April 26, 2005 SOCIAL SERVICES COMMITTEE

Pursuant to Standing Order 68, Mr. Wallace Young, MHA for St.

Barbe replaces Ms Kathy Goudie, MHA for Humber Valley.

The House met at 9:00 a.m. in the House of Assembly.

CHAIR (Wiseman): Good morning ladies and gentlemen. This morning we are

in the Budget Estimates Committee. The Social Services Committee will be doing

the Estimates of the Department of Health and Community Services.

Before we start today's Estimates, members of the committee, you have

copies of the minutes of the meeting of April 20 when the committee reviewed the

Estimates of the Department of Municipal and Provincial Affairs. Could I have a

motion to accept them as circulated?

Approved by Mr. French, seconded by Mr. Parsons.

All those in favour, aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

On motion, minutes adopted as circulated.

CHAIR: Thank you.

Now, as I said, this morning we are doing the Estimates of the Department of

Health and Community Services. Welcome minister to you and your staff. To help

us get started, maybe I will ask the members of the committee, for the benefit

of your staff, to introduce themselves, starting with Mr. Butler.

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

MR. PARSONS: Kelvin Parsons, MHA for Burgeo & LaPoile District.

MR. REID: Gerry Reid, Twillingate & Fogo.

MR. JACKMAN: Clyde Jackman, Burin-Placentia West.

MR. FRENCH: Terry French, Conception Bay South and Holyrood.

MR. YOUNG: Wally Young, St. Barbe.

CHAIR: Minister, if you would not mind, if you would introduce your staff

to the members of the committee. Then, when you are through that, if you want to

make some opening comments before we start the discussion the floor is yours.

MR. SULLIVAN: Thank you, Mr. Chair.

To my left is the Deputy Minister, John Abbott; to my right - was up until

Friday - the Assistant Deputy Minister of Financial Support Services, Donna

Brewer; behind, to my right, Jim Strong, Director of Financial Services;

immediately behind me is Moira Hennessey, Assistant Deputy Minister of Board

Services; and to my left behind is Carolyn Chaplin, Director of Communications

with the department.

CHAIR: Thank you.

Did you have some opening comments that you wanted to make?

MR. SULLIVAN: I just have a few brief - on the thrust of where we are

this year with health. This year we budgeted, I guess, a record $1.776 billion

in health care; a $113 million increase over last year. Some initiatives have

come down in the past year, in particular.

The First Ministers' Meeting; over the next six years we will receive $284

million extra in health care. That is an average of a little over $47 million a

year. We have looked at a plan - just now committed to over $52 million a year

over that period. That is $5 million above and beyond for specific initiatives

talked about at the First Ministers' Meeting. Also, we have added on top of

that, really, above the five year average, about another $60 million into health

care this year. We have made significant investments in health care, in mental

health and wellness strategies. We made our single, biggest investment in the

public health initiative, into the promotion of that aspect, in our Province's

history. We are looking at aspects of - a prevention and promotion aspect is

very important. It is probably the most cost efficient in the long term.

We are expanding community mental health services. We have increased the

funding in that area. We have looked at enhancement for gambling and OxyContin

addiction treatment. We have taken initiatives to put extra money in there, in

those endeavours. In personal care homes, for example, $4 million to assist with

putting sprinkler systems in. They are really fire and life safety measures;

significant numbers, especially to reduce waiting times. This year we are

putting $23.2 million to reduce waiting times. There are five initiatives

identified at the First Ministers' Meeting to reduce waiting times. These five

areas are in, basically: cancer, joint replacements, efforts in diagnostic

imaging, sight restoration, and one other, cardiac surgery. These procedures

alone will result in 43,344 more procedures this year to reduce waiting times in

line with the FMM meeting. We went beyond our allocated amount that would be

directed in these specific areas.

We have looked at medical transportation arrangements in Labrador, to put it

on a level playing field in Western Labrador, $40 they would pay and the rest

would be covered. Labrador West did not have that option. We have changed that.

We have also put a program in place where the first $500 now is paid and 50 per

cent thereafter, instead of paying the first $500 and 50 per cent thereafter.

So, that is another $567,000 in these initiatives, in residents there. We looked

at adding twenty-five new drugs to the program this year. We have increased -

over a 10 per cent increase from last year - in our drug program.

We have looked at long-term care investments in three specific areas, between

Corner Brook, Clarenville and Happy Valley-Goose Bay. Investments into

technology and so on, especially in PACS - that is the Picture Archiving

Communication System - to allow people, especially in more remote areas, and

especially western and Labrador areas, to be able to come on stream with new

technologies in transmission of diagnostic imaging. So that has been

significant.

The pharmacy network, along with moving in that direction, to put extra money

there. We have a twenty-four hour seven-day line that is open; a help line,

basically. It is a toll-free system that will come on stream, in line with New

Brunswick, and Nova Scotia is pursuing that endeavour. I guess P.E.I. is not

establishing one on site but they are looking at buying into that system, too.

Also, we provided significant money this year to assist the boards in

balancing their budgets. We put $20 million extra in there this year, over and

above, and another $11 million to cover inflationary costs. Also, to assist them

in balancing their budgets in this year, particularly during a transition year.

So, there are significant investments made into health care, not only acute but

in other aspects of health care this year.

So, with that, Mr. Chair, I will conclude my opening comments.

CHAIR: Thank you very much.

Just a couple of housekeeping things. I would ask each person, as they are

about to speak, if they would identify themselves to help the people operating

the microphones to be able to turn them on.

The other thing, minister, in terms of facilitating the discussion, rather

than deal with each head at a time we will just call the first head. Then we

will deal with all of the subheads and vote on one motion at the end, as we have

done in the past. I will ask the Clerk if she would call the first head.

CLERK (Murphy): 1.1.01.

CHAIR: Shall 1.1.01 carry?

Gentlemen? Whenever you are ready, sir.

MR. REID: Minister, I am going to take you through some of the headings.

We will start with 1.1.01 and 1.2.01. Did you hire additional staff in the

minister's office? There is apparently a $50,000 salary increase.

MR. SULLIVAN: Which one is that you said, 1.1.01?

MR. REID: I think it is 1.1.01, Minister's Office.

MR. SULLIVAN: Okay. That is because there was failure to include the

Parliamentary Secretary. That was not included initially in the Budget, which is

included now.

MR. REID: Who is that?

MR. SULLIVAN: Who is the Parliamentary Secretary? The Chair of the

Committee.

MR. REID: You said the second.

MR. SULLIVAN: The secretary was normally under the House of Assembly -

MR. REID: I thought you said second.

MR. SULLIVAN: - and it should have been under the department. When

parliamentary secretaries are appointed, their allocation comes from the

department rather than from the Legislature, and that change had to be made.

MR. REID: That is not a bad salary.

MR. SULLIVAN: Pardon?

MR. REID: That is not a bad salary. What is that, salaries and benefits,

is it?

MR. SULLIVAN: No, it would not have been entirely on that basis. Salaries

are done on the same scale as they are done for - a PS03, they would become a

PS04 when they are a parliamentary secretary, I am understanding, as opposed to

a PS03. Wherever their experience on that line is, that is where it would be.

The actual salary for that position, for that individual, is $34,000.

MR. REID: So, it is the secretary to the Parliamentary Secretary, is that

what you are saying?

MR. SULLIVAN: That is correct. The Parliamentary Secretary, which is a

Member of the Legislature - the secretary to the Parliamentary Secretary, if he

wasn't a parliamentary secretary he would be just a regular Member of the

House of Assembly and you would have your constituency assistant. When you move

to a department as a parliamentary secretary, that is taken from the House of

Assembly budget and it is put into the department budget. That was not done

initially, so that had to be allowed for that. That was $34,000 for that item.

MR. REID: So, what you are saying is that right now we are taking the

Parliamentary Secretary's secretary position from upstairs here, putting him

over with you and we are moving the money from the House of Assembly and into

the department, is that right?

MR. SULLIVAN: No. The reason I am saying last year, your estimate on last

year - in the 2004-05 fiscal year ended, when the budget was brought down there

wasn't provision in the budget to allow for the secretary to the Parliamentary

Secretary to be included. That allocation was in the House of Assembly. So when

a parliamentary secretary - it should have been included in the departmental,

not in the House of Assembly. That has been the procedure, I am aware of, since

I came here.

MR. REID: So, right now, the member from Clarenville -

MR. SULLIVAN: Trinity North.

MR. REID: - his assistant is not being paid by the House of Assembly. Is

that what you are saying?

MR. SULLIVAN: That is the same. The same as -

MR. REID: Or does he have two?

MR. SULLIVAN: No, all ministers and parliamentary secretaries are paid

out of the department rather than out of the Legislature. Traditionally, there

are forty-eight members who are entitled to a constituency assistant, or

whatever name you want to call it. If you are appointed to Cabinet, that

allocation - for instance, when you were minister your constituency assistant or

secretary, whatever you want to call it, was paid from your department, not from

the House of Assembly. That is the same in parliamentary secretaries and that. I

think the House Leader would be probably very much aware of that, in that

instance. That is how it has always been done. It was not included in the

budget. It is the same amount of money, but it should have been budgeted in the

department as opposed to under the Legislature.

MR. PARSONS: I also understand, albeit there were parliamentary

secretaries in the previous Administration, there were no secretaries to the

parliamentary secretaries. For example, as a member of Cabinet I had a

constituency assistant as an MHA. It was a departmental secretary, but the

parliamentary secretaries appointed in the former Administration did not have

secretaries in addition to their constituency assistants. So what you are

telling me now is that parliamentary secretaries have both, a constituency

assistant and a secretary?

MR. SULLIVAN: No, it is called the same - the same person. I said

whatever you want to call it. It is still the same person.

MR. PARSONS: Just one person, but they are being paid for by the

department now rather than the House of Assembly?

MR. SULLIVAN: Yes.

MR. PARSONS: Okay.

CHAIR: However, if you would like to suggest that they should have one, I

would entertain such a motion.

MR. SULLIVAN: I referred to it as the secretary to the Parliamentary

Secretary. I could have said it is the constituency assistant to the

Parliamentary Secretary. I used them synonymously there in my statement earlier.

MR. REID: So you are telling me that when I was a parliamentary secretary

at one time, my secretary was not being paid by the House of Assembly?

MR. SULLIVAN: That is correct.

MR. REID: I do not think you are right.

MR. SULLIVAN: Well, I have sat on the IEC every year probably since the

early 1990s. That has come up in the IEC. It is recorded in the minutes of the

IEC, except for two years. We have dealt with that. When looking at the IEC

budget, we have indicated that when you have - and one of the reason we had a

lighter burden when there were nineteen or twenty Cabinet ministers and

parliamentary secretaries, we had a much lower budget in the House of Assembly

then and the appropriate amount was shifted. That has been traditional. I have

sat on the IEC on that, and your colleagues there who sat on the IEC would be

aware of that.

MR. REID: Executive Support, an additional $100,000. It might be under

1.2.01.

MR. SULLIVAN: 1.2.01?

MR. REID: Salaries for Executive Support.

MR. SULLIVAN: Yes.

MR. REID: An increase of $100,000, is that right?

MR. SULLIVAN: That is correct.

MR. REID: Who did you hire?

MR. SULLIVAN: Pardon?

MR. REID: Who was hired?

MR. SULLIVAN: Roughly, $150,000 increase. That is primarily to severance

and vacation pay costs for the former deputy minister.

MR. REID: What was the total?

MR. SULLIVAN: The total amount, you can see there - $152,000 is the

difference there on that line item.

MR. REID: One hundred and fifty-two was to severance and vacation?

MR. SULLIVAN: No, I did not indicate that. I said the difference between

the two lines here is $152,000.

Overall, a person is entitled to severance based on the grid of their years

of service and their age. There is a grade that is standard in the public

service, and vacation pay is what someone has built up and they are entitled to.

Severance could be taken as a continuation of salary. Vacation pay or annual

leave, as we call it, you are entitled to take that when you so desire, so that

option is there.

MR. REID: How much did you pay the previous deputy minister when you told

her to go home?

MR. SULLIVAN: We paid what they were entitled to under the grid, based on

age and years of service.

MR. REID: Minister, you know all the numbers. How much?

MR. SULLIVAN: I do not think it is appropriate to talk about somebody's

income. It is based on what they were -

MR. REID: You told me there was a calculation, and how to calculate it.

Why don't you just tell us how much? You are supposed to answer questions on

the budget. That is the reason we are here today.

MR. SULLIVAN: I am answering questions. I am saying they received what

they were entitled to, based on the grid. I am not sure if I want to give

publicly that this person worked so many years, their age and so on, and those

factors. That is the amount. The estimates are about $150,000, roughly $800

there of which is primarily due to severance and vacation pay for the deputy

minister. That is what the person is entitled to on the grid, and what vacation

pay they had accumulated.

MR. REID: Open and accountable government, no doubt.

We are going to force independent plant owners in the Province to open their

books on the table and you will not answer a question about the books you are

responsible for, when we are spending public money.

MR. SULLIVAN: I will give you the total amount on the item, but I do not

want to talk about someone's personal income, what they have received. They

received according to the grid of their entitlements. If anybody wants to check

on the age, and how many years they were in government, they can find that from

the table. The Salary Details has the salaries of these people, in the

Departmental Salary Details that are published, and someone can work at that and

determine them.

MR. REID: That might be all fine and dandy, what the formula says, but

was she given any extra?

MR. SULLIVAN: Pardon?

MR. REID: We can talk about the formula for severance when somebody

leaves. Was she given any extra?

MR. SULLIVAN: I do not want to talk about someone's age and years of

service. I do not think I should do that, because there is only one individual

involved.

MR. REID: You missed the question, though. I said you are talking about a

formula that you calculated her severance on when she left, based on years of

experience and the position that she had, and all of that. Was she given any

money over and above that which was calculated by the formula?

MR. SULLIVAN: None to my knowledge. She received salary continuation. If

you are entitled to forty weeks, fifty weeks, sixty weeks, seventy weeks, you

can draw that in salary and there is a salary continuation for that individual.

MR. REID: I know how all of that works, but the question I asked - I know

what I am entitled to when I retire, in severance and stuff like that. I am

asking, was she given additional money?

MR. SULLIVAN: Not to my knowledge.

MR. REID: Do you have a Director of Finance there behind you anywhere?

MR. SULLIVAN: Yes, I do.

MR. REID: Maybe that individual can tell me.

MR. STRONG : Not to my knowledge, no.

MR. REID: So you are saying she did not. If you, the Director of Finance,

and the minister, if neither one of you are saying to your knowledge, she did

not, I guess. Is that right?

MR. SULLIVAN: That is correct. I said I am not aware of anything other

than the grade, the salary and the vacation pay she was entitled to, annual

leave. I am not aware of any others. My Director of Finance is not aware of any

others.

MR. REID: Under 1.2.03. there is an increase in Professional Services

under the Medical Services heading. I think it is $117,000.

MR. SULLIVAN: Which one is that? Which number?

MR. REID: I think it is 1.2.03.

MR. SULLIVAN: Yes, but which one under that?

MR. REID: Professional Services, under the Medical Services heading.

MR. SULLIVAN: The breakdown for this year, I can tell you what each of

them are for this year, the $445,000.

MR. REID: One hundred and seventeen thousand. That resembles an increase

of $117,000 under Professional Services.

MR. SULLIVAN: Why has it increased?

MR. REID: Yes.

MR. SULLIVAN: Overall, the funding for the Canadian Co-ordinating Office

of Health Technology was $75,000. Newfoundland and Labrador is currently the

board chair. The liaison to the deputy minister is on this conference. There is

also drug utilization research funding of $46,300 on that. There is $75,000 for

the Co-ordinating Office of the Council of Health Technology, and the balance is

drug utilization research funding. The two of them add up to -

MR. REID: Both of those headings you never had last year: the $75,000 and

the $45,000?

MR. SULLIVAN: No.

My understanding is this emanated from the FMM and this is a new co-ordinating

role. I do believe there is some revenue - do we have revenue offsetting any of

that? I do believe. We get offsetting revenue, too, by the Chair, I think, for

operating the office, in my understanding. Even though there is a cost, we get

offsetting revenue.

MR. REID: Under subhead 1.2.04., apparently there is $40,000 less there

this year under cuts to board services, is there?

MR. SULLIVAN: Item number?

MR. REID: I think it is under heading 1.2.04.

MR. SULLIVAN: Supplies?

MR. REID: I think there are cuts to board services. Are there any people

gone as a result of that, or is it just a $40,000 decrease?

MR. SULLIVAN: Which item overall here? You mean in salaries?

MR. REID: Yes.

MR. SULLIVAN: On the salary issue?

There is one-time funding we received for a smallpox activation response

program. That was a one-time funding for that issue in that area. That is why

there is a difference there of $40,600. It was for that position. That was one

time. That is why it would be down in salary.

MR. REID: Under 1.2.05., last year there was $40,000 more spent on

Professional Services under the heading of Community Programs and Wellness.

MR. SULLIVAN: Okay, Professional Services from $27,000 to $64,500?

MR. REID: Yes. What happened there, and what did you do with the money?

MR. SULLIVAN: That was additional funding we got for the Province's

Wellness Strategy under that specific area.

MR. REID: Yes, I know it is there. I asked the question: What did you do

with it?

MR. SULLIVAN: At $37,500.

MR. REID: Yes, what did you do with it?

MR. SULLIVAN: Well, how is it directed? Into the Province's Wellness

Strategy program. That is an ongoing program.

MR. REID: I think it is under 1.2.07., under the heading of Policy and

Planning.

MR. SULLIVAN: Okay, just give me a second to catch up to you there. Under

1.2.07., okay.

MR. REID: There is $50,000 less there, or was.

MR. SULLIVAN: In Salaries?

MR. REID: Yes.

MR. SULLIVAN: Primarily to position vacancies in last year from the past

year in Policy and Planning.

MR. REID: So there is a job gone there, you are saying?

MR. SULLIVAN: There is a vacancy there that was not filled.

MR. REID: So, it is not filled?

MR. SULLIVAN: It has not been budgeted to be filled this year.

MR. REID: At the same time, though, that position was not filled, there

was an increase of $100,000 in Professional Services. Is that to take care of

the job that the person you let go or did not fill that position was doing?

MR. SULLIVAN: No, the $100,000 was for reporting and accountability under

the FMM. That was -

MR. REID: Could you use the -

MR. SULLIVAN: That was miscellaneous -

MR. REID: Minister, the acronyms you are using, I am not familiar with.

Could you tell me -

MR. SULLIVAN: That is the First Ministers' Meeting on health care.

There were certain initiatives at the First Ministers' Meeting on health care.

In light of getting federal funding, there are certain basic things that the

Province agreed to follow to implement that. If you are getting money, there are

certain structures in place for accountability and reporting and expenditures of

these monies. That flowed from the FMM, and that was held in September, 2004.

MR. REID: You spent $100,000, you say, to get ready for that meeting?

MR. SULLIVAN: That is where the $100,000 - as to how it got spent

overall, I will have to refer that to one of my officials; but, yes, the money

got allocated here and spent, or it is budgeted for this year, the amount. It is

not spent this year, yet, but the amount of money is allocated to be spent this

year.

MR. REID: On what?

MS BREWER: One hundred thousand dollars was an allotment provided to that

division. When you read the First Ministers' Meeting, the Ten-Year Plan To

Strengthen Health Care in Canada, there is expectation from the provinces of a

whole bunch of having to measure, like, for example, wait times, having to

report back over a five or six year period. One hundred thousand dollars was

planned money for that division. It has not yet been decided whether or not they

will hire staff to do that in-house, whether they will contract, for example, to

the Newfoundland and Labrador Centre for Health Information, or whether it will

be contractual people from time to time.

Basically, that was a plan to allow them to begin planning as to how the

Province was going to meet its reporting and accountability requirements that

were within the funding.

MR. REID: So there is $100,000 there in Professional Services and what

you just said is that you do not know if that is going to be done in-house by

hiring extra employees or contracting it out. Is that right?

MS BREWER: Or using this Newfoundland and Labrador Centre for Health

Information, which is an agency that reports to the ministry.

MR. REID: Down in 3.1.01., what type of supplies are purchased? I guess

it is under Purchased Services or Supplies or something. It looks like there is

an increase of $2.9 million in allocation for the Regional Integrated Health

Authorities and Related Services heading. Do you see that there?

MR. SULLIVAN: What line item under 3.1.01.?

MR. REID: It is under Regional Integrated Health Authorities and Related

Services.

MR. SULLIVAN: Under Supplies?

MR. REID: There was a $2.9 million increase.

MR. SULLIVAN: There was a public health immunization trust fund, in

addition, to add certain costs. There were three particular vaccines for

pneumococcal, meningococcal and varicella, three initiatives that were added,

the costs that were announced. That was a $2.854 million extra cost, in addition

to the current ongoing ones of over $2 million.

MR. REID: Under Grants and Subsidies, there is $60 million to $80 million

allocated.

MR. SULLIVAN: That went from $1,220,000,000 up to $1,283,000,000.

Overall, that is the money we provide out to the Regional Integrated Health

Authorities, which means they are getting $63 million more dollars this year to

operate than they did last year. That is used for a whole variety of all of the

services that are operated under all of the Regional Integrated Health

Authorities. That is a combination of health boards, a combination of community

boards, from the cancer rehabilitation treatment foundation overall.

Just to give some examples of some of the new areas that have gone in there,

the new costs, if you want some of them, some of the big items are: We gave $20

million in one-time stabilization funding. We put $11 million in for an

inflationary factor; that was $31 million. We gave $4 million, personal care

home sprinkler systems; $5 million for the fifty cent wage parity with home

support workers. We put $1 million OxyContin task force; $1 million in mental

health; $2.4 million into wellness; $2.1 million into home care; $8.5 million

into various wait times initiatives, operating; another $1.3 million Self-care

Telecare, I made reference to at the beginning about the phone line system;

medical transportation in Labrador, all these initiatives; all the initiatives

that we have talked about overall for dialysis and a whole host of early

learning in childhood. These initiatives are delivered through Regional

Integrated Health Authorities. There is $60-some million on top of last year for

some of these. They are just some of the major items in the list there.

MR. REID: Under 3.2.01. Property, Furnishings and Equipment.

MR. SULLIVAN: Okay, it is up by -

MR. REID: Twenty million dollars.

MR. SULLIVAN: - $20 million. The total amount this year is being spent on

- there are new initiatives particularly with wait times. Out of that $24.42

million this year, we are putting $2.5 million announced toward an MRI in St.

Johns; $2 million for CT scanners; provincial pharmacy network, $2 million;

nuclear medicine gamma, $3 million; $3.72 million, that is equipment to reduce

wait times for PACS - that is the Picture Archiving Communication System, $4

million there. There is an unallocated block that goes out to boards for

different initiatives in this area of equipment that would be allocated out

there of $7 million, so that adds up to $24.42 million.

MR. REID: When your deputy minister was let go last year you had Ross

Reid, who is the deputy minister to the Premier, fill in for that position for a

period of time. Where did he get his salary at that time, when he moved into the

department of health, or was he getting paid twice?

MR. SULLIVAN: It is my understanding that he was getting paid once, the

same as I get paid once for two portfolios at the moment. That is customary

within government. You do not pay someone twice for extra responsibilities. It

was not paid out of Department of Health, to my knowledge, it was continued to

be paid from the area under the headings where it was budgeted for. If any of my

officials have anything further they want to add on whether it is paid out of

health - to my knowledge it was not paid out of health. They continued his

salary where it is to. I have been informed that is correct.

MR. REID: Minister, there is a brand new twenty-bed facility on Fogo

Island. It was built for ten acute care and ten chronic care patients. In fact,

I think in the contract that was signed with government for purchase of

equipment, there were actually twenty new beds delivered to that facility and

set up in the twenty rooms, and that under the cloak of darkness one night, just

prior to the opening of the facility, there was a van or a truck arrived on the

Island, under the cloak of darkness, from the health board in Central East and

took ten of these twenty beds and slunk out the next morning on the first ferry.

Right now we only have ten beds open in that facility. I am hearing horror

stories, and if you do not want to believe me you can check with the people of

Fogo Island.

I had one incident earlier this winter where a female senior citizen went to

the hospital, thought she was having a stroke, and was sent home because they

did not have room in the building for her. She later turned up at the hospital

that night and was airlifted to Gander where she died.

This week I have been dealing with the children of an eighty-two year old

woman who is terminally ill, and because she has lived a short period of time

longer than they first anticipated in the hospital - and I am talking weeks, not

months - she is being told now that they are going to discharge her and send her

home because they need the bed.

Now, in light of the fact that in consultations you had last week with the

Minister Responsible for the Status of Women, and that the position of this

government now is not to do things that negatively impact women, your colleague,

the Minister Responsible for the Status of Women, even went so far yesterday -

or last Wednesday or Thursday - as to saying that they would not be closing the

kitchen in the hospital in Stephenville because the majority of people working

therein are female and she would not negatively impact employment of women in

that facility.

I say to the minister, in your discussions with your colleague, the Minister

Responsible for the Status of Women, don't you think, and she should also

think, that the health of our elderly female portion of the population on Fogo

Island deserves the attention that those in the Stephenville area are receiving

from you and your government and the Minister Responsible for the Status of

Women? Because I think, minister, that it is absolutely ridiculous to be using

the people, especially women on the West Coast, as a pawn in the political game,

when you consider that there are people dying on Fogo Island and you will not

open the ten beds that are needed out there.

I ask the minister: When will you reverse the decision and put the ten beds

back on Fogo Island where they are much in need today?

MR. SULLIVAN: We look at the availability of beds in line with need. If

we wanted to look at and compare the ten beds unopen on Fogo Island, there are

ten beds in a facility built in 1992 down in St. Lawrence that have never opened

to this day. There were 3,200 beds in the Province in 1989. There are 1,500

today. There were in excess of almost 1,700 to 1,800 beds closed during a former

government in office.

One of the movements today is to try to move people out of acute care

institutions and move them home. There is a post follow-up care. In fact, $2.1

million is budgeted this year to deal with people who are released from

hospitals - dealing with acute care who have been released. They are also to

deal with end of life care. Also, some of that would go toward dealing with

mental illness aspects. So, the philosophy, overall, is to look at accommodating

people in acute care but also to try to get them into a home setting and provide

the necessary supports there. That is the trend that things have been moving.

We have half the beds we had in 1989. We have had beds when there were

opportunities to open beds. The same rationale prevails, whether it is in any

part of our Province. We are going to look at the needs of any people, whether

they are male or female, and look at their needs and deal with it appropriately.

We are going to take medical advice and allow medical people to make decisions

on whether someone is discharged or someone is retained. That is not one that,

as a minister, I should be making or staff in my department should be making.

MR. REID: I find your comments hypocritical, minister, when you say that

people are treated everywhere in the Province, when last week, on the spur of

the moment, the minister not even responsible for health stood here and talked

about leaving three units open in Stephenville, including a kitchen, when we

have people who are being sent home, basically, to die in another area of our

Province. When you talk about moving people out of a hospital and trying to get

them home with the proper care, I think you said something similar to that a few

minutes ago, well, I tell the minister that the eighty-two year old women I am

talking about on Fogo Island was told that she was going to be discharged last

week and they did not even have home care provided for that individual when she

was about to be discharged - and to say that people are being treated fairly.

You can talk about the past all you want, and go back to 1989 and everything

else. The problem is, today, that right now health care is not what it should be

on Fogo Island, with a brand new facility with ten empty rooms out there and

elderly people who are being sent home without even having home care available

to them. I think it is criminal.

MR. PARSONS: Minister, could you tell me what it cost your department to

do the Hay report vis- B -vis

Western Newfoundland?

MR. SULLIVAN: The total cost, approximately $380,000 for both. That would

be the Western and Grenfell.

MR. PARSONS: Three hundred and eighty thousand.

MR. SULLIVAN: Roughly $380,000, give or take a little; roughly there,

yes.

MR. PARSONS: Minister, I wonder if you could relate to us the process

that unfolded last week vis- B -vis

the removal of certain Hay report recommendations from the table, were the words

used. I notice it did not come from yourself. It came from the Minister

Responsible for the Status of Women. I wonder if you could enlighten us as to -

I am sort of at a loss here. The report was done under your department. You are

the Acting Minister of Health; yet, the announcement gets made not through your

communications person, not through the government Web site, and not even on the

stationery of the Minister Responsible for the Status of Women. It was done on a

sheet of paper signed by Joan Burke, MHA; not minister, not minister

responsible. I am just wondering about the process. That seemed to be very

unusual as to how it happened. People were as much taken aback by the process as

they were pleasantly surprised by the outcome.

MR. SULLIVAN: I guess we are focused on outcomes more so than processes,

even though you might consider processes important. Overall, it is not uncommon.

I have been around here for some time. I have seen ministers in regions makes

announcements - informally in governments and traditionally. How you want to do

it is entirely a decision of government, who they want to answer to it, anybody

in Cabinet or anybody who is directed, if it has affected their area. I have

seem announcements made by your Administration in regions where the minister did

not make them, the minister in that region made them, so that is not uncommon at

all. A decision was made. A decision was articulated there, and -

MR. PARSONS: It seems to be, Minister, that the decision, however, was

totally couched in the words and justification that it was being done because it

was a women's issue.

MR. SULLIVAN: If the minister made a statement, you will have to take the

statement up with the minister, not with me. Any statement that I made, you can

take it up with me. That is a decision that was made, and it has moved forward

on a decision -

MR. PARSONS: Minister, we did take it up with the Minister of Health in

Question Period, but you are the minister here today and the purpose of your

being here, I would think, is not to defer to other ministers. I asked you a

question: What was your involvement? What are your thoughts on the fact that

this is being done as a women's issue and not as a justifiable health care

issue, public issue?

MR. SULLIVAN: I am not here to give thoughts, to be honest with you. I am

here to give responses, not thoughts. It went through a process. You have been

in government. You know what processes are in place. We will articulate the

results of process. We are not going to get in and discuss details in processes.

That has not happened, and I do not intent to discuss it here, but I will tell

you that a decision was made. A decision was articulated, and who articulates on

behalf of government is a choice of government to do that, the same as anyone

who stands in the House to answer questions. That is a prerogative of

government, who wishes to answer.

MR. PARSONS: I am not talking about the prerogatives of government,

Minister, and I appreciate your responses. I would just like to think that there

is some thought put into your responses, and that is what I am trying to get at.

Whether you want to have thoughts or not, I am just concerned and would like to

see that there is some thought put into your responses. That is why I ask the

question again: Is this done with the full concurrence of the Department of

Health because it is an unsupportable recommendation of the Hay report, or was

this done because it was necessary to do in the interests of women? Now, that is

a pretty straightforward question.

MR. SULLIVAN: There are numerous factors involved in decision making, and

this was a decision by government and articulated by government, answered by a

minister of government here in the House. That was made quite clear, and you can

ask it ten times. A decision got made, it got articulated there, and the result

is out there. I think it is a result that probably the people in the region

should be -

MR. PARSONS: Was it a Cabinet decision, Minister?

MR. SULLIVAN: It is a decision of government, yes. All decisions

articulated there are decisions of government.

MR. PARSONS: Was it a Cabinet decision?

MR. SULLIVAN: I am not going to reveal was goes on in Cabinet.

MR. PARSONS: I am not asking you to reveal what goes on in Cabinet. I

asked you, was this a decision of Cabinet or was this a decision of the Minister

of -

MR. SULLIVAN: I am not going to comment on decisions in Cabinet. I am not

going to speak on any decisions in Cabinet. They will get articulated

appropriately by a minister from Cabinet.

MR. PARSONS: Back for a second, Minister, to the issue of the previous

deputy minister's severance package, for which you refused to answer.

I asked the Deputy Minister of Health, was there a confidentiality agreement

between government and the former Deputy Minister of Health which would prevent

you from making that information public?

MR. ABBOTT: Sir, I can answer that. I have not seen any of the

documentation around that particular matter, but what I have been advised in

terms of the financial aspects is that the severance arrangements were clearly

to be budgeted in our department and, as I understand them, they are based on

current policy within government, but it was certainly before my time so that is

as far as I can go with that.

MR. PARSONS: Well, maybe the minister can inform us.

MR. SULLIVAN: I am not aware of - you mean any confidentiality

agreements?

MR. PARSONS: Was there a confidentiality agreement, to your knowledge,

between government and the former deputy minister regarding the terms and

conditions of her settlement?

MR. SULLIVAN: Not that I am aware of. I am not aware of any

confidentiality. I am aware that the former deputy was paid in line with her

years of service and her age based on a grid, and that grid, anybody could go to

the salary departmental details and look at her salary and see what amount and

what it equates overall.

She was paid based on her earned credits, based on that grid, plus any annual

leave she had entitled to come to her. The severance portion is being paid out.

That area on the grid is being paid out as a salary continuation. It is the

prerogative of the individual to choose when they would like to receive their

annual leave: lump sum, (inaudible) during the course of that salary

continuation, or while technically they are still an employee, they are entitled

to draw down on that when they so desire, the same as anyone can do it on their

annual leave. I am not aware of anything other than that.

MR. PARSONS: Minister, the settlement of the VON matter in Corner Brook

last year, how much did that cost government to resolve that issue?

MR. SULLIVAN: Well, overall, the VON number - was it $20,000 or $50,000

on the VON?

OFFICIAL: (Inaudible).

MR. SULLIVAN: Close to $50,000, I think, was the amount. I am sure we can

find the number there, but it was in the tens of thousands based on - I guess it

equated to the salary increase. It worked out to around fifty cents based on the

number of hours that were provided for the project overall.

MR. PARSONS: You would agree that could be variable numbers, in the tens

of thousands. It might be $150,000 too.

MR. SULLIVAN: No, a specific number would have been recorded there. I

might be able to find that for you during the course of the morning. If I can,

or one of my officials can get that number, we will give you that number.

MR. PARSONS: In the event, Minister, that you do not find it this

morning, I take it you undertake to provide us with that figure?

MR. SULLIVAN: Sure.

MR. PARSONS: Usually, Mr. Chairman, the process is that the undertakings

are recorded as part of the minutes -

CHAIR: They are, yes.

MR. PARSONS: - so they are easier to track that way.

CHAIR: For the benefit of the Clerk recording that, could you repeat the

actual -

MR. PARSONS: How much did it cost government to resolve the VON issue in

Corner Brook?

CHAIR: Thank you.

MR. PARSONS: My second question related to that, Minister, would be:

Where did those funds come from? Where would we look in this budget, or in the

Budget, or in government, to find out where the funds actually came from?

MR. SULLIVAN: Funds are allocated to the Western Regional Community

Health Board. That is where they would be administered through, is my

understanding. If any of my officials want to add to that, those services are

delivered through the community health boards. In this case it would be

delivered through the Western Board, the same as other home support or elsewhere

would channel through other respective community boards in other regions, and

that is where it would be within the budget of those boards.

MR. PARSONS: I understand that the Western Integrated Board or whatever

would be the funnel through which the money flowed. My question relates to, if

this is new money, obviously it was not there; or, if it is old money, I would

just like to know, where was it found? Did you have to give Western the money,

whatever that x figure was? If so, where did it come from, if it was new money?

If it was not new money, where would Western have found it in their budget?

Because we understand that they already run a fairly big deficit.

MR. SULLIVAN: Funds are allocated to the boards. There wasn't new money

channeled for that under the current appropriations, is my understanding. If

Donna wants to add to that she certainly can after. The money that was

appropriated out to those boards at the time, as they were called, was found

within their money that was appropriated and passed in the Legislature. There

was no new expenditure required of funding in terms of any special warrants or

any Supplementary Supply or anything to deal with that issue. That was within

the appropriation that was already approved.

MR. PARSONS: Okay, so -

MR. SULLIVAN: If there is anything -

MS BREWER: There was a one-time budget adjustment that was provided to

Western Health and Community Services. The department, while it allocates the

majority of its funding up front to the boards, there is a small amount of money

that is there on reserve that is used for contingencies for unexpected

initiatives that may come up through the year, so we would have dipped into our

reserves on a one-time basis.

MR. PARSONS: Is that how the money came about? Was it in the Western

Board pot already or, as a result of this VON issue, did government have to dip

into this contingency and give Western the money to resolve it?

MS BREWER: The department dipped into its reserves and provided a

one-time budget adjustment to Western.

MR. PARSONS: Okay, so where in the Budget would one look to find out

where your contingency fund is?

MR. SULLIVAN: I probably can answer, and Donna can add to that.

In the past, a lot of boards never got their budgets until the fall. The year

was half over and they did not even know what they were getting. For example,

traditionally, money flowed in the past at different intervals during the year.

They did not know what their final budget was going to be. What we did this

year, I think on April 1, every board this year got an estimate of what they

were going to get this year. They know what they are going to get in this fiscal

year. There were times when they did not know that until November. I know I

raised an issue here before that a board - it was in November and they did not

know how much they were going to get to operate, and the fiscal year was ending

in a few months' time. This year we put out front the amounts they are getting

and they know what they are dealing with now. They can plan accordingly.

So there was always a holdback by departments, voted for and approved in the

Legislature under the Estimates appropriations, and it could be channeled out.

There could be an epidemic in one particular region that might require extra

funds, whatever the case may be, and you might have to channel extra monies

there. So that was done sort of to, I guess, meet certain occasions as they

arose. That is traditionally, I know, from my experience, what has happened. If

Donna or any of my officials want to add to that, that is my understanding of

how it has worked.

MR. PARSONS: Maybe the lady could go back now and answer my question, now

that we have your explanation: Where would I find it in the Budget?

MR. SULLIVAN: You would find it under the Regional Integrated Health

Authorities, under the line item Grants that go out to all of these agencies. It

would be under 3.1.01.10.

MR. PARSONS: Okay, that $1,283,064,200.

MR. SULLIVAN: Under 3.1.01.10.

MR. PARSONS: Minister, I believe there was a Supplementary Supply request

filed some time before the end of the year, I guess, regarding - there was a

shortage in the doctors' money for payment for doctors, I do believe.

MR. SULLIVAN: That is correct.

I will just give you the generalities. If you want to get into more

specifics, I can gather specifics.

Overall, there was an increase in the last fiscal year. In the previous

fiscal year, when this MOA was signed, there were about thirty-two new doctors

who came on steam, previous. This past year there were seventeen more salaried

physicians came on stream, last year. In addition to seventeen salaried

physicians coming on stream, there was an increased utilization also of over $3

million within the current utilization of doctors there, so there was extra

money spent. That had to be delivered in line with the MOA that was signed in

2002; the end of September, I think, it took effect. We had an obligation to

channel money in line with the agreement to fund those particular areas because

a lot of the vacancies and so on got filled. Therefore, there was a greater

uptake from current and there was an increase in the number of physicians in our

Province and we had to honour our agreement that was signed.

MR. PARSONS: I take it, notwithstanding the existence of the agreement

since when did you say, 2002?

MR. SULLIVAN: Yes, that was the three-year agreement that was signed, if

you remember, with the doctors back in -

MR. PARSONS: Yes.

MR. SULLIVAN: It runs from October 1, 2002 to September 30, 2005.

MR. PARSONS: So, notwithstanding the existence of the agreement, it had

not been budgeted.

MR. SULLIVAN: That is correct.

MR. PARSONS: I am assuming if it was in the agreement you would have

anticipated it and therefore budgeted for it, and not find yourself in a

situation where we did not budget for it, there was an uptake on it, and now we

have to go back and honour the agreement by way of Supplementary Supply.

MR. SULLIVAN: You see, the uptake proceeded the previous year on current,

plus there were seventeen new, so we did not anticipate that. Technically the

overall, I think, would have been $7.5 million, I believe, but there were

certain savings found within the salaried physicians and so on to be able to

offset. I think we had to go to a special warrant on that amount of about $4.5

million because of that, but we found some savings to allow for some of that

overrun within the salaried physicians ones but we could not find sufficient

savings and that is why we had to bring a special warrant to the House. We had

to fulfill the agreement. If we did not bring it when we did, we would not have

been able to advance the money to pay them. I think, if I remember correctly, if

we had not had it done by March 10 we would not have been able to pay the

doctors.

MR. PARSONS: Minister, again pardon me but I have to ask for your

thoughts on this. At the health care meeting held in Western Newfoundland, in

Stephenville, on Thursday night past, there were a number of MHAs in attendance,

myself included. Jack Harris was there. Minister Burke was there. MHA Hodder was

there from Port au Port. The question raised by several people in the audience,

including Debbie Forward, the head of the Newfoundland and Labrador Nurses'

Association, and several people - I believe they were in the health care field

themselves; I got the impression there was a nurse in particular, a lady Jackson

or Jackman - they commented that it was a very positive move of taking these Hay

report recommendations off the table but they also questioned about where the

board was going to go. Doctor Genge was there, by the way, and Susan Gillam, and

the question was - and they, quite frankly, could not answer it, I guess,

because they did not know the answer: This looks like great positive stuff, vis- B -vis

those recommendations, but where do we go, or where is government going to go,

or where can the board go, if this newly constituted board as of April 1 has to

start off with, I believe the figure was a $35 million or $36 million deficit?

The suggestion was made: Look, if we are starting everything from square one,

what is the likelihood of - you have a new board with new directions with a new

government. Why wouldn't you start them off from square one? Because if you

leave them with this $35 million deficit to start with, maybe these good things

that we are seeing like the Hay report being scrapped might not be able to

happen anyway. If they are still told, for example, you have to live within your

budget, and part of your budget includes a $35 million deficit, it seems like

there were not answers there.

I am wondering if you or your officials can enlighten us a bit, because that

seemed to be the lost question that was there. Nobody had any kind of answer to

that.

MR. SULLIVAN: I will give a response to that.

Even when you went back historically, and I will just touch on that before I

move to the present and where we are headed on that issue, every year, back when

there was some board consolidation, the government lifted a good chunk of its

debt - not all of it - and they went forward and they still incurred more debt

on top of that debt. So what we looked at this year, we said: Look, we are going

to allow you - there were overruns last year of about, the bottom line, they

ended up about $18 million overruns, and to use some of the strike savings,

about $10 million, to assist, that we are allowed to retain to help. It would

have been higher expect for that. So we said, starting this year, we have four

Regional Integrated Health Authorities; we will give you a budget on day one,

April 1. We are going to put $20 million more dollars into your budget and we

are going to give you, to allow dealing with getting a balanced budget, we are

going to put $11 million on top for inflationary of $31 million. Here is your

budget on April 1 now. They are not finding out in November when their budget is

and it is too short in the year to budget. They know twelve months in advance.

Here is your budget now. There is $31 million in there, $20 million plus $11

million. Go out and deal and balance your budget. We give you a year of

transition to get in place and balance it.

On the long term there is $125 million accumulated in their accumulated

deficit, you could say, or debt that had been carried on the books now of those

Regional Integrated Health Authorities which (inaudible) the next ten years now,

let's build in to be able to eliminate that debt over a ten year period.

Over a ten year period, if you look at eliminating that debt in a ten year

period, based on the current budget of boards, and that has been going up and

will go up over the next number of years, that would be equivalent, just on

today's budget, it would be less than 1 per cent. They would have to get 99.1

per cent approximately, so less than 1 per cent they would have to find to

balance it, assuming they have no more money based on today's current. So that

is saying: Look, we are enabling you to get it in order this year in transition.

Here is $31 million, $20 million plus the $11 million for inflationary increases

that would probably be there anyway, but at least $20 million directly to assist

in that process. Then, deal with a plan over the next ten years to deal with.

That is where we are. That is what we have indicated, and that is our

expectation.

MR. PARSONS: Just if I might clarify a couple of those points, the

overall board deficits, we will say, in the Province, was one hundred and -

MR. SULLIVAN: The accumulated deficit is about $125 million, the

accumulated deficit over the past number of years.

MR. PARSONS: Okay, so the twenty -

MR. SULLIVAN: Some had balanced theirs and some did not and so on, but

that is the accumulation of all the boards that were outstanding that were

rolled into the four Regional Integrated Health Authorities.

MR. PARSONS: The $31 million that you put in, the $20 million plus that

$11 million for the inflationary piece, that was again towards all of the

boards?

MR. SULLIVAN: That is going into the general pot overall.

MR. PARSONS: Over ten years, by doing that kind of strategy, you are

saying, you ought to be able to keep up with inflation and at the same time

eliminate the $125 million accumulated deficit.

MR. SULLIVAN: Well, this year we put in $113 million net when you factor

out revenues against it, net more gone in this year, so we are saying over the

next ten years they will come back with a plan to show over the next ten years

that they would have to eliminate a little over $12.5 million a year, average,

based on a budget of $1.25 billion.

We know that health care funding over the next six years, the ten year plan

federally, the money we are getting federally is going to allow a 6 per cent

increase after the six year period thereafter as an inflationary amount that we

are going to get from the federal government on the portion that we got under

the FMM.

MR. PARSONS: So you are not saying this $20 million this year was a

one-shot deal. You are saying you are going to put money in every year for ten

years to allow to erase the $125 million accumulated deficit.

MR. SULLIVAN: No, I did not say that, no. I said we put $20 million in

this year to assist in balancing it, and this is a transition year, and what we

will do in the future, we want a ten year plan. We will look at things on an

annual basis, on what service the board is providing, what is happening, what

initiatives. It depends. Certain boards may be advancing certain initiatives;

other areas might be in other initiatives. The funding they get will be a

product of the service they deliver.

MR. PARSONS: Okay, let me go back. I am not a mathematician, and I am not

very good at figures. I would just like to understand stuff, and Joe

Chesterfield, as I say, likes to understand it as well. It saves a lot of

trouble if people can understand where you are going.

The $31 million that you put in this year, which is the transition year,

where is that going to be, or expected to be used, and by what boards? How do

you see that working?

MR. SULLIVAN: Well, that is something that I will refer to an official,

how it is going to be broken down. What the boards get, including that $20

million and the $11 million, is a product of services they provide, how much

will go into one. If one board - the $20 million, and I will let officials

expand on it - if a board is in a situation whereby they need to have more

pressures on dealing with that deficit than others, there would be an

appropriate allocation of that amount to be able to deal with that. How it is

divvied and how it is broken out and how it fits into the other $1.25 billion, I

would defer that to -

MR. PARSONS: Do it in a context, if you would, of the Western. I was told

at the meeting the other night by Dr. Genge, the Chairman of the Board, that

there is about a $35 million or $36 million deficit in Western and Grenfell.

That is what I took it to be, Western and Grenfell.

OFFICIAL: No, just Western.

MR. PARSONS: Maybe it is just the Western Board. You can clarify that for

me as well.

What does he do? You gave him a budget on April 1, which was great. He has

some idea of what his budget is going to be on a go-forward basis for this year

for 2005 and 2006.

MR. SULLIVAN: That is right.

MR. PARSONS: He knows he has this $35 million deficit for his board.

MR. SULLIVAN: That is not on an annual basis, now. That is a debt, not

deficit. His deficit is not $35 million.

MR. PARSONS: No, that is a debt.

MR. SULLIVAN: Yes, that is debt.

MR. PARSONS: So, what happens? That is the whole point. If government is

saying to Western, get rid of your debt - how are they going to get rid of their

debt if what you are giving them for the year is being fully spent without even

putting anything towards the debt? That is what we are trying to figure out, out

there.

MR. SULLIVAN: I will refer to my deputy in a second, but we are looking

at a whole new structure now that has several rolled into one. There are certain

efficiencies in operating one organization as opposed to several also, but maybe

the deputy or somebody could comment on the structure of where there are greater

pressures in achieving that level in some boards than others there. If there is

anything, John, on that?

MR. ABBOTT: Mr. Parsons, in terms of taking Western, right now they

approximately have accumulated deficits in and around $28 million. They will

continue to have that accumulated deficit.

This year what we did, so that deficit does not increase, is to allocate them

a portion of the $20 million so that they basically stay flat. We provided

another $11 million across the system to deal with inflationary increases as

well as some program increases to respond to their pressures. That allocation

was done based on their submissions to the department. We looked at each of the

boards, looked at what they requested, had some discussions, and then did an

allocation. So the sum of that is that, when we provide them with their budgets

by the end of March, they knew then for the coming year that they would have

"balanced budgets" and that, all things being equal, the accumulated

deficit will not increase.

The expectation now this year is to have a discussion with each of the boards

to say: How can you develop a plan to address that accumulated deficit? As the

minister said, there would be a pay back, as it were, to bring down that deficit

over the next ten years.

If you take the total of the $125 million, divide it by ten, that means that

the system is to define and achieve efficiencies in around $12.5 million over

the boards, and that is where the minister's 1 per cent number comes in.

MR. PARSONS: Okay.

Therein lies the crux of the problem, I guess. The question that was asked at

the forum was, if we are currently spending all that we are given for the level

of services that we have, and the thought was that was why the HayGroup came in,

to tell us and help us where we could find these efficiencies - that is why I

understood that Western brought them in, to tell us where we can find some

efficiencies - and they made a whole bunch of recommendations, so now if these

recommendations of clinic closures and obstetrics at Stephenville and obstetrics

at Port aux Basques and food services and all of that, if those recommendations

which Hay said should be done to save you money are not going to be done, the

question asked of Mr. Genge was: How are you ever going to pay back this $28

million?

MR. ABBOTT: Well, if I may, just on the Hay recommendations, there are

still obviously quite a significant number of recommendations in the report that

we will be expecting the board to look at, address, to see if, from their

perspective, they are doable and they wish to recommend implementation, which

would see significant saving in those that are, shall we say, still to be

addressed by the board.

MR. SULLIVAN: I might add, Mr. Chair, there are numerous recommendations

and numerous initiatives not only with the consolidation efficiencies but also

in best practices, utilization rates, admissions by people discharged earlier

and not the length of stay. In some of the areas it is longer than the norm, it

is longer than in some parts of the Province, by having a follow-up in community

health and so on, and initiatives to work hand in hand. There are numerous

thrusts that should give more efficient delivery and be generated while they

could be in the envelope of moving the pressures from the acute care. There

could be longer term savings if a person is in hospital two days less and the

follow-up care in the home would not necessarily be as expensive as a follow-up

from where they has surgery, by putting resources into the community health

line. There is a whole area of things now.

They have an opportunity now. By having a separate entity before, as an

institutional board and a community health board, and whether it is a nursing

home board and a separate one here in this area, there are efficiencies and so

on that could be achieved; because, instead of pushing off from one budget onto

another your are dealing with it all under the one budget now. Therefore, those

issues will take a transition of this year to be able to look at areas of their

operation and then to be able to come back with a plan. So at least they are

getting funded to meet that this year and then it will give them an opportunity

during the course of the year to come up with a plan to see how they can deal

with this in the long term.

MR. PARSONS: Minister, my next question - and I do not want to get into

specifics but I have written to you and it has been very recent. I am not even

sure if you have even seen the letter. I do not like to bring up personal

specific circumstances, but it relates to a bigger picture problem and that is,

what does a person do...? - I will give you the circumstances.

An individual who has cancer of the kidney was booked for surgery on

Wednesday of this week. I have had lots of cases where people come to you, for

example, and say: Can you do anything to get me pushed up the line on a heart

surgery rotation or wherever? My stance on that is, everybody's life is worth

the same. If you are on a list, somebody put you on a list for good reason, and

I leave that stuff to the medics. That is one issue, but we are talking here

about a situation where a person was on this list, has a life-threatening

surgery booked, cancer of the kidney, and the urologist is leaving Corner Brook.

The surgery that he was due to have on Wednesday - and this is a person who, by

the way, is not a complainer. This is a person who stoically sits back and just

says: Any suggestions as to what I might do?

I, quite frankly, do not know what to tell the person to do. What does

someone do in that situation? What do they do?

MR. SULLIVAN: I would not want to get into specifics, but you mentioned

that someone had surgery booked on a Wednesday, for example?

MR. PARSONS: This Wednesday. It was booked for tomorrow.

MR. SULLIVAN: Booked for tomorrow, and the surgeon is leaving?

MR. PARSONS: They were told on Thursday past that: Your surgery is

cancelled. You will have to get the next rotation, which is going to be some

time in May. They have been told as well: By the way, you are not on the May

list.

MR. SULLIVAN: Why would it be cancelled?

MR. PARSONS: Because the urologist, apparently, is leaving Corner Brook.

The person who was going to do this surgery tomorrow on this individual, for

whatever reasons, is not going to be there to do it.

MR. SULLIVAN: So is there a shortage, or somebody else would have to pick

up that patient and do it?

MR. PARSONS: Nobody is prepared to pick him up. He has just been told:

You have to wait like everyone else, and right now - it is not a case of getting

your toenail off. This is a person who has cancer of the kidney. I just do not

know, quite frankly, who to tell him to consult with. Who does he call?

Obviously he is not getting a lot of help from the doctor who was supposed to do

it, because he is in the process of moving, and obviously he cannot get another

doctor because he does not know one.

I do not know what to tell the person. I agree that there are wait lists and

I agree that we all have problems, but when you meet these urgent - I call them

urgent - life-threatening situations, is there any kind of person in your

department you can contact with these emergency type situations to get some

explanations on?

MR. SULLIVAN: Yes.

MR. PARSONS: It just happened that I was coming here today and I said, I

have to ask because I would not be doing my job if I never even asked to find

out for the person.

MR. SULLIVAN: I guess on that one, what I would indicate, we can follow

up and see by virtue of a doctor leaving that somebody has put in an inordinate

wait for something that was medically determined to be more urgent in nature. We

can follow up. I have no seen the letter but it must have just come in very

recently.

MR. PARSONS: Yes, it was very recent to you. I only found out late

Thursday. The letter came to you on Friday.

MR. SULLIVAN: Overall, in reference to dealing with cancers and that,

this year we made a significant investment in funding that is going to reduce

cancer surgeries by 30 per cent this year, in this year's budget, that we will

have a 30 per cent reduction in wait times for cancer surgeries.

That, I know, is a significant investment. It may not help this individual,

but we will follow up on that specific thing, but it will benefit the general

lines of dealing. We are looking at even in cancer lines people working extra

hours on weekends to be able to accommodate people who need, whether it is

radiation or chemo, to be able to access that by extending hours. There is extra

money in the Budget to deal with that, too, in addition to a 30 per cent

reduction in wait times for surgery for cancer.

That is part of the bigger picture, but that specific one we will follow up

on.

MR. PARSONS: Thank you, Minister.

CHAIR: Mr. Butler.

MR. BUTLER: Thank you very much.

Minister, just a few questions. I want to go back to the heading 3.1.01.

under 10., where you mentioned Grants and Subsidies. I know you mentioned

earlier the different boards get their budgets, they know what money they have

as of April 1.

I am wondering, for 2005-2006, this $1,283,000,000, once those budgets are

done, is all this money allocated? What would be kept or in the reserve we heard

reference to a little earlier?

MR. SULLIVAN: Well, all the money is earmarked. I will have to refer that

to an official to see if there is a certain amount of reserve for any unusual

circumstances that do arise; if there is anything or whether it is all allocated

out to the boards. There is $300,000 on reserve out of the $1,283 million.

MR. BUTLER: Three hundred thousand?

MR. SULLIVAN: Three hundred thousand.

MR. BUTLER: Okay. So that leads to my next question, and do not get me

wrong, I am not against what happened there a while back because I am so pleased

to see - I think it was $1.2 million or $1.4 million allocated for the cancer

clinic in Central. Where would that money be in this 2005-2006 budget, seeing

there is only $300,000 left there under that heading? Is this new money that is

going in or is it money that will be put into the budget coming up for

2006-2007? Can you outline where that $1.2 million or $1.4 million is?

MR. SULLIVAN: That is going to come under our - there were certain

capital announcements we announced for capital expenditures this year. Under

capital, there are numerous initiatives announced for capital expenditure.

When this request came up, the Premier asked the minister to go out and look

at the site with the deputy minister and other officials. When he came back

there was a report done, and I discussed with the department on coming back from

that with the deputy, and we discussed this issue in government as to - first of

all we said, what is needed? For instance, in 2002-2003, there were 1,298 people

in Grand Falls-Windsor receiving treatment for cancer. It is projected this year

to be 1,400, and we said, are there other needs? While you are looking at it,

are there other needs for that area?

We looked at Gander from that same period, it went from 1,129 people to 1,850

now projected who will need it. Is there a solution under the Central Regional

Integrated Health Board to deal with that within this year's budget? They went

back and looked at the capital projects that were announced for this year, where

they are, what stage they are, how fast they can advance these projects. How

much would be needed to complete this project in Central Newfoundland is $1.55

million; $1.2 million for Grand Falls-Windsor site and $350,000 for the Gander

site. They indicated that you cannot spend all of that this year. Maybe you

might only get to spend $600,000 or $700,000; $800,000, whatever the number may

be. There are other projects ongoing, too.

It was felt, in looking at our expenditure for this year, that there is

sufficient monies in our cash flow. If anyone needs an explanation in how that

works, I can give an explanation on that. That is more a financial process, but

I will answer that. There are sufficient numbers within the cash flow to be able

to do this within the cash flow, but at the final analysis, when the projects we

announced this year and the cancer ones in Central, at the end of the day, we

are still going to need $1.55 million but it will not need to be drawn because

all these projects are ongoing. They will not get all finished this year, but we

will need $1.55 million in next year's budget, not this year, to be able to

complete all those capital projects then out of what is allocated. So, it is

really - cash flows are sufficient without new monies to do it but next year we

are going to need to come up with $1.55 million. If they all get finished in

2005-2006 or 2006-2007, technically, we would need another $1.55 million, but

the cash flow is sufficient to be able to carry these projects what we announced

earlier and this project without needing a new appropriation of money.

MR. BUTLER: So, will the cancer clinic or the facility be finished this

year?

MR. SULLIVAN: In any event, it would not have gotten finished this year.

Under the previous proposal that came in, you know, to this past - actually,

four years. The proposal that came in for the past four budgets, came into

government, it was a scenario of over $4 million to build on and to house other

areas under this proposal; like, the pharmacy and the labs. There is a variety -

I think the dialysis. There is a whole area. We looked at a bigger proposal that

could have cost $9 million to $10 million. We moved on an initiative to build

on. You have to get a plan now, a design. You have to get the construction, get

it built, covered in. It is an addition to a facility. The practicalities of

seeing that finished by the end of March, that would not have been practical

under any scenario but a good bit of the work could end up being finished and

completed but the intent, this should be finished in the 2006 year. It would not

get finished this year anyway, but the cash flows are sufficient. We do have to

allocate some extra money in next year's budget to be able to complete the

ongoing ones, but there is no new requirement of money needed to be able to do

it.

MR. BUTLER: Minister, with regard to the long-term health care facility,

was there a ranking for Conception Bay North or Carbonear area? What is the

status of that facility?

MR. SULLIVAN: Overall, the rankings of the three in long-term care are:

Corner Brook, number one; Clarenville, number two; Happy Valley-Goose Bay,

number three. I can say that other facilities out there, the one that is in

Carbonear or the Conception Bay North region, is a strong priority. We know what

it is like. St. John's has serious problems, and Carbonear. We are aware of

that. If you want to look at this region as an example, we are very much aware

of them but the top three priorities got funded this year and Carbonear is

beyond these as a high priority. I have seen this. I have visited. I went from

one end of it to the other. I am personally very familiar with it. People in my

department are aware that it is a concern that needs to get addressed in the

future; as things get looked at in the future and to what extent. I guess when

you come to a budget table you look at how much we can get into Capital and so

on, but it is a concern and it is something that is targeted. As to when, I

guess at this time we cannot tell you.

MR. BUTLER: Minister, the facility for Conception Bay North area was not

ranked number one or number two in the past by officials in your department?

MR. SULLIVAN: The top three are the ones that we moved on this year.

Actually, the Corner Brook one was moved on last year, and Clarenville and Happy

Valley-Goose Bay.

MR. BUTLER: No, the question I asked: Was there at a point in time - I am

not saying this year - where Carbonear ranked higher than some of those that are

listed here today?

MR. SULLIVAN: I, personally, cannot answer that, where past rankings are.

I can tell you on current rankings. If there are things that have changed over

the past number of year, there could be a variety of factors that could change

rankings. If an official wants to pass judgement - there are numerous things

that can change rankings, demographics of an area, increased population. I know

from reading background areas that the Clarenville area has the highest elderly

population in that region in our Province, unless things have changed in the

last years. I have read that. I have looked at things right back from Nycum

studies on that. One particular area, the area down in Happy Valley-Goose Bay,

is in bad need of it. Carbonear too, of course, is one, but there is nothing,

that I am aware of, based on the numbers and the needs and so on, that theses

were the top three.

MR. BUTLER: Can any of your officials answer the question that I just

asked?

MR. SULLIVAN: I am not sure if they can, but I will certainly ask if they

are aware. I can do that.

MR. ABBOTT: Mr. Butler, in terms of our priority setting, basically, the

process we went through is to look at, as the minister said, population-based

issues, as well as the facility issues, and to present to the minister and then

to Cabinet a listing of the specific projects that we think, as a department,

need to be addressed, and then that list was presented to Cabinet during the

budget process. The selection was then made there, but in terms of the minister

identifying the three, they were the ones that we identified on that list as

well.

MR. BUTLER: Was there a time - my understanding is that Carbonear ranked

number one through - I do not know if it was studies, reports or analysis,

whatever was done, that Carbonear was number one when it came to long-term

health care. I was just wondering, what happened to that or is that correct?

MR. ABBOTT: Just - if you can give me a second. I will ask Ms Hennessey

to answer.

MS. HENNESSEY: Mr. Butler, there are quite a number of priorities within

the department for long-term care. I have been with the department a long time,

and as I go around the Province there are very many long-term care facilities

that need a lot of work. Right now the government has ranked the ones in Corner

Brook, Clarenville and Happy Valley-Goose Bay as the highest priorities for

redevelopment. But, as our minister has said, there are other pressing needs out

there that we need to address all the time.

MR. BUTLER: So, there was never a time that, within your department,

Carbonear was ranked number one? That is the question I would like to have

answered.

If it was number one I am wondering why it was downgraded, because it is my

understanding that it was within the department, within the system, that

Carbonear - internal - was ranked number one. I am not saying the other ones do

not need it just as much as we did but I am wondering, what happened? If

Carbonear was ranked number one, how come all of a sudden you are down in fourth

or fifth place? I mean, something had to change there. I can tell you, the need

out there - there is nothing happened out there to take care of the problem.

MR. SULLIVAN: Mr. Chair, overall, I guess, if you look at - I guess you

can look at the condition of facilities. You could look at the future needs to

meet the wait lists. I guess if you looked at wait list and the condition in

some, you might say that St. John's probably, I would think - if some of the

officials - has the highest wait list of anybody to get in. Therefore, if you

consider the longest wait list, it might be determined as being the greatest

need; along with the condition of facility is another factor that weighs into a

need.

I think the wait list here in the St. John's region is probably the longest

in the Province, I would think. Yes, I have been informed. So, we might say that

is the greatest need, but you have to look at a variety of factors. I guess when

you look at - there is no doubt that the three are certainly distinct needs,

along with St. John's and Carbonear are strong needs too. Maybe if you had to

do it on rankings alone, the longest wait list, it should be in St. John's; if

you look at that basis alone, but there are conditions and other factors of

facilities and so on that have to be taken into play.

MR. BUTLER: No, my question, minister, and I am not going to belabour it

any longer -

MR. SULLIVAN: I am not aware if it was ranked first.

MR. BUTLER: I understand those three and I agree they are ranked the way

they are, for whatever reasons. My understand is, and I cannot get an answer

from anyone to confirm to me that Carbonear was not ranked as number one.

MR. SULLIVAN: I am not aware that it was ranked number one.

MR. BUTLER: Okay. So, your department is saying, basically through you,

that Carbonear was never ranked as number one?

MR. SULLIVAN: Well, my understanding of the indicators, there are a whole

list of priorities there but -

MR. BUTLER: It is only a simple question, minister.

Is there anyone over there who can confirm for me that Carbonear, yes, was

ranked number one at a point in time not too long ago?

MR. SULLIVAN: I said I am not aware that it was. No, I am not aware that

it was. I am not aware.

MR. BUTLER: And there is nobody - none of your officials are aware of it?

MR. SULLIVAN: Well, I think they have spoken to that issue.

MR. BUTLER: We will leave that one, Sir.

The other thing I want to ask a question on is with regards to emergencies.

If someone goes to an emergency, what is the practice? I guess we all know what

the practice is. There is a doctor there who sizes up the situation and is

wondering if you should stay in the hospital or not. Is that solely the way it

is looked at? - because I can give you an example that happened out our way.

This individual who was dying with cancer was taken to the hospital. The doctor

in emergency sent him home. The family returned with him again. He was sent home

the second time and they said: You are going to have to go to St. John's to

see your cancer specialist.

We had to call that specialist here in St. John's and I had to call

emergency in Carbonear for them to admit that man because he could not travel to

St. John's. They had to get a doctor at his residence to call them. Is that a

practice? To me it was a terrible thing, and what the family went through. To

have to get hold to a cancer specialist here in St. John's and get word to the

doctor in emergency in another hospital to say: Look, you have to take this guy

in. He is too weak. He cannot travel to St. John's.

Is there anything we can do about that? Like you said, is there anyone in

your department we should be calling rather than trying to track down some

specialist here when he is off duty?

MR. SULLIVAN: I will give my general comment and knowledge of situations

like it, and if someone wishes to comment on it then, they can certainly feel

free to do so.

Usually when people - especially people who have cancer, sometimes they may

take ill. It could be 1:00 or 2:00 o'clock in the night. I know people I have

spoken with at the emergency department 2:00 o'clock in the morning. Sometimes

their cell counts are up and there are major problems with people receiving

treatment, whether their platelets are down or their white cell count varies.

Some people take ill and have gone to emergency. They would be examined, I

guess, by a doctor at emergency who would not be acutely aware of the medical

condition of anybody coming into emergency, not always.

I know specialists have indicated to their cancer patients, when they come to

emergency: If you go there and you are ill, and you are going to be discharged,

for example - some have indicated - Look, contact me. Because they have told

them, if you get into a situation do not stay at home, immediately get in.

People are not always routinely aware of that. So there are circumstances that

can vary from individual to individual, and doctors there on duty make decisions

based on their medical expertise and sometimes decisions get made. It is not

done by political or administrative. Decisions are made, and should be made on

admission, based on medical information. If a doctor did not admit somebody, a

department cannot dictate - or anybody - to a doctor, who is the medical

professional, to interfere in the carrying out of their responsibilities. We are

not experts in that area but if there are concerns there, I think it would not

hurt, as a suggestion, that communication with the doctor, with their specialist

- it would not hurt if they are in an area and a region where they may have to

receive it. I think it would not hurt to have communications with that emergency

if a patient comes in, or they are to be monitored. I think that would make them

more acutely aware of their condition. That may be the case.

I have dealt with - numerous people I have talked to have gone to the

emergency with cancer and have contacted me. I have suggested they speak to the

doctor and make them aware of it, or contact their specialist if they have to,

if there is something that the emergency doctor may not be aware of. When

someone comes into an emergency, in most cases if they are busy there is a

certain triage they go through. Usually a nurse will look at somebody and the

more higher priority ones get on the line. I have sat there for eight hours with

people with me saying, the wait time is now eight hours. I know at the emergency

it was seven hours and gone through that process that other people more

important - more urgent ones have moved through the system. So, as to the

admission part, I think that is a medical opinion that - other than raise that

attention to the appropriate people to follow-up, that would be, I think, a

medical follow-up process.

If there is something John or Moira on how (inaudible). I did work at the

emergency for a year.

MR. BUTLER: In that particular case, and I do not want you to respond to

this, but I know in this case that individual had to be taken twice by ambulance

operators, that is how weak the individual was, and then for a doctor at

emergency to say: no, we are sending you back home - and his specialist,

whatever.

The other thing - I know this question was asked to you in the House of

Assembly the other day and I am after forgetting the exact title of the

individual, like a doctor who would be operating in emergency. Apparently when

the ambulances go pick up a patient, before they can perform any medical

procedure or do anything, they have to get a clearance from this individual, I

guess, back in emergency at the hospital. I just forget the title. Out our way

last week - and I think the Member for Carbonear-Harbour Grace asked you the

question -

MR. SULLIVAN: Medical control?

MR. BUTLER: Medical control officer, that is it, sir.

I was just wondering, have you had the opportunity to check into that to see

if it has been resolved? My understanding at that time, as of 12:00 o'clock -

a lot of people were concerned and the people on the ambulances were even

concerned about what the outcome could be.

MR. SULLIVAN: Well, it has not been raised since, and I have been out

there. The issue has never come back. I do not know if - Moira, if you could

comment on that, please.

MS HENNESSEY: That issue was resolved, Mr. Butler. There was a physician

leaving the area who was responsible for medical control, but the medical

control was transferred to another physician as of midnight that night, so there

was no break.

MR. BUTLER: So, it is resolved?

MS HENNESSEY: Yes.

MR. BUTLER: Wonderful.

MR. SULLIVAN: My understanding is that for the operation of your

ambulance service and your certain level of services, there must be a medical

control officer designated in this operation, I understand.

Before midnight came there was somebody other than that physician, then, had

been designated and took up those responsibilities, I think Ms Hennessey said.

MR. BUTLER: Because what we were told, and what the ambulance operators

understood that day, they were told that before the paperwork could be done,

before the new individual was taking over, it would be a week or a week and a

half. That is what caused the concern. If it is resolved, that is wonderful.

MR. SULLIVAN: Well, Mr. Sweeney probably panicked. It did get done before

midnight.

MR. BUTLER: The other question with regard to Carbonear again, and we are

talking about budgets and balancing their budgets and so on, I was just

wondering, I do not know if you can elaborate a bit on the situation with that

facility out there. Where do they stand? I know we are talking about $28 million

with the Western Health Care Board. I was just wondering, what is the situation

with our board out there when it comes to - do they have a balanced budget? Are

they in the same position as other areas and so on?

MR. SULLIVAN: I will just ask to see if they have the breakdown of the

budget for those areas. I think the Avalon Institutions Board is running a

deficit of - about $14 million rings a bell with me

OFFICIAL: You have all the deficits integrated now, right?

MR. SULLIVAN: Yes, they are all integrated now but, I think, from my

memory, they had their line of credit of $7 million and we approved to pick that

up to a maximum of $14 million, anything above $7 million and up to $14 million,

so they were probably running about $10 million it was currently when they

closed out, I have been informed. Because, I remember, they had exceeded the $7

million and, of course, the banks wanted assurances on a line of credit and we

approved to pick up the surplus over $7 million as a guarantee for them. That is

why I said not to exceed $14 million. It is in that range. I think it closed out

at $10 million.

MR. BUTLER: Minister, could you or your officials give me a figure on

what it would cost to assist an individual or senior staying in their own home

versus, if twenty-four-hour care cannot be provided, what it would if they were

put in an institution or a home?

MR. SULLIVAN: In their own home? Do you mean twenty-four-hour care?

MR. BUTLER: Yes, say twenty-four-hour care in their own home.

MR. SULLIVAN: I would say, off the top of my head, in the vicinity of

$70,000 a year. If you look at twenty-four hours multiplied by the wage,

multiplied by - if it is self-managed, there is a certain cost. It would be

higher if you are managed through a home support agency; there is a higher

figure. So, take the number at twenty-four times seven and multiply by 365 and

then by $7.28 an hour; plus, there is a fee if someone - I would say in the

$70,000 range to be in our own home.

MR. BUTLER: So, what would that be versus if that individual -

MR. SULLIVAN: Institutional care has been estimated to be - some of the

buildings are sort of owned and the cost of capital, if you factor in - roughly,

to get nursing home care, it is in a similar range. That is nursing home care.

Personal care homes, Level I and Level II, cost the government in the

vicinity of probably as little - some very minimal, and some $2,000 or $3,000 a

year. It is in the range of more like $3,000 a year in a personal care home.

Personal care homes charge a fee of about $1,208 or $1,210, somewhere around

there, and most of that is recovered through their old age security and so on.

There is an average of about $3,000 a year, roughly, per person in a personal

care home.

Maybe they have more accurate figures there, but I have looked at the figures

up to two or three years ago, and looked at the total cost of the budget by the

number of the beds. So, let's say $3,000 a year is a ballpark in a personal

care home, and roughly about $60,000 or $70,000 range to be in your own home,

maybe more. I could run it up quickly there. It would take a minute, based on

the price. Maybe someone can run it up there based on - currently, it was $7.28.

There is going to be an increase, so you are close to $8.00; plus, you get some

of the processes. So, in the run of a day, at twenty-four hours, that is $200.

If you look at 200 times 365, that is $73,000 that it would cost in a year. That

is to give twenty-four-hour care in your home, and about $3,000 in a personal

care home. There is about a $70,000 difference.

MR. BUTLER: I have been advised not to ask you any more questions with

numbers.

The other thing -

MR. SULLIVAN: And in managed care it would be that much higher again. You

could probably add another twenty-four hours through home support agencies, and

you could look at close to $100,000 through a home support agency, about

$100,000 a year to give care in your home.

MR. BUTLER: Why I asked that question, I have a couple of cases like that

and we hear so much about trying to assist people to stay in their homes as long

as possible.

MR. SULLIVAN: There is a big price beyond a certain limit, huge.

MR. BUTLER: Okay.

MR. SULLIVAN: In a city usually done through home support agencies it

could cost you $100,000 a year for twenty-four hours and it could cost you

$70,000-some a year out in an area where it is done by self-managed care.

MR. BUTLER: At the Carbonear Hospital, like I just mentioned, there is

one doctor who left and caused this concern there a little while ago. I believe

the individual who is taking over that position, or about to take it over - but

you tell me it is taken over now - he is leaving in June. I was wondering, has

the board expressed any concern to the department about doctors leaving the

Carbonear area? I know that is two who will be gone from the Carbonear General

Hospital by, I do not know if it is the first or the last of June of this year.

On the same line, I guess, when it comes to staffing, I know from visiting

people in the hospitals that nurses, no doubt about it, are just run ragged, in

my terminology. I have seen people in the Pentecostal Home up in Clarke's

Beach, with sixty-five to seventy residents, in the night there are two nurses

on, and two assistants, two people looking after thirty-five. I am just

wondering, is the department, through the boards, looking at additional

staffing?

We have so many young nurses who are being trained, and ever so many from my

area are working down in the States. I know they are making big money but I was

just wondering, is there any major concern there where we are losing more

doctors? We heard Mr. Parsons say just now there is another doctor leaving the

Corner Brook area. I do not know where he is going, but the two who are leaving

Carbonear are gone out of this Province. I was just wondering what is being done

to have a look at not only the doctors but the nurses and the full health care

system when it comes to staffing?

MR. SULLIVAN: Well, overall, when you have close to 1,000 doctors in the

Province you are going to get a certain turnover. There are reasons they may

leave. Some are personal and some may be work related reasons. I guess that is

the prerogative of the individuals there.

We have had an increase of about fifty-some physicians in the last two to

three years in our Province. We have a ratio now that, while some areas you

might consider to be under serviced and in other areas the ratio is different,

we now have a ratio of about one point one specialists to one for general

practitioners, when most jurisdictions are roughly a one to one ratio, I think,

it is generally over. We may have some imbalance in some areas, and in some

others we could be short. We are always cognizant of maintaining full

complements, and we made significant progress since the MOA was signed, an

increase in the number of doctors.

On the nursing issue overall we have had, back several years ago, back six or

seven years ago, we did get into a situation with nurses where we had a shortage

of nurses in our Province. We went out and advertised outside the Province, and

even outside the country, to get people to come back home here. Over the last

number of years only a small percentage of those graduating from the School of

Nursing have landed with permanent jobs. There are some who have gotten casual.

Some have gone outside of the Province. We are not at the point right now, but

we are monitoring it to ensure that in the future we are not going to get into

the situation we got into five or six years ago, where we had to spend

inordinate amounts of money to try to fill that void. The number of people, I

think, is 225, I believe, the nursing intake per year, and the majority are not

getting permanent jobs, which means there is not a shortage of nurses at this

time; but we are aware, with the aging population, with a lot of seniors - the

average age being, I think, forty-eight for a nurse - that there is point where

we are going to need them. We are monitoring that, and we are not going to get

into a situation where we have a hole to get out of. That is important, to keep

the finger on the button.

There is a concern. A lot of decisions get made, too, in line with their

need, in line with the number of beds that are utilized. Another important thing

that we need to move to is that people get trained in numerous different areas:

personal care attendants and LPNs and nurse practitioners. It is important, too,

that people be able to perform along the line of - the scope of their practice

should be in line with their training. If people trained at these particular

levels, it would alleviate those shortages.

That will give you the spectrum of, I guess, health care in that area.

MR. BUTLER: Back some time ago, Minister, I received a letter - a copy of

a letter, I should say. It wasn't just sent to me; it was sent to others -

from the social workers at the Janeway expressing concern about the time frame

it took working with another department, Human Resources, Labour and Employment.

I was just wondering, has that situation been taken care of? Because when they

were trying to contact the, I guess, CSOs, are they, with the Human Resources -

MR. SULLIVAN: Yes, Client Service Officers.

MR. BUTLER: - the social workers in the health care system, there were

breakdowns in communication when the social workers were trying to get some

assistance for someone to transport or travel out of the Province and so on. I

haven't heard anything on it and I was just wondering, can anyone relate to

that, that the social workers at the Janeway are satisfied now that the

co-operation between both departments has, I guess -

MR. SULLIVAN: In my short while here I haven't been aware of it. There

hasn't been an issue that has come to the surface in that. I would assume it

got dealt with in the process, but if somebody is aware of it here, who wanted

to comment on it, certainly feel free to do so.

MR. ABBOTT: Mr. Butler, I am not aware of that particular issue, although

similar issues have arisen, certainly, during my tenure.

I guess one of the things that we are expecting to see through the

integration is that those kinds of issues, then, should be, will be, addressed

internally within the larger board. That is one of the things the department

found, certainly in recent times, is that we had several organizations out

working with similar clients, or the same client, and those delays in service

were happening, and right now we are working on a weekly basis with the CEOs to

address those kinds of issues to make sure, in fact, that they do not arise. Not

to say they will not, but that is certainly what we are attempting to do through

the integration.

MR. BUTLER: I have one question just for my colleagues over here, just

one other question, but I will make a comment before I ask the last question. It

was referenced, Minister, when you mentioned earlier - and I agree with you to a

certain degree - about the length of stay in the hospitals. It is more efficient

now, and people get out earlier, and I am sure everyone wants that to happen,

but I think also we have to be very cautious. I am sure some officials in your

department must know of the incident that happened here in St. John's, I would

say within the last three weeks, where an individual was being discharged from

St. Clare's after having a procedure done. A taxi came to pick them up and,

whatever happened, the story that I got was, they were asked to be discharged

too early for the procedure that was done. An emergency took place, and I think

they only got the individual back in the OR in time to save that person's

life.

I understand where you are coming from. I agree with you if it is a minor

thing, but I am wondering now if we are not pushing it too far, for some

procedures, to leave the hospital sooner then they should.

MR. SULLIVAN: My comment on that is that a discharge is done under, I

guess, medical consent, and not necessarily would it have to be designated to a

certain procedure. I think a lot depends not just on the procedure but on the

individual's condition prior to surgery, the condition that he had going into

surgery, the severity of that condition, his ability to respond and get back.

They are decisions that, I guess, medical professionals, doctors, make in

contact with the individual himself in light of the procedure carried out. So

they can be fairly reasonably subjective to certain degrees based on the doctor's

knowledge of the particular patient and so on. That is something that I am not

in a position - nor would I dare attempt - to render judgement on that, but

there are a lot of factors that go into making that decision.

We all hope that when someone is discharged they are ready to go home and the

follow-up is provided. There is evidence out there that early discharge can be a

positive factor to individuals in recovery, too, as well as moving out of an

acute setting and so on. There are certain disadvantages by being in the setting

too long. There are advantages, and that is based on best practices and

procedures there. That is a medical decision, and they are a lot more qualified

to make that than any of us.

MR. BUTLER: My last question, Minister, has to do with a situation where

individuals have a home setting for some individuals who are mentally

challenged, and they are placed in the homes. It is not a home where there are

fifteen or twenty. They may have one or two come in there. I am just wondering.

I know they have to go, I guess, through all the procedures and that before they

are advised of which home they can go and stay in and so on. I am wondering,

once an individual takes a resident into their home, what follow-up is there, or

is there any other guidance for that person? Because there is a situation, there

is a letter to your department that I sent on behalf of a response that I

received from health care workers in the Bay Roberts office when I was told that

- because the person who called me just wanted some guidance on what they could

do, what their rights were and so on. I was told by a health care official that

they could not talk to me about it. I said: Look, I do not want to find out the

facts of it, it is none of my business, but I am just calling for you to call

this individual. She was concerned of what she could or could not do.

An incident happened, the RCMP had to be called on several occasions, but I

was just wondering, once someone takes - I will just use myself. If I took

someone in who is mentally challenged and once I have them there and everything

is passed and the guidelines are all adhered to, and something goes wrong, is

there any system in place within the department where I, as the individual who

took this client in, have something to fall back on or supports to carry an

issue through? This lady felt that this did not happen. She was left on her own,

more or less, and could not get the support of people to help her with that

incident. She was told that she should call the ambulance operator; she should

call the RCMP, which was done. But after a serious situation took place, it

finally got resolved. She felt that after taking them in the system let her down

to a certain degree. I tried to get some answers for her but I was told that I

could not be responded to. I was just wondering, are there any supports in place

for situations like that?

MR. SULLIVAN: You are referring to people who may be mentally challenged

that are taken into your home to live there on a full-time basis. Is that who

you would be referring to?

MR. BUTLER: I do not know if they would have been there for a full-time

basis.

MR. SULLIVAN: Or would it be respite? Because there are people who have

people in their homes and they there are on a full-time basis. They may get some

respite for that. There are other people who may just take them during that

respite period and provide it. Either way, I guess, your question might be

applicable. There are two scenarios, I am not sure which one you are referring

to.

MR. BUTLER: I did not think it mattered, but, sir, to be honest and fair

with you, I cannot answer you that. I do not think it is there for the long-term

in the meantime; probably a respite type thing for awhile. I am not quite sure.

MR. SULLIVAN: Okay. John, do you have a comment on that one?

MR. ABBOTT: Mr. Butler, the services that you are referring to would be

managed and funded by the community health board at the time. Their

responsibility does not rest once the individual is placed in a home, whether it

is in an individual setting or a co-op apartment, depending on the arrangement.

So, the staff at the board office are responsible for continuing to monitor and

work with the families. If that did not happen, then there was a breakdown

obviously in the services that were required. Our job then in the department, if

that is brought to our attention, would obviously be to follow up with the

community health board and now the Regional Integrated Authority to make sure

that those services continue to be provided.

MR. BUTLER: I think what happened here, they got through to the officials

but I do not think it went through the way she thought it would to help her out

of the situation she was placed in.

Thank you.

CHAIR: It was requested that we take a five minute break from the

minister for a few moments. Can we take a five or ten minute break and then come

back and resume hearing at that point? It is 10:55 a.m. now, let's come back

at 11:05 a.m. and resume and finish up then.

Thank you.

Recess

CHAIR: Okay, we are ready to reconvene. Mr. Collins, the floor is yours.

MR. JOYCE: (Inaudible).

CHAIR: He is a member of the Committee. We will go through the Committee

first.

MR. COLLINS: One of you can go first if you want to, but I will go third

and watch the clock.

CHAIR: Mr. Joyce.

MR. JOYCE: Thank you, Randy, for your consideration. At least there is

someone here considerate.

I will get back to a few questions that were asked earlier about the VON in

Corner Brook. It was stated publicly - by the Premier, by the way - that the

money used was because of the new health care accord funding that they signed in

Ottawa. It was said here earlier this morning that the funding was found in

existing funds. Is that correct, that it was found in existing funds?

MR. SULLIVAN: That is correct.

MR. JOYCE: So, the strike went on for sixty days because there were no

funds - the former minister. Now here in the Estimates it is being stated that

the funds were found in existing funds.

MR. SULLIVAN: That is correct. There was no new appropriation of monies

in the Legislature. That was money that was budgeted but -

MR. JOYCE: None of these funds came out of the new health care funds?

MR. SULLIVAN: Money for health care initiatives that were identified -

one was in palliative care initiatives. Government felt it was important to move

forward in that specific area. VON, even nationally, has a fair amount of

expertise in palliative care and by moving on a project - and that project

certainly would be assessed. There are allocations also in this year's money

to continue one of the directives that came from the First Ministers' Meeting

on the health accord to be able to move toward that. So there is designation in

a pot of money this year, overall - palliative care is one of three intended

uses of $2.1 million.

MR. JOYCE: I will make it very specific. Last year the funds were taken

out of existing funds after sixty days straight.

MR. SULLIVAN: How long the strike lasted, I cannot tell you that and what

it was, but I can tell you the money that was used last year was money that was

appropriated and approved here in the House of Assembly and it came from the

budget that was approved. There was no special warrant or new supplementary

supply bills to pay for that. It came from money that was approved and

appropriated for here in the House.

MR. JOYCE: I asked one of the officials: Would they confirm that in

Corner Brook already there is what they call an End-of-Life Program and a

Palliative Care Program existing in Corner Brook before this study was done?

MR. SULLIVAN: Yes, one of the reasons in that area was because they

already had initiatives in that area. I do believe, and my officials can

comment, they were more advanced in this area, in the Western region and other

parts of the Province. That was a logical area if you are going to look at

dealing with palliative care or end of life care, that would be the appropriate

area to do a pilot.

MR. JOYCE: No, my question is: Would they confirm that there were already

two programs existing in the Corner Brook region?

MR. SULLIVAN: That there are two prior to that?

MR. JOYCE: Prior to that.

MR. SULLIVAN: I will have to -

MR. JOYCE: End-of-Life Program and a Palliative Care Program.

MR. SULLIVAN: Well, I will have to refer that to an official to see if

there were two existing. I think VON provided some palliative care service, to

some extent, under home care.

MR. JOYCE: The two programs, one is the End-of-Life that was being

offered by the community health Western and the other one was a Palliative Care

Program with an extension to the homes offered by the Western Health Care Board.

MR. SULLIVAN: My understanding is the Western Health - and I will ask, to

get confirmation of that. The Western Health Care Corporation, to my

understanding, was in- hospital palliative care. That is similar to palliative

care in here, the corporation one.

MR. JOYCE: No, there is also an extension to the home under a doctor's

recommendation. There was an extension already in place. I know the officials

are just checking back there on the books, so I will just wait.

MR. SULLIVAN: Under the Institutional Boards, you mean?

MR. JOYCE: Yes.

MR. SULLIVAN: Under the Western region, the Grenfell Institutional Board?

MR. JOYCE: No, under the Western Health Care Board.

MR. SULLIVAN: Yes, there are two boards. There was the Western Community

and there was the Institutional Board.

MR. JOYCE: There were two. There was one under the community health

Western, which was called the End-of-Life Program, and there was one under the

Institutional Board called the Palliative Care Program. The Palliative Care

Program also had an extension to the home, where they offered services in the

home, if someone wanted to spend their last weeks or month at home. I am sure

the officials know it.

MR. SULLIVAN: Yes, I will ask the officials. What I am aware of was that

- I was not aware that the Institutional Board had one in the home. I was aware

of the Institutional Board because one of the concerns in space requirements

came up is getting a palliative care unit within the institution. That occurred

over the last, I think, two years roughly, that they had accommodation there.

Whether the Institutional administered one in the home, I am not aware of that

kind. I will certainly ask my officials if that is the case.

MR. JOYCE: Well, it definitely is. Go ahead, sorry.

MS HENNESSEY: In January, 2002, there was a Palliative Care Program

established at Western Memorial Regional Hospital. So, there is an in-patient

service there and they do provide some support to the community.

MR. JOYCE: And to the homes?

MS HENNESSEY: Yes, support.

MR. JOYCE: They do, yes. That is the documentation that I have also.

So, my question is: Who made the decision to do a study in Corner Brook when

there are already two programs? I can see why the minister resigned. Who made

the decision? Was it a Department of Health decision? Obviously, it was not a

Department of Health decision. Who made the decision to do it when there are

already two existing programs in Corner Brook, confirmed here this morning?

MR. SULLIVAN: Well, there was an initiative with VON. They have expertise

in the area of palliative care, and even the organization on a national level,

to initiative a pilot project to look at that because it was one of the

initiatives of the First Ministers' Meeting in a designated area for

expenditure. We followed through on that in this year's budget and made

allocations to continue to put some money into the end-of-life care.

MR. JOYCE: My question is: Why are you putting $150,000 into a pilot

project when your own departmental officials confirmed this morning that there

are already two existing programs? Who made the decision? Did the Department of

Health make that decision? That is my question. Who made the decision?

MR. SULLIVAN: Any decision we make are made in government, and the

Department of Health is a department of government. It is to look at a program

that could, hopefully, encompass and be expanded on a provincial basis in that

area. So that is the initiative behind that program.

MR. JOYCE: Okay. A pilot project, with two existing.

My next question is, there is $150,000 allocated in the budget. In a

statement that was made in Corner Brook, by the Premier at the time, is that the

VON could take off $50,000 for wages and settle the strike. Can your department

here now - and I am sure you have it - supply me with a breakdown of what the

funds were used for? What that $150,000 was used for in Corner Brook?

MR. SULLIVAN: You cannot run any program without human resources.

Obviously, you have to allow for a salary component if you are doing a pilot

project. That has to be built into it. There is money that have to go in to pay

individuals who participate in that. So, you cannot run a project in the absence

of any allocation for the human resource element.

MR. JOYCE: I agree with the human resource element. I have no problem

with it, but my question is: Will your department now - if there is nothing to

hide on this palliative care, if it is such a great pilot project, even though

there are two already existing in Corner Brook - can you supply me with a

breakdown of the $150,000? Because if someone is out giving home care, they are

definitely not going to be involved in doing a pilot project study for

palliative care. That is a given; that is already a given.

Will your department undertake here today to give me a breakdown of what the

$150,000 was used for? How much of that $150,000 was taken and used to pay wages

for home care workers to settle a strike because they did not want a golf

tournament interrupted? Will your department undertake that here today?

MR. SULLIVAN: When things are completed - things are in the process of

being completed. Within the next few weeks we will get a final report on that

and we will look at the assessment then and respond when -

MR. JOYCE: Can I get the information? This is my idea of the estimates.

If there is money in this budget, which your department confirmed this morning

that it was taken out of this existing budget, the budget for last year carried

over, that if there were funds used out of that budget - and here is the

estimates and it is in there for general - that we should have access to what is

in that budget and this is what the estimates are for.

MR. SULLIVAN: We did not have the number there, the exact amount for

that. We said we would check on that.

MR. JOYCE: Well, I am telling you what it is, it is $150,000.

MR. SULLIVAN: Whether that is the amount that was expended is the next

question. In the next few weeks we will have the report and the details and then

we will be able to have specifics upon conclusion of that.

MR. JOYCE: Will the minister undertake here now to supply me with a copy

of the breakdown of what the funds were used for? The appropriation of funds:

what was used for wages; what

section of the VON wages was for; the complete

breakdown of the $150,000 that was committed to, give or take money - whatever,

$5,000 or $10,000 - the $150,000. Would you take that undertaking, as part of

the Estimates Committee, to give me the breakdown of that $150,000?

MR. SULLIVAN: We will follow up with - the Western Community Health Care

Board is the one that delivers that money to VON. We can check with the former

board and look at their expenditure, and they would have to depend on VON to

provide a breakdown to them on how it was utilized. So, we will follow up on

that.

MR. JOYCE: Can I get that or not?

MR. SULLIVAN: I cannot give you what we do not have. The Western board

will have to get that. We will follow up to pursue that and see if we can get

the answer to that from the Western board and the Western from the VON.

MR. JOYCE: With all due respect, you are here this morning saying that

government made a decision on the HAY report under the Western board. So you do

have control of the Western Board. You are telling me here now that the

officials that are with you here this morning do not get a breakdown on how

funds are spent in the Western region?

MR. SULLIVAN: I did not tell you that, no. I did not say that.

MR. JOYCE: Well, that is what you are saying. You have to check with them

to see if they got a report. So, obviously, the report is going to be given to

the Department of Health. Sure it is.

MR. SULLIVAN: When we get the report I said, in the next few weeks.

MR. JOYCE: Will I get a copy of the breakdown of how the money was spent?

Yes or no?

MR. SULLIVAN: I said I will follow up with Western for them to get a copy

from VON and follow up on that.

MR. JOYCE: Will I get a copy? Yes or no?

MR. SULLIVAN: I cannot give a commitment. I do not know if I am going to

get it from them. If I get it from them, yes. We will follow up and we will

pursue it and we will try to get these figures.

MR. JOYCE: So you are saying if the Western -

MR. SULLIVAN: I am not going to tell you something that I do not know if

I can deliver on. I will endeavour to do that. That is what I will say.

MR. JOYCE: But with all due respect - and I do not want to belabour this.

With all due respect, here you have just made a decision. Your government made a

decision. You notified the board that morning - the chairman of the board found

out that morning the decision was made, that Wednesday morning. Here you are

saying that you have complete control of the decision because government makes

the decision. Here you are saying that -

MR. SULLIVAN: What decision on Wednesday morning on VON?

MR. JOYCE: Not VON, on the -

MR. SULLIVAN: I thought it was VON you wanted the response on.

MR. JOYCE: No, the Chairman of the Board found out about the Hay report

decision on a Wednesday morning out in Corner Brook.

MR. SULLIVAN: That has nothing to do with VON.

MR. JOYCE: It definitely has, because if you are in control, if you can

make the decisions, obviously if you are spending $150,000, your department - I

asked the officials: Will you get a report of that, or is that just $150,000

(inaudible)?

MR. SULLIVAN: I will answer that.

First of all, you are confusing two issues. The VON report is not connected

to the Hay report, number one. Secondly, I will endeavor to get that through the

Western Board that is now a part of the Regional Integrated Board from VON on

their expenditure. We will endeavor to get that. That is what I ha