May 31, 1994 Alberta Hansard 2349 Legislative Assembly of Alberta Title: Tuesday, May 31, 1994 8:00 p.m. Date: 94/05/31 [Mr. Deputy Speaker in the Chair] MR. DEPUTY SPEAKER: Please be seated. head: Government Bills and Orders head: Third Reading Bill 20 Regional Health Authorities Act [Debate adjourned May 30: Mr. Collingwood speaking] MR. DEPUTY SPEAKER: The hon. Member for Leduc. MR. KIRKLAND: Thank you, Mr. Speaker. I'll start the debate this evening with my comments on Bill 20, and I'll reiterate some of the comments you've heard in this House before.

The Liberal caucus and the Liberal Party some 10 years ago suggested regionalization. It was brought up in '86 and again in '89, if I recall correctly, and so the principle of the Bill certainly is something that we embrace in our heart. I think the areas that we point ed out in our continuing and ongoing debates in the House here over the last little while have indicated that there are shortcom ings within this Bill that cause concern to this side of the House. I know that the hon.

Member for Rocky Mountain House indicated that from his perusal of the Bill and the understanding he had, there certainly were no user fees to be associated with this particular Bill. I don't share that particular concern. We look at a Bill that has a lot of gaps in it and a Bill that is left open to final determination of its destination by regulation, and I would suggest that in fact that is enough to cause this side of the House concern. We, I guess, as an opposition party certainly have to be suspicious. It becomes the nature of the game.

As the side opposite is suspicious of Bills that we put forward, we share that same sort of suspicion when they put one forward. This Bill, as I see it – I've read it, and it's been a while since I've reviewed it, Mr. Speaker. It would strike me that when we look at the regional authorities having the abi lity to charge for goods and services, therein lies the concern on this side. Goods and services are not defined in any of the clauses that I read.

If in fact this was a good quality Bill and there was no intention to actually introduce those user fees, I would suggest it could have been addressed in the Bill and allayed the concerns of this particular side. The goods and services, as I see it, being handed down to the regional health authority – and I think the hon. Member for Edmonton-McClung has alluded to this on occasion – really enables the provincial government to escape the perusal and the charge of the Canada Health Act.

It does not become a provincial responsibility at that particular point, and we have a concern that ultimately that is what will happen. We see ongoing downloading by the government of the day, certainly with the accountability and the responsibility. There are many areas of this Bill that have yet to be defined. That is one area that causes us a great deal of concern, Mr. Speaker. I've not heard the Minister of Health or anyone else in the House confirm or explain how the provincial programs will interrelate or interreact. When I say the provincial programs, Mr.

Speaker, I think of the kidney transplant unit, the heart transplant unit, the cancer clinic: those particular clinics. No one has defined, as I have listened to the debates here, exactly how – and I always use my own health region as an example. The Ever- green region, as it is now called, interfaces with those provincial programs. Now that causes me a concern when we do not define the flow of dollars from the h ealth region to something like the provincial program.

That concern is caused because if I am a person being treated for cancer and I have to proceed into the Edmonton health region to secure those services, there are dollars associated with that. I have not seen where that flow of dollars is defined. It causes a concern. It may put municipal authorities such as the health board officials in a position of deciding whether they can or can't pay for a service that is required for somebody in their health unit or their health region. So that certainly causes me a concern. The regulation, as I indicated in my opening comments, also causes concern to me.

We have seen, I would say, a massive shift from a free and democratic government to a government that is off-loading most of the u ltimate and final decisions to the minister's desk. I see that as circumventing the democratic process. I would say that in light of the record of the government of the day in not being as sensitive to Albertans as they possibly should have been. I have a concern in that situation that we will see inconsistency arise throughout the province as a result of regulations changing, from day to day in some cases. I can envision that happening.

I would suggest that the strength of the lobby groups of some health regions will cause regulation to change, perhaps to the detriment of other health regions. These areas have not been clearly allayed in my mind with the debate I've listened to in the House. Though we spoke to the principle many times and the fact that we endorse it, Bill 20 leaves a lot of gaps, as did the Municipal Government Act and the School Amendment Act. In my estima- tion, if it was quality legislati on, those gaps would have been filled.

It again raises the spectre in my mind of exactly why we couldn't take the time to put forth a very definitive Bill. I've heard it stated that I would sooner deal with regulation than legislation, and there is some merit to that comment. I would suggest that when we look, as we have over the past 20 years, at some of the actions of the government – and I know we hear "That is then and this is now" – that causes me concern.

Regulation, in my estimation, does not give the government the firm direction required for planning purposes for the administra- tion of health units and also to those constituents who live within those health units. So with those comments, Mr. Speaker, I'll open debate on Bill 20 tonight. I would ask that it show clearly that I was on record supporting the principle, but the Bill itself has large gaps in it. They do cause me concern. As I listened to the debate, I hoped that those concerns would be set aside. They were not.

I daresay that there's no one in this House who can tell us where we will be in two years with health care in this province because there are so many undefined areas and so many areas that have yet to be defined. That has caused a very large concern in the minds of Albertans. We can, I think, find testimony of that large concern with the 15,000 people who marched in protest of the Grey Nuns hospital potentially being closed as an acute care hospital. That to me is the tip of the iceberg. I would suggest that health care is paramount in everyone's mind in the province of Alberta.

We have had an excellent health care system in this province. Certainly there are efficiencies to be gained within it. I would like to think regionalization should in fact capture that, though I'm not convinced as I stand here and debate today that that has happened.

2350 Alberta Hansard May 31, 1994 Mr. Speaker, these will be my final comments on Bill 20, and I'll turn the floor over to one of the other members. MR. DEPUTY SPEAKER: I wonder if the Assembly would give unanimous consent to the reversion of the Introduction of Guests? All those in favour? HON. MEMBERS: Agreed. MR. DEPUTY SPEAKER: The hon. Minister of Municipal Affairs. head: Introduction of Guests DR. WEST: Thank you very much, Mr. Speaker. It's my privilege tonight to introduce to you and to members of the Assembly a distinguished couple in the members' gallery, Mr. Rod Krips and his wife Ellen.

Rod is the administrator of the Viking health care complex. I've known him for years. He's been a very capable individual and very dedicated and demon- strated the most professional approach to health care in this province. It's appropriate that they're both here to witness third reading of Bill 20. Although it's in my colleague for Vegreville- Viking's constituency, Vermilion-Viking was the constituency that I used to serve, and I had a close relationship with the Kripses.

I would ask that they stand in the members' gallery and receive the warm welcome of this Assembly. head: Government Bills and Orders head: Third Reading 8:10 Bill 20 Regional Health Authorities Act (continued) MR. DEPUTY SPEAKER: The hon. Member for Edmonton- Gold Bar. MRS. HEWES: Thank you, Mr. Speaker. I have a few com- ments to add. Just in adding my welcome to the visitors, there are many, many people in our health care system throughout our province who have served for years in the system.

I think they have been very concerned at some of the drying up of resources to something that we've held dear and treasured over the years. I'm looking to them, and I'm hopeful that they are going to continue to show leadership as we reform the system. Mr. Speaker, I'm certainly on record publicly and in this House in support of regionalization, and I have been since 1986 when I came into this House. I have talked at length about health care reform and the need for health care reform.

I was pleased when the former minister took the plunge and said: yes, it isn't more money that we need in the system; we need to reform it. But I think it was clear that at the time the government changed, there were some political risks in that, and so the reform was put on ice until such a time as it was felt to be politically a potential to do it. In the meantime, the cuts had begun. There was a very severe cut of 3 percent across the board. Some institutions of the province able to sustain, others not. Mr.

Speaker, the reform process was stopped in its tracks, but the government continued to cut the budgets and the resources to the institutions and the programs of health care. Then the government demanded reform. What we saw then was forcing individual downsizing and change by reducing resources. We saw closed beds; we saw staff terminated. All of this happened in advance of the new networks.

I think the Calgary scene is a good example where hospitals and other health care institutions had begun to get together, to work together to find economies of scale, and then suddenly they were thrust into the position where an analyst was sent in and recom- mendations were made. All this happened in advance of the health authority being named and being given the responsibility. So I say the government has gotten the process backwards. In spite of all of this , in spite of the fact that we're trying to appoint regional health authorities, we don't have any real criteria for them that I've seen published as yet.

We don't have any real detail on how they are to work, on exactly what their responsibili- ties are going to be, on what is expected of them, on what their budgets will be in the final analysis: all of their responsibility. Curiously, we're still building hospitals. We're still building them in spite of the fact that we're developing authorities on the one hand who are anticipated to form new networks and find new ways of working together and making a far more efficient system. We're still building hospitals in the old style and the old plan. So I simply do not understand the sense in that at all. Mr.

Speaker, I'm concerned that the model we have developed here can still end up being acute care institution driven. I think most thinking people in this province have now agreed that what we need is a health care system that is built on health, on helping people to be healthy, and healthy communities. Acute care is a part of that, as is extended care, home care, or community organizations of one kind and another. We need to roll in the potential for management of our environment: clean air, clean water, safe cities.

We need to have networks that expand way beyond the treatment institutions that we have thought of as being health care in the past. The community councils are most unclear to me. I'm not sure what the intention of the minister is in regard to creating these councils. I expect it's some sort of bridging mechanism between the existing institutions and boards of those institutions and the new authority, but I'd be more comfortable if I knew exactly what that relationship was intended to be and what the objectives were.

I would also like to see terms of reference for those councils and for the board members of the authorities themselves. The Bill no doubt leaves room for user fees, a source of great concern and worry to people across the province. The Bill seems to me to dictate the end of public health as we now know it without any real understanding of what is anticipated that it will become. The Bill is silent on the relationship of the health care authori- ties to education, for instance, to social services, to justice. We do not have any direction in the Bill about that.

The Bill is silent about the role of existing foundations, which almost every health care institution and most education ones as well in our province now have. We do not know, for instance, where the money goes that has accrued in a number of these foundations. Does that now go to the authority? Do they have command of it, or does it stay with the individual institution th at raised it? Mr. Speaker, we don't know where the surpluses go. Mr. Speaker, we've got appointed boards who have the capacity to tax but are not accountable in the sense that they are not elected.

The Bill is open ended regarding many of the regulations that we believe should be far more specific. The Bill does not give us the real detail on what basic health services are; that is, what is insured and what is not insured. The Bill allows for a voucher system, and that still to many people in this province

May 31, 1994 Alberta Hansard 2351 remains a real mystery as to what that means and what's intended by that. I feel that the government has been remiss in not filling in the blanks. My greatest fear is that they haven't got them filled in, that they don't know themselves, that we're creating the authori- ties and hoping that those authorities will be able to develop the networks in their regions and that somehow it will all tumble together. It seems to me that we have something far too impor- tant to leave to that kind of development.

I would hope that the government has some more definitive plans in its back pocket, but if so, why haven't they revealed them? I believe the people of Alberta have been very supportive of their health care system, and they want and need to know exactly what they can expect from it. Mr. Speaker, I had a letter today from a constituent on behalf of a parent who's going to be needing heart surgery very shortly, a very concerned family. They do not know how or when the parent will be able to get the surgery.

They are deeply worried about the health and well-being of this parent and don't know where to turn, and I don't know where to turn. I don't know how we as members can reassure these people that in fact the health care system will be there to serve them and the needs of their family, because I have not personally had that reassurance. Mr. Speaker, it seems to me that the whole thing is being driven by the deficit, and no one denies that we have to address the deficit. We have to get it in control. That has been a part of this caucus's commitment to the people of Alberta since the very beginning.

Finally the government has come onside, but unfortu- nately their processes, their methodology to deal with it are not the methods that I would use, because it's being done in a punitive way and it is going to hurt people. This Bill, this health delivery system, this regionalization and restructuring of health delivery is being driven by a desire to reduce health care costs, not a bad objective but one that I think has to be handled with great, great care. Mr.

Speaker, if we do the regionalization correctly, as we had earlier envisioned it, I believe the quality of care can be main- tained as we move to a restructured system and that over time the costs will be reduced. Unfortunately, I don't believe the system that's being chosen here or the process is one that will give us that kind of service in the very near future. 8:20 Mr. Speaker, just a few more comments, some specifics. I am concerned about the regional authority being given the power to charge fees for goods and services.

It seems to me that we're going to have some considerable differences between regions as to what's essential and what's nonessential. I would liked to have seen that far more definitive. The costs to individuals may be quite different from one part of the province to another. The notion of user fees, I believe, is one that brings great resistance from Albertans. We have been satisfied with our system as it is. We don't want to go to a two-tiered system. I've spoken already about the notion of who decides what is essential and what is nonessential, what are basic services. We have not seen any conclusions.

I'm looking forward to seeing some from the committee, because that again – what is insured? – is something that troubles people. Mr. Speaker, the public health units. Perhaps the minister can tell us tonight what the long-range plans are for public health units. These have served us well. I see public health as being the major driving force in a restructured health care system keeping our communities healthy. I see this Bill as being silent in that regard, and we have not had any clear answers. I've already mentioned my concern about the co-ordination with health and social services.

I have many times in this House expressed concern that our teachers in our education system with an integrated system, which I do support, Mr. Speaker, are now expected to provide certain hea lth services to young pupils. I believe that does a disservice to both health care and education. I think that what we need to do is have a far more conclusive program that integrates health care with our school system. In years past we had public health nurses and dentists and social workers into our schools providing backup for the teacher who was the first line.

That has been withdrawn because of lack of resources, and I would like to see us go back to that. I think the very least that a Bill of this kind, a regional health authority, could speak to is the idea that it should be there. The integration of education, social services, and health care should be somehow incorporated in this Bill so that it can be permitted to happen when resources are available.

In the meantime, we abandon the children, we abandon the teachers in the schools and leave them to their own devices as to how to deal with health care needs in the education system, for which they are not trained, and I think many of them are uneasy about having to cope with it. Mr. Speaker, the voucher system I have mentioned before. No one seems to know exactly how this is going to work. I don't know where this idea came from. I wish the minister would tell us where it has been tried and where there has been any empirical data that shows that this system is one that works and has served people.

If it does, then tell me about it. Tell me where the research has been done that this is a good idea and that it works for people. Is it going to be universal? I expect so. Does it breach the Canada Health Act? Well, perhaps it does. We have to be reassured about that. We don't need any more lawsuits. Mr. Speaker, I'm eager that we respond to our communities about their health care. If there's anything that people want to protect and anything that they treasure and that differentiates us from our good neighbours to the south, it's the provision of more than adequate health care.

My own view was that as we move to restructure the system which, as I've said, I've always supported, and reform the system, we would maintain what we have as we moved into the other phases. That doesn't appear to be what's happening. We're going to end one and start another one, and I think the fallout will be very noticeable, not only in closed beds in hospitals where people are lined up waiting for surgery but in termination of trained people, health care professionals, through- out the province who will move out of Alberta perhaps never to return. Mr.

Speaker, I am also worried about the fallout where relocation and labour readjustment has not been planned for in this regionalization, and I have no evidence of it, if in fact it has. Somebody tell me. Show me the plan; show me the arrangement for it. Mr. Speaker, I thank you for the opportunity to speak to third reading. I'm hopeful that as we move forward in health care reform those experienced professionals and community leaders will come together and w ill work as we've expected to bring about reform in a gradual manner that will not punish people who are ill and who are frightened. My last comment, Mr.

Speaker, is that I had hoped that mental health would be incorporated. I've now come to the conclusion that it's a good thing it hasn't been, because this Bill is so loose and open ended that I think mental health would have been swallowed up and perhaps never achieved any position at all. So I'm glad that it's not in this first go-round. Mr. Speaker, there are too many question marks still in existence for this Bill, too many unanswered questions, too many

2352 Alberta Hansard May 31, 1994 things left to regulations, too much up in the air. I'm sorry to say that I believe the Bill is badly flawed. MR. DEPUTY SPEAKER: The hon. Member for Calgary-North West. MR. BRUSEKER: Thank you, Mr. Speaker. I, too, would like to make a few comments on Bill 20, the Regional Health Authori- ties Act. I intend to vote in favour of the title, because I think it's a good concept, but as the hon. Member for Edmonton-Gold Bar concluded in her comments, I have to agree that there are simply too many things in the body of the Bill that leave me with some concerns.

I want to start in particular, Mr. Speaker, as a Calgarian speaking to the issue of the Hyndman report. The Hyndman report is something that is out there in the public domain. There have been numerous petitions pres ented in this Legislature by members actually from both sides of the House expressing concerns. I think probably the most common concern that I've heard is dealing with the Alberta Children's hospital in Calgary. That has a fine reputation.

It is creating a lot of concern for the parents of children that unfortunately have found themselves in need of the services offered by the Alberta Children's hospital but having found themselves in need of that service are very pleased with what they find when they get there. [interjection] There are a great number of people who have signed petitions, that have written letters, that have called my constituency office, and I suspect a good number of the members opposite as well that come from the city of Calgary, hon. Member for Stony Plain.

For example, I believe the Member for Lethbridge-West has tabled petitions here. The Member for Bow Valley has tabled petitions in the House expressing concerns about the potential closure. When we have raised the issue about the closure, for example, of the Alberta Children's hospital, the response from the govern- ment side has always been: well, that's up to the local authority to make that decision. That indeed may well be the case, but that doesn't provide any satisfaction or any degree of comfort for the people that are raising the issue.

So far as I can tell, the govern- ment has simply sidestepped the issue with respect to the Alberta Children's hospital. I have attended meetings at that hospital and listened to parents tell in often the most heartrending fashion their story of what it is and why it is they've had to discover what's there. 8:30 Mr. Speaker, I've been to the Bow Valley centre, formerly known as the General hospital in Calgary, and they have just a tremendous facility there for trauma care, people that have been involved in accidents.

Similarly in the H yndman report this is proposed for consideration of closure, and again the same response from the government with respect to the Bow Valley centre as has been forthcoming with respect to the Alberta Children's hospital, which is no clear sense of direction. That leaves certainly the practitioners that are involved with some concern. For the residents that live near the area served by that hospital, it leaves them with a concern that they will not be able to access the hospital care which they need.

Now, I understand that the concept is to turn over these decisions to the regional health authorities. Mr. Speaker, as I said from the outset, I think that's a good concept. Instead of having a number of hospital boards in the city of Calgary, we will get one large region. I want to talk about those regions, b ecause when I look at the map that was produced by the government with the news release announcing how these are going to be divided up, and I look at zone 4, which includes Calgary – and of course I represent a constituency in the city of Calgary – zone 4 will include all of the city of Calgary.

It will include Cochrane. It will include Airdrie. I think it may include Irricana, which is another small bedroom community to the northeast. It probably in total represents somewhere in the neighbourhood of 800,000 persons living in zone 4, or what is proposed to become zone 4, I guess I should say. By contrast, if I go up to the north end of the province and I look at zone 15, the only two centres that are shown on the map provided by the government – and obviously there's going to be some population outside of just these two centres – are the towns of High Level and Fort Vermilion . . . AN HON.

MEMBER: High Prairie. MR. BRUSEKER: No. High Level. . . . which are substantially sma ller than what we have in the city of Calgary. So there's not even any consistency between one region and the other from the size of the population that is being served by the region's board.

Now, I recognize that certainly you've got a sparsity and distance factor, and this is similar, I guess, to the issue we had before in this House with respect to electoral boundaries, but it doesn't seem to me to be consistent in terms of making sure that there will be equal access to equal health care for all individuals across the province. I think that is a concern, and this Bill does not satisfy my concern as I read through it. For that reason, Mr. Speaker, I have difficulty in supporting the Bill. One of the other issues with respect in particular to the issue of regions.

I'd be remiss if I didn't mention the Member for Spruce Grove-Sturgeon-St. Albert, the Member for Redwater, and the Member for St. Albert having tabled petition after petition after petition in this House requesting that the city of St. Albert be included in Sturgeon as opposed to included in the Edmonton hospital region. So far I've not heard that particular issue addressed by the Minister of Health or the Premier or the Deputy Premier in addressing this particular Bill. Mr.

Speaker, these members that I have referred to tabled those petitions on behalf of constituents who are expressing a concern and saying, "This is the way we would like our region to be set up." The regions are supposed to be representing and addressing the concerns of the people in that area. Those people in those areas have expressed their concern, I think very clearly, by signing petitions. I'm sure letters have gone to the Minister of Health. Certainly they've gone to the members that represent those areas. Y et so far that particular issue has not been ad- dressed.

I think this House would be remiss to pass this Bill without addressing that particular issue, because I know that the individuals, the people that live in those areas, have expressed that concern clearly. So I think with respect to the issue of representation, with respect to the issue of where they will go to get their health care, of planning an overall approach for a region, which is what we're talking about in this Bill, if that's the way the residents would like it to be considered, then it makes sense that that's the way it should be. I quite frankly don't understand the government's reticence to shift St.

Albert into the region where the residents have asked for it to be located. Mr. Speaker, the hon. Member for Edmonton-Gold Bar raised the issue of user fees and touched briefly upon it and raised concerns with that. I share those concerns that were mentioned

May 31, 1994 Alberta Hansard 2353 earlier on. I guess my concern is that if we start opening the issue of user fees, how does that relate to the Canada Health Act? Will we see cuts in transfer payments to the province if physicians are now allowed to start charging user fees? If we start opening the door, if we start saying, "Well, for this procedure you can start charging a user fee," then are we going to see those user fees grow and grow and grow to the point where then people will start being restricted in their access to a physician?

On the other hand, if we open the door on procedure A, then what's to prevent procedure B from suddenly being considered for user fees, and then procedures C and D, et cetera, et cetera, et cetera. The possibilities almost become endless in terms of how many user fees and how much each individual user fee could grow to become. That is not addressed clearly in Bill 20 or in the – how many pages of amendments do we have? – 27 pages of amendments. I know we're not on the amendments, Mr.

Speaker, but again there's the issue that if we have a Bill that's introduced and then the amendments that come out are lengthier than the original Bill, clearly there's a problem with the Bill. I would suggest that it would behoove the government to stop for a minute or a month or perhaps several months to say, "Gee, we should really look at this once again before we put this through, because there are a number of issues still of concern." One of my concerns that I want to raise again, Mr. Speaker, is the issue of regulation.

I think the Member for Edmonton-Gold Bar in her comments said that it leaves too much up in the air. As I read through this Bill, there are many, many places that refer to regulations. The Lieutenant Governor may make regulations. The minister may make regulations. The regulations shall do this. In fact, in some cases it simply says, "The Lieutenant Governor in Council may make regulations," so we don't even know if there will be regulations. Certai nly if there will be regulations, we haven't seen them yet, because they've not been drafted.

If they've been drafted, they haven't been introduced into this Legislative Assembly, and that to me is a concern, and I think it's a concern to all Albertans because they're not really sure where we're going. On one hand I think most Albertans would agree with the general principle and the general philosophy of: let's regionalize hospital boards; let's reduce the overhead; let's streamline the administrative costs. I support that concept as well. But if we are asked to support a concept, I think it requires more detail and more information from the government as to how that process will in fact be implemented.

Mr. Speaker, one of the concerns that I have with the Bill deals with in fact the language of the Bill and two terms that sort of spring out: "health services" and "health related services." Well, I guess one way to interpret those would be the issue of: are these essential or nonessential services?

Now, if that's the intent of those terms and similar terms like that, then I think it would be more instructive and more clear if the government simply used the terms "essential" and "nonessential." In speaking to this Bill and in fact to many pieces of legislation before this House, I would encourage the Minister of Health in this particular Bill and in fact all cabinet ministers as they introduce Bills wherever possible to write the Bill in plain and simple English that every person can understand.

If they so choose to do so, they can pick up the Bill, read it, and have some degree of understanding as to what it says. If we read through some of the clauses that are in the amendments or read through the clauses that are in the Bill itself, sometimes it requires two, three, and even four readings before one really grasps what it is that that particular

section is attempting to address. So I would encourage as a general policy for all pieces of legislation – and this one in particular because we're discussing Bill 20 at the moment – that plain English be used, that the sentences be shorter, that the sentences be clearer, and that the terminology be well outlined so that people know what it is they're dealing with. Mr. Speaker, the level of authority for the regional boards on one hand and the Minister of Health on the other is still in my mind not yet clear.

Despite the debate we had at second reading, despite the debate we had at the committee stage, I'm still not clear as to how responsibility is going to be delineated. As I discussed the Bill at second reading, I raised concerns about areas where the health regional board may choose to offer some service and then again they may choose not to do so. So you get some variation from one place to the other. Y ou will get some variation from one region to another.

Certainly, as I've already pointed out, because some of the regions are in fact different, you will see a different ability of thos e different regions to provide different health care. 8:40 I'm still unclear and I suspect some of the people who will be applying for and will be interested in being on some of these regional health boards are not from area to area going to be clear as to what exactly it is they will be required or responsible to do.

In the business world we see people getting on boards of directors and we see increasing responsibilities now of persons who find themselves as directors or in similar types of positions in corpora- tions, and the issue comes back to what is the personal liability of that individual in a position of a di rector. Well, in this case we will have a similar sort of operation, where the regional health board will act like a board of directors. They will have increasing responsibility placed upon them. But what if they choose not to accept to provide service X, whatever that may be? That, too, I think is a concern.

Again speaking briefly to the issue of the map. Looking at the map of Alberta that has been provided, when one simply scans all of the proposed health regions, one can't help but w onder how some of those regions were arrived at. Some of the lines seem most peculiar. I have mentioned a couple, one being St. Albert, whether it should be in with Sturgeon or Edmonton. I've raised the issue with respect to Calgary and area. But there are a couple of others that just seem really peculiar. For example, in zone 2 a line separates Cereal and Oyen and puts those two into two different regions.

Y ou have to wonder why that would be the case. In zone 6 in Rocky Mountain House, for example, there's one little area that kind of pokes up near Drayton Valley. How come that little area pokes up near Drayton Valley? MR. LUND: Nobody lives there. It's part of the municipality. MR. BRUSEKER: Oh. Part of the municipality. Well, that's interesting. I didn't know that. Thank you, hon. member. I guess I would like to know why there are some little anomalies like that.

Certainly the Member for Rocky Mountain House is going to be the expert in his own constituency, and I appreciate him sharing that information with the House. I guess those concerns, Mr. Speaker, are some of the concerns that I still have with respect to this Bill, and I hope that when we get to the point where we're having closing comments by the minister, in fact she can address some of those issues. Not only for members on this side of the House but for all Albertans I think

2354 Alberta Hansard May 31, 1994 it would increase the level of comfort that they need to have with this Bill. As I said at the outset, I think most Albertans and certainly members of the Liberal caucus support the concept of regionali- zation. The question is: how is it being implemented? As I read through Bill 20 and the amendments to B ill 20 and listen to the discussion we've had on that Bill, I'm still unclear, and I suspect therefore many Albertans are also unclear. Thank you, Mr. Speaker. MR. DEPUTY SPEAKER: The hon. Member for Lethbridge- East. DR. NICOL: Thank you, Mr. Speaker.

I just have a few closing remarks on Bill 20 as well. Again, this is a Bill that takes on the characteristics that have become kind of the benchmark for legislation dealing with the major issues that have been brought forth in this session.

First of all, we have a concept here in terms of health care regionalization which is definitely worth supporting, definitely needed, and definitely a program which will work toward the achievement of the end result that all of us ran as the major part of our campaign in terms of fiscal responsibility and a degree of getting Alberta back into a position of financial responsibility. The process we had for bringing about the definition of the regions gave us a lot of input. It gave a lot of time for the people of the communities to react.

But at that point basically the influence of the community, the influence of the people of Alberta was kind of put back into a secondary mode, and the end result was a set of regions that was defined by Alberta Health, and the regions now are basically responding to these. I think it would have been much more appropriate had the process been to go out to the communities as they were approached at the beginning and given them a program through a set of Bills or through a change in the methods of f unding for Alberta Health that would allow them to combine on a voluntary basis.

We have seen in southwestern Alberta the upheaval that was caused by the change in the focus of the health care system when the St. Mike's system was changed from acute care to long-term care. The community got together through their own incentive, through their own initiatives and put together an advisory board that dealt with regional issues. This is now transferred into the regional boundaries that were brought together by the Barons- Eureka and the Warner health care units and the institutions that fall within those. This was community driven.

It was really the process that the people were told at the beginning they would have the option of following. Then this all fell apart, and we ended up with kind of imposed regions on much of the rest of the province except for the main centres of population in Calgary and Edmonton. We also had basically a system where the communi- ties now are left with a set of boundaries to define the regions which do require adjustment or do require a stretch of the imagination to bring about the rational use of those regions.

As some of the facilities that were conveniently allocated to one side or the other of a boundary depreciate and become outdated, will we have the option to relocate those facilities into a more appropriate position within a region and then adjust the boundaries of the region according to population and facility needs? There's no real mechanism within the structure of this Bill to deal with that so that we can possibly sh ift some of these little kinks in regions that are there now, as have been outlined by the Member for Calgary-North West.

So this is kind of an adjustment process that needs to be brought into the idea of the regionalization. As I've said, regionalization itself is a concept that I think all members in the House support. It's a method of reducing the administrative overhead costs of providing health care if we can reduce the number of boards, reduce the number of institutional administrative units. What we end up with, then, is really a lack of definition of how these ins titutions that exist today work together in the new framework.

What we have now is no real definition within the Bill – hopef ully this will come from the regulations – in terms of the relationship between local needs versus the regional needs versus the things that are helped with at a provincial level, the tertiary hospital focus. What we've got to deal with basically are the processes of transferring and co- ordinating those services.

I know we've heard lots of talk of the possibility of a regional authority being responsible for the total health care of their residents, and if you end up having to go to another region for your appropriate care, what you'll end up with is billing back and forth.

What we've got to deal with here, then, is the possibility of a lot of administrative problems associated with transferring these dollars through identifying the patient with the region the patient comes from, the relative merits that have been placed on that particular treatment or preventive situation by each of the regional authorities, and how that corresponds. We don't see in the Bill any real definition of how this standardization co-ordina- tion is going to come about.

We have the potential, then, unless regulations are very well defined, to end up with kind of a patchwork health care system across the province as each of these authorities takes a different focus, takes a different initiative on their health care priority. They'll end up, then, with alternatives in the method of providing health care.

So those are basically some of the concerns that we end up with, dealing with the regionalization part of this Bill. 8:50 We then get into some of the operational characteristics of it when we start talking about some of the things that deal on the possibility of the application of user fees – this is a concern – how these are going to expand, if they will expand beyond the limited focus that's out there now. This is not clearly defined.

It's going to again be left to the regulations, which will hopefully be brought about or implemented so that they become reasonably uniform so we don't have some areas where user fees are appropriate, where other parts of the province served by a different regional authority have a different set of restrictions or a different set of directions for what can be paid for directly or what has to be paid through user fees. We end up then w ith the possibility of again this potential for a patchwork system in terms of the essential services and the user-fee approach.

We've heard some of the other members this evening already speak about the public health concerns. This is one of the issues that has come up in the Lethbridge area, Lethbridge-East, on numerous occasions when I've had works hops, open houses, discussion groups.

Even phone calls that have come into our constituency office say, "How is the function of the public health unit going to be built into the regional health authority?" Some of the amendments that were proposed during committee I think go a good way toward clarifying this, but they still leave out some of the incentives or the mechanisms that we need to provide the regional authority board members with a real commitment to the idea that prevention is better than having to deal with the cure.

If we can prevent people from being sick, we're going to be dealing with them on a lot lower cost basis than we would be if we're dealing with them on an acute care recovery basis.

May 31, 1994 Alberta Hansard 2355 The other concern that still exists in the Lethbridge area, the Lethbridge-East constituency, concerning this Bill has to do with the lack of constraint that's put on the requisitioning power of the regional authority. This ties back into the boards. A lot of the concerns are with the initial appointment to the boards and the potential mix of elected versus appointed boards in the final allocation or the final definition of the boards as the process of replacing the boards gets synchronized with the municipal election process.

This is the reason, we're being told, that the appoint- ments are occurring now, because they want to bring it in line with the municipal elections. But we're also not told that all members would be elected. We're not told the criteria for representation between urban centres versus the rural population service centres, the small town s versus the farm communities. How will they look after their interests and their perceived needs for medical treatment within the framework of getting the bills put in place?

Then as these boards act to requisition – you know, the previous health care Bills have had requisitioning powers which have been really limited to the support services for the capital facilities. In this new Bill now we see that there's been a limitation on the requisitioning power to, quote, capital costs. Well, does that mean that within our constituency the southwest regional health authority could be creating a requisitioning program where nonelected members are going to be subjecting the members of the community to a tax burden that they don't have an option to deal with?

This has to be taken into consideration as we move from the original appointed boards and roll this over to the final structure of the board, whether it be elected or elected/appointed or totally a ppointed. This is one of the areas where I think we need to have a little bit more clarification and a little more public consultation in terms of getting these regulations in line with the community and what the community sees as being their health care system. [Mr.

Clegg in the Chair] I guess the other issue that has come up quite often – and I didn't see this clarified satisfactorily in the amendments and I still think we need to deal with more – is the role of some of the specialty professions within the health care system, some of the things like the physiotherapists or the radiologists. How are these going to be handled? There's a real fear here that these are going to be turned over to privatization. Some of the members in our community that look at the Bill and look at the options are quite excited if they can take off and become privatized and do direct billing,

whereas others are really concerned about it. So I think this is one of the areas where I would hope the minister takes a lot of time to go back to the communities and really look at how the communities perceive these specialty services or ancillary services as part of the health care program, the health care process for the community and how they'll get bu ilt into dealing with them in terms of the whole mandate of the regional health authority. Mr. Speaker, I'd just like to conclude my comments talking about Bill 20 and the regional health authorities.

This Bill basically takes a couple of good steps forward in helping the mandate of financial responsibility that we set about. The Bill looks at an additional focus in terms of not only dealing with health care financial responsibility but the delivery, and we end up, then, with a change in focus of what our whole health care system is going to be about. I see this Bill basically coming down now to a mix of objectives. We've talked about the financial responsibility at length, but it also deals with part of the govern- ment's mandate or the government's initiative toward privatiza- tion.

There's a lot of room now within the

interpretation of this Bill for privatization within the health care system, and this is something that we need to look at in terms of real evaluation and concern by the people of Alberta: whether or not this is the direction we should be going and whether or not it's consistent with the Canada Health Act. Another issue that comes up in the context of this Bill is the transfer of power, first of all in terms of the focus between centralized control in the Department of Health in Edmonton versus the community's control.

We end up now with Alberta Health and the minister, the executive setting a lot of the regula- tions. These then get implemented through Alberta Health, handed down to the authorities. They have to deal with them. Then we also end up with the community health councils and how they're going to fit together. What we've got effectively is a perception of downloading yet still a very heavy hand at the top through the power for nondebated, nonpublic input regulation control and regulation change.

So what we've got is what seems to be a process of allowing the communities more power, but if they don't respond the way the central authority, Alberta Health, would like, there's that regulation hammer that they can use to basically change the way the community responds. That leads me into the final fo cus that I'd like to take on that Bill: the very high concern that I have for this shift from legislative direction for Alberta to a change where we have regulation running Alberta. This basically puts together the four focuses of this Bill.

I would suggest that in the long run the latter one is the most highly controversial of all of the issues and, from my perspective, one of the ones that makes it very difficult to support the Bill. What we've got is a Bill that has a focus that is going to help, but in the process of helping it creates a lot of concerns. From that basis, Mr. Speaker, I find that in the end, even on third reading, I'm going to have to vote against this and for those reasons. Thank you. 9:00 MR. ACTING SPEAKER: The hon. Member for Lac La Biche- St. Paul. MR. LANGEVIN: Thank you, Mr. Deputy Speaker.

I rise this evening to speak to Bill 20. I believe that in the past few years all the political parties of this province have expressed support for regionalization. What has happened is that this time a Bill is proposed to do exactly that. There is some disagreement on how the process should work or how we should attain regionalization. I have some concern, but in general I believe the Bill is a good Bill. I know that in region 12, where my constituency lies, the people are generally happy with the region that was formed because the trading area and the living areas were taken into consideration.

When the first proposal was made, about three hospitals were not included, but because the people of these areas asked to be included, it was changed before the final proposal was made. I think it shows that there was an attempt to accommodate the people in that region. I know there is one concern. We have a concern and I have a big concern about having the county of Strathcona in region 12, because most of the people who live in that county are residents of Sherwood Park, about 40,000 people. They're urban people and they have no ties with rural Alberta. I think they have demonstrated that.

They have made demonstrations, they have

2356 Alberta Hansard May 31, 1994 made petitions in regards to the Grey Nuns hospital here in Edmonton, and they have been very vocal as far as health is concerned in the city of Edmonton. That demonstrates that they have closer ties with the Edmonton hospital. I know that nobody from Sherwood Park will travel to Lac La Biche, Bonnyville, or St. Paul to get health services. If they are sick, they will immediately come to an Edmonton hospital. So I don't under- stand that reasoning. It's the same with the people from St. Albert.

They have presented in this House numerous petitions asking to be with the rural district, region 1 1. I know and everybody I think in that community would know that if they cannot get the proper services in their own hospital in the city of St. Albert, these people will by their own choice come to a city hospital, or if they're transferred by a physician, they will be transferred to a city hospital. Y ou will not see these people going to Athabasca, Boyle, Barrhead, Westlock, or Mayerthorpe.

I don't understand then why they would want to be with region 1 1 when we all know that they will be getting their services from the city hospitals. I would hope the Minister of Health would look at that now that these regions will be formed, that in each rural region – and I can't talk for the city because I'm from rural Alberta – there should be one rural hospital which will specialize in giving some additional health care than is provided now in rural Alberta. This will alleviate the need for people from rural Alberta to travel to the city all the time when they n eed specialized health care.

I think transfers to city hospitals should be done for organ trans- plants, heart bypasses, or some very serious surgeries. Most of the other procedures could be done in one rural hospital that would be designated in each region. [Mr. Speaker in the Chair] I support some user fee, and I support that by speaking from experience. When I was chairman of the hospital in my commu- nity, a town of 5,000, we experienced 26,000 visits to emergency in one year. I think this is extremely high. We made a survey on that and found out that 80 percent of these visits were clinical visits, not emergency visits.

The total cost to the hospital board at that time was $400,000 per year to look after all these clinical visits that came to the hospital. They came there because it was convenient, because they could get the doctor to l ook at them faster, and because of ease of access. I think that if we at that time had looked at using some user fee to have a deterrent so that these people would go to the medical clinic, we could have saved the board $400, 000, b ecause the people immediately, if there was a small user fee – and I say a small user fee – would have chosen to go to the clinic where there was no user fee.

I think it would have been the proper use of health care. This system of seeing 26,000 visits a year in a small hospital like the one in my community is really an abuse of health care. It's abused because there is no charge for it. Whenever something is free, people just take advantage of it sometimes. I would hope that the minister in the regulations would look at remuneration to board members and put some kind of guidelines on that.

I again say that because I can see that many, many board members would be very reasonable and would not abuse that, but in some cases maybe there would be excessive remuneration paid to board members. I can only relate to rural counties. I know rural counties where the reeve will make $20,000 to $25,000, and in others it will go up to $1 10,000 and more. I think if there are no guidelines, you don't know where you're going to end up paying remuneration to board members. The requisition to the municipality was raised as a concern by several MLAs in this House.

I don't see that as a big concern because it has always been a possibility for hospitals to requisi- tion. I did it when I was chairman of the board in St. Paul. We did it twice. We requisitioned the municipalities that were involved in the funding of that hospital, and I think it's just a continuation of what we had before.

I have some concerns with the health units, because as we form the new regional health regions, as in region 12 which I represent, there will be four different health units operating within that region, and each health unit has its own boards and its own rules and regulations and ways of operating. I think it does not give equal service to all residents of a region. I would see at one time that health units should be coterminous with health regions and even the further possibility that we would dismantle the health unit completely and amalgamate all that service into the regional health authorities.

I think that one authority would be more cost- efficient. At this time what is being experienced in many hospitals in rural Alberta is the discharge of patients when they need to have home care for the transition time when they're recuperating at home. If you have to discharge a patient on the weekend from Friday noon till Monday noon, there's no way you can get the help or co-operation from the health units because they're working on a five-day work week. I think the hospitals should have control of the home care nurses.

If you can discharge a certain percentage of your patients one or two days earlier, even on a weekend you'd save thousands and thousands of dollars to the health system in this province, and you'd give better health services to the patient who would need that service at home. The ambulance service to me is another sore point. I know that in all regions now you're going to have different ambulance service, a different level of service, of competence, and maybe we should look in the future of having one ambulance service that would represent the whole region and be administered under the same board.

Every resident of that region would have the same service from the same ambulance service. I know the transition is not going to be painless. There's going to be some pain and adjustment to be made, but there will also be some benefits in the long run, and the centralization of service will be a payoff. The larger boards will increase the buying power, and they're going to save on supplies and medicines and whatever they need to buy for hospitals. There will be the reduced cost of administration, and that has already started.

I know that the hospitals at Bonnyville and Elk Point starting tomorrow, June 1, will have one administrator instead of having one for each hospital. Just in that case there is a saving of $1 10,000 for one position. There are many hospitals in my region which can join administrators and accounting services, and there will be quite a saving on that and a better use of existing facilities. 9:10 I know there've been some points made that we're still building new hospitals at this time, and I'd like to say that in region 12 there's only one hospital that was under construction during the last year.

It was not for acute beds; it was for long-term beds. These long-term beds were needed very badly. The official opening was held in Elk Point last Friday. I attended that with the hon. Member for Vegreville-Viking. They're opening 20 long-term beds, and already there's a waiting list because of our aging population. I think that every time we see construction of a hospital in rural Alberta we have to ask ourselves: is this for acute care or for long-term care? When it's for long-term care,

May 31, 1994 Alberta Hansard 2357 I think we're looking after the senior citizens of our population, and I would support the long-term care beds when they're needed.

I would urge all the MLAs of this House to work closely with the Minister of Health in choosing the regional health board members, to make sure that we have people who serve on there of quality, good experience, and commitment because the first few years of transition will require people who have the knowledge of health care in this province, who will know what is needed to make our health care more efficient and to deliver better health care with fewer dollars. I think th at's what we have to do, and we should not satisfy ourselves with just cutting the budget and trying to trim expenses.

We have to satisfy ourselves that we can save some dollars and at the same time keep the quality that we have today or improve health care quality. I would urge all members of this House to support this Bill in third reading and to co-operate with the region they represent to make sure that their transition is as smooth as possible and that we can look after the health care of Albertans. Thank you, Mr. Speaker. That concludes my remarks. MR. SPEAKER: The hon. Member for Edmonton-Meadowlark. MS LEIBOVICI: Thank you, Mr. Speaker. I wish I had the same faith the Member for Lac La Biche-St.

Paul has with regards to this particular Bill, but my comments on this Bill can probably be summed up, in short, in two words: empty shell. That is what this Bill is. On May 19, not more than five working days ago, this govern- ment brought in 27 pages of amendments, 27 pages of amend- ments to a Bill that was introduced. Now, is this good planning? Is this something that instills faith in either the loyal opposition or in the public of Alberta? I would like to submit that the answer is no, that if we were to have thought that there was a plan, perhaps Bill 20 should have been Bill 1.

Perhaps Bill 20 would have been one of the first Bills introduced in this Legislative Assembly so that there could well have been, as there always are from this side of the Assembly, reasoned arguments and input from those affected by this Bill. Now, the Regional Health Authorities Act is not just a Bill that deals with a matter that has no import to the public. When we are talking to our constituents and ask what is important to them, one of the first things they'll probably say is that it's their health.

It doesn't matter how wealthy you are, it doesn't matter how happy you are in your family life, if you don't have your health, you have nothing, because that is one thing you cannot buy. So when we look at the impact of this particular Bill, we see that it is an impact that has grave consequences for the health of Albertans. When I look at a Bill, I try and see what are the parameters that the Bill is built around and what are the reasons that I would look at voting for the Bill, and I listen to the arguments put forward by all members.

I listened to the arguments that were put forward by the Minister of Municipal Affairs as well as the Minister of Health. They said a few things, one of which was that this is the right thing. Another thing that was said was: well, let's try it. Let's try it. We don't know if it will work. We don't know what the impact will be, but let's try it. A third, of course, was: trust me; I know this is the right way. As the Member for Edmonton- Meadowlark, what I'd like to put forward is that this may have been the right idea. The idea of regionalization might have been the right idea, but this is the wrong way to do it.

In effect, this is too important to say let's try it, like we did with the ALCB. Didn't we do that? Overnight we said: Let's go sell all of our stores. It doesn't matter if we lose a few million dollars. It doesn't matter if we put a few thousand people out of work. Let's try it. And that's what we're sayi ng with this Act. Let's try it and see if it works. It doesn't matter if someone gets lost or dies in an ambulance on the way to a hospital that no longer exists; let's try it. Then it's "trust me." I saw an example of that this afternoon with our Deputy Premier, who was looking at confidential telephone lists.

What are we? Big Brother? What kind of dictatorship are we really in that telephone lists – yours, mine, the press gallery, anyone who makes a phone call out of the Assembly – are not confidential? Now, that's a reason for trust? I don't think so. I don't think it is at all. [interjections] MR. MITCHELL: Y ou rattled the cage. MS LEIBOVICI: Good. They're waking up, eh? I'm setting them up for you. On second reading we put in a reasoned amendment. That amendment was that this is an important Bill and what we need to do is take this particular Bill and put it aside.

We need to think about it, and we need to allow Albertans to have input into the Bill. The reasons for that are quite simple. We see fear in people. We see members on both sides of the legislation talking about it and talking with constituents who are afraid that their hospitals are going to close. We have the Children's hospital in Calgary, and we know that that is an issue of grave concern for the citizens in Calgary.

We have the Grey Nuns and the potenti- ality of the Misericordia in Edmonton, and we know that those hospitals and the potential closures and changes to those hospitals are of grave, grave concern to the members, to the citizens in Edmonton. So the reasoned amendment was a good amendment and one that we hoped would have made sense to the government. But, no, we're back to, "Trust me; it's the right thing," and "Let's try it," with no thought of the consequences.

Have any of the hon. members taken a moment, just taken a moment out of your busy schedules – because I know you are all busy – and said, "What if I'm wrong?" Have any of the members sat back and said, "What if I'm wrong?" Has the Minister of Municipal Affairs asked that question to himself, and can he live with the consequences? Has the Minister of Energy? Has the deputy minister? Has the Minister of Education, who has a double question to ask, not only in Health but also in Education? And the same for the minister of advanced education: what if you are wrong?

Y ou can repair a road that you haven't fixed the potholes in for a year or two years or three years, but you can't give a child back an education that they're missing. Y ou can't give a young adult back a career that they've not been able to gather. Y ou can't give back someone's life that they have lost as a result of inadequate services. So the question is: what if you're wrong? Can you live with that?

I know I on this side of the House can't live with the fact that I have not to my utmost attempted to show that there are problematic areas within this particular Bill and that these areas need to be addressed and looked at. Now, again I had the opportunity on Saturday to spend some time with some young interns and residents who are looking at their futures within the province. I was told point-blank by one: "This is for the MLA. I've been given an offer of $150,000 to go to Baton Rouge. On top of that, I will get my subsidies. What do I have left in this province to stay for?

Do I have a health care system that truly cares about the health of Albertans?" I had another young doctor come up to me and say that he had

2358 Alberta Hansard May 31, 1994 become an anti-Tory Tory. This is something that I've just got your attention on, and this is something that he said to me as a result of the actions of this government. Doctors can't get jobs in this province at this point in time. We have a government that says that they're a free enterprise government, yet what are you looking at doing? Y ou're looking at putting a cap on the number of doctors in this province. 9:20 We have a number of issues that have yet to be addressed, particularly issues with respect to labour.

I've heard over and over again the statement that it's not going to affect care, that we're not attacking the front-line workers, yet only six months after the CUPE locals in Calgary agreed to a 5 percent rollback, the employers are back asking for another 5 percent, and that doesn't take into account their wages that have been cut because of reduced hours. Then at the same time – and this is real planning – we see hospitals that are spending millions of dollars to get in ahead of the potentiality of regionalization.

So we're asking the front line, the ones that are going to provide the care, to take another hit while the hos pitals are spending dollars on capital expansion programs. We see under the new amendments that have been brought forward that the hospitals that are currently under the Public Service Employee Relations Act are going to be amalgamated with the Labour Relations Code, and that is a good move. When the government has initiatives that are good, then I w ill be the first one to say that that is a good move.

And that is a good move, but it would have been a lot better to go the extra move and give those hospitals the same right to strike as those under the Labour Relations Code. When we look at, in terms of labour again, the work force adjustment strategies and the work force adjustment task force, the problem with that is that it's just too slow. There were dollars allocated in the budget. Those dollars have, to my understanding, now finally been moved over, but unfortunately there have been hundreds of people that have been put out of work, and the work force adjustment is just too late for them.

With regards to the regionalization, I wonder if the real cost of regionalization has been taken into account. When I talk about the costs, I talk about things like the severance packages, the total costs of severance packages. Have those been calculated? Have those been accounted for? When I talk about costs, I talk about things like: what happens in the case of a group like Caritas, where there might still be equity owing to the Grey Nuns, I believe, somewhere in the neighbourhood of $15 million? What happens there? That hasn't been thought out. Everyone seems to have their own

interpretation of what is going to happen to the current boards. Who is the boss? Is it the local board? Is it the regional board? There seem to just be no real answers. Again we go back to the point that we have a Bill that's an empty shell, that we have a Bill which has had 27 pages added to it in the last five days, yet we still don't know how it's going to work. We still don't have the regulations. We're still acting on blind faith. We still think that because of this Bill we're actually going to reduce the costs of Alberta Health as a result of the regionalization.

Well, I would like to know what the projected decreases are in terms of Alberta Health. Are we just going to be growing 15 miniature Alberta Healths with these boards? Has there been any thought in terms of the costs and what those costs are? Those are some of the concerns that I have. One of the other questions that comes to mind is in terms of who actually has advised on this particular Bill. When we looked at the Gimbel Bill, we saw that the high-ranking officials in the Department of Health did not have the authority to advise.

When they tried to advise on Gimbel, they were told, "Well, you can't do that; it's not your place to advise the Legislative Assembly or a committee of the Legislative Assembly." So I'd like to know who has been advising the minister on this. It hasn't been the public. It hasn't been that there has been any hearing or caring or listening to all the petitions that have gone forward or to the reasoned arguments of the opposition, and, as well, there doesn't seem to be anyone in government that is listened to on this.

A great concern that I have is with regards to what happens after the original appointments in the health regions. Right now what it says is that the regional health authority can be either appointed or elected. We are seeing appointments that are going to occur in the first instance, and perhaps that's what needs to happen. But it would have been nice to have seen in the Bill some kind of outline that in effect these appointments would not be ongoing and that there would be elections.

The reason I bring this up is that the Edmonton regional facilities planning committee had originally said that they were not looking at elections, that to have elections would mean you could have highjacking of health authorities by special interest groups like perhaps the public. It seems that the public has become a special interest group to this particular government. Again, I think that's a fundamental principle that should have been addressed in this Bill, that there needed to be the thereafter clause which indicated that within two years or three years these boards would be appointed.

Another fundamental flaw within the Bill is with regards to the provision of user fees. Although the Minister of Health has indicated that, no, this is not the case, and, no, user fees will not be charged for essential services, in effect the Act still talks about, quoting from 20(k): to charge fees for goods or services they provide and respecting the amounts of the fees that may be charged for those goods and services. Nowhere in it does it say that essential services will not be charged for. If that is the intent, then why not spell it out in plain English, like we saw with the Municipal Government Act?

Spell it out if that's what the case is. The other grave concern is with regards to the voucher system. We should not have a system within this province that allows for there to be any kind of discrimination against those who are not wealthy, those who are chronically ill, who may have a family history of disease, or the elderly. That's what may happen as a result of this particular Bill. The Member for Lac La Biche-St. Paul said a couple of curious things that I wasn't quite sure what the meaning of was. He seemed to indicate that there is a rural and an urban population split with regards to health.

If you live in the rural area, you should not be allowed into the urban area, and if you live in the urban area, you should not be allowed to use services in the rural area. MR. LUND: That's not what he said. MS LEIBOVICI: I would hope that is not what he said, but that is what my understanding was, and I would hope that we would never see that that is what might occur. Hospitals, no matter what part of the province that you live in, should be accessible to everyone. There should be no restriction on access, and that is why we are against a user fee of any kind.

May 31, 1994 Alberta Hansard 2359 The member had also indicated that perhaps if there was a small user fee for the hospital, then people would be forced to go to the clinics. Well, I didn't quite hear in the argument whether there was a reason for people not going to the clinics, such as that maybe clinics aren't open 24 hours or maybe the clinics don't provide the kind of care that the hospitals provide, and that's why people were going to the hospitals.

I do not think that people willingly go to hospitals, that hospitals are a place to visit like one would go to a movie theatre, so I wonder about this whole notion of abuse, whether that is a notion that is valid. I would like to challenge the minister, if this is a Bill that the minister is fully confident in, if this is a Bill that the minister feels there is full support for, if this is a Bill that the minister is not worried about with regards to the electorate, that she enact the provisions within the Hospitals Act which talk about plebiscites. It's

section 3, where it indicates: The Minister may require that a plebiscite be held under the Local Authorities Election Act in a district or proposed district by which the electors of the district may indicate their approval or disapproval to construct new facilities, disestablish existing facilities, amalgamate boards within the district or other matters pertaining to the provision or operation of hospital or nursing home facilities in the district.

Now, this is a government that has already indicated that they're willing to live by referendums, unless of course that's only referendums that are outside of their provincial jurisdiction, that they have no control and no say over. If this government is a government that is willing to live by referendums and plebiscites, then the challenge is clear to the minister.

This is a clause that is an invitation to the minister to submit to the democratic process, to require that a plebiscite be held, and, if there are enough citizens within an area who wish to have these provisions enacted, that the minister call that plebiscite.

Again, if the government is so sure of their mandate, as they repeatedly like to let us know that they are, that a year ago they were elected to be government – if that is the mandate that they are sure of, that they are confident of, that in their travels around this province they have heard untold support for the kinds of changes that they are making to the health care system, then there should be no reason that the minister would not enact these provisions. These are good provisions; these are provisions that allow for input from the people who su pport the health care system through their taxes.

With those comments, I would like to indicate that I will not be supporting the B ill. I guess that comes as no surprise to the members on the opposite side. I think that I have made my position clear as to why I cannot support the Bill, and I would hope even at this late date that the members do sit back, do take a moment to reflect and say, "What if I'm wrong?" Thank you. 9:30 MR. SPEAKER: The hon. Member for Edmonton-Rutherford. MR. WICKMAN: Thank you, Mr. Speaker. I just want to speak relatively briefly. I view this Bill as a Bill that does take a step forward.

It takes a step forward in the sense that it does talk in terms of regionalization. Regionalization is nothing new. In fact, it was in 1989 that this particular caucus, or the Liberal Party, went throughout the province and promoted regionalization, promoted rationalization of the health care system. Again in 1993 this party went throughout the province and advocated and supported regionalization and rationalization of the health care system, never advocating, as some members of the Conservative Party put it at the time, the closure of rural hospitals. No, we didn't advocate the closure of rural hospitals.

We advocated exactly what this Bill is doing: regionalization. Now, that is the one step forward, but even that step I don't call a gigantic step, because there are problems within that regionalization as to which hospitals are part of which region and so on and so forth. Even with that one step forward in the terms of the concept of regionalization, I then have to look at the faltering steps that the Bill takes in other directions. The good that comes from that one good principle of an aspect of regionalization is tremendously shot down by the negatives in the Bill. I want to just dwell a bit on the negatives.

I don't always like to dwell on negatives. The Minister of Municipal Affairs likes to accuse us of being negative, but we are not negative, Mr. Speaker. We simply try to point out where there's good, there's good; where there's bad, there's bad. Sometimes it's tough to find much good, and this is one of those Bills where we don't find too much good. Now, when I look at some of the negatives – and I've got to say that we do tend in this caucus at times to look at things with a degree of suspicion, and we do look for underlying motivation that may be there, but we do it with good cause.

The government has sent signals not only to us but to Alber- tans, signals to taxpayers that we're on a trail towards privatiza- tion. If anybody doubts the statement that I make that it's government pushing the health care system towards privatization, all one has to do is look at the Gimbel Bill that was in front of this Legislative Assembly as well as in front of Private Bills. Certainly it was in front of a committee.

Nevertheless, the telling story to me of the privatization that the government seems to be intent on in all aspects of life, including health care, is when the Premier of this province even before hearings were held on that Bill got up in public and announced that he supported the Gimbel Bill because that concept of privatization was good. It was after that that all these representatives from the powerful groups throughout the province came one by one, dozens upon dozens, to the public hearings and spoke against the statements the Premier had made in terms of privatization. The fear was there.

The fear had been implanted. So it's not only us that tend to be a bit suspicious at times, Mr. Speaker. It's Albertans, Albertans that are in the know when we talk in terms of these special interests such as health care. Y ou get representatives from groups that represent thousands of people throughout this province expressing similar concerns coming to our caucus and saying: "Y ou've got to stop that government from doing what it's doing, because they're leading us to a two-tiered system. They're leading us to privatization.

They're leading us to a system where the rich are going to afford a certain style of health care, and those that don't have the same resources are going to have a whole different level of health care, sort of what we see in the United States." Now, I look at some of the principles that are in the Bill, some of the principles that can be led to in terms of actions on the part of the government. Even within this Assembly during question period very, very recently, I believe it was the Member for Calgary-Fish Creek that lambasted the Minister of Health for statements that she had made on the Children's hospital.

What I interpreted her to sort of imply was that there is snookery, political motives involved in that whole proposed relocation. That member to her credit pointed out that there were statistics that questioned very seriously the intent of the government. I can even go to a statement that the Premier of the province made on April 15, 1994, where the Premier praised the Hyndman report,

2360 Alberta Hansard May 31, 1994 which recommended the closure of three hospitals and the relocation of the Children's hospital. Mr. Speaker, that was of concern to myself, to this caucus, to Albertans, particularly to Calgarians that feared the closure of three hospitals in their city plus the relocation of the Children's hospital. Of course the same fear is here in Edmonton in terms of the Grey Nuns hospital, in terms of the Misericordia hospital, in terms of the uncertainty that has been created within the health care system. So you can understand . . . Point of Order Relevance MR. LUND: Point of order, Mr.

Speaker. MR. SPEAKER: Order please. The hon. Member for Rocky Mountain House is rising on a point of order. MR. LUND: Under Beauchesne 459, relevance. Please spare us from this rambling. MR. SPEAKER: The Chair presumes the hon. member is questioning the relevancy of the hon. member's comments to this Bill. Debate Continued MR. WICKMAN: I thank the member for standing up and giving me a chance to refuel with my glass of water. I was running out of steam there for a second. Mr.

Speaker, speaking to the B ill, the concerns that are expressed throughout the whole process – and it's been pointed out: the closures and the possible closures, the building of a new hospital in Barrhead, Westlock. Again, I want to refer to a statement that was made in Hansard as a matter of fact by the Minister of Transportation and Utilities: "I want to share with these members," referring to us, "that if there is no con- struction . . . in the minister's riding this year . . . there'll be no construction in any of their ridings." Well, it points out a certain style . . . Speaker's Ruling Relevance MR.

SPEAKER: Order please. Perhaps the hon. member could sort of connect those comments to the objects of this Bill that we're presently discussing in third reading. MR. WICKMAN: Mr. Speaker, the concern that I was trying to point out in this concept of regionalization was the concept, the principle that the government is leading towards in terms of health care. I'm trying to point out the inconsistencies, the decision- making process that we're into that can cause us a great deal of problem and causes us concern and points out why . . . MR. SPEAKER: Order please.

The Chair can certainly well understand concerns that various hon. members may have about the administration of the delivery of health services in our province, but that has to do with the general administration of the department perhaps, which is really not germane to the regionali- zation of health districts in our province, which is the subject of this Bill. 9:40 Debate Continued MR. WICKMAN: Mr. Speaker, when I look at the actual structure of the proposed regional health boards that are to be established throughout the province, that does pose a number of questions.

It poses the question as to the process of placing the members on those particular regions, then the responsibilities of the regions in terms of redefining the region they're responsible for, redefining the possibility of mergers or shifting, whatever. So the regionalization aspect becomes very, very important from that point of view. That's been addressed by several members of our caucus, but there are two more points I want to make before I conclude and allow the Member for Edmonton-Whitemud to carry on with his wisdom. The user fee.

In the Bill that is in front of us, clearly it spells out the potential there is for the user fee concept. The Member for Rocky Mountain House shakes his head no, but it's there. It's been pointed out time and time again. The other aspect, Mr. Speaker, is the question of the vouchers. Now, again the member states flatly that there is no possibility of a voucher. It may not refer specifically to the term voucher, but it does make reference to the ability for individuals to receive payment to utilize health care services out there in the community.

If that's not a voucher system, I'm not sure exactly what you'd call it. That whole concept of vouchers, that whole concept of user fees leads to that final point of mine, and that is the taxation. Clearly in the Bill there is the ongoing authority to requisition. There's the authority to impose those user fees. No matter how you look at it, Mr. Speaker, when we talk in terms of taking dollars out of the pockets of Albertans, to me that's an increase in taxation. It's a form of taxation.

Government members can say "No new taxes" all they want, but when we have Bills like this Bill in front of us, it does give us the message that in fact there are new taxes. Mr. Speaker, on that note I'm going to conclude. I would very dearly love to be able to sit here and say that I'm going to support the Bill, but I can't. There are simply too many shortcomings. MR. SPEAKER: Thank you. The hon. Member for Edmonton-Whitemud. DR. PERCY: Thank you, Mr. Speaker. I wish to add my comments at third reading of Bill 20. There are four points I want to make in my comments, and I shall be brief. The first point.

This Bill is very much – and I'll use the glass of water: you can say it's either half full or half empty. On the issue of regionalization, as my hon. colleague from Edmonton-Rutherford has said, this regionalization makes a lot of sense in terms of trying to integrate health care delivery services and reduce costs. It certainly was a good idea that the Liberals had pushed in '89 without much success, I might add, and subsequently. The issue of regionalization certainly played a major role in the Conserva- tive leadership race as well with the member that was really pushing it, the hon.

Nancy Betkowski, not being particularly successful. She's no longer in the House. So the first point: I agree wholeheartedly with the move towards regionalization. The second point is, though, that I have concerns regarding the structure of the boards. I had hoped that the amendments, the large number of amendments that the government had brought through would have dealt with some of these issues. Here there is the issue of the length of th e transition of these boards. An amendment that we had attempted to bring through to put a two- year span on that was defeated, and I think that's regrettable.

A second point is that I think again in terms of ensuring accountability, elected hospital boards make a lot of sense. I really do regret that there are the provisions in there for appoint- ment as well as election. I would much preferred to have seen elections on the Bill. That is of concern to me.

May 31, 1994 Alberta Hansard 2361 A third point tied in to this issue of appointment is in fact that there is no mechanism in here for ensuring how appointments are made to the board – and this issue has been brought up before – and no commitment to use the screening process for significant appointments, et cetera. I can readily understand how in the transition there is a need to ensure that there are knowledgeable individuals in place as we go thr ough the consolidation phase.

Again, in the absence of the commitment to ensure an arm's- length process where merit not political stripe determines who sits on these boards, it really does cause me concern. A fourth point is the incremental move that is contained in this Bill towards user fees. This is an issue that in fact should be debated in the House in some detail: how we address the issue of universality versus equity, how we define access, whether or not we do want to move to a two tier. That increasingly seems to be the thrust of government moves, the emergence of a two-tiered health care system.

These issues ought to be debated on their merits in this House, and I don't believe that they were debated to the extent they ought to have been certainly given the restruc- turing that is proposed by this Bill. With those comments, Mr. Speaker, I will conclude. MR. SPEAKER: The hon. Member for Edmonton-Centre. MR. HENRY: Thank you, Mr. Speaker. I have a few comments that I'd like to make at third reading of Bill 20 as well. When we're talking about regionalization, there's broad support for the notion of regionalization and restructuring and reform of our health care system.

However, I have a concern that what we will end up with if we don't know where we're going is simply a different system that has the same components juggled around rather than a truly reformed system that restructures the way we look at health in our province and the way we look at health care services and the way we deliver them. It is very clear to me that in Bill 20 we run the danger of simply creating another level of bureaucracy, another level of governance within the system.

What I am worried about, particularly in the Edmonton area and particularly in my constitu- ency, is that we'll end up with councils or local boards that will essentially parallel the existin g institutional and public health boards and then we'll have a superregional board on top of that. What we'll end up with is simply the same players in a different configuration with another layer on top of them all, not actually reforming the health care system.

What we need to do, if we're really interested in looking at health care reform and looking at improving the health of Albertans, is broaden the mandate in terms of what we describe as health and look more specifically at some of the environmental factors. As the hon. Member for Edmonton-Highlands-Beverly pointed out in her Standing Order 40 yesterday, there is a very clear connection between children growing up in poverty and incidences of poor health or of poorer than average health in childhood, adult years, and later.

Very specifically, I don't see any move that would address the kinds of situations we have with low-income mothers, parents who aren't able to have adequate nourishment because the income level of support, whether it be through family or government or community agency or whatever, isn't there and we end up with underweight babies who require massive amounts of intervention simply to survive and be able to enter into the life cycle of poverty and despair. 9:50 I know we can't solve the whole world's problems, but I also want to point to the whole notion of health promotion.

I think this regionalization, in terms of reforming how we deliver health care, doesn't address that issue of looking at more preventive health care and looking at earlier interventions that allow us to not only save money in the long run but provide a healthier environ- ment.

I don't expect the Bill to have all those components that will outline that we need neonatal clinics, that we need early intervention nutrition for expectant mothers, but I would expect to see a system that would hopefully be closer to the community, that would be closer and be able to deliver those services and be able to identify what is nece ssary in each community and not simply in each municipality or in each grouping of municipalities.

What we know is that the health care needs of children and of families in Riverbend in Edmonton are very different from those in Boyle Street, which are very different from Riverdale, which are very different from the Oliver area or the Prince Rupert area, and those are very, very different from the promenade in the Grandin area in my constituency as well where we need different kinds of intervention. Sometimes we need more, and frankly, Mr. Speaker, sometimes we need to pull back and have less formal intrusive intervention and have more community support.

What we need is a system that will allow that decision-making at the local level. What are we getting in response to that need? What we're getting is a system where we're going to have a board that's appointed by the government, not elected by the people, not from the communities. We're going to have community councils, which seem in my view to be ill defined and seem to be more advisory in nature to the regional board.

The danger here – and we all know that there are major players in any system, whether that be the health care system or any other major established system that have territories and have turf that they want to protect. Unfortunately, what we see in the regionalization is that those very people and those very institutions and those systems in place are now working very, very hard to guarantee their place in the new order rather than looking at a very, very different way of operating, of delivering services.

I'm glad to see that public health and public health concerns are included in the amendments, and I congratulate the minister for having brought forward the various amendments, including the one that includes public health. We often forget in our province that the very basis – and in my experience and prior, frankly, to my life experience public health was a primary care delivery system in our province.

We can't continue to operate exactly like that, but the principles of public health, of early intervention, of prevention, of health promotion, and of dealing with family and community units are still very valid principles that we need to not exclude from the regional system but actually include. I'm glad the minister has done that, but I'm concerned that the whole regional system is not adopting that proactive community develop- ment mode. It wasn't unusual for a public health nurse not too long ago in this province, Mr.

Speaker, to work with a community, to help a community provide the kinds of supports that are needed for an elderly person living on their own or for expectant mothers when the fathers have to be away for employment purposes and otherwise. I've seen these kinds of things work. I've seen public health stimulate that kind of thing. I know there are many members here who have sat on public health unit boards, and I'm concerned that some of those principles are not driving what it is in terms of regionalization. I also want to address the issue of user fees.

I'm concerned that in our society in public health in our province we have accepted a certain amount of user fees, if I can put them that way,

2362 Alberta Hansard May 31, 1994 or fees for services or goods based on the ability to pay. That's not what is at argument here. What is difficult here, Mr. Speaker, is that we have a Bill without regulations. We have a lot left up to the minister later on down the road when she feels like it and when they get around to it making various regulations that will govern the extent of those user fees.

If we're talking simply about some of the user fees that are in effect for auxiliary home su pport services on an ab ility-to-pay basis and if we're simply transferring that ability to the region, then I'm not sure we have a problem. But if we're talking about essentially moving towards a two-tiered system where there will be user fees that aren't based on ability to pay and there will be user fees that violate what I believe the principles of the Canada Health Act to be, then I'm going to have a problem with that. The difficulty in the Bill is that it is not defined as one or the other.

I want to also acknowledge and give credit to the minister for having more clearly defined the use of the municipal requisition- ing power that the regional authorities will have to include only certain capital projects similar to what's in the Hospitals Act today, and I thank her for making that clear. I regret that she hasn't done that with the user fee section. I want to make a couple of brief comments a bout the regions.

Frankly I look and I think, well, perhaps we've seen the govern- ment develop regions on the basis of training areas or on the basis of existing medical training areas, if I can call them that, or medical usage areas and not by political or not by convenience principles.

I look at the city of Edmonton and I look at region 10, I believe, and I wonder why the minister has i gnored the recommendation from her own report, her own task force in the Edmonton region that indicated that there should be a region that would include all of the suburbs so that Sherwood Park would be connected with the same region as the Grey Nuns hospital, which is a large usage, as well as Leduc and other places. She's chosen to include St. Albert, and I'm not sure I understand why part of that recommendation was accepted and part of the recommenda- tion wasn't accepted.

If there's a rationale for having the entire city's municipal corporate boundaries in one region and all the suburbs connected to their rural areas, then let's be consistent about that. If you want to use an actual usage basis, most of those communities that are surrounding Edmonton, their primary usage of health care is in the city of Edmonton, and perhaps that should be in one region. We have a bit of a hodgepodge, and frankly I'm not sure what she's trying to do here. I look at regions 6 and 7 and recognize that the Member for Lacombe-Stettler's constituency is in two regions.

I'm sure she's raised this with the minister. It makes some sense to me as a former resident of Lacombe that Lacombe would be in the same region as Red Deer, because of course a lot of the services provided by the Red Deer regional hospital and the health unit board are used by Lacombe residents. Also the case can be made for Ponoka in the same way and certainly Eckville and Bentley and surrounding communities. I go further northeast and I can't figure out why Bashaw is put into that region.

In my experience – granted my experience is five to 10 years out of date now – in that community the major trading areas especially for medical services are Camrose and Stettler, yet it's in a different region than Camrose or Stettler. [interjection] Well, my experience is that most people and especially senior citizens who live in Bashaw have physicians in Stettler and Camrose, and when they enter a hospital not many enter into the region that they are now going to be a part of.

I question that as well as some family and community support services that are delivered through the Bashaw-Camrose connec- tion not through the Lacombe connection. I question those boundaries. I also question why Grande Cache is in the northeast and not in the Y ellowhead – if I can use those vernacular – in region 12 and region 8. So I just question the whole development of those regions and why we got to that point. As well, Cereal and Oyen seems a pretty convenient boundary, and I'll acknowledge not knowing that part of the province as well.

I simply have a question in my mind about that. 10:00 It's my understanding that some parts of the province will be allowed to elect their regional boards, and as a representative, if that is the case – I understand it to be the case, and the city of Edmonton has been told that their board will be appointed – I want to express on behalf of my constituents and the citizens of Edmonton profound disappointment and shock that the government would have two levels or two ways of treating Albertans.

It seems to me that if the citizens can be trusted to elect their regional board in one part of the province, surely that can be the case in the other part of the province. I look at some of the health care and other service deliveries in the city of Edmonton, and I look particularly at the Edmonton board of health historically and today. I look at hospital district 24, in the Edmonton region. These are elected or appointed by elected bodies, and these are very, very effective and efficient service delivery mechanisms. I look at the school boards in Edmonton, and I think we can be proud of them.

Nobody, certainly, is perfect, and nobody has all the answers, but certainly we have elected bodies – we have our city council – who have provided good services, and why that can't happen on the regional basis for health care when it is being allowed to happen in other parts of the province, to me, is a two-tiered way of dealing with Albertans. I have to raise the question: are Edmontonians being punished for not voting appropriately in the last election? AN HON. MEMBER: They did vote appropriately. MR. HENRY: In my view, they did vote appropriately – and we won't get into that.

But that's what I'm hearing from my constituents: "Why can't we be electing our own regional board, and why can't we have our say? We can do that in conjunction with municipal elections and others." There are some very prominent Edmontonians who have a strong history of public service in our community and a strong history of community health and a strong level of respect in our community who I will be seeking out to apply to be on the regional board, but they should be able to go to their peers in the community and ask for acceptance that way, the way every member of this House has done.

If any member of this House is prepared to say that electing the regional health boards will not give you good quality, then they question their very presence in this House and their very participation in the democratic process. Edmontonians must be allowed to elect their own regional health board. In conclusion, I want to say th at I am afraid this government has missed a golden opportunity in health care reform in our province. We have an opportunity to lead the world in our province. I want to point to one where I hope that we do lead the world.

I think the minister is on the right direction in terms of mental health and her recent a nnouncements, which I know is outside the regional boards, but where mental health will be

May 31, 1994 Alberta Hansard 2363 community based and community delivered. Having a long background of volunteering in that field, I want to express a hope on behalf of people in the community working in mental health that what we do is make sure we have all the resources available, not just government resources but community resources and people and communities ready to have people eventually moving out of institutions into community care.

But we have to make sure that we simply don't dump people into the inner city – whether that be the inner city in Red Deer or in Edmonton – and leave them to fend for themselves, because whether we like it or not, some people need a minimal amount, sometimes, of ongoing support in our community. I believe that the minister shares my view that we will always need to have institutions for a certain level of care in terms of mental health.

I want to simply close by saying that this government keeps telling us that they're a new government, and I hope in that way they are a new government, because for the last 10 to 15 years in my experience in this province we've heard a lot of lip service paid to community mental health care, and what we've had is simply more dumping out of the institutions and minimal commu- nity consultation in getting – and I notice the Minister of Munici- pal Affairs agreeing with every word I say. This has to be a first in the history of the minister and myself, but I did want to record that.

I know he will ensure that people who need ongoing support in the community are not simply dumped out of institutions and that we will end up with a better system. In closing with the regional health system, I wish we had done better here. I wish we had real health care reform. What we're going to have is restructuring, and with budget cutbacks we're going to have less of exactly the same juggled ar ound in a different way. Thank you, Mr. Speaker. MR. SPEAKER: The hon. Member for Edmonton-Roper. MR. CHADI: Thank you, Mr. Speaker. I'm going to make it very brief. I'm going to speak on third reading of Bill 20.

I think it's very important that every single member voice their concerns or their support, if that may be, on the third reading of these Bills, particularly the most contentious Bills that are before this House, like 19 and 20 and perhaps a couple of other ones. Mr.

Speaker, I can recall the Premier saying not long ago in the House when we were introducing all these Bills, particularly in the last three weeks to a month: we will introduce these Bills, and we'll make better Bills out of them because these are the Bills are before us today and let's see what we can do with them; let's work on them and introduce amendments and bring these amend- ments forward, not only from the government side but the opposition side, and let's make the best possible Bill. Well, that's noble and quite honourable, those words, but sometimes we find that it doesn't always happen that way.

When the Bill that's before us now, Bill 20, came to the forefront – and I know we've heard this time and time again in the House – the Bill was 19 pages. When we looked at only the government amendments, there were 27 or 28 pages. I can't recall exactly, but something to that effect. In no time at all, that amount of amendments came forward to strengthen the Bill. Well, in all this haste, could it be that we're moving just a little quickly here? I mean, 27 pages. My God.

If we are going to introduce 27 pages of amendments and plow these things through to a 19-page Bill, then I would think we are doing something that may be wrong here. Perhaps if we waited another couple of weeks, there may be not 27 pages of amendments but 10 or 15 pages of amendments, Mr. Speaker. I'm wondering if we aren't moving too quickly on this, and I would like to see . . . There are things in this Bill that I support, and I think every member in this Assembly supports. There are some things that I think need tightening up. Point of Order Questioning a Member MR. DA Y: Point of order. MR.

SPEAKER: Is the hon. Government House Leader rising on a point of order? MR. DA Y: I was wondering if the member opposite would entertain a brief question that would just require a yes or no answer? MR. CHADI: Well, I don't see any reason why not. Go ahead. Debate Continued MR. DA Y: In relation to the amount of debate time on this particular Bill, I wonder if the member is aware that we have already had over 66 speakers and close to 14 hours of debate. That's not counting all the months of consultation leading up to this. I was just wondering if he's aware of that. MR. SPEAKER: The hon.

Member for Edmonton-Roper. MR. CHADI: Thank you, Mr. Speaker. The truth of the matter is that there may have been a fair amount of speakers, but I think those speakers are predominantly from this side of the House, the Liberals who have been trying to get a point across. Now, no matter how many hours we get up and speak, we are doing it on behalf of our constituents and on behalf of Albertans.

It is because of the very fact that the members on this side of the House got up and said that this Bill is fundamentally flawed that brought this government, and particularly the Government House Leader, to come forward with 27 pages of amendments. [interjec- tions] Well, whoever brought them. The fact of the matter is that we are trying collectively to put together a good Bill for Albertans because that is our collective goal here.

So following on what the Premier said – and I firmly believe that we should follow those wise words, those words that said: let's make the best Bill possible – we perhaps have moved a bit hastily here. And I want to say for the record, Mr. Speaker, that I think that everyone on this side of the House, including myself, would feel that medical care in the province of Alberta must be provided to every citizen equally regardless of their financial status whether they are living in Calgary or in High Level or in Assumption. For those who live in Beiseker, I'm sure they are entitled to the same health care.

Equity in health care must be a major, major concern for all of us, for all members of this Legislature. That is the fundamental reason I stand up here today and speak to Bill 20, because I think there must be that equity in the health care system. 10:10 Mr. Speaker, in Bill 20 there are some loopholes. There are some holes that I think we should have considered maybe tightening up somewhat, and when I speak about the haste, that's what I'm talking about.

Why is it that we have to move so quickly that we can't clean up some of the areas that are of concern to members on this side of the House and in particular to the Albertans that have elected us all here? I'm not speaking just

2364 Alberta Hansard May 31, 1994 on behalf of myself or my constituents, because there were petitions tabled not only from this side of the House and from my constituents but from all over the province. There were people that have come forward from within the Calgary and the southern Alberta area with massive amounts of signatures on petitions because they're afraid. They're concerned. Why are they concerned? They're concerned about some of the things in this Bill. There are some holes in Bill 20 that they feel threatened by. So what do they do? They come out, and they start speaking.

The way they speak is by signing a petition and bringing it forth. That is their voice. They're coming forward by way of these petitions. I know many members, members on the opposite side, government members brought forward petitions, many of them. Thousands and thousands and thousands of signatures have come forward in support of the Calgary Children's hospital. We've seen it time and time and time again in this Assembly. Y et what are we doing about it, Mr. Speaker? Do we care? Are we listening? Well, perhaps we're not, because we're not satisfying those concerns that are out there.

If we were, we obviously wouldn't be getting all these petitions day in and day out, day in and day out in this Assembly. We saw it with the Grey Nuns , Mr. Speaker, the Grey Nuns hospital in southeast Edmonton: massive amounts of signatures on petitions that kept coming forward into this Legislative Assembly. Why? Because those people are concerned. They're concerned. The Sturgeon general hospital is no exception. We've seen all of those come forward. They have come through time and time again, day in and day out.

So if those petitions are coming in, goodness, we've got to realize that perhaps there is a flaw in the Bill. Maybe there is something we could do to tighten it up to alleviate some of the concerns that are out there. So, Mr. Speaker, the part that concerns me when I talk about equity in health care, is in particular the area that allows for user fees in the Bill. I know that user fees are happening today in certain areas. I mean, we're being charged in certain areas of our health care system. But there are no limitations in this Bill; it's left to regulation.

That's not good enough for me or my constitu- ents, I would imagine. We've got to be able to tighten it up. I would have thought that a couple of words in

section 20(

k) would have done the trick. We would have said that there were certain limitations, that it all would allow user fees, and that's where it would end, that if we ever did get into the arena of user fees, it could be done by amendment to this Bill down the road. What has happened now is that it's left wide open. There are no limits whatsoever. That is a concern to me. It's a concern to me because I feel that down the road we're going to be faced with a backlash from our electorate. That's something that I think would go against what the Premier was saying: make the best Bill possible.

The consideration of taxation without representation was another area of some concern to me, Mr. Speaker. Once we voiced our concerns,

section 13(

a) was of course changed. It was changed because we said that this needed to be tightened up, that this was not right. It was changed to allow certain municipalities to make payments to the regional health authority for capital purposes only. That is, as far as I'm concerned, acceptable. It went on to say that they could "borrow money by temporary borrowings or debentures, without recourse to the proprietary electors or obtaining approval from them." Well, again, I'm a little bit concerned with that, but at the same time we may have had it before.

Even if we did have it before, it doesn't mean that we have to leave it the way it is: "Well, we had it before. We don't have to change it." Well, if we're changing the entire system, then change it so that it makes it better for everyone.

Section 13(c): "Accept requisitions on it for money required by the regional health authority and assess and levy taxes within the municipality." This area has no limits whatsoever, Mr. Speaker. Even Bill 19, the School Amendment Act, has a similar type of capability to requisition the municipality, but there's a limit on there, and that limit is 3 percent. Now, what's good for one sector of our society or one department of our government ought to be good for the other department.

Now, what's wrong with implementing something like that in there so that we don't run into difficulty down the road, wh ere we can say that we could accept requisitions on money required but to a maximum, to certain amounts like 3 percent, an equivalent amount to what is in the School Act? So that's a concern of mine that I think could have been addressed in this Bill and wasn't addressed. Again, could it be haste that makes waste? Mr. Speaker, the Bill is region driven insomuch as there are regions within the Regional Health Authorities Act that are going to be richer, obviously, than others.

A case in point would be, say, the area where we have health region 10, perhaps 12, region 4 versus 17, certainly 15, where there's Slave Lake, High Prairie, Wabasca and that entire area, particularly the northern areas. Now, those areas are going to be able to requisition funds from their municipalities and impose user fees in those areas which I think other areas may not have to. I would suspect that if we are going to have fairness and equity in our health care system, we may want to consider tightening that up somehow.

Quite clearly, an area that has a much heavier or broader tax base is going to be in an easier position to provide health care than, for example, Fort Vermilion, High Level, or Assumption. With those comments, Mr. Speaker, I would regretfully suggest to you that I will not support Bill 20. There are things in the Bill that I like, and I would think that we could have made this Bill better. I would look forward to making it better down the road, but for the time being I will not support it as it is written. Thank you. 10:20 MR. SPEAKER: Is the hon.

Member for Rocky Mountain House rising to conclude debate on this matter? MR. LUND: That's right, Mr. Speaker. Thank you. It certainly is a great pleasure to finally be able to rise and close the debate on Bill 20 after all the debate. I want to thank hon. members for their participation tonight. Regrettably I must say, though, that it's almost all things that we've heard before. I do want to start by really congratulating the hon. Member for Lac La Biche-St.

Paul for his comments, because quite clearly it was refreshing to see what happens when you get out from underneath whatever is so oppressing over to my left here. The hon. member certainly did come out with some good, really constructive comments, and we w ill certainly be taking those forward, as I remember what he said. While Edmonton-Roper did bring up one thing new – and certainly that issue will be covered under the regulations dealing with the amount of money – I must regretfully say that Edmonton- Rutherford for some reason is really coming off the wall tonight.

It was regrettable that he was so far off target in his comments. I kept track, and anything new that was said, I got here, but I discovered that Edmonton-Whitemud and Edmonton-Centre had nothing new to say. It had all been said before.

May 31, 1994 Alberta Hansard 2365 Mr. Speaker, it is quite interesting how some of these things that I thought we had put to bed kept on coming up, like user fees, like vouchers, like requisitions. Well, as I was sitting here thinking of an analogy to what's going on, I couldn't help but think that maybe it was something like sacking cats. I'm sure that a number of our rural members know exactly what that's all about. If you've got half a dozen six-month old cats and you're trying to get them in the sack and you're alone, you know what it's like. Well, that's what it was like trying to take this Bill through.

Y ou think that you've got one thing put to bed, and lo and behold out it comes again. So that is the kind of feeling that I had. They're hanging their hats, Mr. Speaker, on the idea of a voucher system. They're hanging their hats on 19(1)(i). Clearly that is something that is currently going on today. Then 20(

k) is the one where they're hanging their hats on the user fee. Clearly that's not what that's about. The hon. Member for Edmonton- McClung said that there was no need for the minister to report to the Legislature. Well, I would urge him to look at

section 12(3), because clearly there is. He forgot to mention the $1 10 million that we're putting into home care over the next three years that deals with that issue. I was at a total loss when the Member for Clover Bar-Fort Saskatchewan was talking about 15 regions. She had a problem with 15 of them, but two of them seemed to be okay. Someday I would like her to tell me which of the two are okay. I don't know whether she hasn't looked, but I don't know where the 15 come from. She talked about a problem in 15. Mr. Speaker, I could go on and on through this. The issue about boards being elected or appointed.

As I have said many times, this is enabling legislation. It enables certain things to happen. Nowhere in this Bill will you find that boards cannot be elected. That's not in the cards, and I don't know where Edmonton-Centre got that the Edmonton board is going to be appointed, because that decision has not been made. Y es, all of the boards are appointed to start with, but beyond that clearly, unless we follow the advice of the city of Edmonton council, there is a possibility that they will be elected. The city council is of course wanting to see the members appointed. Mr.

Speaker, in view of the hour and since there's really nothing new in what was said and I've answered them all before if they want to just take a look at Hansard, I would urge them to use some of that $2 million in res earch to have their researchers go through Hansard and dig out the answers to their questions. If that doesn't do it, just give me a few dollars and I'll produce a video for you that will answer all your questions. With that, Mr.

Speaker, I would move third reading of Bill 20 and urge that the question be called. [Motion carried; Bill 20 read a third time] Bill 22 Maintenance Enforcement Amendment Act, 1994 MR. SPEAKER: The hon. Member for Calgary-East. MR. AMERY: Thank you, Mr. Speaker. It's really exciting to see this Bill in third reading and to know that the provisions of this Bill are so close to being implemented. Bill 22 will provide Alberta with the broadest range of enforc