need to

proceed to business plan approval. I can tell the member that we are

close but that the project has begun, effectively, because the pre-works

are underway. Wherever you were starting, they were always going to have

to come first. I didn’t want to wait. I didn’t want to go through

business plan approval for the whole project, away from the pre-works. I

want to go on that project. It’s a high-priority project for me. I know

however high a priority it will be for me, it’s always going to be a

higher priority for the member.

What we’ve talked about are the priorities there, which is

improvement on the operating room side. They’re operating in 1979

operating rooms. Our brilliant staff at the hospital do a great job for

patients and continue to do so at that hospital. But they’ve got to be

better.

The other place is mental health and addictions care. I’m not

telling the member anything she doesn’t know, but other people may be

interested to know that even the operating rooms are not as urgent, I

think, a need as making…. I know the member was in the Interior

recently. If you compare the unit that’s been built at the new Royal

Inland Hospital with the unit that people have to get well in at the

University Hospital of Northern British Columbia, it’s a huge

difference.

Cardiac care is something we want to bring closer to

home.

The reason why we’re doing the pre-works…. I know the member has

to say these things and everything else. It’s not just a parkade. This

is crucial and integral to doing this project. The reason we are

proceeding in getting that work done is it’s integral to all of the

other work being done.

We’re close, and I can assure the member…. I always tell her when

I’m going to Prince George. I’ll be telling her on that occasion. That

will be a good day for the people of Prince George, but one of many,

because we’ve got a lot of work to do to build that project together,

both with, obviously, the regional hospital district, ourselves, driving

that process forward.

I believe, profoundly, in the need for this project. It’s a

priority for me. There’s always a debate in Northern Health about what

should go.

A long wait for projects in Dawson Creek: proceeding with

that.

A long wait in Fort St. James: proceeding with that.

Long wait in Terrace: proceeding with that.

This is just as important as those projects, and I appreciate it’s

a wait. I also will tell the member that the reason we’re proceeding

with the pre-works is the priority we get to getting this

done.

S. Bond: Thank you to the minister for that response. He’s right about the

fact that I do have to say those things.

He should also know it is one of the motivating factors for

wanting to c