1988 Legislative Session: 2nd Session, 34th Parliament

HANSARD

The following electronic version is for informational

purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

THURSDAY, JUNE 16, 1988

Afternoon Sitting

[ Page 5143 ]

CONTENTS

Routine Proceedings

Liquor Control and Licensing Amendment

Act, 1988 (Bill 38). Hon. L. Hanson

Introduction and first reading –– 5143

Transportation and Highways Statutes

Amendment Act, 1988 (Bill 34). Hon. Mr. Rogers

Introduction and first reading –– 5143

Oral Questions

Vancouver Island bee inspection. Mr.

Stupich –– 5144

Employment Plus program. Mr. Cashore –– 5144

Parks maintenance. Ms. Edwards –– 5144

Sport awards program. Mr. Barnes –– 5145

Late government payments on day care

centre billings. Ms. Marzari –– 5145

Firing of employees with PCB concerns. Mr.

Harcourt –– 5145

Committee of Supply: Ministry of Health

estimates. (Hon. Mr. Dueck)

On vote 45: minister's office –– 5146

Mrs. Boone

Ms. Edwards

Ms. Smallwood

Mr. Michael

Dental Technicians Amendment Act, 1988 (Bill 37). Second reading

Hon. Mr. Dueck –– 5160

Mrs. Boone –– 5161

Hon. Mr. Dueck –– 5161

Dental Technicians Amendment Act, 1988 (Bill 37). Committee stage. (Hon. Mr. Dueck) –– 5161

Third reading

Municipalities Enabling and Validating Amendment Act, 1988 (Bill 26).

Second reading

Hon. Mrs. Johnston –– 5161

Mr. Blencoe –– 5161

Hon. Mrs. Johnston –– 5161

Sechelt Indian Government District Home Owner Grant Act (Bill 43). Second reading

Hon. Mrs. Johnston –– 5162

Police Act (Bill 21). Committee stage. (Hon. B.R. Smith) –– 5162

Hon. Mr. Strachan

Mr. Sihota

Mr. Rose

Mr. Barnes

Land Title Amendment Act, 1988 (Bill 24). Committee stage. (Hon. B.R. Smith) –– 5169

Third reading

Law Reform Amendment Act, 1988 (Bill 27). Second reading

Hon. B.R. Smith –– 5169

Mr. Sihota –– 5169

Victims' Rights and Services Act (Bill 31). Second reading

Hon. B.R. Smith –– 5170

Mr. Sihota –– 5170

Mr. Loenen –– 5174

Ms. Edwards –– 5174

Mr. Blencoe –– 5174

Hon. B.R. Smith –– 5174

Commercial River Rafting Safety Act (Bill 29). Second reading

Hon. Mr. Strachan –– 5175

Ms. Smallwood –– 5175

Ms. Edwards –– 5175

Hon. Mr. Strachan –– 5176

Pension (Miscellaneous Amendments) Act, 1988 (Bill 39). Second reading

Hon. Mr. Veitch –– 5176

Mr. Clark –– 5177

Hon. Mr. Veitch –– 5177

Resource Investment Corporation Amendment Act, 1988 (Bill 44). Second reading

Hon. Mr. Veitch –– 5178

Mr. Williams –– 5178

Mr. Clark –– 5180

Mr. Miller –– 5181

Mr. Michael –– 5182

Mr. Lovick –– 5183

Hon. Mr. Veitch –– 5184

Appendix –– 5185

The House met at 2:07 p.m.

HON. MR. VEITCH: In the members' gallery

today, Mr. Speaker,

we have two very distinguished visitors. His Excellency Dr. Vladimir

Pavicevic is the ambassador for the Socialist Federal Republic of

Yugoslavia. Accompanying His Excellency is Mr. Nikola Jelincic, who is

the consul general of Yugoslavia at Vancouver. I'd ask the House to bid

them a warm welcome.

HON. MR. PARKER: Joining us today in the

gallery are friends

from Oregon. I'd like to introduce to you and to the House State

Senator Joan Dukes, her husband, Eric, and their son, Ian. Would the

House please make them welcome.

MR. ROSE: I'd like to introduce to the

House a young man

who's come from half-way around the world to be with us today. While

the Law Clerk, the second member for Delta (Mr. Davidson) and I were in

Zambia in 1980 we met the family of Eric Mkandawire. His father

expressed an interest in having a Canadian education for his son. As a

result of a lot of cooperation from Mr. Speaker, from the Hon. Perrin

Beatty, the Minister of Defence, the Progress Club of Vancouver or

North Vancouver — I've forgotten which one it was — Notre Dame College

in Wilcox, Saskatchewan, and of course the charming member for

Coquitlam-Moody, we were able to arrange for him to have a two-year

scholarship. He's half-way through now, doing very well; his grades are

better every quarter. Would you welcome Eric Mkandawire from Malawi.

HON. MR. VANDER ZALM: I would like to see

the House welcome a

very good friend of mine and a resident of Port Moody, one who's

certainly been successful in the community and in our province, Mr.

Frieder Kempe. He's in the House.

MS. EDWARDS: I'd like the House to join me

in welcoming a

friend of mine from Cranbrook who's on a bit of a Cook's tour, I think.

When he's home, Robert McLeod is the news director for CKEK radio.

Would the House join me in making him welcome.

MR. PELTON: Hon. members, we are honoured

in this House today

to have with us the Speaker of the Queensland Legislative Assembly in

Australia. The Hon. Lionel Powell and his wife, Mrs. Powell, are here,

and they are accompanied by the Deputy Clerk of the Parliament, Mr.

Robert Doyle. Could we make them welcome, please.

Also, hon. members, on behalf of our Speaker I would like to

introduce Miss Robbin Frazer, president of Spectrum Three Consulting

Ltd. Could we give her a warm welcome as well, please.

MS. A. HAGEN: As is often the case, young

people give us an opportunity to meet other young people. We welcomed

to our home this week a friend who entertained our son in West Germany.

As a result of his coming to Victoria, I've had the opportunity to also

meet two other young West German travelers who are visiting British

Columbia. I'd like to ask the House to join me in welcoming Ludwig

Boehme from West Berlin, Karl Bastuck from Lahr, and Bernd Koch from

Marburg, who are visiting British Columbia.

HON. MR. SAVAGE: It is indeed a pleasure

for me to rise in

the assembly today and welcome, on behalf of the second member for

Delta (Mr. Davidson) and me, a constituent, Mr. Dennis Elsom, who has

been responsible for developing a good part of North Delta. Would this

assembly please make him welcome.

HON. L. HANSON: In the gallery today

visiting us from

Burlington, Ontario, we have Mr. and Mrs. Al and Lorraine Neumair.

They are the parents of a very important person in my office, one of my

secretaries. Heidi. Heidi is trying to convince them that British

Columbia should be their permanent home, and I'm sure that when they've

seen the beauties of British Columbia, it will be. Will the House

please make them welcome.

MR. LOENEN: It gives me a great deal of

pleasure to introduce

someone who has made a great contribution to our community over many

years of service: Irene Frith, who is a former alderman and is

currently chairperson of the North Fraser Harbour Commission.

Accompanying her is Ted Hurschman. I would like the House to give them

a warm welcome, please.

MRS. GRAN: Mr. Speaker, seated in the

gallery today is a

group of grade 7 students from Simonds Elementary School in Langley.

Would the House please welcome them.

Mr. Speaker, seated in your gallery are two friends of the

second

member for Langley (Mr. Peterson) and mine. One is a farmer, Juergen

Wernikke, and the other is a developer, Ken Thompson. Would the House

please welcome them.

HON. MR. COUVELIER: I also have a friend or

two, and two of them happen to be in the House today. I'm pleased to

ask the House to welcome Mr. Peter Daniels and Mr. Graham Roberts of

Victoria.

Introduction of Bills

LIQUOR CONTROL AND LICENSING

AMENDMENT ACT, 1988

Hon. L. Hanson presented a message from His Honour the

Lieutenant-Governor: a bill intituled Liquor Control and Licensing

Amendment Act, 1988.

HON. L. HANSON: I move the bill be

introduced and read a

first time now. This bill is the result of extensive public

consultation and follows the recommendations of last year's liquor

policy review. I am pleased to introduce the Liquor Control and

Licensing Amendment Act for first reading at this time.

Bill 38 introduced, read a first time and ordered to be placed

orders of the day for second reading at the next sitting of the House

after today.

TRANSPORTATION AND HIGHWAYS

STATUTES AMENDMENT ACT, 1988

Hon. Mr. Rogers presented a message from His Honour the

Lieutenant-Governor: a bill intituled Transportation and Highways

Statutes Amendment Act, 1988.

[2:15]

[ Page 5144 ]

HON. MR. ROGERS: I move the bill be

introduced and, read a

first time now. In speaking very briefly to it, this is what would best

be described as a miscellaneous statutes amendment act specifically

geared to this ministry and dealing with such exciting issues as axle

weights, lengths of trailers and other things which I am sure will

stimulate the members during second reading and debate.

Interjection.

HON. MR. ROGERS: Oh, absolutely. No, this

isn't housekeeping; this is vehicle-keeping. I move the bill be read a

first time now.

Bill 34 introduced, read a first time and ordered to be placed

orders of the day for second reading at the next sitting of the House

after today.

Oral Questions

VANCOUVER ISLAND BEE INSPECTION

MR. STUPICH: A question to the Minister of

Agriculture. I

understand the bee inspector, Ed Milot, who worked so hard to persuade

the ministry against their determination that those offending 340 hives

be removed from Vancouver Island, was fired this morning. That's what I

heard from the local radio station early this morning. I'd like the

minister to comment.

HON. MR. SAVAGE: To the hon. first member

for Nanaimo, I

would like to inform the member that I have done some investigative

work this morning. The altercation involved a sailing of the 7 o'clock

ferry from Horseshoe Bay on-site at the ferry terminal. As I understand

it, there was some confusion about the leaving of the Island of those

137 hives out of the 347 that are on the Island. I don't think there

was an altercation, but I believe Mr. Milot came to the terminal with

two police officers, as I understood it, and apparently was expecting

some sort of altercation, from what I am reported.

But I can tell you, hon. member, that the chief inspector who

was

on-site does not have the authority to release anyone. That is the

jurisdiction of the minister or the deputy minister, so I can assure

you that that is not the case. He may have been told that, but that is

not in fact the case.

MR. STUPICH: I would expect that relations

between the chief

inspector and the inspector who's doing his job would be rather cool at

the present time. I wonder if the minister has given any consideration

to appointing the one who seems to be doing his job and knows his job

so well, Mr. Milot, as chief inspector and making Mr. McCutcheon the

assistant, so that he'll learn something about the job.

HON. MR. SAVAGE: I do not wish to comment

on that until I've completed my investigation.

EMPLOYMENT PLUS PROGRAM

MR. CASHORE: My question is to the Minister

of Social

Services and Housing. Yesterday the minister announced with great

fanfare from the Crystal Garden — of all places.... Given the money

that's been removed from JobTrac, I don't know how the minister was able to afford to

announce it from that place. Mr. Speaker, the minister has some

explaining to do. Can he tell this House the real difference between

the former JobTrac program and this effort that was announced for the

second time yesterday?

HON. MR. RICHMOND: If the member would read

the news releases

that are sent to him and would study in detail the program, he would

find out there are significant differences.

The reason it was announced yesterday is that.... We are

announcing the public launch of the program because the success of this

program depends on the small business people of this province, the

private sector, picking it up. It seems it's being met with enthusiasm

in the private sector. The reaction so far seems to be excellent. So I

appreciate the member asking the question, because it gives me an

opportunity to say in this Legislature, and to the public of British

Columbia, that we hope the small business people avail themselves of

this very worthwhile program.

MR. CASHORE: Supplementary question. I find

that very

interesting, having received a call this morning from a person who went

into one of the offices of the Ministry of Social Services, and the

people there didn't know anything about this program and were not able

to help that individual. We all know that this program is a shadow of

the ineffective, inadequate JobTrac program that didn't create real,

lasting, meaningful jobs. When pressed, the minister acknowledged to

the press that the program is a little late this year. How can the

minister expect these business people and non-profit societies to

access this program when he is just coming out with the information and

the material now, in mid-June? The offices don't even know anything

about it. How can we expect these businesses and non-profit societies

to read the material, go through the process they must go through and

make use of it before winter sets in?

HON. MR. RICHMOND: I just wonder if the

member meant that all

as one question or as a series of questions. I will try to be as

explicit as I can. I did say to the press that, yes, ideally we would

have liked to have had the advertising program put together perhaps ten

days ago, but we still don't feel we are late for this summer season,

Mr. Member. It's still just the middle of June, and we have a great

summer season of tourism and great weather to go through in this

province. The program is for a minimum of two months and a maximum of

six, so I think the uptake on it will be very, very good. I have every

confidence in the private sector of this province. And the parks and

tourism components of it — which the member failed to mention — will

leave lasting legacies for this province. It's our experience that when

we get these people on income assistance their first job and they have

something on their resume, not only do they achieve the self-esteem and

worth that we desire, but in many instances they stay on with the

employer and it becomes a permanent placement.

PARKS MAINTENANCE

MS. EDWARDS: My question is to the Minister

of Environment

and Parks. One of the new Employment Plus programs is to enhance

projects in about 30 parks across the province. Will the entire parks

maintenance program in the few parks left that are not privatized now

be handled by the Employment Plus program?

[ Page 5145 ]

HON. MR. STRACHAN: For the benefit of the

record and members

of the Legislative Assembly, let me say this. The program, as it was

last year, is funded to the tune of $2 million for parks enhancements.

The contractor this year, as was the case last year, is the Outdoor

Recreation Council. They're not doing maintenance work; they're doing

trail enhancement and many other good works for the benefit of the

parks system. This year they are also going to be expanding their

program to deal with some municipal parks and regional district parks,

so it's more urban based.

I'm quite proud of the system. I'm proud, as a minister, to be

participating in it, and I can assure this assembly that it's going to

achieve two very good measures: one, it's going to improve our park

enhancement system; secondly, and most importantly, it's going to

provide entertainment and training for the young people of our province.

MS. EDWARDS: A supplementary question. If

the minister is not

hiring auxiliary staff, as you have said before; if the existing staff

is merely skeletal, as you have said before; and if the Employment Plus

project is not for maintenance but for enhancement, who is maintaining

the parks?

HON. MR. STRACHAN: Maintenance staff or

maintenance

contractors, as has always been the case. We have 208 parks; 156 of

them are privatized in terms of maintenance, and the rest are done by

Parks employees. More are going to be privatized. The maintenance will

be done by the maintenance crews, and the enhancement work will be done

by the Outdoor Recreation Council and this project.

SPORT AWARDS PROGRAM

MR. BARNES: I have a question for the

Minister of Tourism,

Recreation and Culture. A couple of weeks ago the minister and I had, I

thought, a very productive exchange discussing the tributes of Harry

Winston Jerome. At the present time the Premier's sport awards program

is available in something like 1,000 schools across the province with

111,000 participants. I understand that the program will not be

funded after the end of June. Can the minister indicate why he is

withholding the $200,000 grant that he has been making available over

the past six years?

HON. MR. REID: Yes, the school program

which concludes at the

end of this 1987-88 year will be ended. There is $60,000 in place at

the moment to complete that program. We are discussing it with the

private sector and some sponsors in the communities of the province who

have showed an interest in picking up some of the components of that

program. It will be in place in 1988-89, but it will be funded not only

by taxpayers, but by some interested private sector sponsors.

MR. BARNES: I didn't want to get into too

long a dialogue

over this, but it sounds to me like this is through the back door. What

you're saying is you're privatizing this program, because $60,000 is

far less than what is required. Without notice, it sounds to me as

though the program will be at risk. It's very disappointing as well for

the minister to be making this information known today that they are

going to be significantly reduced in their ability to carry this

program on. Just remember as well that the minister invited this side

of the House two weeks ago to come up with recommendations which would

help to perpetuate the memory of Harry Jerome in the schools. This is a

very disappointing bit of information.

HON. MR. REID: I'll take that in a

roundabout way as a supplementary question, and I'll address it in this way. I give that

member the assurance that all the programs we have been involved with

in the past are better than they've ever been before, and this one is

no different from other programs we have in place. Because there is a

shift in corporate sport marketing in the province by the private

sector wanting to have some promotional opportunities with sport, we

are also making this available to that particular program. It is a

$200,000 contract for the year. The contract for 1987-88 runs out at

the end of June. The contract has not been renewed, because we're

setting different guidelines for it for the future. But I give you the

assurance that the program has not been discontinued.

LATE GOVERNMENT PAYMENTS

ON DAY CARE CENTRE BILLINGS

MS. MARZARI: A question to the Minister of

Social Services

and Housing. Yesterday I put forward a question about non-payment of

bills to the day care givers in this province. The minister assured me

that he had not received any complaints from day care givers that they

had not received payment on their coupons. I have in my hand two

letters dated March 19 and June 6 from day care givers to the minister

claiming that they had not received payment and they could not continue

to operate on such a shoestring. I have too a letter from the minister

back to one of them, dated March 29, recognizing completely the nature

of the problem and stating that bills would be promptly paid by this

government within 14 days of receipt. Would the minister care to change

his answer of yesterday to reflect the evidence I bring forward today'?

HON. MR. RICHMOND: The letter that the

member refers to.... I haven't seen the one she has, but I am certain it refers to a day

care centre in Kamloops and to a specific case of a specific family. I

have not received any letters from day care centres regarding the

overall late payment, as she suggested, up to eight weeks, I believe it

was. If she would care to show me letters stating that, I would be

happy to deal with it.

FIRING OF EMPLOYEES WITH PCB CONCERNS

MR. HARCOURT: I have a question for the

Minister of Labour,

and it cleats with an item that the member for Surrey Guildford-Whalley

(Ms. Smallwood) brought to the attention of the Minister of Environment

(Hon. Mr. Strachan), who took the matter on notice. I am talking about

the plant in Burnaby where five employees were fired for raising their

concerns about the potential hazard to their health from the PCBs on

the site. Will the minister tell the House what initiatives he has

taken to investigate this whole matter?

[2:30]

HON. L. HANSON: The Minister of Environment

took the issue on

notice. As for the concern of the individuals that they were fired

improperly. there are remedies for those individuals. If they are a

unionized firm or if they are under agreement with their management,

they have an arbitration

[ Page 5146 ]

process, and if they aren't under that, they have other

remedies

through my labour standards branch. At this point I am not doing any

investigation, because the employees have not come forward with a

complaint to me or to my ministry.

MR. HARCOURT: A supplementary, Mr. Speaker.

Surely I don't

have to remind the minister of his responsibilities to working people,

the enforcement of health and safety laws. I think the matter is

important. It's a non-union outfit. The real issue is people who are

concerned about dangerous chemicals and bring it to the attention of

the authorities in good faith, and who are fired for that. I think

there should be a strong message back to those employers in that

non-union outfit that they can't do those sorts of things when these

people are dealing in good faith. Would the minister agree to undertake

an investigation of this matter?

HON. L. HANSON: Now that the Leader of the

Opposition has

made his question somewhat more clear, the Workers' Compensation Board

has been in to investigate the hazard of the material you are concerned

about. I haven't had a report yet from them as to what their

determination is.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 45: the minister's office, $305,183.

MRS. BOONE: I'd like to ask the minister

some questions. For

a few minutes I'm going to be focusing more on the hospital end of

things — for a short time anyway. On behalf of the first and second

members for Nanaimo (Mr. Stupich and Mr. Lovick), I'd like to get this

out of the way if I may. It's a specific question regarding the Nanaimo

hospital, which apparently has the longest surgical waiting-list in the

province.

About three days a week, in-patients must be housed in

emergency

unit beds because beds aren't available anywhere else. About 40

acute-care beds are filled by patients waiting for extended-care beds

to become available. I understand that the minister is aware of this

situation and that he's had a dialogue with the members for Nanaimo. I

would like to know what the status is regarding expansion of the

hospital or anything that will alleviate the problems they have in that

area.

HON. MR. DUECK: Some hospitals have longer

waiting-lists than

others, which is understandable. It's due to many reasons, some being

that the growth of population is greater and the ageing of the

population in certain areas is higher — and that certainly applies to

the Nanaimo area, where they have a large number of senior citizens.

As for the bed-blockers, as you call them, who are occupying

acute-care beds at the present time, this has been alleviated somewhat

by the opening of the new extended-care and intermediate-care

facilities. We also have — and I'll just get some of the information

here.... Mr. Chairman, I want my people to get the information, what

the status of new extended and intermediate care in that area is right

now. I'm not sure whether we have that information. When you zero in on

specific hospitals, you know.... There are 135, and I can get that

information very quickly. The average occupancy of non-acute-care beds

is roughly between 10 and 15 percent in all hospitals, and it has been

that way for some time. We also find that if we build enough extended-

and intermediate-care beds and take them out, it is a matter of a very

short period of time before they're filled again. So there will always

be some people in acute care who could perhaps be better served in

extended or intermediate care.

I should also mention at this time that the thrust of this

government is to try and keep people at home as long as possible. We

find we've been very successful in this. The average age now in a

continuing-care facility is 82, which is quite an improvement over even

five years ago and certainly an improvement from ten years ago. So we

are keeping people in their own home, whether that be an apartment or

their own house, and doing quite well with support services, such as

home nursing and homemakers. We find, too, that that area is one that

needs to be beefed up and improved. I believe it will be less expensive

and ultimately much better for senior citizens than putting them into a

facility.

I'm quite happy in general terms with what we're doing in this

province. If you're talking about extending intermediate care, it might

be of interest to you that we are planning 1,200 new beds in the

province over the next two years.

MRS. BOONE: Certainly we're looking for new

intermediate-care

beds, but the immediate problem of the people in Nanaimo is that

they're looking for an expansion to their hospital. I understand they

have been dealing with the ministry, looking for a new hospital

addition, since 1981. What they are looking for is approval for a

three-phase expansion, and they hope they might get approval from the

ministry within a short time so that they can go to tender on working

drawings for that hospital. Can the minister tell me, please, what

status that project has?

HON. MR. DUECK: Mr. Chairman, I think I

mentioned that I

haven't got it here. But we sent for the information, and I will give

it to you in a few minutes.

MRS. BOONE: On another note, I've tried to

get some

information from some of the hospitals regarding their budgets. It's

difficult because they've only just received their budgets, so they're

not quite sure how well they will meet their requirements — or if they

are going to meet their requirements. A general problem has been a lack

of funds for the operational side, for the equipment side; not enough

funds to just purchase some of the ordinary equipment — not necessarily

the new technology but just everyday equipment. As you know, that was a

problem we brought to your attention last year. The hospitals have not

been able to keep up with inflation, and they have not been able to

deal with some of the issues they've got. Can the minister tell me,

please, if there's been any substantial change to hospital budgets in

those areas, if he has heard from hospitals regarding this problem, and

if there's any intention to increase those budgets so that hospitals

can purchase the nitty-gritty things of hospital budgets. I'm not

talking about the large, technical things; just the everyday things

that hospitals are finding it difficult to purchase right now.

HON. MR. DUECK: Mr. Chairman, we deal, of

course, with the association that represents the hospitals, which is the

[ Page 5147 ]

BCHA. They are very happy with the funding this year. I think

the

hospitals are adequately funded. They're all meeting their budgets. If

the problem you are alluding to is in one specific hospital, we may

have to deal with it and ask them what their concern is. But the

majority of hospitals in the province are very satisfied with the

budgeting procedure and are adequately funded.

MRS. BOONE: I would like to ask the

minister some questions,

because you mentioned the need for people to stay at home and the

desire of this government to keep people at home. Yet we haven't seen

any increase in the home care budget at all — well, just a pittance.

There is a minor increase there, but it's not enough to really deal

with the situation or be an encouragement for people to stay in their

homes. I know the member for New Westminster (Ms. A. Hagen) went to

great lengths with that, but that is an issue that I would like to see

addressed, and I don't see how we can be addressing the area of keeping

people at home when we don't increase that home care budget.

We also haven't seen any increase — and I mentioned this to

the

minister several times last year, and we debated this — with regard to

hospices. We talked specifically about hospices for AIDS victims. The

minister said we needed hospices for all kinds of terminally ill

people, which I agreed with, yet to date we have not seen any increase

in hospices in the province, and those are areas that are cost

effective. They treat people humanely and are far better alternatives

to keeping people in very costly acute care. Yet we don't seem to be

moving on this issue at all. In fact, we are not even moving on the

palliative care units that are connected with hospitals, and we have

seen some shifting away from that.

One of the complaints I had from a hospital was that there is

encouragement or additional funding to encourage people to promote

development of palliative care units. Again, these are areas that are

very cost effective and very humane, and they treat people properly —

the way they should be treated — yet we don't see any movement in that

area at all. I find it difficult to understand how the minister can be

patting himself on the back for keeping people at home, providing

alternatives and doing all this prevention when in fact we don't see

the support systems out there to actually help people do those very

things we want to do.

Can the minister tell me what the plans are for hospices, and

there are any plans to develop hospices and encourage hospitals to

develop palliative care programs or specialized units even within the

hospitals? What kind of movement is there in the ministry in this

direction? This is the progressive direction, one the ministry should

be moving in, and it should be moving there much more rapidly than it

is.

[2:45]

HON. MR. DUECK: To get back to the question

I said we would

get from the office, the planning process at the Nanaimo hospital is in

place. The planning is underway for 89 to 90 acute-care beds, and

construction approval will follow when that process is completed. Also,

diagnostic treatment and support services will be provided at that time

with the new facility.

The question on palliative care and hospices: we have two

hospice facilities in British Columbia now, and we have just announced

$1.3 million for operation of 24 hospice beds in British Columbia.

During the current fiscal year, the Vancouver hospice is expanding its

operating capacity from 11 to 15 beds. The additional beds will become

operational by December 1988.

In addition, proposals for hospice development by University

Hospital, Shaughnessy site, and St. Paul's Hospital are presently being

considered. Hospices have been developed to care for those where a cure

is not expected and who probably face the last days of their lives. We

have said before that we believe hospices should be for ill people —

for people dying of all kinds of diseases. We have not segregated any

particular disease, although in St. Paul's there is an area set aside

mostly for AIDS patients, but we are moving in that direction.

Palliative care — I believe it's on the drawing board, but

perhaps

when we expand hospital services to Eagle Ridge, Royal Columbian may

again go into palliative care,

MRS. BOONE: The minister mentioned an

expansion of beds, and

I'm very pleased to hear that. You mentioned a lot of things that are

on the drawing board or being considered. I didn't hear of any hospices

at all for outside the lower mainland. I find that kind of interesting,

after the rant the Premier went on yesterday with regard to putting

things outside the lower mainland and taking care of people outside the

Vancouver areas. We don't see any hospices going outside that area. Are

there any plans for any hospices or palliative care units to be

developed outside the lower mainland area'?

HON. MR. DUECK: Mr. Chairman, I think the

member is wrong. I

think we have many areas. First of all, a hospice is not necessarily a

facility. Many organizations throughout the province provide hospice

care. We also have hospitals, although they don't have a closed-in

facility saying,"This is the hospice area," and shutting it for

everything else. But they have hospice beds. They do care for those

people who are dying.

I don't know how you can possibly say that hospitals don't

look

after the dying or the sick. How you can possibly say, in our province

where we have the best possible health care of any country. that we

don't look after...? We haven't got enough hospice, enough beds.

This year's budget alone — and if you'd like to listen, I will repeat

it — was increased by $362 million. and you say we don't provide the

services. We provide absolutely excellent services. If we would only

look at some of the good things we do and ask how we can improve them,

rather than criticize.

MRS. BOONE: I certainly never said that our

hospitals didn't

take good care. I said that hospices deal with people in a more humane

way. They treat them, and it's more economical. I never, ever said and

I would never say that our hospitals did not treat people property. As

the member from Coquitlam said once, you've got to stop taking these

things personally and listen to what we're saying.

You have a report that was done on acupuncture. I've requested

that

report. You've indicated that that will be made available once it goes

to cabinet. I would like to know at this time when that report will be

available to us or when it's going to cabinet.

HON. MR. DUECK: Mr. Chairman, very soon.

I want to mention one more thing, and this is probably not the

appropriate time but I think I will still do so. I got word just a

little while ago that I'm a grandfather of a baby boy.

[ Page 5148 ]

MS. EDWARDS: Mr. Minister, I can't let that

unanswered

question go past. The member for Prince George North asked you if there

were going to be any more establishments of hospices — that means

facilities; that means a room where a hospice group can literally do

some work with those who are dying. The question was: are there any

more going to be established? Because there are not enough in the

province.

HON. MR. DUECK: Mr. Chairman, I think I did

say which ones

are now under consideration, with some extra money funded for those

facilities I mentioned. The question was then whether it was for the

rest of the province. At that point I did say that a hospice is not

necessarily a facility, and you can imagine that not every town will

have a separate hospice facility. They do that in the workings of the

hospital in general. That's why I asked why you are down on hospitals,

because even the smallest hospital will cater to dying people. Even a

hospital that has ten beds will deal with people who are dying, and

that is a hospice situation. They'll deal with that individual

differently than they do with someone who's there in recovery and will

only be there for another two days. So that situation does exist, but

whether in fact every hospital has a hospice area, no, and it won't

have.

In the more populated areas — I think I mentioned it, and I'll

say

it again, if you want to mark this down — an extra $1.3 million has

been set aside for the operation of 24 hospice beds in British Columbia

during the current fiscal year. The Vancouver hospice is expanding its

operation capacity from 11 to 15 beds. The additional beds will become

operational by December. In addition, proposals for hospice development

by the University Hospital, Shaughnessy site, and St. Paul's Hospital

are presently being considered.

We've also been in touch with hospice societies in various

areas —

New Westminster, for example, has a very active hospice society — but

we don't necessarily have facilities specifically designated as hospice

facilities. But they're used as such, and hospitals in general do that.

I'm very glad they do. I have to say again that I believe that just

because we haven't got every hospital designating hospice beds....

Every hospital in the province does cater to and look after the dying

in the same manner as if we had the hospice beds set aside. In the

larger areas, it's easier to set aside and have personnel looking after

those people only. It's much simpler to do it in a larger populated

area.

MS. EDWARDS: I guess what you're saying is

no, there isn't any more funding going beyond the ones that you

mentioned.

The question in my mind, and certainly the issue in my

community, is

how you get a room or two set aside within a hospital that can be used

by the family of the dying. How can you do that within the funding

formula that's there? Too often it is far too difficult within

hospitals all across the province — and there are people dying all

across the province; as you said, it isn't just the lower mainland and

the well-populated areas that should get this. They need some space

where the people who are dying can spend some time apart from the

wards, with their family. That's what I was asking.

HON. MR. DUECK: To begin with, I would like

to make a

correction. I said the Nanaimo hospital. That's phase one, and that

does not call for new beds, but rather for the area of equipment and

services that we're providing. Phase one will not include new beds.

Hospice is much more than what you're saying; I'm sure you're

aware

of it. We also have hospice services to their own homes. Many people

prefer to spend their last days at home, which I'm sure you're very

much aware of. We have hospice agencies do exactly that work in the

homes where people lived before getting ill. We provide that through

the hospice society and also through home nursing and homemaker

agencies. There is that service available.

If you criticize that there isn't enough, I'll accept that,

but to

criticize that we haven't got it and that people aren't looked after, I

reject that; I will not accept that.

MS. EDWARDS: Mr. Minister, the annual

meeting of the B.C.

Hospice-Palliative Care Association was in my community this year. In

visiting that convention, the major problem that they still face,

according to the people that I spoke to, is a simple issue of getting

all these volunteers that are training themselves and being trained and

learning to help the dying in their last days.... The major problem

is a little bit of space within hospitals.

Yes, of course a lot of people prefer to be at home, but many

people

cannot be at home. They go to a hospital and end up in a four-bed ward

or even a semi-private, their family comes to visit and they have no

privacy. That's the kind of thing that I was hoping to hear you say you

had looked into and that you had found a way that even the smallest of

hospitals can, under the funding formula, set aside some physical space

for this kind of activity to occur, so that people who are dying in

hospitals do not have to say the final words that they have to say to

their families in, perhaps, a ward of four.

HON. MR. DUECK: I know what the member is

saying, and of

course, if I could meet that request in every instance exactly the way

you described, it would certainly be much better than having it less. I

said this before: if you criticize that there isn't enough being done

in some hospitals, I accept that, but when I consider the resources

available, I think it's not bad. As a matter of fact, I would say that

in most hospitals that I visit, the care of the dying is very well

looked after; and we're always looking at ways of improving it with

funding — of course it takes funding — and also with people and

suggestions that the administration and the board make to us, and also

from hospice. I meet with many hospice organizations. I met with the

people in New Westminster, which is a totally volunteer group. They're

fine people doing an excellent job, but they're doing it mostly in the

homes where the desire of people is to spend their last days at home.

Sure, we can expand. We can certainly improve on hospice. But

still have to say that most people are very satisfied. The families

that go through this very traumatic experience when loved ones die, by

and large, are quite satisfied with the system, and we're providing the

care that people need quite adequately with the resources available.

MRS. BOONE: I think the minister is missing

out on the

economic side of this as well. Aside from the humane aspect, it is a

more economical way to deal with this issue. It's not an easy one to

deal with. It's certainly not the best time in people's lives to be

dealing with it. But it's at a time when we have beds being filled up

with people, when we are having difficulty getting people into

emergency, situations taking up.... In the Nanaimo area, people are

unable to get into hospitals because of the long waiting-lists.

[ Page 5149 ]

The obvious answer is that we've got to look at the

alternatives.

The alternatives are putting some more money — it may be an initial

outlay right now — into the hospices, which will eventually save you

money; and into home care, which is the other area that has not been

strengthened nearly enough to meet the need, so that we can take the

strain off our hospital system. If we really want to take the strain

off that, then we've got to provide those other services. And the only

way we can do it is through some initial recognition that those are the

areas we're going to fund, that those are the areas that need to be

strengthened. We haven't seen that commitment.

I'm sorry I've got to do this, but I just got a letter

yesterday

regarding a mental health situation, and I'd like to go back to that.

It comes from Victim Support Service in Golden. They are expressing

severe concern over the fact that their mental health position is going

to be vacant and they have no guarantee that this position is going to

be filled. I believe they have written to you, to their MLA, to the

paper and everybody around, trying to get some answers on this and some

care for the people they are dealing with. The mental health situation

there is probably similar to the one I mentioned with regard to

Mackenzie — just no services available.

[3:00]

The letter goes through a lengthy report on the number of

people

they see at Victim Support Service, the type of people they deal with —

the sexually abused people they have to cope with; the psychological

and emotional effects of sexual assault on children, and what is

happening.... I would like to have some assurance from the minister

that he will look into this situation and ensure that this community

has a mental health worker. It is very short-sighted to deny these

people those services when we're going to be paying the consequences

down the road of people not getting early intervention. I'd like the

minister to give me the assurance that he will personally look into

this and make sure this community gets the mental health services they

deserve.

HON. MR. DUECK: Certainly early

intervention is of utmost

importance. I can't argue with that statement at all. These are all

good statements. As a matter of fact, any of the statements coming from

that side are very valuable, and I wish I could commit myself to all

the good suggestions being made.

I cannot recall at this moment if a letter was sent to me with

regard to the Golden situation. I would like to ask: when was the

position vacated? Perhaps the member knows that. It will be noted, and

we'll certainly look into it, because if there is a need in that area,

we will either try and find a replacement or send a team in on a

temporary basis — a flying squad that will go in and do it so many days

a month, a week or whatever.

The statement the hon. member made just before the last time

she

rose was: "We haven't had the commitment from the minister." I don't

know whether that was meant in general terms or in one specific area. I

want you to know that my commitment, I think, is very sincere. I think

my commitment to health is perhaps more sincere than you believe or

think — although in the second breath you said: "Don't take it

personally." I do, and unfortunately I'm that type of personality: I

can't seem to leave my personal feelings behind, just go ahead and do

my job and then go home and say: "So what." I just can't operate that

way. I want to assure this House, and I want it on the record, that I'm

committed to health care, to every phase of health care; and if in our

deliberations — and I've made notes of many things you've mentioned —

you can help me, I appreciate that. I do not take it as an offence.

I sometimes do reject people who try and act personal — or the

ministry.... Just saying all the good things we could do or should

do.... Yes, I could spend another billion dollars, and we would

still have that side of the House getting up and saying: "Do you know

that there's...?" That's natural. I would probably do the same if I

were sitting there. For heaven's sakes, when we spent $4 billion....

I think we're very efficient when we compare figures with other Health

ministries in Canada. Improvements can always be made, but by and large

the ministry is very efficient. I think we are using our dollars

properly, and we're spending an awful lot of dollars. I hope that we

can do this in future too.

I just got a note here about Golden. The position will be

filled. We

are recruiting at the present time, so I don't have to get back to you.

Just to give you an idea how committed I am, last year — and I

don't

want to talk about letters that come from these various groups that put

pressure on, but other than that — I received over 15,000 letters, and

if you add the others it's over 30,000, and I sign them all myself. I

don't read all of them.

When you ask about one specific letter, I must say that

sometimes,

unless it's something that really seems to captivate my mind, I don't

always remember, but I can get that information for you.

MRS. BOONE: I'd like to move on a little

bit here to your

medical ethics program. The committee was established last year on

medical ethics to debate moral issues such as abortion, euthanasia and

access to health care, and that is what I'm specifically talking about

today.

I would like to know what is happening with this committee,

We've

heard some comments from it. The ethics committee responded on the

issue of AZT. The minister didn't follow the advice of the ethics

committee, but they did respond on that. I'd like to know if the

committee is meeting and when they are going to be coming out with

recommendations for the government. Does the minister have a list of

the topics that committee is considering right now? That committee has

Dr. David Boyes. Dr. Bill Webber, Dr. Kluoe, the ombudsman and a Roman

Catholic nun — who remains nameless, I suppose; I don't know her name.

Can you give me the answers to the questions I just asked you with

regard to that committee, please?

HON. MR. DUECK: Exactly what do you want to

know? Who the

members are? You read them off; that's not what you wanted to know. The

ethics committee report has been received by my office. I have gone

over it. It will be taken to cabinet in the near future. Whether it

will be released or not will be up to cabinet. I think you erred when

you mentioned that AZT was one of the questions considered by the

ethics committee. I believe you are mistaken I think that was the AIDS

advisory committee that looked into that, and the ombudsman recommended

it. We've gone through that and our reasons for it many times.

I think yesterday we spent some time with speech pathology,

especially in the Simon Fraser area. I have a report back now which I

would like to put into the record. It will also help you with the

questions that you asked, or one of your

[ Page 5150 ]

members asked, yesterday. Further to our discussion in this

House,

my ministry has reviewed the problem of waiting lists for speech

therapy services, both in the Simon Fraser Health Unit and other health

units around the province.

As a short-term solution to this problem, we will be

contracting

with community agencies to enhance preschool speech therapy services on

a priority basis. Further, we will be sending in a team of

professionals, first to the Simon Fraser Health Unit and to the

Campbell River area to immediately clear the assessment backlog and

ensure the successful implementation of this preschool speech therapy

initiative. As a result of this strategy, we anticipate a significant

reduction in the waiting-lists in these two areas within three months,

and elimination of the waiting-list by March '89.

Further, the professional team will be taking action to

address the

problem of coordination of services between the various service

delivery agencies. They will address the allocation of speech therapy

resources to preschool programs, where they are the most effective.

Following the work in the Simon Fraser Health Unit and Campbell River,

the team will begin to address similar situations across the province,

beginning with the health units with the next longest waiting-lists.

It should be noted that this is an interim solution, and in

order to

address the longer term, I will be discussing with my colleagues from

Education and Social Services and Housing, which are both involved

because it involves the education of these professionals.... Once

the people reach school, Education takes over, and of course Social

Services has their people that they are also providing the service for.

We wish to bring forward a proposal to establish a committee

experts to review the speech therapy situation in the province and to

make recommendations concerning a coordinated approach to the delivery

of this service. I think I touched on it yesterday. I asked my people

to check this situation and see if they could fast-track it, and they

came up with this suggestion this morning. I said that we must do it,

and to do it immediately.

MRS. BOONE: I want to thank the minister

for his prompt

response. I can assure you that every part of this province will

welcome the reduction in the waiting-lists. I know that in my area

alone there are 200 at the Northern Interior Health Unit. We've

constantly had that problem, so any efforts the ministry can make with

teams or what have you to reduce those waiting-lists would be greatly

appreciated,

Any action to coordinate your efforts with the Minister of

Advanced

Education and Job Training (Hon. S. Hagen) to ensure that we have

trained people in that area would also be well accepted by this side of

the House, and I encourage you to do that as soon as you can. But I

really appreciate the action your ministry has taken on speech

therapists at this time; it's certainly appreciated.

Interjection.

MRS. BOONE: I'm being nice to him now

because he's just become a grandfather. Congratulations.

The member for Surrey-Guildford-Whalley has some questions for

you right now, so I'll turn this over to her.

MS. SMALLWOOD: I was very pleased to hear

the minister say

that he cares about all aspects of the health care system. As a

hard-working Minister of Health, I certainly hope that he would.

I would like to have a little bit of information about what

has gone

on with the hospital system, in particular with regard to abortion.

I've looked at some of the figures since the controversy a couple of

months ago, when we had women having to leave the province because this

government refused to pay for and make accessible abortions in this

province after the Supreme Court ruling. I'd like the minister to

provide a bit of information about the work his ministry is doing to

make abortions more accessible throughout the province, in conjunction

with the Supreme Court ruling that was subsequently upheld by the B.C.

Supreme Court.

HON. MR. DUECK: I don't think I do any work

in that area. We

know that the judgment has come down, and there is now no law in place

regulating abortions. They are certainly legal; it's between the

physician, the woman and the hospital. Hospitals are really an entity

all of their own. They have management, they have a board, they have an

administrator or president — whatever you want to call them — and they

function with a global budget.

At the present time we are funding abortions. I cannot give

you an

answer as to how many people are leaving the province. I would doubt

that many people would leave the province when they can have that

procedure done free of charge. I can't see why anyone would have an

abortion out of town when they are free in this province. We believe

that the federal government will come to grips with this subject sooner

or later. It may be later rather than sooner, because it is something

that most politicians do not like to talk about or discuss. I believe

some sanity has to come back and there have to be some guidelines and

legislation for this procedure.

[3:15]

We believe that with the program we have for strengthening the

family there are options. I have had people come to me and state — also

by letter — many times that when they look back to earlier years when

they did in fact have an abortion, they wish they had had some

counselling or alternatives. We have endeavoured to provide that by way

of counselling, literature and education, so that people can make an

informed decision.

We believe that focusing on minimizing the demand for

therapeutic

abortions is the right direction to go in. We make no apologies for

that. However, we hope that every physician that agrees to do an

abortion does it for medical reasons. Sometimes in the past I believe

there has been a grey area, because when we have an abortion rate

nearly double the national average, it leads me to believe that perhaps

if people had had the alternatives and the education and the

background, perhaps they would have thought this over a little more

closely. With the federal government taking a stand on this and putting

some guidelines in place through legislation, hopefully this whole

issue of abortions can be brought back to some sanity where we don't

abort over 26 out of every 100 live births, and at the same time ask

for immigration from other countries because our population is

declining. And hundreds and hundreds of people are waiting to adopt

children; that's why the adoption area is also in this particular

initiative of strengthening the family.

MS. SMALLWOOD: I am going to try very hard

to get some

information from the minister. I don't plan on engaging in the kind of

debate that is very tempting, after some of the

[ Page 5151 ]

comments the minister has made. Suffice it to say we disagree

— and disagree quite fundamentally — on this issue.

Could the minister tell this House how many women have

submitted

bills for abortions and travel during the time the government had a

policy in place which was later found to be in contravention of the

Supreme Court ruling?

HON. MR. DUECK: I haven't got the numbers

here, of course.

However, the people who have asked for refund have been advised that

they can get a refund for that period of time when we were not funding

abortions.

MS. SMALLWOOD: I wonder if the minister

would undertake to provide that information to the House.

I'd like to comment on the minister's reaction to my question

about

indicated that the government has put in place a program called

Strengthening the Family. He has indicated that many of the people he's

talked to have indicated they would have appreciated more information

when they had to make that very difficult decision. I want the minister

to know that the opposition supports — and has done so as a policy

position for a long time — the providing of information for all

alternatives, including the alternative of having an abortion should

the woman choose to do so.

The minister talked about the education program which I gather

your

ministry is involved with, along with the Ministry of Social Services

and others — for instance, about the pamphlet that talks about

contraception. A little while ago we heard some criticism that there is

misinformation in that pamphlet, and that if people followed the

information within that pamphlet it could bring about unwanted

pregnancies. Could the minister tell the House whether or not the

ministry has addressed that problem?

MR. CHAIRMAN: Just before we proceed, hon.

members, the second member for Langley asks leave to make an

introduction.

Leave granted.

MR. PETERSON: On behalf of the first member

for Langley (Mrs.

Gran) and myself, I'd like the House to join me in welcoming some

students and teachers from Langley Prairie Fundamental Elementary

School who are sitting in the public gallery right now.

HON. MR. DUECK: Those particular pamphlets

that you refer to

were in fact done by the B.C. Public Health Association. The so-called

errors.... Perhaps they're not errors, but if you read it a certain

way it may not be as clear as it could be. They have undertaken to

update those pamphlets when they run out. The pamphlets are designed to

encourage readers to consult with their physician or other health

professionals to obtain more in-depth information pertaining to their

individual needs. This is evidenced by reference in both pamphlets to

the need to consult your doctor.

We went back to the B.C. Health Association when this concern

arose,

and they said that it was not an error, but perhaps the wording was

such that some people would think that this would be sufficient without

consulting a physician. I'm satisfied that saying that you should

consult your physician on every one of these products was the emphasis.

That was very clearly spelled out. Most people have taken it as such. I

think the concern came more from people that were trying to find fault

with the pamphlet rather than looking at it as a guide for their own

personal use.

Strengthening the Family. You mentioned that all areas should

covered. I want you to know that we do not, in any way, say in all that

literature that the alternative is just abortion. That is part of it,

and we make no apology for that. The Initiatives for Strengthening the

Family have nine strategies. I want this for the record again:

(1) professional education targeted at medical and helping professionals;

(2) public awareness program; (3) exploration of disincentives to the

family in government policy; (4) adoption; (5) enforcement of

maintenance for children;...(7) marriage preparation; (8) day care

initiatives; (9) supportive living environment for pregnant women. It

goes on and on.

[Mrs. Gran in the chair.]

We can expand on every one of those: education, for example.

It also

has three pamphlets, I think. In "How to Avoid Pregnancy" it also says

rather than choose an abortion, these are the alternatives. It says

"choose," so it's up to the individual. We've run this by many

societies and many people. I think it was well done and well written.

Anyone who says that that documentation and the TV commercials were in

bad taste or done in such a way that we were zeroing in on the abortion

issue is absolutely wrong. We're saying that these are the

alternatives; you make up your mind, but you can do it with informed

information. That's what we're trying to zero in on.

I don't know why you're spending time on abortion, because

it's out

of our hands. It's in the federal government's jurisdiction. You're

trying to start a dialogue going again. Suffice it to say that we are

now funding abortions. We hope that every physician does that procedure

only when medically required.

MS. SMALLWOOD: The minister's comments are

somewhat

contradictory. The minister indicated that one of the packages, one of

the pamphlets, one of the components of the Strengthening the Family

program, while it was less than correct, was not the responsibility of

the ministry; it was put together by another organization. Then the

minister goes on to say that the pamphlets are to provide information

so that people can make an informed choice.

Again, I don't think that it's good enough for the minister to

say

that this organization that has produced these pamphlets, part of the

information package, would reprint them and correct this flaw when they

run out of them. Either the government is interested in providing

information so people can make an informed choice, or this government

has a policy of compulsory pregnancy and this program is tainted in

that direction.

The minister would do well to take a look at the message that

he is

giving, and if he is interested in informed choice, then provide all

the information and take the responsibility of ensuring that the

information is accurate. You are playing with people's lives. They

deserve the best. They deserve the information that is necessary to

make that informed choice.

The minister asked why we bring this issue up at this time.

Number

one, this is the ministry's estimates and is the opportunity for us to

canvass what is happening within the health care system in this

province. This is a very important

[ Page 5152 ]

issue for families and in particular for women. When we take a

look

at what is happening in the hospitals around the province.... We

canvassed something like 46 hospitals in the province and found — this

was in March, not that long ago — that 23 of the hospitals were

performing abortions, and for various reasons the remainder did not

perform abortions or had in some way severely limited the service that

was provided.

It causes — and I think that we have had this discussion

before — a

great deal of stress and inconvenience for both the women and their

families if they cannot find the kind of health care that they

certainly deserve, that they pay taxes for and that the minister should

be ensuring. I can't help but think that if it was another duly

recognized medical service, the minister in some way would be

encouraging, discussing and educating — doing something with these

hospitals to ensure that there was indeed a balanced delivery system in

the province. For the minister to say that it's not this minister's

responsibility or that some politicians are uncomfortable dealing with

this issue, or pass the buck to the federal House, is not acceptable.

Interjection.

MS. SMALLWOOD: For the member for Vancouver

South (Mr. R.

Fraser), you'll have your opportunity and I would appreciate you giving

me mine. You could be next on the Speaker's list.

If the minister would be good enough to take a look at the

kinds of

discrepancies that we are seeing with these numbers and the fact that

this recognized medical procedure is not accessible to many

communities.... Many of those communities are communities off the

lower mainland. The government party earlier today was going on and on

about how it cares about the whole province and doesn't just care about

the lower mainland. Well, this is a good instance of a medical service

that is not provided off the lower mainland, causing particular

hardship for the families off the lower mainland. If the minister would

respond, I would appreciate it.

[3:30]

HON. MR. DUECK: Madam Chairman, it's like

deja vu from last year, going over old rhetoric.

Perhaps you saw the news just recently about the Vernon

hospital. I

don't interfere in the Vernon hospital. They have now elected a board

that's pro-choice. You don't see me phoning the Vernon hospital and

saying: "What are you doing?" Neither do I phone another hospital that

has decided, by a board that's democratically elected, that makes that

decision.... Not all procedures are done by all hospitals. When we

do over 11,000 abortions a year, you're telling me that the procedure

is not available. We have Catholic hospitals that have never done

abortions and never will. Are you telling me that I should tell those

hospitals they should now perform abortions?

That's how the system is set up. They elect a board. They

decide

democratically what they will do in that particular hospital. I've

taken that stand right from the beginning, and you know that. I've had

just as much pressure from the other side that I should interfere with

hospitals that are performing abortions. I absolutely refuse to do

that, because I said they were elected democratically, they made that

choice and I would not interfere. And I haven't done it the other way

around. So don't give me that garbage and say that I should run over

there when it suits you, and when it doesn't suit you, I should take

the other side. I've gone right down the middle and said they are doing

their own procedures the way.... The hospitals are elected by a

board and they make that decision, and I've honoured that decision.

MS. SMALLWOOD: Before I finish this topic,

I want to make it

perfectly clear that we are not talking about what suits me. We are not

talking about what suits the government's opposition. What we are

talking about is support for the family. This is supposed to be what

this government stands for. We are talking about good medical services

that are provided on an equitable basis across this province. We are

talking about access to good-quality care. We are not talking about an

individual's opinion here. We are talking about service to women and

families. That's what we are talking about, Mr. Minister, and that's

what I will continue to lobby for.

HON. MR. DUECK: I must respond to that,

because that's

exactly what I've said right along. I'm responding to a democratically

elected board that makes that decision. I have not interfered. Even

when we had therapeutic abortion committees, I did not interfere with

the boards that were pro-life; I did not interfere with the boards that

were pro-choice. I said that that is a question under the law that's

decided by that particular board. You are trying to tell me that I'm

supposed to take the other route. That's a different system you're

talking about; you're not talking about democracy now. If you're

talking about good health care, I can tell you right now that we're

providing good health care in this province in every area.

I reject your statement and your saying that you want good

health

care and that you're not being biased. Your statements alone show that

you're biased. You're zeroing in on the area that you zeroed in on last

year. I told you then and I'm telling you today that it is up to the

board. There is currently no law in place. It's up to the board to

decide to perform abortions if it so desires. If it doesn't wish to do

them, it is a decision that that particular board makes — and that

board is democratically elected.

MADAM CHAIRMAN: The Chair would like to

remind the hon. members to direct their remarks to the Chair and not to

each other.

MRS. BOONE: I'd like to ask the minister a

few more questions

about the support-for-the-family program. The program that you have

right now crosses three different ministries — Health, Education and

Social Services and Housing. Who is coordinating this program? What

kind of evaluation is being done on this program? How is it being

monitored? How will the people of B.C. know if this program has been at

all successful?

MR. R. FRASER: Why do you ask?

MRS. BOONE: Because it's a tremendous

amount of money, and I

know the first member for Vancouver South is very concerned about how

the taxpayers' dollars are being spent. We would certainly not like to

see this money being wasted. For the sake of the member for Vancouver

South, I'd like to know how we're going to know if this is successful,

so that we can determine whether we should put money into it.

[ Page 5153 ]

HON. MR. DUECK: Madam Chairman, I will

address my remarks to the Chair.

In this regard, an interministry committee has been set up to

monitor and evaluate the program, and it continues to do so.

MRS. BOONE: Who is on this interministerial

committee then?

Is it the deputy ministers, the ministers, the support staff? How are

you going to be determining whether it's successful? What are the

criteria for determining the success of this program? Is this something

we're going to see on an ongoing basis each year — $20 million being

put in? Or are we just going to support the family for one year'?

What is the program here? What is the purpose to this program? I'm

afraid that the people of British Columbia really don't understand the

purpose of this program, unless it's to totally.... I'm not sure.

The support to the family.... I just don't understand what the

support is.

HON. MR. DUECK: Madam Chairman, the hon.

member must be one

of the very few who does not understand the program. I have had

hundreds of letters and calls, and people I've talked to say: "It's

about time that you addressed some of these areas."

When we talk about marriage preparation, we have a society

working

on that, and certainly you cannot argue that for marriage preparation,

those people who desire to have some information may receive that.

Everyone who goes for a marriage licence will have information given to

them. They can get counselling if they so desire. Many churches, of

course, do that at the present time. We're not in any way competing

with them or saying to people that they should have this counselling,

but they can have it if they so desire.

Enforcement of maintenance for children. Surely you can't

argue that

that is a good thing. Surely you're not sitting there and just saying

you don't understand, if we're going to get after people who take off

from their family. Let's say a man. You must know of hundreds of them —

I do too — from your experience in the community, where these poor

people.... Maybe a woman with a couple of children has to go on

welfare, while the man has a good income, probably in another province,

and nothing is being done. Surely you're not telling me that this is

not worthwhile.

There are so many things. To streamline the adoption process.

...

Are you saying that that's not a good idea? I can go down the list

again and again. It's good stuff, It's the Premier's initiative whether

this will go on for next year or the year after, or how much of it will

continue. I cannot tell you at this time, but it's being evaluated. The

things we have in this program are excellent. I think we all want it;

I'm sure you do too. We want to strengthen the family. If we can in any

way help the family unit get stronger, could you object to that? I

certainly can't.

MRS. BOONE: I find this really difficult. I

was trying not to

get emotional, as the member for Surrey-Guildford Whalley (Ms.

Smallwood) did. But when you talk about strengthening the family, you

seem to say one thing — not you Mr. Minister, and not even your

ministry, but this government — and do totally the different thing. We

stood here and asked the Premier of the province whether he would

increase the welfare rates so that single parents could have more to

feed their children. That is a basic thing.

We are dealing with poverty. We are dealing with people who

need

some assistance. They are on the very basic living scale, They don't

need some more pamphlets distributed to them. They don't need those

things. At one point we're saying to people that we'll give them

marriage preparation courses, and yet once the marriage is over there

are no counselling services out there for those people if they have any

difficulty.

I can tell you about Cassiar and Mackenzie and any number of

places

throughout the northern half of the community and the interior half of

the community that have very little in counselling services or mental

health services. We leave these people. Sure. we want to strengthen the

family, but you strengthen the family by giving that family the tools

to live. You give that family enough income to survive, you give that

family enough money to clothe themselves; feed themselves: get bus

passes so they can go to work. Those are the things that we need to

strengthen the family.

There are some other areas you mentioned, but I can't even

remember

them at the moment. Strengthening the family is an important thing to

do, but you can't strengthen the family with pamphlets and media hype

and everything along these lines: you have to give them something they

can hold on to. Get them out of the poverty-stricken areas they are in,

and then you will see the family unit being strengthened, Mr. Minister.

I know this is not in your area, and so I can't hold you responsible

for that. I certainly don't hold you responsible.

Day care. Fine. What kind of money do you need to streamline

adoption processes? Surely any kind of a streamlining of adoption

processes would cost less money, not more money. You can streamline the

adoption process. We've been involved in my office on two occasions in

the last two months Just trying to get through the bureaucracy of

adoption, assisting people in those areas. You can streamline that

bureaucracy. It's not going to cost you a heck of a lot — $20 million,

Mr. Minister. Come on.

I want to talk to you a little bit about the associate family

component of the program. Apparently it's bringing together natural

parents with the associate family who are trained to assume

responsibility in helping to raise a special needs child with a natural

family. Before the minister jumps at this, I'll tell you that I'm not

adamantly opposed to this. This does not sound terribly radical. I

would like to know, though. how these families are chosen. Who is

responsible for them? Is it the Ministry of Social Services and

Housing'? Are they being paid the same rates as foster parents'? Do

they go through the same screening process that foster parents go

through'? What is the detailed information with regards to this

program'?

HON. MR. DUECK: Welfare rates and adoption

are areas that

Social Services looks after, so I'm not going to answer those

particular inquiries, although the mention was made that perhaps that

was one way to strengthen the family. I can't argue that. One also has

to feed the family, not just give information education. It's a

combination of many things.

[3:45]

As far as the associate family is concerned, I haven't got my

information here, but they are assisting the natural parents, which you

mentioned. The annual cost for 25 that we've placed now in the

associate family situation is roughly $730,000. I don't have the

individual per hour or per month. That is through Social Services, but

I can certainly get you that information. This year we hope to place a

further 20 children in that particular situation. We believe that a

child is always better off in his own home, but there are situations

[ Page 5154 ]

when this cannot be, and that's why we've chosen this

particular way of looking after some of these children.

The screening process is very carefully done, I hope, and I

certainly trust that we will only have associate parents that can

qualify in the parenting skill. I personally don't get involved in

that, but I think the criteria set up should be such that only those

are chosen. I believe that is true, and we haven't got that many out

there yet. I think, as even happens with the real parents, there may be

situations when we have to make changes. I hope that's not necessary,

because the screening is quite adequate.

As far as pay is concerned, if you want to have the

information as

to whether we pay a family per child by the hour or by the month, I

will get it for you. I think it comes front Social Services, but I can

get it for you.

MRS. BOONE: I understood that this

associate family program

was through your ministry, but the payment for the families comes

through you, does it not? I'm a little confused, I'm afraid. Who

chooses the families'? Who does the screening process for the family?

Is it Social Services and Housing, and do they do it at the same time?

They do the adoptions and foster parents. Does the money come from them

or from you'? If the money doesn't come from you, what is all that

money being used for'? It's in your budget. It doesn't make a lot of

sense as to who is responsible for what. I guess what I want to know

is: who is minding the house here'?

HON. MR. DUECK: We work with the Ministry

of Social Services

and Housing, which is primarily responsible for developing foster care

homes; for example, multiply handicapped children, pediatric extended

care, and so on. The moneys come out of the Ministry of Health for the

associate family, and funding was made available, of course, from the

special fund through the Premier's office. It comes through us, but it

comes from that fund to us and then to the associate family. That is

why I was a little bit hesitant as to whether it went from that fund to

Social Services and back to us. Apparently it comes to us from that

fund, and then we pay for it. We work very closely with Social Services

on this.

The per diem cost to the associate family is $80.

MR. MICHAEL: I just want the minister to

know that not

everybody in the House is a critic who is continually demanding

unreasonable requests that members know can't all be met in one year. I

think it's fair and reasonable to congratulate the minister on his

efforts on behalf of the health recipients of the province of British

Columbia. I think the record will show this year that the minister got

by far the largest dollar increase in his budget — in excess of $300

million; somewhere close to a $350 million increase. The current budget

— $3.9 billion — is by far the largest of any single minister.

He is to be congratulated for fighting on behalf of those in

need. I

am surprised that we don't hear the members opposite, at least on some

occasions, giving recognition to the hard-working efforts of our great

Minister of Health.

When the cost of living is projected to be somewhere in the

neighbourhood of 3.7 percent, and he is able to extract from this

government, from Treasury Board, from the Minister of Finance and from

the Premier — all very close watchdogs of the public purse — an

increase in the neighbourhood of 9.9 percent, I say to you, Madam

Chairman, that is a job very well done for the health community and the

province.

I suppose the members opposite would like the Minister of

Health to

follow in the footsteps of those great politicians that have just been

ousted from office in the province of Manitoba. A recent editorial from

the Winnipeg Free Press

— I will make sure the minister gets a copy —

one of the great newspapers in western Canada, dated April 29, 1988....

I think the minister and the members opposite would be well

advised, before thinking about expanding budgets beyond 9.9 percent, to

read this editorial from the Winnipeg Free Press entitled "Manitoba's

Financial Mess." Let me read a few paragraphs to the minister:

"The extent of the fiscal mess left

behind by the

Pawley government is described in the report issued this week by the

Dominion Bond Rating Service. The report destroys any lingering

illusions that the New Democrats were following a responsible fiscal

policy in their last years in office. It makes nonsense of the claim

made by some of their members and friends that they were, in fact,

fiscal conservatives. It demonstrates that the government has spent the

past few years digging the province into a financial hole which the

next government is going to have a hard time climbing out of.

"The problem is that the NDP government

has been

increasing...spending every year at a rate more than twice as high

as inflation. That means it has been increasing spending much faster

than could be financed by a normal increase in tax revenue. It financed

that spending through the early years by an ever-increasing deficit and

in the last couple of years by a slightly smaller deficit and a massive

tax increase.

"The net result of this approach has been

an immense

increase in the provincial debt and an increase in the annual costs of

servicing that debt from $90 million to $523 million. Every dollar

spent servicing that debt is a dollar which cannot be spent on service

to Manitobans. Most of those dollars go to financial institutions

outside of the province and outside of the country."

The editorial goes on: "There is worse to come. If future

governments let deficits keep on rising, there will be another result.

The province's credit rating, which has been slipping slowly but

steadily since the New Democrats came to power, will sink to a level at

which the province and its utilities, such as Manitoba Hydro, will find

it difficult to borrow money at any price."

From the articles I've read and the people I've talked to, I

believe

that we in British Columbia do not have to bow our heads to any other

province or any other country in the world for the great service that

we provide. I think it's opportune once in a while not to listen to the

doom- and-gloomers opposite, but to reflect a little bit on the

positive things that are happening in the province.

MRS. BOONE: I certainly hope that same

organization reviews

the debt in British Columbia — a $20 billion debt. I'd really like to

find some other Social Credit government in Canada that we could

compare you with, but unfortunately there is none. I guess that speaks

for the Social Credit record in this country.

We have canvassed this at different times before, but I'd like

ask the minister some questions about the full funding of the drug AZT.

I've mentioned to the minister — and I think

[ Page 5155 ]

to the Premier as well — the economic advantages to funding

AZT

which have been brought forth by various people regarding keeping

people in their homes and out of hospitals. The minister acknowledges

that this is something we are striving to do. That's something AZT

does: it keeps people in their homes; it keeps them out of those acute

care beds which we need for other people; and it reduces our hospital

costs.

British Columbia is the only province that doesn't fully fund

AZT.

It's something we've been calling for for many months now. It's

creating a hardship. I know that victims do get reimbursed after

$2,000. Some of these people, who are sometimes in a very weakened

state,

are actually leaving their jobs and becoming dependent upon the state

in order to have this drug paid for. Surely it's more cost-effective

and more advantageous to people to provide that drug to these people on

a regular basis so that they don't have the stress, in this weakened

time of their lives, of trying to scrape up the money for that drug.

As I stated, it will keep people out of hospitals and at home.

It is

the only drug we know of that assists AIDS victims at all. It's a

terrible disease, and I know the minister is aware of that. It's

something we have to deal with as a society. I would really like to see

the ministry reverse its decision on the funding of AZT to get us in

line with the rest of Canada and to make us aware of the

cost-effectiveness of this drug.

HON. MR. DUECK: We've gone over this ground

many times. At

this point I want to state for the record that your leader is a little

confused about the Pharmacare program, although I have gone into detail

on a number of occasions to explain it. He still insists that we should

do the same as we do with the growth hormone. If you would give him the

message and tell him that we do....

MRS. BOONE: I did.

HON. MR. DUECK: Oh, okay.

The other thing I have said on AIDS is that I agree it is a

very

insidious disease, the worst, I suppose, in this century; and what

makes it so scary is that it is fatal in all instances. They have not

yet found a cure or are even close to developing a cure for this

particular disease. However. there is some good news. Three months ago

we were informed that there were not 20,000 to 30,000 people with the

virus checking positive; rather, we believe there are now perhaps

between 4,000 and 5,000. So the picture is a little brighter.

When it comes to the AZT drug used for this particular

disease, it

has not been found to be a cure at all, which I think you are aware of,

but it has shown some remarkable results in prolonging the life of some

individuals. However, of the 150 — and I use round figures only — who

have this disease, approximately 50 are on welfare and pay nothing. We

believe there are another 50 — and it's very difficult to get the exact

numbers — who could qualify, but will not make an application and pay.

We have approximately another 50, most of whom we believe could

qualify, but they will not make an application; they walk out of the

hospital and say: "Sue me." I have gone on record in the House; I have

told whomever I could speak to in various media — whether by way of

open line or on TV — and said that if anyone desperately needs this

drug, and cannot pay and cannot qualify under the terms of Pharmacare

and Social Services, please contact my office, or someone in my office

or the Ministry of Social Services, and we will sit down and find a way

to help them. To date I've had no one contact me. How much more of an

invitation...?

[4:00]

In this life, if you have a birth — my little grandson was

just born

— you must go and register. If you want to have unemployment insurance,

you must identify yourself. If you want hospital insurance, you must

identify yourself. That is the system, and you keep asking why we don't

do the same as any other province. Most provinces haven't got a

Universal Pharmacare program: we have. I believe we have the best

program, but it may not be the best in some areas, because some

provinces are in fact funding this particular drug at no cost to anyone

who has the AIDS Virus. You can take bits and pieces out of anything

and make whatever you want of it. We have a universal Pharmacare

program, but we recognize that whenever you have a program, it doesn't

fit everybody's best interests. There are some people who are just over

that earning level and they may be hurt more than someone who is just

under and gets it all free.

However, we have made exceptions by saying: please come

forward. We

have helped some people in other areas who did not qualify under Social

Services terms: but the money they spent on drugs and other health care

costs was so great a percentage of their income that we were able to

help them in that particular area without them going on welfare or a

Social Services program. There are various areas — and I just want

that on the record — in which we are willing to help, because we all

agree that this is a terrible disease. I wish someone could find some

way to come forward with some drug or other method Of countering this

particular disease, whether it's inoculation not to get it or even to

cure it after you've got it.

The Pharmacare program was changed and that's what triggered

all

this. We put in an upper limit. It was triggered by the families that

had children with a growth problem, because it could cost them $20,000

to $25,000 a year. That was not acceptable, so we looked at it and

said: "Look, let's make it an upper limit of $2,000." That's when, of

course. everyone came into the argument on AZT only, on the drug for

AIDS. There are other drugs — not just the growth hormone drug or AZT;

there are quite a few of them — on which people are spending hundreds

and thousands of dollars, and they all go under Pharmacare. The

Pharmacare program — for the record again — is $78 million this year.

I'd better check that figure to make Sure. It's probably more.

While they're checking that, you were also asking about this

total

program of Strengthening the Family, and was there any research done;

did we just dream this up, and wanted to counteract abortions. Or was

it from the other hon. member'?

We did a pre-program social market research, evaluating the

degree

of public understanding and knowledge respecting contraception, family

planning, adoptions and alternatives to adoptions; and this data will

be used to do post-information program evaluation. Information material

on Strengthening the Family was developed based on social market

research which identified areas where information was lacking and/or

desired. An independent firm said: yes, these are the areas where

information is lacking and where we should have more education and

information and programs, to help some of these people that were

saying: "Look, we haven't got this information. We are ignorant in

these areas." So we developed this, formed the research that.... Not

"we did"; we had an independent research team doing this on contract,

and this is what they came back with. Then we developed the program to

address the concerns that they found in the province. They took quite a

bit of time doing it. It wasn't an

[ Page 5156 ]

ad hoc or a dream that someone pulled out of a hat, the way it

sometimes comes across from the side opposite to us, Madam Chairman; it

was a well-thought-out program.

I made an error on the Pharmacare, and the error is horrifying

— and

I knew this. It was not $78 million; it was $178 million. Remember that

most people pay for their own drugs. You can just imagine how many

pharmaceutical drugs are being paid for by the province, and this is a

population of three million people. When you look at this.... You

check with the other provinces: what does the government pay in

pharmaceutical drugs? You'd be very much surprised at how much more per

capita we pay than the other provinces.

[Mr. Rabbitt in the chair.]

MR. CHAIRMAN: The second member for

Richmond requests leave for an introduction.

Leave granted.

MR. LOENEN: Mr. Chairman, it gives me a

great deal of

pleasure to welcome to the House 14 grade 7 students from the Seacliff

Christian School in the great community of Richmond. I do this on

behalf of the first member, the hon. Premier, who regrets that he was

unable to be here. He would have liked to have been here because he is

a neighbour, Fantasy Gardens being immediately beside the school. I

would ask the House to please welcome the students this afternoon.

MRS. BOONE: Just a few comments on this.

The minister

mentions 150 that are on AZT, 50 that are fully being paid for on

welfare, 50 that could.... In my arithmetic that leaves about 100.

Interjection.

MRS. BOONE: Okay, it doesn't matter. The

point that I'm

making is that to have people constantly have to go and plead for

special assistance is very humiliating and not something that should be

done, in particular in these areas. It ought to be paid for fully as a

procedure, so that these people can keep at their jobs, can keep at

home, can stay as worthwhile citizens in the community for as long as

possible.

I'd like to shift into a different area. I want to talk a

little

about billing numbers. I think we'll probably do this every year, Mr.

Minister, because it is something that I am concerned about, and I'm

concerned about it for a couple of reasons — for many reasons, actually.

Number one, we are restricting our young doctors; we are not

allowing them to receive billing numbers, and we're losing a lot of

them. They're leaving the province or the country. I don't want to see

that happen. I have a great fear that at some point our elderly doctors

are going to retire and we are going to be faced with having to import

doctors along the way.

My question to the minister is why we are allowing the same

numbers

to be trained at UBC, when we are bringing them out and have no jobs

for them. Surely it would be a better idea to restrict the number being

put through medical school rather than providing them with the ability

to train and get their education and giving them at least the idea that

they may be able to work in the province and then not allowing them to

have a billing number.

It is not having the effect we wanted, which was to get

doctors

outside the lower mainland. I do appreciate that there is a program in

place now, and I'm hoping that program has been successful. We

supported that program providing incentives for doctors to go. But I'm

hearing that doctors do not want to go to those areas. If they take

a job in a remote area, then they're going to be stuck there forever

because their billing number is geographically restricted. So it's

doing the opposite of what we wanted it to do in regard to getting

doctors into the outlying areas.

I have some concerns because the minister always says that

this is

being done to keep a ceiling on the costs of MSP, which is a rapidly

growing thing, and I can certainly share the concerns of the minister

to try to keep a cap on that and control the spending that's going on

in the MSP program. However, there is currently a ceiling on that

Medical Services Plan. In fact, last year some doctors were returning

money to the Medical Services Plan because the billings went over the

amount allowed by the ministry. It appears to me that if there is that

ceiling, then there is no harm in giving new doctors billing numbers.

The only thing that will do is weed out the poor doctors out there,

because they won't be able to survive if there's a lot. This is a free

enterprise government that believes in competition, and surely we ought

to be allowing competition to take place in the medical profession.

If we are adamant in maintaining the practices of all the

existing

doctors at the levels they've got — which is what we are doing — we are

making sure that these doctors have no competition and that they

maintain full practices all the time. That is what the restriction of

the billing numbers is doing. It is definitely not a money problem when

there is a cap on that whole billing process. Surely we can give these

doctors some numbers, allow them to set up their practices and take

their lumps. If they don't make out well, then surely that's what the

free enterprise system is for; they can go under. If they make out

well, then fine; it's showing them that they are good doctors and

providing the proper service. But at least allow them to put their

shingles out so that they can practise.

I also have some concerns because there are alternatives that

the

ministry hasn't looked at. The alternatives are in setting up community

health clinics. If you look at the areas....

AN HON. MEMBER: Like in Esquimalt, right?

MRS. BOONE: Like in Esquimalt. If you look

at a lot of areas

where people can't get proper health care.... If you go to Ontario,

you'll find that places like Sault St. Marie established a community

health centre there as a result of the unions getting together to

develop a plan, and it's funded by the ministry. In Toronto they have

three or four different community health clinics in the city, and of

course, they have salaried doctors. They offer a degree of service that

is really quite impressive. They have 24-hour service, which would do

away with and prevent the misuse of the emergency wards such as you've

been talking about. They have groups organized for health care, and

they produce some really good pamphlets on all kinds of things such as

hazards of office work. This is the one I like: "hazards of housework."

I think that one is really good. I think everyone should have a copy of

this to establish what the hazards of housework are. They deal in the

prevention aspect.

[4:15]

These are true community organizations that deal in prevention

and work as a community to deal with hazards in

[ Page 5157 ]

that community such as air quality. They had a problem with

lead in

the soil in that area. As a community health centre, they dealt with

all those things. They use a team approach; they have chiropodists, and

they have a lot of different organizations and groups working within

the community health centre. When you look at some of our areas, and

you see that they are struggling to maintain services and doctors,

surely we can look at these community clinics as a means of providing

services to those areas.

There are also other alternatives in the form of health

service

organizations — some people call them HMOs or HSOs — whereby physicians

are paid a fee per person, and that fee per person changes with their

age and sex. That is the fee they get for the year for that person,

when they register with them, whether they are extremely ill and

require a great deal of service, or whether they are very well and

never actually go to the doctor. There is a great incentive in that

situation to keep people well; to keep people out of hospitals; to not

prescribe drugs unnecessarily; to not have, as the term goes, a

revolving door through which people are called back unnecessarily. We

certainly aren't saying that all doctors do that, but we know there are

occasions when some physicians do.

It's an alternative to the system we've got right now. I'm not

saying that you have to have one or the other. but perhaps you can look

at implementing all three of them so that people have some options, so

that young doctors can earn a living in British Columbia, and so that

people can go to the physician they want to go to.

The restriction on billing numbers has an adverse affect,

particularly on women doctors and on women. If a woman doctor leaves,

there's no guarantee that she is going to be able to fill that position

with another woman. Therefore the clients who specifically went to that

doctor because she was a woman are being denied the right to go to a

woman doctor.

There are a lot of problems with this, and I really hope the

minister reviews the situation, looks at Bill 41, changes his attitude

toward it and makes it so that our young doctors can stay and work in

this province. We're losing a tremendous number of qualified, young,

vital people who are leaving our province and going elsewhere as a

result of this government's policy towards billing numbers.

HON. MR. DUECK: I want to answer some

questions I didn't fully answer before; I'll come back to the latest

suggestion.

The associate family was asked about. The screening for the

associate family is done by the Ministry of Health's services to the

handicapped program and contracted agencies. The Ministry of Health

approves them, and some people are turned down because they don't meet

our standards. We check criminal records, we check personal references,

and homes are thoroughly reviewed, so a very thorough screening is done

before anyone is placed in an associate family. I just thought you

should have that information.

Again on AIDS, I don't want it to be left as though we're not

spending money for this unfortunate group of people. We are. We figure

the five-year estimate, based on projections of 650 cases, is $120

million. It's no small dollar we're spending in this particular area.

That includes research. hospitalization and special education programs.

Last year we spent many millions of dollars in various areas, and I

think that's worth putting into the record.

I think your colleague asked how many people went out of

province or

out of Canada to get abortions during that period when we were not

paying for abortions. Approximately 40 women submitted out-of-Canada

accounts for abortions they couldn't get in British Columbia during

that period. These accounts have all been paid. Fewer than 100 got

reimbursed during that period, and 40 were out-of country.

Speaking about doctors and billing numbers, that has been an

ongoing

dilemma not just for British Columbia but for many provinces. You made

much of the free enterprise system, and I can assure you without any

problem that if it was truly a free enterprise system, like with

lawyers, there would have to be no restriction, and there would be no

restriction. Supply and demand would look after themselves. But when it

comes to doctors. that isn't so. We pay. It's a socialized system, but

with free enterprise people working. It's a

quasi-capitalistic-socialistic system. It's a good system; it works

well. But we have to have control over it.

You also asked why we graduate all these doctors and don't put

them

to work. It might interest you, for your information, that we graduate

roughly 120 doctors a year. In 1987 we gave 228 permanent billing

numbers. You've got that in context? One hundred and twenty graduated,

228 permanent billing numbers, plus 230 locums that relieve doctors

when they're on holidays, sick or away from their practice for other

reasons. A total of 458 new people came into the system, but only 120

received the diploma and graduated from medical school.

You may ask when they are not all employed and why some

doctors are

brought in from out of province. I think you know the answer, but I'll

still repeat it for the record: you will need a certain physician, a

certain discipline, a certain specialist that the hospital requires

because they have a vacancy for a certain specialized area, and they

cannot put this individual to work who has just graduated,

I agree with you that the system is not good insofar as we

cannot

give everyone a job. But you must also remember that there are many

engineers who can't find work: there are many teachers.... My son

had to go to Fort McMurray. No one likes to go to Fort McMurray when he

was born and raised in the lower mainland. He went there for three

years because that was the only place he could find work.

We still have a shortage of certain health professionals,

not just

doctors, and I can't get them into a certain area of need, because they

all want to practise in Vancouver and Victoria. But you can't have it

both ways. It is a supply-and-demand situation. If they want to go out

and look for a place where they are needed. they will get a billing

number. And yes, it is restricted to a certain area, but that doesn't

preclude them at all from applying for another position while they're

working within that restricted area of practice. It doesn't put them in

any different position than if they stayed here, did locums and then

looked for vacancies as they came up. We have a fairly good system of

priorities and criteria, and how they apply. They must have hospital

privileges and many other things. We still have an area in the province

that is underserviced and we have too many doctors. We have more

physicians per capita in British Columbia than any other province in

Canada: and when you talk about the lower mainland and Victoria, we far

exceed the numbers required.

You also said that perhaps we should let them all come in,

with a

cap, and it would look after itself. I can just imagine the hue and

cry if we let the 1,005 waiting for billing numbers come into the

system. Suddenly the doctor used to earning $200,000 a year would have

to take $75,000 a year. I'm

[ Page 5158 ]

sorry, but it's not just for the costs as far as the ministry

concerned; even if they tell you that they wish everyone could come

into practice, if we put on a cap and let them all come into the

system, it would cause quite a turmoil, I can assure you.

Out of the 228 permanent billing numbers, 87 graduated from

UBC. So

that's the percentage still coming from this particular area.

We believe that the cost of MSP would dramatically increase —

and

we've got a record of it; it increases by X number of dollars for every

billing number we issue. If we let all 1,005 come into the system, we

project that it would cost us, in not too long a period of time,

roughly $100 million.

Interjection.

HON. MR. DUECK: Yes, we have talked about

that. There many

options. We have talked to the B.C. Medical Association. The contract

we had.... We were able to negotiate a ceiling, they did honour that

contract, and they did pay back from their fee schedule. So we are

working with them, but not without fairly extensive negotiations. It

wasn't easy. But they have cooperated, and we have a fairly good

relationship with the medical profession. I meet with them on a regular

basis.

Sure, they want things changed. However, we are restricted by

funding. It's not as simple as just saying,"Well, let's saw it off in

the middle and somehow, through arbitration, we will arrive at some

figure," and then go the Finance ministry and ask for another $50

million or $100 million. You would be the first one to say: "Where's

all this money going to'? Taxes are going up. We can't afford it." So I

suppose that's also my unfortunate position. I have to watch the

dollars we're spending in health care.

We have information that Ontario is seriously considering

limiting

doctors. I meet with Health ministers across Canada, and they told me

at the last meeting that the only reason they have not yet.... Some

have even got legislation just about drafted, or have drafted it and it

is ready to go into the House. They would probably like to go forward

with legislation similar to ours. They've looked at our legislation.

You know that it's under appeal at the present time, and we don't even

know the outcome. It could be quite a disaster, depending on what we

want to do at that time.

I don't particularly like restricting young doctors. Surely no

one

does, because they are the latest, the most enthusiastic.... They

love medicine. That's why they graduate; that's why they went to

school. They're the brightest. I meet with them again and again, and we

try to find ways of solving this problem. I've had various committees

working on this: "Help us somehow. Can we find some other method of not

letting the MSP get out of hand?"

Interjection.

HON. MR. DUECK: It's not workable. If we

let all those in, I cannot imagine having a ceiling, and the average is

$50,000 a year.

Interjection.

HON. MR. DUECK: Well, we're working on the

Victoria Health

Project. That is going in the exact area you're suggesting. We're going

in that direction, but you can't do it all at once; you can't say:

"Today we're in that business." Until that is on track, running in

tandem with the system we have today, it may even cost us a little more

in the short run. But we're going in that direction.

Some of your colleagues have suggested it in the past and have

had

these ideas, and many people in the health professions have suggested

exactly what you're saying. The United States has done this in some

areas. We've checked with the Americans, with many of those systems

that they have going, and we find that the HMOs.... Most of the

people who have joined them are actually well. With our system we still

have to look after all the others. There may be a physician who says,"

Fine, I'll take this on," with so many people in a particular

catchment area or class of employment or what have you, and checks it

very carefully. If they're all of a fairly moderate age, it may work

all right. But we have to look at the total population, because we have

universality, so it's a little different than the American system. We

don't want to copy everything the Americans have, because it's pretty

disastrous.

[4:30]

The Ministry of Health and the Medical Services Commission do

not

make unilateral decisions to issue practitioners' numbers; rather, each

decision is made cooperatively with the local hospital board and local

community input, when received, like a manpower plan. Some hospitals

have in fact been very diligent and have given us a manpower plan. If

we approve of that, then there really is no problem. They can hire the

people they need without much intervention from our ministry. But those

hospitals that haven't got a manpower plan in place.... We certainly

have to take control of it. Of course, all such decisions are governed

by the Medical Service Act. So it's cooperation with the medical

profession and the hospital boards, and by and large I think they have

all cooperated.

Although they don't like these young doctors not coming in.... We

don't either, because they are the gung-ho ones who would like to go.

They've got the latest information, the latest education, and we want

them in the system. We've even talked about retiring the older

physicians, but under our present structure with the Charter, we cannot

put into law that when you reach the age of 65 or 70 or 75 you must

retire. So we have a number of very senior doctors who are still

practising. It's very difficult to nudge them and say: "Perhaps you

should make room for your colleague, who's anxious to get going." We've

asked the BCMA if perhaps through some method of education and

discussions with some of the seniors they could voluntarily make room

for younger doctors. They don't wish to do that either. They want us to

solve their problems, because this is where a lot of controversy comes

in. Unfortunately, up to this point in time we have not been able to

develop a better mousetrap; consequently we're using the one we've got.

MRS. BOONE: They are having problems in

Ontario — or they will

have problems — with their Medical Services Plan. They talk of the

revolving door. I understand and accept that the minister has to deal

with that budget and come to grips with it. I am saying that there are

some alternatives we could implement that would still deal with the

situation, because you do have that capping procedure here in British

Columbia which stops the billings from going through the roof. We have

a lot of physicians out there — young doctors who are going to be an

asset to our community.

[ Page 5159 ]

The outlying areas, I know, are places where community clinics

would

survive. Those people who won't go there because they don't want to be

stuck there forever or don't want to make a financial commitment to

putting in a practice, purchasing equipment and doing all those things

would go to such a community on a salary basis if they knew that there

was a place that they just had to plug into, where they didn't have to

get equipment, purchase a place or hire staff — the staff were all

there. That's something we can be looking at for those areas.

There have been times when a lot of different places have had

shortage of physicians because they just couldn't attract them. They go

fine for a while, and then all of a sudden some problem is created.

Rather than this part where you've got an overabundance of physicians,

I'd sure like to see you trying a community clinic in some of the areas

that really need the facilities. Certainly I'd like to see community

clinics all over the province, but I'd really like to see you dealing

with those in some of the remote areas as well.

The HMO concept is something I think we should be looking at,

with a

view to implementing it quite rapidly, I would think, in order to give

doctors a chance to get started. The experience from Ontario is that

those people in the HSO — they call them HSOs there — are happy. They

can still have an entrepreneurial spirit to a degree. They can go and

rouse up as many patients as they want. As long as they make sure that

those patients are kept well, then they're fine and dandy; they still

are able to develop their practices. The people who have opted into

going into those areas are by and large quite happy in that situation.

I'd like to deal with a couple of issues, and I think we're

getting

a little late. If we can shift gears again, Mr. Minister, over to the

minister's office, I can't help but notice that there has been a

substantial increase in salaries and benefits in the minister's office,

yet the number of FTEs is actually down. I'm wondering if this is going

to outside contracts, or are you paying your staff really well over

there? Why do we have the increases in the salaries and benefits in the

minister's office when, in fact, the FTEs are reduced?

HON. MR. DUECK: I will answer the last

question first. I am

by nature a fairly tight person, so I don't think you can accuse me in

any way of paying someone too much. The salaries for the secretaries

and my executive assistant are all set — they're standard — so I have

really no ability to change them. But two FTEs were funded by the

ministry last year, and this year they come under my office. We added

the extra one because of the increased workload that I think I

mentioned to you. It is extremely busy in my office. I'm not saying

that to indicate that people aren't working as hard as in another

office, because they are; they are very conscientious.

Of course, there was an increase also in the minister's

salary;

that's part of it. There was an increase during the year. That's also

in there and the benefits that go with the increase. It's fairly open.

I can give you — I haven't got it with me right now — the individual

remuneration of any individual person. It's not a hidden thing at all,

except we did add an extra person. We now have five women and one man

in my office.

MRS. BOONE: When you get into the ministry

operations....

I have a breakdown here on some things: professional services are down

11 percent; data and word processing supplies are up 17 percent; office

and business expenses are up 32 percent. We get into information,

advertising and publications — up 137 percent. Statutory notices,

annual reports and non-discretionary publications are up 819 percent.

It certainly appears that the ministry is spending a

tremendous

amount of money advertising or promoting various things. Is the

majority of this due to the Strengthening the Family program? What are

these extraordinary cost increases in the advertising areas of the

ministry?

HON. MR. DUECK: Part of that was transfer

for the AIDS

program and also for Strengthening the Family, and that's why it's

distorted — because it came from another fund and was brought in here,

and it looked like I was spending it in my publication and advertising.

We don't spend in proportion with some ministries like Economic

Development where they have to do a lot of promotion work. We're very

lean and mean in that area. But it does distort those figures, and

you're right, it looks terrible.

MRS. BOONE: The ministry has moved so in

any things in the

budget this year I'm having a difficult time finding them. I'm

wondering what you're going to change next year so you'll really

confuse me. Please leave it the same for next year so I can understand

what's happening here.

In the Medical Services Plan I notice that there's less for

salaries

and benefits again, and I know this is probably due to the fact that

you are shifting the responsibility for billing to the physicians

rather than through Medical Services Plan. However, you turn around and

the operating costs are up. Why is it that operating costs go up when

you have fewer people there? Why would operating costs go up when you

are losing some of the staff and losing some of the work you have to do?

HON. MR. DUECK: There has been no shift for

the electronic

billing up to this point in time, and it's not reflected in this budget

at all. Hopefully that will come next year.

We have a 5 percent efficiency reduction, and early retirement

also

accounted for quite a large sum. I suppose when you take all that

together it really gives you the wrong percentages, because a lot of

things have shifted and have gone from other funding into this

particular area. The early retirement costs are paid out of this fund.

If you wanted to know anything specifically in any area you

don't

understand, I would be only too happy to give you the percentage and

actual dollars in written form,

MRS. BOONE: I think we've had a fairly good

canvassing of the

estimates. I thank the minister for his answers and candid responses. I

look forward to dealing with you on some of these issues I have brought

up which you said are good ideas. I would like to encourage the

minister to call that committee together so that we can sit down and

discuss some of these ideas we've got. Your deputy pointed out that I

suggested some things that he had actually promoted earlier, so we must

be on the same wavelength on some issues. There are certainly many

issues we can work together on. There are many issues we can deal with

in a proper way, working to the benefit of all British Columbians.

[4:45]

In my opening remarks I mentioned that I would really

encourage the

ministry to do a full review of the health care system, because what

we're doing right now.... You've got your plan down here in James

Bay or Victoria. and you've got

[ Page 5160 ]

different things, but what we really need to do is have a full

review so that we can say this is the area we're going in, this is what

our priorities are, this is what our goals are, and then set out and

meet those goals.

Some of those goals, as I stated earlier, should be in

providing

more funding towards the prevention end. If prevention is our goal,

obviously we have to address the situation of a speech therapist —

which you've already done — the ideas of home care, the ideas of

hospices, all these different areas. But we need to set our goals

first, and I would really encourage the minister to work towards that

and develop a full review of our health system so that the people of

British Columbia know where we are heading in the health area.

HON. MR. DUECK: I would like to thank the

members of the

opposition for the way they've handled the estimates of my ministry. We

don't always agree, and sometimes we get excited. One of the members

from Coquitlam, I think, lectured me and told me not to lecture you. I

take that in good spirit. I do get excited at times. I believe you

should be very nice to me, especially today; I am a new grandfather.

Interjections.

HON. MR. DUECK: It is a boy. We have five

granddaughters and one grandson.

I would like to state what I said in my opening remarks: that

when

it comes to health care we wish to do it in a constructive way. I must

admit that by and large it has been done that way. I would like to

thank my critic for having done it in a calm and educational way, where

the concerns were brought to my attention in such a way that it was for

educating me, perhaps, in the areas she felt were necessary. In the

meantime, the suggestions that she and some of the others have made are

certainly taken in that vein. We are already proposing many of the

suggestions. We do agree in many areas, although some are not

completely acceptable to us.

We have been doing a long-term review and a short-term review

for

some time. I would like the members to know that we are not doing it ad

hoc or by the seat of our pants. We are doing it with a business plan

in mind, which is my background, and I want to continue to do that.

I would like at this time to thank all my staff, especially

the

senior staff