1973 Legislative Session: 2nd Session, 30th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

WEDNESDAY, MARCH 14, 1973

Afternoon Sitting

[ Page 1295 ]

CONTENTS

Routine proceedings

Oral Questions

Mr. Speaker's telephone. Mr. Williams — 1295

Hospital boards to pay cost of in-service training. Mr. Williams — 1295

Telegrams on Bill No. 42. Mr. Smith — 1296

Sandringham Hospital. Mr. Wallace — 1296

Appeal to court order re Kamloops area. Mr. Fraser — 1296

Prosecutions under Mortgage Brokers Act. Mr. Brousson — 1296

Payments to Meneham and Dunsky Advertising. Mr. Schroeder. — 1296

Ferry service in Ocean Falls area. Mr. McClelland — 1297

Purchase of Ocean Falls paper mill. Mr. McClelland — 1297

Man and Resources meeting. Mr. Schroeder — 1297

Committee of supply: Department of Health Services and

Hospital Insurance estimates.

Mr. Williams — 1298

Hon. Mr. Cocke — 1310

Hon. Mr. Cocke — 1298

Mr. Kelly — 1310

Mr. Chabot — 1298

Hon. Mr. Cocke — 1311

Hon, Mr. Cocke — 1298

Mr. Wallace — 1311

Mr. Chabot — 1299

Hon. Mr. Cocke — 1311

Mr. Wallace — 1299

Mr. Williams — 1311

Hon. Mr. Cocke — 1299

Hon. Mr. Cocke — 1312

Mr. Williams — 1300

Mr. Wallace — 1312

Hon. Mr. Cocke — 1301

Hon. Mr. Barrett — 1313

Mr. Williams — 1301

Mrs. Jordan — 1313

Hon Mr. Cocke ; — 1302

Hon. Mr. Cocke — 1314

Mr. Wallace — 1302

Mr. Williams — 1315

Mr. Gardom — 1302

Hon. Mr. Cocke — 1316

Hon. Mr. Cocke — 1303

Mr. Fraser — 1316

Mr. Nicolson — 1303

Hon. Mr. Cocke — 1316

Mr. Williams — 1303

Mrs. Jordan — 1316

Hon. Mr. Cocke — 1304

Hon. Mr. Cocke — 1318

Mr. Gardom — 1304

Mr. Wallace — 1318

Mr. McClelland — 1304

Hon. Mr. Cocke — 1319

Mr. Wallace — 1304

Mr. McGeer — 1319

Hon. Mr. Cocke — 1305

Hon. Mr. Cocke — 1320

Mr. Nicolson — 1305

Mr. McGeer — 1320

Hon. Mr. Cocke — 1305

Hon. Mr. Cocke — 1320

Mr. Rolston — 1306

Mr. Wallace — 1321

Mrs. Jordan — 1306

Hon. Mr. Cocke — 1322

Hon. Mr. Cocke — 1307

Mr. Wallace — 1323

Mrs. Jordan — 1307

Mr. McGeer — 1323

Mr. McGeer — 1308

Mr. Nicolson — 1324

Hon. Mr. Cocke — 1309

Hon. Mr. Cocke — 1324

Mr. Williams — 1309

Mr. Nicolson — 1325

Department of Highways estimates.

Mr. Fraser — 1325

Hon. Mr. Strachan — 1328

Hon. Mr. Strachan — 1327

Mr. Chabot — 1329

Mr. Curtis — 1328

Hon. Mr. Strachan — 1329

The House met at 2 p.m.

Prayers.

MR. SPEAKER: The Hon. Minister of Health Services and

Hospital Insurance.

HON. D.G. COCKE (Minister of Health Services and Hospital Insurance):

Mr. Speaker, I would like to welcome a number of people from New Westminster,

former capital city of B.C. I would ask the House to join me in welcoming them.

MR. SPEAKER: The Hon. Minister of Public Works.

HON. W.L. HARTLEY (Minister of Public Works): Mr. Speaker, I

would like to introduce a group of 36 students from Hope

Secondary School with their teacher, Don Olds. I'm sure you

will join me in welcoming them to the assembly this

afternoon.

MR. SPEAKER: The Hon. Minister of Mines.

HON. L.T. NIMSICK (Minister of Mines and Petroleum Resources): Mr. Speaker,

I would like to …

AN HON. MEMBER: Mike. Mike.

MR. SPEAKER: He's a new Member.

HON. MR. NIMSICK: I always forget that mike. When I started

here, there were no mikes. We had to use our own voices and

that is the way I've been trained.

Mr. Speaker, I would like the House to join me in welcoming

a very important person from Radium Hot Springs — the town of

Radium, Mrs. Eileen Madson who is a trustee in the Windermere

district and a former NDP candidate.

MR. SPEAKER: The Hon. Member for North Peace River.

MR. D.E. SMITH (North Peace River): Thank you, Mr. Speaker.

I would like the House to extend a warm welcome today to the

chairman of the Peace Liard Regional District, Mr. E.A. Framst,

one of the directors and the administrator of the regional

district, who are in the gallery this afternoon.

Introduction of bills.

Oral questions.

MR. SPEAKER: The Hon. Member for West Vancouver-Howe

Sound.

MR. SPEAKER'S TELEPHONE

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

I would like to address a question to the Speaker. I notice

that you have a telephone at your place. Would you indicate to

whom it is connected?

MR. SPEAKER: Directly to my secretary, and she didn't send

in what I asked her to.

MR. WILLIAMS: Just as long as it's not God, Mr. Speaker.

(Laughter).

MR. SPEAKER: I could use His help too.

HOSPITAL BOARDS TO PAY

COST OF IN-SERVICE TRAINING

MR. WILLIAMS: Mr. Speaker, I would like to address a

question to the Hon. Minister of Health. With reference to the

in-service training of students in some of our universities and

senior schools and their in-service training in hospitals. This

covers a number of disciplines. Would the Minister indicate

whether his department has any programme which will enable the

hospital boards to pay the cost of in-service training?

HON. MR. COCKE: Mr. Speaker, in answer to that question — it's a very fair question, for that matter — we have no

programme at this time to finance university and/or BCIT health

trainees. However, the department is at the moment discussing

the whole question of in-service training. We recognize there

is a need to put the young people to work in health services if

at all possible, as opposed to going out during the holiday

season working on roads or working in some other area that they

are not being trained for.

Our department is viewing this very seriously at the present

time and we hope we can come up with some kind of programme

that will help.

MR. WILLIAMS: Supplementary, Mr. Speaker. Specifically with

respect to that part of the training which is required in the

sense of practicums and internship: is it in that direction

that the Minister is looking at the provision of funds that may

be required?

HON. MR. COCKE: Yes. The problem is, of course, that most of

the health facilities in the province are totally autonomous or

relatively autono-

[ Page 1296 ]

mous, depending on where you want to grade it. Because of

their autonomy, they have the right to decide whether or not

they will pay a certain group of people.

Traditionally, as you know, interns and other people, even

more so in some of the other health trainees' cases, have been

brought into the hospitals and have worked for nothing as part

of their educational programme. I would like to reverse this

trend and make it an opportunity for us to help finance their

education. I think it is a very important education. That is

the way I feel.

MR. SPEAKER: The Hon. Member for North Peace River.

TELEGRAMS ON BILL 42

MR. SMITH: Thank you, Mr. Speaker. A very short and, I hope,

concise question to the Hon. Attorney General. Is the Attorney

General passing along the telegrams he has received on Bill 42

to the Minister of Agriculture (Hon. Mr. Stupich) so that the

Hon. Minister of Agriculture can keep a close track and records

on both the pro and the con side of the debate?

HON. A.B. MACDONALD (Attorney General): I have kept my

telegrams and I have had some very good ones. I have told the

Minister of Agriculture about them and it has cheered him up

tremendously.

Some of them are beautiful, I must let you see them.

MR. SPEAKER: The Hon. Member for Oak Bay.

SANDRINGHAM HOSPITAL

MR. G.S. WALLACE (Oak Bay): To the Minister of Labour. Could

he tell the House in light of further discussions which he has

had whether there is any further decision regarding the

labour-management strike at the Sandringham Hospital?

HON. W.S. KING (Minister of Labour): Mr. Speaker, I am not

sure who he is referring to with respect to decisions. The

Department of Labour is still involved in discussions with the

parties to the dispute. At this particular point there is no

further news that I can give the House. We are in consultation

with the parties.

MR. SPEAKER: The Hon. Member for Cariboo.

APPEAL TO COURT ORDER

RE KAMLOOPS AREA

MR. A.V. FRASER (Cariboo): Mr. Speaker, a

question to the Minister of Municipal Affairs. Has the

Minister issued instructions to any legal firm to pursue an

appeal to the court order, seeking to restore the democratic

franchise to the residents of the Kamloops area?

HON. J.G. LORIMER (Minister of Municipal Affairs and Commercial Transport):

The question is under discussion with my lawyer.

PROSECUTIONS UNDER

MORTGAGE BROKERS ACT

MR. SPEAKER: The Hon. Member for North Vancouver-Capilano,

and followed by the Member for Langley.

MR. D.M. BROUSSON (North Vancouver Capilano): Mr. Speaker, I

would like to address a question to the Hon. Attorney General.

Would the Attorney General advise the House if there have been

any prosecutions to date under the Mortgage Brokers Act ?

HON. MR. MACDONALD: I'll have to take the question as

notice.

MR. BROUSSON: I'm sorry, I didn't hear.

MR. SPEAKER: To take the question as notice and no doubt

reply on the order paper.

The Hon. Member for Chilliwack.

FUNDS USED TO PAY

MENEHAN AND DUNSKY ADVERTISING

MR. H.W. SCHROEDER (Chilliwack): The question is directed to

the Hon. Premier and Minister of Finance. On February 20 last,

in answer to a question, the Premier as Minister of Finance

advised the House that there were no advertising contracts in

the Department of Finance with Menehan and Dunsky Advertising.

As the Minister of Finance acts also as president of the

British Columbia Railway, would he advise the House what funds

were used to pay the three representatives from Menehan and

Dunsky Advertising listed in "The Way Out" bibliography and

acknowledgements?

HON. D. BARRETT (Premier): That material was prepared by the

group gathered together under professional law as consultants

and all the bills will be paid by the B.C. Railway. It is a

B.C. Rail proposal and the B.C. Rail will pay for the

consultant.

The printing was done by the Queen's Printer.

MR. SCHROEDER: Supplementary: Does Menehan and Dunsky

Advertising have any special

[ Page 1297 ]

relationship with this Government since they handled the

campaign literature for the election?

HON. MR. BARRETT: No special relationship — just like Bill

Clancey. No special relationship. (Laughter).

MR. SPEAKER: The Hon. Member for Langley.

Interjections by some Hon. Members.

MR. SPEAKER: Order, please. There is no point of order.

Would you kindly sit down. Order, please. The Hon. Member for

Langley.

FERRY SERVICE

IN OCEAN FALLS AREA

MR. R.H. McCLELLAND (Langley): Mr. Speaker, my question is

addressed to the Hon. Minister of Lands, Forests and Water

Resources. The last time, Mr. Speaker, that the Minister was in

the House for the question period, which seems some time ago

now, he indicated that he had some rather great plans for the

general area of the B.C. middle coast, in particular with

reference to Ocean Falls. I'd like to ask, Mr. Speaker, if this

planning involved the Minister of Highways in carrying out the

former government's undertaking to provide adequate ferry

service in that region.

HON. R.A. WILLIAMS (Minister of Lands, Forests and Water Resources):

The bulk of the work undertaken to date has been directly with the Crown Zellerbach

company itself.

MR. McCLELLAND: Supplementary to the question, Mr. Speaker:

There was an authorization by the Treasury Board given to the

joint committee, which consisted of the former Minister of

Highways, the former Minister of Municipal Affairs and the

former Minister without Portfolio, the Member for Mackenzie, to

provide ferry service for that area. Has that authorization

been cancelled?

HON. MR. WILLIAMS: I might say, Mr. Speaker, that some

further consideration has been given to the question of ferry

service in that area. That's all I might say at this stage.

MR. McCLELLAND: Mr. Speaker, if there are substitute plans

for that area, could the Minister give any indication of what

those substitute plans are? Has the authorization for that

ferry service been cancelled?

MR. SPEAKER: Excuse me. One minute, please, before we go further in

the supplementaries. I take it that this really is directed to the Department

of Highways, is it not?

MR. McCLELLAND: Mr. Speaker, I asked the question of the

Premier last week. The Premier suggested that the matter must

be dealt with under the Minister of Lands, Forests and Water

Resources. That's why I've directed this question to him.

HON. MR. WILLIAMS: I think it's really part of the whole

general question. We expect that there will be an announcement

before very long.

MR. McCLELLAND: Just one further question, then, on the same

area, Mr. Speaker. Is there any truth to the rumour that the

Government is entering into …

MR. SPEAKER: Order, please.

PURCHASE OF

OCEAN FALLS PAPER MILL

MR. McCLELLAND: I'm sorry, Mr. Speaker. Is it true that the

Government is entering into negotiations to purchase the paper

mill in Ocean Falls?

HON. MR. WILLIAMS: I accept the question as notice, Mr.

Speaker.

MR. SPEAKER: The Hon. Member for Chilliwack.

MAN AND RESOURCES MEETING

MR. SCHROEDER: This question is for the Hon.

Minister of Lands, Forests and Water Resources. Were the Man and Resources

programme employees of the government given any instructions to hold a meeting

in the Oak Bay Junior auditorium last night? If so, were they advised to place

the Government's position on Bill 42 before the assembly?

HON. MR. WILLIAMS: I would like to make it abundantly clear,

Mr. Speaker, that the Man and Resources programme, which is

being carried forth across Canada under the Canadian Council of

Resource and Environmental Ministers, is totally independent.

Some funding is provided and was provided under previous

budgets. Possibly supplementary funds might be found later this

year. But they are totally independent. They have their own

regional representatives and govern themselves.

Orders of the day.

House in committee of supply; Mr. Dent in the chair.

[ Page 1298 ]

ESTIMATES, DEPARTMENT OF

HEALTH SERVICES AND HOSPITAL INSURANCE

Vote 87: accounting division, $339,042 — approved.

Vote 88: public health services, general services $2,181,586 — approved.

. One vote 89: public health services, division for aid to handicapped — $733,924.

MR. L.A. WILLIAMS (West Vancouver–Howe Sound): On the question of aid

to the handicapped, would the Minister advise whether or not, in the course

of the assistance that his department provides, they concern themselves with

the matter of construction of facilities for use by the handicapped. We've had

speeches in this House — from the Member for North Vancouver–Seymour (Mr. Gabelmann)

in particular — raising question as to the adequacy of, apartment construction

and public building construction.

It seems to me that since this Minister is involved in

matters of rehabilitation and so on, rehabilitation through all

aspects of the lives of the handicapped people is an essential

thing. We're all particularly concerned about the instances

raised by the Member, where handicapped people are living in

accommodation which must be patently unsafe by reason of the

construction of stoves and kitchen equipment and so on. I would

like to know if the department is taking any positive view with

regard to recommendations which may go forward to other

Ministers concerning changes that must be made.

MR. CHAIRMAN: I recognize the Hon. Minister of Health

Services and Hospital Insurance.

HON. D.G. COCKE (Minister of Health Services and Hospital Insurance):

Yes, Mr. Chairman, there is a concern around the construction of facilities.

There have been capital grants from the Government for construction of facilities

but that does not come from the health department. That comes from the Department

of the Provincial Secretary.

In our particular situation, which is operating funds or operating grants

or paying for services, these are federal matching grants. On that basis we

are providing those grants. It could be that in the future, more of the health-oriented

granting will be done by the health department, as opposed to that other department.

But up to the present time, it has not been. We are trying very hard and as

quickly as we can to rationalize some of these anomalies, at least what we feel

are anomalies. As soon as we can, we will.

MR. WILLIAMS: On the same subject, Mr. Chairman, last night on television

many of the Members had the opportunity of seeing a report which was done on

transportation facilities which are available in Vancouver.

HON. MR. COCKE: Transportation?

MR. WILLIAMS: Yes, the Community Transport Society. Many of

their customers are handicapped people. One of their greatest

needs for transportation is travel to hospitals and doctors for

the purposes of physiotherapy and other similar rehabilitative

treatment. I understand that this particular service is an

expanding one. They're running into financial difficulties.

Could the Minister indicate whether or not his department is

concerned in this aspect as well?

HON. MR. COCKE: Yes, Mr. Chairman, we're quite concerned

about it. However, that financing is done by the Department of

Rehabilitation and Social Improvement. As a matter of fact, the

Minister of that department (Hon. Mr. Levi) has given a large

sum of money in support of some of the transportation

facilities in the province. It is not handled directly through

health because of another federal sharing arrangement under

CAP.

Vote 89 approved.

On vote 90: public health services, prescription drug

subsidy plan, $1,563,978.

MR. CHAIRMAN: I recognize the Hon. Member for Columbia

River.

MR. J.R. CHABOT (Columbia River): Mr. Chairman, I was

wondering if the Minister would give us a little bit of

background detail on the prescription drug subsidy plan, such

as: how many people are benefiting from this plan? what are the

numbers he expects to participate during this current fiscal

year? what kinds of guidelines and checks might your department

have established to ensure that only those people who genuinely

need this type of subsidy will receive this type of

subsidy?

I am aware — and I will be informing the drug subsidy plan

of it — of two individuals who really shouldn't have these

yellow cards to got subsidized drugs. These people are

independently wealthy. They're almost as rich as the Minister

of Lands, Forests and Water Resources (Hon, Mr. Williams). They shouldn't participate in a drug subsidy plan in this

province. Just what kind of security check do you have to

ensure that only those people who are in need really

participate in the plan?

HON. MR. COCKE: Mr. Chairman, we would have

[ Page 1299 ]

had a pretty good system of keeping control of this

situation, had the prescription drug subsidy plan not been

messed up during the last election campaign. Prior to that, the

subsidy plan was based on the qualifications for a subsidy for

Medicare, which is relatively straightforward. It's not quite

right yet. I hope that someday we're going to be able to

rationalize that. But anybody who qualified for the Medicare

subsidy would qualify for the prescription drug subsidy.

But then, unfortunately, the Minister at that time during

the campaign indicated on television that anybody with dire

need could also qualify, providing he put in an application.

Well, everybody has dire need, so they feel. And it's taken us

a good deal of time to work our way out of that problem. So, to

date our present policy is that those people who qualify for

the Medicare subsidy also qualify for the prescription

subsidy.

MR. CHABOT: Just on one further supplementary question, Mr.

Chairman. The Minister is twisting words. "Dire need" in my

opinion would certainly indicate very clearly that people are

receiving the overall medical plan subsidy. That's similar to

your twist today when you talk about a $25 car insurance. And

today it's no longer $25 car insurance. You're twisting words

that are …

MR. CHAIRMAN: Order please. Would the Hon. Member be seated.

Would the Hon. Member be seated, please. I would ask the Hon.

Member not to impute bad motives to the — order please — to any

Member of this House. Now, if you want to ask a genuine

supplementary which would pursue the subject further, then you

may do so.

MR. CHABOT: I'm not imputing any motives, Mr. Chairman and

you know it. I'm just saying that he's twisting words and you

know that too. It's a fact. All I ask is that he clarify a

matter; he says that anyone that qualifies for a subsidy on the

medical plan, qualifies for the drug subsidy plan as well. It's

my information that only those that qualify for the 90 per cent

subsidization qualify for the drug subsidy plan.

There are people that — qualify for 50 per cent of the

medical plan, but do not qualify for the subsidy under the drug

subsidy plan. I think he should make that abundantly clear.

You have left the impression here this afternoon that those

people that do qualify for a subsidy of any amount on the

medical plan qualify for the drug subsidy plan — which is not a

fact in the understanding of the plan as I know it.

HON. MR. COCKE: Mr. Chairman, it's interesting to say the least. The

Member across the way gets up and starts making all sorts of claims about lands,

forests, water resources in his questioning. And then he expects me to respond

impassively, Mr. Chairman. I don't feel that that's necessary. I respond in

like. And I respond to those people who twist …

But anyway, Mr. Chairman, the fact of the matter is as I

indicated — and if I didn't I'm sorry — that those who qualify

for whole subsidy under Medicare, yes, that's quite right; full

subsidy under Medicare — also qualify for the drug subsidy.

MR. CHAIRMAN: I recognize the Hon. Member for North Peace

River.

MR. D.E. SMITH (North Peace River): Thank you, Mr. Chairman.

This vote was transferred, as I see it, from a previous

Minister's jurisdiction into your jurisdiction. Would the

Minister tell me the amount of the vote for the last year, as

compared to this year? I see this year it's $1,563,978. What

was it before?

HON. MR. COCKE: Mr. Chairman, that Member knows perfectly

well it was a special warrant of last year's government that

was declared after — it was declared after this House rose last

time. It was a brand new programme that was in anticipation of

events to come. Mr. Chairman, there was no vote for that last

year. The expenditure last year…I think there was an

election, wasn't there? Yes, the expenditure last year was

$371,000.

MR. CHAIRMAN: I recognize the Hon. Member for Oak Bay.

MR. G.S. WALLACE (Oak Bay): Mr. Chairman, could I ask the

Minister if he has any thoughts of enlarging or altering this

basic concept that he outlined, that the qualifications would

be those pertaining to subsidies under Medicare. Is there any

thought of expansion or alteration?

HON. MR. COCKE: Yes, Mr. Chairman. What we're trying to do

right now…as you know the Medicare Commission also reports

to the health department. So what we're trying to do now in

both those departments, Mr. Member, through you, Mr. Chairman,

is try to design a new kind of formula that will take care of

both. The inequity of that kind of formula is perfectly

obvious.

The trouble with it is, that this year you might very well

be earning $20,000 a year; but because last year you weren't

working and you qualify, this year, when you don't need it,

you'll be getting a subsidy. Possibly next year, when you're

out of work again, you won't be getting a subsidy because of

what you're earning this year. We know how unfair it is. And

we're trying our very best to try to work out a

[ Page 1300 ]

formula.

MR. CHAIRMAN: I recognize the Hon. Member for West

Vancouver-Howe Sound.

MR. WILLIAMS: Mr. Chairman, on the drug subsidy plan the

amount to be expended for the subsidy itself in the next fiscal

year is $1.5 million. I wonder if the Minister would indicate

the basis upon which that allocation is made; because in the

interim financial statements for the 9 months ending December

31, 1972, it would appear that only two warrants had been

issued under the prescription drug subsidy plan. One was in

August for $150,000, which was spent, and one in October for

$375,000 of which only approximately $180,000 had been spent.

And yet we're indicating next year the cost would be $1.5

million.

Now, as well as that specific detail I think we should have,

it's noteworthy, Mr. Chairman, that the employees engaged in

the functioning of this plan — 10 in number — are all clerks or

clerk-stenographers. And, of course, no one is suggesting that

we don't have to have stenographers or clerks functioning. But

I think the Minister should clearly indicate who has control

over this kind of expenditure.

What members of his senior staff are looking after the

management of this subsidy plan, because it is a significant

amount of money — and probably one for which much more money

should be provided if we're really going to do a job on the

subsidizing of prescription drugs. And other Members have

spoken on just how essential they are for so many people in our

community.

Now, on that same subject, would the Minister please

indicate whether he has had any indication of success with the

medical profession in the encouragement of prescribing drugs

generically, rather than by the use of trade or brand names?

This was a programme which I understood the previous

administration was attempting to foster, and certain

regulations were prescribed in this regard.

Recently I've seen it suggested that the medical profession

has in some cases resisted this proposal because of a concern

on their part as to the quality of the drug prescribed

generically, rather than by trade name. This is, if true, a

very serious thing and, I think, one that I'm sure the Minister

and his staff must have investigated.

HON. MR. COCKE: Mr. Chairman, first let me say — and I'll answer one

of the questions first. As far as the people who are running that programme,

the departmental comptroller and the assistant comptroller, who are paid out

of another vote, are the executives in charge of that programme — highly qualified,

well trained people for that kind of work. O.K.?

The second thing is the income tax — you asked why we're

increasing the value of the vote. Well, this year the income

tax exemption, as you know, has been increased. That means that

there will be a number more people qualified than qualified

before. Not only that, this programme is becoming better known

throughout the community.

Many people did not know that there was a drug subsidy plan,

and many physicians didn't suggest it, and that sort of thing.

But it is becoming more widely understood, and more widely

utilized. On that basis we don't want to underestimate. We feel

that this is a relatively safe and sound estimate of our

expenditure this year.

As far as the success with the profession, Mr. Chairman,

through you: I don't know. I can't tell you. We haven't had any

real serious consideration of this matter in my department, or

in this department, since I've been the Minister. We are at the

present time discussing the whole question of Pharmacy Act,

pharmacy and so on, and so forth, with people in that

profession.

As far as whether the doctors are putting on their stamp, no

substitutes and that sort of thing, I haven't heard too many

reports of that. I am a little bit sympathetic to them

insisting that there's a high quality.

Granted, the federal people are now involved in standards. But until such time

as they've had an opportunity to assess the wide range of drugs that we have

in Canada — as to their standards, as to their quality, it's very difficult

to insist that you have no alternative — or at least that you can provide that

alternative,

MR. CHAIRMAN: I recognize the Hon. Member for Oak Bay.

MR. WALLACE: Mr. Chairman, I think it's rather important to

follow that a little further if I may, in terms of the degree

to which we are provincially in serious discussion with the

federal government. I'm sure the Minister has just read in the

Press the other day about this federal programme called "Quad."

I can't remember just exactly how the letters add up to …

quality of drugs.

This really, Mr. Chairman, is a very important problem in

our society. Nobody questions the fact that we must attempt to

provide drugs at reasonable cost. This is a premise we would

all totally accept, I'm sure.

The federal government has made several attempts in this

direction, and even this latest attempt, called the Quad

programme, is running into some serious criticism by people who

know what they're talking about. I'm not necessarily just

talking about people with vested interests. I'm talking

about

[ Page

1301 ]

people who are interested in the chemical assay of drugs and

what we call their bio-availability — the degree to which the

drug ever gets into your system once you swallow it.

With the ever increasing range of different drugs being

discovered and refinements of former drugs, this is a

fantastically big job for even the federal government to

tackle. Now, I know that they've increased their budget. I

don't have the figures right with me, but in the last two or

three years they have increased this enormously. Even now the

federal people themselves are admitting what a very large task

this is, with drugs produced domestically in Canada and drugs

that are imported into Canada.

If there's any thought again that doctors in particular are

not aware of the tremendous financial burden that it can be to

some of the patients, I would strongly say that that is not the

case. Once again, it's rather like some of the comments that I

made the other day. Primarily the doctor is interested in

protecting the patient and in giving the patient drugs which

are to be of value. If you pay $2 for a prescription and the

drug never gets into your bloodstream, you might as well pay $4

and at least get what you think you're getting in terms of the

pharmacological effect.

I think that this is such a big problem and a very vital

one, that I wonder if the Minister is considering any closer

federal-provincial understanding or committee with this latest

federal body trying to solve this problem across Canada.

Would he like to comment on the fact that this is obviously

the route we have to go? It's very difficult to carry out this

kind of work provincially when so much study and expense are

involved. Since the federal government is going into it in an

ever increasing degree, perhaps we should be much closer to

them in our deliberations on this.

HON. MR. COCKE: Mr. Chairman, when the Ministers of Health

met in Regina in October, we had a long discussion on the whole

question of drugs. At that time, the Quad programme had been

established for some time but I think they merely managed to

get to a range of about six drugs. We recognize that if they

are going to keep going at that rate, either it would be a

failure or something would have to give and the provinces would

have to assume some sort of responsibility. I think this is an

area where the federal government belongs, and I think they

accept that. I think that we should be responding to and

cooperating with them as much as we can.

We've met with Manitoba and two or three other western provinces and discussed

the whole question of buying of drugs and one thing and another. We feel it

can only be done if, in fact, the quality standards are set some place — we

feel that the place to do that is in Ottawa. So we're open, and we're cooperating,

and we'll do anything we can. Manitoba has threatened, of course, to go on their

own programme, but they're too small and so are we. It's just too monumental

a task. Therefore we'll do anything we can to help them keep that programme

going.

Vote 90 approved.

On vote 91: development of alternative care facilities,

$600,000.

MR. CHAIRMAN: I recognize the Hon. Member for West

Vancouver-Howe Sound.

MR. WILLIAMS: Mr. Chairman, I wonder if the Minister would

indicate precisely how these moneys are to be expended in the

next year. We're increasing the appropriation by $100,000 in

these estimates. Yet in the 9 months ending December 31, 1972

while there was $500,000 to add, last year — the department had

only expended $239,000. What's it for? Who's running the

programme? What kind of alternative care facilities are being

contemplated for development that would require this kind of

money?

HON. MR. COCKE: Well, Mr. Chairman, let's go backwards.

Who's running it? The hospitals are running it. This is that

community-based home care programme. It didn't get underway

last year at all, to the extent that we wanted it to. As a

matter of fact, some of the moneys that were in this vote were

not used for that programme at all. This year, however, those

moneys are to be used for that programme. Ultimately it will be

phased into our whole home care programme. We're negotiating

with Vancouver right now.

It's very hard to understand, Mr. Chairman, but when you

deal with old votes and new votes, it's very difficult. That's

why I'm trying to explain — this is a home care programme that

last year was in Kamloops, Coquitlam, New Westminster and

Victoria. O.K. This year we're expanding it and the health

units, together with the hospitals, will run the programme. We

hope to expend all of this money and more, Mr. Chairman,

because we'll be moving into that other vote on home care. But

that's precisely what it is. It's to reduce the utilization of

acute care hospital beds by getting people out early and taking

care of them at home.

MR. WILLIAMS: Am I to understand, Mr. Chairman, that the

hospitals and the agencies in the communities will establish

the programme and then submit the programme to your department

for approval, along with some estimate of the likely cost, and

that then there'll be a grant made to cover those costs? Is

that the way it would function?

[ Page 1302 ]

HON. MR. COCKE: Yes, we pay the salaries. Naturally they

have to decide roughly on the cost and we estimate what the

cost will be. For example, for Vancouver, which is a major

undertaking as you can well imagine, there's a large estimate

of cost. Therefore we just pay for the service directly — in

other words, the salaries or whatever else is entailed in this

programme.

MR. WILLIAMS: But surely the hospital which establishes the

programme must first submit it to you to get your approval. Are

you just giving them carte blanche approval?

HON. MR. COCKE: No, it's the health unit that establishes

the programme in cooperation with the hospital. We say to the

hospital, "Look, we are going to try to lower your

utilization rates. This is the way we'll do it…. . " Now the

hospital has to be in total touch with the programme, but the

health unit has to do the financing.

MR. CHAIRMAN: I recognize the Hon. Member for Oak Bay.

MR. WALLACE: Mr. Chairman, could I just clarify that this

item has nothing to do with the financing of the special care

facilities. This is included, I take it, under hospitals and

health services — the special care facilities.

HON. MR. COCKE: No, nothing to do with special care.

Vote 91 approved.

Vote 92: Hearing Aid Regulation Act, $15,000

-approved.

Vote 93: grants for health agencies, $813,000

-approved.

On vote 94: narcotic addiction treatment centres,

$100,000.

MR. CHAIRMAN: I recognize the Hon. Member for Oak Bay.

MR. WALLACE: Mr. Chairman, we've had a great deal of

discussion about this whole subject, and the Minister of

Rehabilitation and Social Improvement (Hon. Mr. Levi) has made

a statement of general policy.

I wonder if the Minister of Health at this point can tell us more specifically

the direction that will be followed in the near future. I know this is a very

complicated and difficult subject, but it's also a very urgent one. It is increasing,

and the figure here is the same as last year.

The Minister of Rehabilitation and Social Improvment had

mentioned — and I agree with this — that the funds should

perhaps better be dispersed to the community level. There was

an implication, if not an outright statement, that such moneys

would not be provided to centralized foundations in

metropolitan centres, with very little effective treatment at

the periphery. I wonder if the Minister has had the time to

work out any kind of new formula, or whether this is just

marking time until the new policy develops. Could he comment on

that, please?

HON. MR. COCKE: Mr. Chairman, the latter part of your

statement is quite right, Mr. Member — this is marking time.

The Minister of Rehabilitation and Social Improvement did

announce that there are new directions — community-based

directions. That's the way we're going to go, but for the time

being there's certainly no way that we're going to pull the

carpet out from under those agencies that are now functioning,

which might very well be, in some cases, part of the new scheme

of things.

So we feel that it's absolutely necessary to leave this vote

in and continue on with the programmes we have until such time

as we have alternatives. It's just like taking a crutch away

from a wounded person.

Vote 94 approved.

On vote 95: public health research, $600,000.

MR. CHAIRMAN: I recognize the Hon. Second Member for

Vancouver–Point Grey.

MR. G.B. GARDOM (Vancouver–Point Grey): Mr. Chairman, a

couple of questions to the Hon. Minister. It seems from recent

reports that the federal government will be coming out with the

results of its nutritional study around October of this

year.

I also read in the paper a very alarming account of Dr. Z.I.

Sabry, who's the head of Nutrition Canada. He said there are

more foods with less nutritional value creeping into Canadian

diets and suggested tighter controls on manufacturers are

needed. It carries on:

"The programme 'Give us This Day our Daily Bread' said that

one-third of all medical costs are to repair damage from

malnutrition — everything from vitamin deficiency to obesity,

arteriosclerosis to salmonella poisioning. The programme

challenged a long-time medical assumption that children, if

left alone, will instinctively choose a healthy and balanced

diet."

Mr. Chairman, I don't think we've ever had any indication of

provincial strength in British Columbia in this particular

area. I'd ask the Hon. Minister: Do we really have public

nutritionists in the Province of

[ Page 1303 ]

B.C.? If so, where do they hide? What are they supposed to

do? Are there any available programmes? Is there any available

material?

I've advocated in this House many times over the years that

the nutritional quality of foodstuffs — and of drink too, for

that matter — should be taught within our school system. I

appreciate that this is outside the area of the Hon. Minister,

but the lady Minister (Hon. Mrs. Dailly) is just sitting in

front of him and I know the two of them get along exceptionally

well together. Perhaps he would be able to use his many charms

to influence her to see that we have a school programme along

these lines.

I feel very, very strongly that if breakfast cereals, apart

from being pleasantly contained and tasty, are nutritionally

phony, the public should know about that. I'd say that if what

I'd call "Phonyos," by virtue of secret decoders or

chances at moon trips, are being shoved onto the breakfast

tables in this province, notwithstanding the fact that they are

nutritionally bankrupt, then something is wrong and the public

should know something about it. Maybe we need a "Nosey Nader"

in this province to look into the business of processed

foods.

I would ask the Hon. Minister if he would not be in favour

of placing a greater emphasis upon a fair and reasonable

understanding of packaging, and teaching the people within the

province, specifically through the schools, how to relate the

cost of product one to the other.

We've got to concern ourselves, as the Minister indicated a

few moments earlier in his remarks, as to standards and to

quality. I do feel very strongly in this particular area. Our

headway in the province has been miserable to say the least.

I'd appreciate his comments.

HON. MR. COCKE: Mr. Chairman, let me first say I want to

congratulate you on your patience for tolerating a discussion

on Marc Lalonde's vote. That research that you are talking

about, Mr. Member, is research being done solely by the federal

government. But it's very relevant.

As far as our work on nutrition is concerned — and I would

hope that you will be as gracious with me as you were with that

Member so that I might answer the question — we will have now

four times as many nutritionists on our staff as we had last

year. Four times as many.

AN HON. MEMBER: How many is that?

HON. MR. COCKE: Four. (Laughter).

Mind you, both metropolitan areas have nutritionists. You

will note that we've done TV programmes for this local area on

nutrition in recent months. They're going to be shown all over

the province.

AN HON. MEMBER: What are their terms of reference? What are

their duties?

HON. MR. COCKE: Their duties are, of course, to co-operate

with the Hon. Minister, of Education's (Hon. Mrs. Dailly)

department. All through our department they do in-service

training, for instance, of all public health nurses. They can

even teach doctors, can you imagine it, about the feeding of

the human being.

Mr. Chairman, we are quite concerned about the whole

question of nutrition. We're waiting for the reports that come

out of Ottawa on a rather extensive research programme. Some of

the reports that we've seen from the States indicate very

clearly that cereals just aren't worth the powder to blow them

out of the kitchen. I hope that we can do a lot of educating

with respect to that.

As a matter of fact our head nutritionist in one of her last

little brochures that she's made has been pushing Crunchy

Granola for kids. I think that's a very, very much better kind

of cereal than ones that they've been accustomed to in the

past.

MR. CHAIRMAN: I recognize the Hon. Member for

Nelson-Creston.

MR. L. NICOLSON (Nelson-Creston): Thank you, Mr.

Chairman.

The responsibility for enforcement of certain regulations

falls to the local public health officer, the medical

specialist. A problem which comes up here is the hours of work.

I refer specifically to a problem where, with commercial

campsite facilities, on a weekend such as the Memorial Day

holiday weekend, United States tourists overcrowd campsites. I

have had complaints of these sites being overcrowded.

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

he wouldn't mind bringing it up under vote 98 rather than vote

95, which deals with public health research.

I recognize the Hon. Member for West Vancouver Howe

Sound.

MR. WILLIAMS: Mr. Chairman, I borrow a line from the

Attorney General (Hon. Mr. Macdonald) when he sat in

Opposition, "What are you doing over there?" You want $600,000

for public health research. You know, these block votes are

very, very convenient, but we only spent $270,000 in nine

months last year. What do you want the $600,000 for?

handicapped, a $700,000 vote. There are 18 people on staff

under that vote, Now here we have $600,000, public health

research. What are you doing? What are we researching? Who's

doing the

[ Page 1304 ]

research? What areas are we looking into? Dental care?

AN HON. MEMBER: Ottawa.

MR. WILLIAMS: No, Ottawa's carrying on certain significant

research programmes. Here we have a $600,000 item for public

health research to be done in this province. I think we're

entitled to know what is being done and who's doing it.

HON. MR. COCKE: Yes, Mr. Chairman, quite right. Up until now

and I'm not sure that it will always be that way most of the

research grants have been approved through the universities. In

other words, the university has been charged with the

responsibility of assessing whether or not this is a good

project. That sometimes delays the area.

Let me say this: the expenditures in 1966-67 were $453,000;

1967-68, $494,000; 1968-69, $749,000, and so on. Last year,

1971-72, $522,000; this year to date — now it depends. You give

research grants but you don't put all the money in until such

time as criteria are met.

Some of the things that we've been doing are glaucoma

research, anaerobic treatment of animal wastes research, risk

factors among young drivers, 16 to 24 — some research there.

We've done some development of moral judgment in-depth

adolescence.

I agree, Mr. Chairman, that there should be a greater

interest, a greater participation in this whole question of

research. But we have to be very, very careful that we're not

duplicating. That's one of the great fears.

As a matter of fact, one of your Members is indicating very

clearly that we do need some coordinating activity to go into

this question of research. Right now the Foulkes committee is

looking into that very idea.

MR. CHAIRMAN: I recognize the Hon. Second Member for

Vancouver–Point Grey.

MR. GARDOM: Mr. Chairman, while the Hon. Minister was

talking about research, are there any steps being taken in

dental — if I have his attention — are there any steps being

taken in dental research? I wonder if the Hon. Minister could

inform me if he happens to know where the closest dentist to

the parliament buildings is. While he was giving his last reply

my tooth fell out. (Laughter).

HON. MR. COCKE: Mr. Chairman, I offer condolences.

MR. GARDOM: That's typical.

Vote 95 approved.

Vote 94: grants, subsidies for local health services,

$575,000 — approved.

On vote 97: health security research project, $125,000.

Mr. CHAIRMAN: I recognize the Hon. Member for Langley.

MR. R.H. McCLELLAND (Langley): Mr. Chairman, my question is

perhaps somewhat opposite to the last Member's question about

costs. I'm wondering, when the total amount of this vote is

$125,000 and the committed full-time salaries are already

almost $119,000 plus two other part-time people at $1,500 a

month, plus $10,000 already spent for advertising and perhaps

more to be spent, how are you going to pay all of that out of

$125,000 and will there be more money put into that from some

other vote?

MR. CHAIRMAN: I recognize the Hon. Minister of Health

Services and Hospital Insurance.

HON. MR. COCKE: Mr. Chairman, last year there was a special

warrant. As you know, we weren't elected until August. I set up

the health security programme in September and there was a

warrant for the balance of last year. This is in the estimates

for this year's activities which will only go until

October.

As I indicated to the House sometime ago, the health

security programme, as far as I'm concerned, is one of the most

positive steps this Government has taken with respect to health

care. We feel that the work they have already done in advice

has more than paid for any expense they put this Government

to.

MR. McCLELLAND: Mr. Speaker, with respect, I don't think the

Minister has answered my question. In fact, I'm sure he hasn't

answered my question, because it would seem to me that

regardless of whether the programme is scheduled to end in

October or not we seem to be committed for that total amount of

money this year.

MR. CHAIRMAN: Order please. The Minister has answered the

question, inasmuch as he said that a warrant had been provided

until March 31 of this year and that this money is budgeted for

the coming fiscal year beginning April 1.

I recognize the Hon. Member for Oak Bay.

MR. WALLACE: I'm not particularly questioning the financial output.

I would like to ask a question about the continuing philosophy behind this kind

of project. I think the debates so far — Members who

[ Page

1305 ]

spoke on your salary debate, Mr. Minister, through you — have made it very clear that the whole realm and range of

health services is a very complicated and expensive one.

The techniques and the discoveries and the new drugs and

prostheses and all the breakthrough that occurs almost month by

month in this whole field would suggest it is very difficult to

maintain services and personnel and medical education and a

host of other things in an up-to-date and economical way. I am

wondering if the Minister is anticipating…I think this is

the second $125,000 we are budgeting for, is it not?

HON. MR. COCKE: Yes.

MR. WALLACE: This was, I think, to be a one-year project

when it was first conceived. I am just wondering in the light

of: (1) the success that he has described; (2) the complexity

of health care and (3) the rapid advances and new treatments in

technology, et cetera — whether, in fact, he is considering

this as a continuing project and as an integral part of his

ministry?

HON. MR. COCKE: Well, Mr. Chairman, I would be anticipating,

as I indicated to begin with, that I am sure that out of a $433

million department, we should be spending some money to try to

save money. That's what the health security programme is all

about; to rationalize and to coordinate the efforts of our

department — which is four departments, as you know.

I don't really know. I am sure we will be doing further

research; and whether or not Dr. Foulkes or any number of his

people will be doing that specific work, I can't say at this

time. All I can say is that in a monstrous department with

fantastic investments such as this, we will have to have a

great deal of help in trying to keep things coordinated.

MR. CHAIRMAN: I recognize the Hon. Member for Langley.

MR. McCLELLAND: Mr. Chairman, I would just like to ask the

Minister if it is true then that the $125,000 total vote in

this vote 97 means that Dr. Foulkes and the rest of his staff

will be paid for a full year's salary for their work from March

to October; or will their salaries be prorated up to that

time?

HON. MR. COCKE: Well, Mr. Chairman, I guess it is very difficult. Can

I just go this way once more and I don't want to be tediously repetitious. There

is $250,000 in this programme. Because the programme began during the month

of September, the first $125,000 had to be a special warrant. We are now in

a session of the Legislature — the balance is $125,000 which is to be the final.

At least that is the total amount of the plan now — $250,000.

So those people who started at the very beginning and were

on a salary from the beginning — yes, they will be getting that

salary throughout the programme, ending in October. Those

people who started six months later…there are people coming

and going in that programme, but everybody is given a contract

that says he is finished in October.

MR. CHAIRMAN: Shall vote 97 pass?

Vote 97 approved.

On vote 98: Local Health Services, $7,779,011.

MR. CHAIRMAN: I recognize the Hon. Member for

Nelson-Creston.

MR. NICOLSON: Thank you, Mr. Chairman. As I was outlining

earlier the responsibility for enforcement of health

regulations at such facilities as tourist camp facilities,

tenting grounds, trailer parks, falls to the local public

health officer. In recent years we have had some complaints in

our area that the enforcement of this thing was not done

because the problem arose on weekends; specifically on holidays

weekends and most noticeably on the Memorial Day weekend.

Attempts to get the officers out at that time were somewhat

unsuccessful and I don't blame these public health officers.

After all, they are paid a salary. They are expected to be at

work 40 hours a week in addition to normally attending many

meetings with ancillary services in the community. They put in

a lot of time. So, it is not unreasonable that they could

expect to have their weekends to themselves.

I would wonder if there could be some provision made for

time off during the week and for time on during weekends where

we might anticipate this problem would happen again?

[Ms. Young in the chair]

HON. MR. COCKE: Mr. Chairman, it is very difficult to answer the question.

All I can say is that the feedback I am getting in the department is that medical

health officers in these various areas throughout the province are working their

heads off. I know there are cases that have to be overlooked by virtue of a

man's ability to sleep, to work those long hours. All I can say is, that certain

circumstances develop in any area where you just can't meet the needs.

We have to sort of build our public health officers and

staffs on the basis of the normal, expected, anticipated needs.

We are adding 17 new public health inspectors this time around.

There are more PHNs. I think I discussed it the other day — 25

or 30.

[ Page 1306 ]

I think we are moving in the right direction.

MS. CHAIRMAN: The Hon. Member for Dewdney.

MR. P.C. ROLSTON (Dewdney): Mr. Chairman, just a question

about the relationship of the public health people who are

entirely paid for by the taxpayer of B.C. and the private,

general practitioners and the specialists who are partly paid for

by the private sector. It has been confusing to me to know how

to respond — how to see a greater sense of trust and

collaboration and sharing between the public health officers,

certainly the public health nurses; and we could go down to the

public health inspectors, and the private general

practitioners.

Now, we are all here. We want to save money; we want to do

things in the most proper way. We obviously want good medicine:

we want good health. I must say, in my other profession as a

pastor, it has often been quite confusing, in fact even

embarrassing at times, to see the relationship. Now, I know as

a Government we made a commitment towards collaboration and

towards a public type of medicine ultimately. I wonder if you

could just help us so far in this particular situation?

I have had meetings with all 30 doctors in my riding and we

have tried to work out this type of communication and sharing.

The other thing I want to ask, of course, is…right now I

think we have got to be getting some direction from you as to

plants. There seems to be a bit of confusion, in my mind at

least, as to how we start gearing for a public type of outreach

clinic from hospitals.

Private medicine is largely oriented around the hospital as

well as their own offices. But they do a great deal of work in

the hospital, using public facilities — subsidized public

facilities — and yet we put an awful lot of capital into public

health plants, not necessarily anywhere near hospitals. Could

you help us in both of these areas?

HON. MR. COCKE: All I can say for Dewdney is they are lucky.

The member for Dewdney is providing the kind of liaison that is

so lacking in so many areas in the province. He is putting it

together up there. He is getting to see doctors and the health

officers and so on. I just want to commend that Member for

doing a fine job.

Our direction has to be based on the community health and

welfare concept. I'm not speaking in terms now of the community

health centres specifically, but the kind of communication

network that is absolutely essential to provide contact.

Many doctors don't even know where to send a person for some service that that

community might have readily available. What we have to do is get that information

out and get some sort of coordination of the activities of the area, and the

sooner the better. Thanks for your help, Mr. Member.

MS. CHAIRWOMAN: The Hon. Member for North Okanagan.

MRS. P.J. JORDAN (North Okanagan): Thank you, Madam

Chairman. I'd like to go back to this business of health

inspectors in relation to campsites. I don't want to be

misinterpreted because I think I should by nature of our family

associations be very conscious of this — but for a while this

whole business of health inspection of campsites became an

overzealous activity and really rather ridiculous, particularly

in the more remote areas of the province.

I would ask the Minister in instructing his staff to rely on

local judgment when these inspections are made; to recognize

that the needs of a remote fishing camp — which has about a

40-day occupation period, and at that not usually to capacity — would be somewhat different to those in a more populated area

where you have public campsites or private campsites that would

be working under congestion.

As I understand it, from the engineering point of view a

primitive style of chemical privy is much safer as far as

ecology is concerned on the waterfront than a septic tank

that's only used a few months of the year — maybe two or three

months of the year.

We got to the point where we were requiring this type of

installation, septic tanks, on remote Waterfront areas where

they didn't function property because they were overloaded for

a short period of time — maybe even just two or three weeks

during the year. Remote campsites are also required to really

make available a much larger square foot basage for not only

the camping unit, but also 12 ft. set backs for parking plus, I

think it was 30 feet or 40 feet for a driveway space. When you

get into a small lake there is sometimes just not this much

land available nor is it occupied nor is it under that much

pressure. So I would ask the Minister in carrying out his

duties to not let this prohibit a very enjoyable camping

experience for people on the basis of perhaps an overzealous

health rule.

I would like to bring to the attention of the Minister and

his department the problem of septic tanks in the

non-metropolitan areas. I'm not completely conversant with how

these people are trained or if they are, but essentially people

get their advice on the type of septic tank they need through

the health department and the health inspectors. I would

compliment the Minister, this is an excellent service. On the

other hand, they are not highly technically trained people in

this area and all the soil conditions that are run into raise

controversy.

It seems that there is no real training programme in British

Columbia for people who install septic tanks. Nor is there any

real protection for the public

[ Page 1307 ]

when they hire someone who is listed in the telephone book

as a septic tank installer.

If you want to put in a septic tank you will sometimes go to

your public health inspector and he, without making specific

recommendations, will say, "Well, he does a pretty good job."

or, "He doesn't do a good job" and "We found it acceptable."

There's no way you can be sure that the person you hire for

$800 to $1,500 to $2,000 is going to do a proper job.

If the installer takes out the certificate with the health

department then the health inspector does have the authority

to insist that any omissions…Is the Health Minister going

to talk to the Premier all the time, or is he going to listen?

HON. MR. COCKE: He's talking to somebody behind me, Madam

Member.

MRS. JORDAN: It's a good subject for you to listen to.

The only protection you have is if you are alerted ahead of

time by the health inspector that the installer should take out

the certificate from the health office. Then if there is an

error they can say to the installer, "You must go back." Even

then you have to go to court if there's a problem.

There's really no protection for the public at large that

these people are properly trained as to soil conditions; as to

the type of septic tank or holding facility that is most

suitable; and a guarantee that this work is done properly.

It's a lot of money to build a house. And most of these

houses are built by people on a minimum income and smaller

incomes. So I would ask your thoughts on this and if there is

no such training programme; if there is no such certification

programme in British Columbia for septic tank installers, could

you get together with your colleagues and investigate the

feasibility of doing this?

MS. CHAIRWOMAN: The Hon. Minister of Health.

HON. MR. COCKE: Ms. Chairman, going backwards, you're quite

right on the problem that people have with respect to getting a

septic tank. It's installed incorrectly, a permit was taken out

- and they are down the tube for the money that they've lost.

Our public health engineers — and you know that we have a

number of engineers working in our department — are most

uptight about this and are certainly advising ways and means of

getting around this. Up till now there have been problems with

pollution control. I think that some of those are going to be

reationalized in the not too distant future.

As to how we can set up a programme — even on major facilities there's no advice

given by the engineers. So what we would like to see as soon as possible is

a much closer liaison between our public health engineers and those people who

are installing. It might very well be a course.

MRS. JORDAN: You mean BCIT or the vocational school?

HON. MR. COCKE: Yes, that's right.

Going on to the campsite situation. I persuaded cabinet, as

a matter of fact about a month and a half ago, that we should

have an order-in-council that would reduce the impact of some

rather severe regulations around this whole question of

campsites and restaurants, giving the public health inspector a

little more latitude so that he can go in there and make his

own sort of value judgment.

I think that will relieve the situation that you're

describing in areas where there are people for just a portion

of the year and not for the whole year — and that they are not

overdoing it as far as septic tanks and other…So anyway I

think that that's been taken care of. If not, maybe I'll hear

from you next year.

MRS. JORDAN: Could I just ask the Minister one more question

in relation to this? I must confess I left my notes at home on

this so I'm not sure I'm on safe ground.

My understanding is that the public health inspectors, the

new ones, are trained at BCIT. Then they come out with a

classification into the field and there have been problems

where these people are theoretically quite sound, but

practically on very shaky ground. They have been signing

certificates which have left the health unit in an embarrassing

situation. It leaves the chief health inspector having to go

between the public and this individual who wasn't

competent.

A better way to approach this would be to change the

classification procedure. Give these young people the technical

training in BCIT and then send them into the field for 6 months

or a year internship so that they can relate the technical

knowledge that they have achieved with the practical knowledge

and also perhaps gain from the experience of those they're

working with. Then, if they qualify give them their

certificate. Then give another probationary period before they

are given a permanent position as far as staff is

concerned.

I think it would save your department a lot of problems. I

think it would serve the young people much better because they

get an awful lot of fairly technical information while they're

still relatively young and applying it is difficult. It

certainly would appear to serve the public much more

efficiently.

MS. CHAIRWOMAN: The Hon. First Member for

[ Page 1308 ]

Vancouver–Point Grey.,

MR. P.L. McGEER (Vancouver–Point Grey): Ms. Chairperson, I don't know

if this is the correct vote to …

MS. CHAIRWOMAN: Probably not.

MR. McGEER: …bring up the matter of the stairways up to

the Press gallery, but it's very evident that they …

MS. CHAIRWOMAN: I think that comes under public works.

MR. McGEER: Public Works. It may wind up, of course, coming out of

the Minister of Health's budget. (Laughter).

Ms. Chairperson, again I want to bring up the subject which

I'm not sure best comes under this vote. Perhaps you can give

me some guidance on it. This is that under local health

services, surely would come the local study of the effects of

fluoridation. I said a few words about this the other day in

the Legislature and, Ms. Chairperson, they were just a very few

words.

I want to say I'm fed up with getting letters from nuts and

quacks and screwballs on the subject of fluoridation, which

happens every time I make a speech. I realize that most of the

people who are not in favour of fluoridation are very

reasonable, intelligent people. The problem is that they are

exposed to propaganda put forward by nuts and quacks.

There was a perfect example last Friday after I'd made a few

remarks — and really a very few remarks about fluoridation,

considering the importance of the subject. This was a hotline

show, and I'm not going to use the words of description about

hotline shows that the Minister of Highways (Hon. Mr. Strachan)

used, but certainly I thought that the programme came forth as

a result of that speech was not what you would call objective

and balanced.

An individual appeared on that programme and what he had to

say was discussed at some length. This was a Dr. Mick from the

United States, who has offered to put up some huge sum of money — $100,000 or $200,000 — for anybody who could prove that

fluoridation did no harm at all. What I want, Ms. Chairperson,

is for the Minister of Health to take the $200,000 from that

man and put it into facilities for handicapped children.

Here's an opportunity to take one of these charlatans and take his money as

well. We've got the data right here in British Columbia that would make it possible

for us to have that money for improved health services. We only have to go to

our own local health service offices in communities where we've got fluoridation

— Prince George and Kelowna — that have been going on for years and years doing

nothing but making the teeth better for the people in those communities.

If it can be shown that fluoride is doing some damage, as

the people who write to me suggest in these nut letters that I

receive, then we should be stopping fluoridation in Kelowna and

Prince George. Obviously, we're not going to because it's doing

a tremendous amount of good in those communities. Not in

Kelowna, Prince George or any of the other hundreds or

thousands of communities in North America that do fluoridate

their water can we find one single instance of any individual

coming to any harm, however small. That's why we should take

the $200,000 from that man.

The only place that you can find any discussion against

fluoridation at all is in the media, because that's the only

place the nuts can get any publicity. So, Ms. Chairperson,

here's the chance for the Minister of Health to get a little

added money for his budget and do a favour for the people of

British Columbia.

You know this hotline programme — and perhaps the Minister

of Highways (Hon. Mr. Strachan) in this particular instance had

the description right — spent time discussing the approaches of

this strange doctor from the United States. But if one had

taken time to read the names of the people and the titles of

the scientific papers that have either endorsed this measure or

proved beyond question its validity, it would have taken more

than that whole radio programme. That's how overwhelming the

evidence is in favour of this very important public health

measure.

You don't have to any longer cite individual papers and

individual experiments justifying pasteurization of milk or

immunizing people against diphtheria or any of the other great

public health measures today. But for some reason we have to

keep doing this again and again and again over

fluoridation.

So, all right; if it still has to be done here in British

Columbia, and we have to find some way of getting a balance in

the information that goes out to the public in this province,

why doesn't the Minister of Health take this job on? Make that

doctor in the United States put his money up. Get it in an

air-tight contract. Then use Kelowna and Prince George as

examples of proof positive …

AN HON. MEMBER: And Fort St. John.

MR. McGEER: And Fort St. John, yes. Any of the communities — not one single solitary speck of evidence of the slightest harm

of any kind. Use that kind of evidence to convince the people

of British Columbia to do what they should for the teeth of our

coming generation.

[ Page

1309 ]

AN HON. MEMBER: I was told it was a communist plot.

HON. MR. COCKE: Ms. Chairman, I'm surprised at the people

wearing the blue today and normally with a red flower in their

lapel. Twice now they've spoken on the wrong vote and they're

so well informed. Unfortunately, that Member came in a little

late, so I thought I would not challenge his speaking on

this.

I say to that Member, however, who is so very interested in

research, why doesn't the university take up the challenge?

You're the people who have the knowledge and the wherewithal.

You take up the challenge with that man and win the $200,000 to

better educate the people in British Columbia on the whole

question. Now, getting back to the Member …

MR. McGEER: Ms. Chairperson, I'd like to ask the Minister

what he would be prepared to put up in the way of research

funds, because the university doesn't have the staff. He does.

But if he will state the amount today, I'm sure that the

Faculty of Dentistry would …

HON. MR. COCKE: Ms. Chairman, he missed that vote. I'll talk

to you privately.

The Member for North Okanagan (Mrs. Jordan) was discussing

the whole question of the education of the inspectors. The

young people are having difficulty. It is under study at the

present time. I do hope that we can work them in on the same

kind of basis that we were discussing when we were discussing

the question of health care people working on an on-the-job

training type of thing. I think it's a good programme.

MS. CHAIRWOMAN: I recognize the Hon. Member for West

Vancouver-Howe Sound.

MR. WILLIAMS: Thank you, Ms. Chairwoman. Would the Minister

indicate the extent to which his staff in local health services

works with the other departments in matters of the supply of

water and in sewage and septic tank treatment in the outlying

areas? I will pose to the Minister two specific problems in

each of these areas.

In my constituency, in the Village of Pemberton, the water

system is many, many, many years old. It is falling apart. In

order to have this replaced, a plebiscite has been taken. But

the amount of money which is available is less than the total

cost. This is something which has to be worked out with the

water rights people, I appreciate, but it has the potential of

a very serious local health problem.

The system in that village — and I'm speaking only of the village for the moment

— is so old that the only way they can find out where some of the water mains

are is when they spring a leak. Then they suddenly find water where they never

had any reason to believe that there was a water line there. That's just how

bad the system is.

In the surrounding improvement district they have the same

problem. This past November, when there was a serious freeze

before any snow fell, the water mains from the water source

froze up. The whole of the Pemberton North Improvement District

was without water for a period of two weeks. Many, many

thousands of dollars were expended on an emergency basis in

trying to provide water for the Pemberton North Improvement

District.

The startling thing is that the schools are served by the

Pemberton North Improvement District water service. There was a

period of time, for two weeks, when the schools were without

water. The toilets didn't flush; the urinals didn't function;

no water.

This created a very serious situation. As a matter of fact,

there are still some areas served by Pemberton North which

today don't have water because there's still a fair amount of

frost in the ground. It will be another three weeks before all

of the lines thaw out. Those people who are without water today

are being served by a tank truck, which brings it around and

peddles it by the bucket. This is going back 40 or more years

in the history of water supply.

I think that as a local health measure, while these problems

don't all fall under the Minister's department, they must be of

very great concern. I would therefore like to know what kind of

coordination there is between the health department and the

other departments responsible to ensure that in these old

areas, which are expanding, there is proper concern about the

delivery of safe, clean water.

The area served by Pemberton North is rapidly expanding.

There are mobile home complexes being developed throughout that

area. Some of them are without water today. The same problem

exists with respect to their septic tanks. The serious question

is raised in this particular area as to whether septic tanks

really function.

The local health officer, who has the responsibility of

approving these, covers a tremendous area — all the Pemberton

Valley, all the way down to Squamish and over onto the Sunshine

Coast. It's a tremendous job for him. It's an area so large

that he can scarcely cover it in a week's travel.

In another part of the constituency…and this isn't a

water problem. I'm speaking of the great expansion that has

taken place in the Whistler Mountain area — Alta Lake. They've

got a water system, and that's fine. That's an area where,

geologically, all the ground upon which homes can be built is

rocky. There's no drainage field; yet septic tanks have been

installed. Some very ingenious attempts have been made to solve

the sewage disposal problem.

There has been condominium construction in

[ Page 1310 ]

which they have built their own systems for handling all of

the sewage from all of the units in the group. But the question

is: where does the effluent finally discharge?

It's becoming increasingly clear that the extensive

development in that area is resulting in the discharge

eventually finding its way into Alta Lake, Green Lake, Alpha

Lake — the whole chain of lakes which are part of the Cheakamus

River system. Once it gets into that area, then it flows down

the Cheakamus River and through Daisy Lake to eventually come

out at Squamish.

As I say, the responsibility really falls upon your one

local health officer. It's a very serious one, and I would like

to know what sort of relationship there is between the

Minister's office and pollution control, which is authorizing

the installation of these facilities.

The Minister of Lands, Forests and Water Resources (Hon. Mr.

Williams) has one matter before him in this regard where it is

proposed to perhaps construct a major hotel complex in that

area. If this goes in without any sewage treatment facility, it

can create a very serious situation. It could eventually result

in the destruction of Alta Lake.

HON. MR. COCKE: Ms. Chairman, the Member is quite right.

There are problems in this whole area.

Under 5,000 gallons, our department takes care of granting

permits; over 5,000 gallons, that's the Pollution Control

Board.

How much coordination or how much communication? None at

all. I hate to say it, Mr. Chairman, but that's been the

history ever since the breakaway of pollution control from

health originally in 1967. I've seen correspondence going right

back to before, after and all during.

Our department last year took 30,000 water samples and did

15,000 septic tank inspections. We're quite unhappy. I've had a

number in our department come in to see me and say, "Out of

1,000 septic tanks in area 'x"' — and I can't name the areas; I

don't want to at this point — "in a particular community, 60

per cent are not working right, 60 per cent are pushing

effluent into the streams, the ditches and whatever happens to

be handy." We've got a lot of work to do to catch up on

that.

My colleague, the Minister of Municipal Affairs (Hon. Mr.

Lorimer), is in charge of the water systems in the province as

far as granting permits for water systems. We check them. It's

up to us to sample them and we do sample continually, as we

have in Pemberton. But it's up to his department to grant

licences.

You recall that he had a problem over integrating Kelowna with some of the

outlying areas. One of the real prime reasons for that was the fact that one

area outside of Kelowna had such a bad septic tank situation — and they get

their water from the ground only 100 feet down — that we're desperately worried

about it and had to, some way or another, get them into the whole community

system as far as sewage and disposal and that sort of thing is concerned. We

were leaning on him a long, long time before he made that decision; the health

department brought it to my attention very early. We're really concerned.

Now as you know, the water as yet is not infected. But it

certainly would become that way in the not-too-distant future.

We've got a lot of work to do in this province.

MS. CHAIRWOMAN: The Hon. Member for Omineca.

MR. D.T. KELLY (Omineca): I don't really know, Ms.

Chairwoman, whether I'm under the right

section or not. I am very

concerned about a situation that exists in my riding and that is the

trouble we have getting doctors to come into our area and stay there.

Right now in my own community we have a doctor who is there

on a one or two days a week basis. It's very marginal. One week

they might be there three days and the next week they might

come one day. Although we have had a permanent resident doctor

in the past, it seems that if the income isn't sufficient it's

only quite natural that the doctor will eventually leave

because he can better himself somewhere else.

For example, if he's young and has just graduated, he

wouldn't want to spend too much time in the boondocks, since he

might lose out on updating his training and what have you.

I have two communities actually that are in excess of 1,000

people that have no doctor whatsoever. Now they're only 30 or

40 miles from the nearest doctor. But when you take an area

such as my riding and most of the central and northern ridings

of the province, 30 or 40 miles of icy roads and that type of

communication — in some instances telephones are few and far

between — it can be like 100 or 1,000 miles.

In my particular town we have a doctor negotiating at the

present time. But he's negotiating with a company. I think this

is absolutely wrong. I think the people of this community

should have this service without having to negotiate with any

company or anybody else. That doctor should be made available

and, if necessary, I believe the government should give a bonus

or at least a subsidy to the doctor to live in that community

and to help serve those people.

Up until now we have been on a hit-and-miss basis for almost

five months in my particular community with 1,200 people. I'm

sure that would keep a doctor busy. In fact, when the out of

town doctors come in, they have to accept at least 50 patients

in an afternoon. I don't believe a doctor can do 50 patients

justice in one afternoon. This is the kind of thing that's

going on.

[ Page

1311 ]

I would like the Minister to tell me whether we might expect some help in this

matter, Thank you very much.

HON. MR. COCKE: You're quite right, Mr. Member. It's not the

right vote, but certainly it's the right problem. There is no

vote for that really, other than my own vote.

At the present time — and I've made this announcement time

and time again — we are asking doctors. We can't tell them; we

can't put them in irons and say, "You must go to a certain

area." But we are asking doctors, urging doctors to go to the

north, to go to the isolated areas, and to come and see us

because we'll make a deal. Not mining companies or other

companies — we'll make a deal with people. We've done it

before; we'll do it again. Ms. Chairman, I just urge doctors

who want to get into the isolated areas to come and have a talk

with our department.

Vote 98 approved.

Vote 99: division of laboratories, $1,066,186 — approved.

Vote 100: division of vital statistics, $744,780

-approved.

On vote 101: division of venereal disease control,

$260,670.

MS. CHAIRWOMAN: I recognize the Hon. Member for Oak Bay.

MR. WALLACE: Madam Chairman, I'd just like to comment on

this. There seems to be little doubt that the incidence of

venereal disease has increased. We are faced with an increasing

problem of drug resistance to the treatment of some forms of

venereal disease. This increase in the budget from $243,000 to

$260,000 seems to me to be a rather small increase to deal with

what is a substantially increased problem over the last few

years.

I don't think we need to go into the many social factors

that contribute to this with the lifestyle of many people today

compared to a few years ago. But any statistics I have read

from publications of vital statistics or in the Press seem to

leave little doubt that venereal disease is on the

increase.

I wonder two things: whether the Minister would care to give the House some

indication of the statistical increase at least in the number of cases treated;

and secondly, whether he would consider embarking on a more vigorous programme

of public education to alert the public to the fact that what was once a disease

which seemed to be almost wiped out when penicillin first came along and other

reasons too — social improvement and the general health of the community and

preventive methods and so on.

I know this all went through a phase when venereal disease

greatly decreased. But now it is on the increase and, as I say,

our lifestyles somewhat contribute to an increase; yet the

amount of money being allocated is not very much more than the

previous year. Would the Minister care to comment?

HON. MR. COCKE: Ms. Chairwoman, I keep looking over there

and missing my place. We have a high rate of gonorrhoea at the

moment. There were 8,000 cases in the province reported last

year. We suspect that there are a great number more than that.

We suspect that there are a lot more than that, by virtue of

the fact that a lot of people's anonymity is being protected by

their own physician and so on.

But in any event we are cooperating on an educational

programme. As a matter of fact, the Minister of Education (Hon.

Mrs. Dailly) is very seriously looking toward using the film

"V.D. Blues" as a possible educational device in the schools.

You probably saw it on television the other day. It apparently

was an excellent piece of work. So she's considering that.

As far as we're concerned, we're working effectively in our

department I think. I think we're holding the incidence down

under the circumstances. We've used hippie nurses — you know,

like some of our PHNs, that have circulated in the community

and provided real good education, telling these kids where to

go to get care and help and so on. We're doing our best and

we'll certainly try everything we can to keep the incidence

down.

MS. CHAIRWOMAN: The Hon. Member for West Vancouver-Howe

Sound.

MR. WILLIAMS: Ms. Chairwoman, using these nurses is a great

idea. But, Mr. Minister, I note that the number of public

health nurses in this division has decreased by one; and you

only have one director who has medical specialist

qualification. You have a medical specialist part time. You now

have a research officer that was there before and these three

nurses — three public health nurses. The staff nurses, I assume,

are involved in the direct treatment of patients within your

own division.

For rural treatment and consultative service, there's an

expenditure of $6,800. It seems to be that this is a growing

problem…and the Minister didn't answer the question from

the Member for Oak Bay (Mr. Wallace) who asked what is the

incidence of increase in venereal disease as reported, it is

known that there are many who are hiding the disease. What is

the incidence of increase over the past 12 months.

[ Page 1312 ]

All the indications are, from what one would read, is

there's a growing concern among all of the public health

agencies, certainly in North America, about the rising

incidence of venereal disease, which once we thought was under

control.

I think that one of the difficulties is that during the war

there was so much attention paid to this problem, and then

along came the so-called miracle drugs. I rather suspect in our

communities that people believe that it's all O.K., but we know

that it is not.

It's a very serious problem for our young people,

particularly with increased mobility. They're moving about this

country east and west, north and south. The opportunity for

contagion is being expanded tremendously. I just think that the

size of the staff that's available here is likely to be

inadequate.

I do notice that there is one item under the expenditures,

Mr. Minister; Medical services, $20,000. Does this indicate

that you purchase services from other practising

physicians?

HON. MR. COCKE: Yes, well I can just say this, that the rate

in 1941 — 46 per 100,000 — was 460. That went down

successively, down to a low of about 208 per 100,000 in 1968.

It's gone back up to 366 per 100,000 at the present time. We're

not viewing this lightly. As a matter of fact, the direct work

that's done in this area is done by the local health services,

not out of this vote particularly. The PHNs, the doctors and so

on and so forth are doing the direct work.

We've also been cooperating on a couple of LIP grants that

have been going to put people into the community on a VD

education situation. So, we don't like the increase, and we're

not going to live with it any more than anybody else. We know

some of it is getting pretty dangerous. I'd like to put on the

record too, as a fact, that some of the strains that are coming

back from Mexico and from Vietnam are pretty weird strains, and

they're pretty tough to control by normal means. Just

penicillin won't handle them any more.

MS. CHAIRWOMAN: Shall vote 101 pass?

Vote 101 approved.

Vote 102; Administration and Out-Patient Care, $1,047,047 — approved.

On vote 104: British Columbia Overall Medical Services Plan,

$90 million.

MS. CHAIRWOMAN: The Hon. Member for Oak Bay.

MR. WALLACE: Madam Chairwoman, we're on vote 104?

MS. CHAIRWOMAN: Yes.

MR. WALLACE: I'm a little staggered to think that for a

second there a vote involving $90 million of medical services

was going to be passed by this House without some comment. I

had previously meant to stay out of this debate for obvious

reasons. I'm a doctor myself. Doctors are not always looked

upon by society as being totally objective when it comes to

talking about their own services to the community.

But seriously, Madam Chairwoman, this is a very vital

subject and I will try to be objective and I don't plan to make

a long speech. The fact is that this whole programme of the

manner in which health services are to be provided to the

citizens of British Columbia is under review by Dr. Foulkes'

committee.

Many Members of the House have commented on this and I

approve of the attempt to integrate and coordinate the services

that are available, and to find better methods of giving better

health care to the people in British Columbia; and that's what

it's all about.

I would like to recall that the Minister of Health, in his

budget speech, commented on the Hastings Report, which was a

study of an alternative method of providing doctors and

paramedical services to the citizens.

The Minister, I thought, made a very wise statement when he

said that the concept of providing health care to the

individual patient through a community health clinic might be a

wise alternative, but that no doctor would be compelled to

function under that particular method of health care delivery

if this was not his choice. I think the important thing in

health care delivery at the present time is to have two or

three alternatives and, if at all possible, to have these

methods run in parallel courses so that they can objectively

and economically and wisely be evaluated one against or beside

the other.

I think it should be put on the record — and I'm not

speaking for the medical profession, I'm quoting what the B.C.

Medical Association has said — that it is certainly not opposed

to the concept of community health clinics; but it sees this as

a possible vehicle to provide services such as we've heard

tonight in Omineca, that may not be being delivered at the

present time.

On the other hand, Madam Chairwoman, I'd like to just make

the comment that the machinery by which health services are

delivered, important as it is, is not as important as the

quality of care which is delivered. We have to equate these two

goals. We want the best care for the patient, and yet we want

the most economical dollarwise method of delivering that

care.

I would like to hear some comment from the

[ Page 1313 ]

Minister on his particular feeling about community health

clinics; because if we take an area like Victoria, with which

I'm most familiar, it just would seem to me ridiculous to go

ahead and start building community clinics when we have all the

services already available, but don't have a well-integrated,

organized method of providing them to the patient.

I feel that the people of this province are listening and

reading very carefully about the project that Dr. Foulkes is

undertaking. And I think, in many areas such as the ones we've

heard mentioned today, they are wondering if this particular

new method is some panacea for the problems of the past.

But whether you build a clinic, or whether you have the

present service through private physicians, the fact is that we

have to face, Madam Chairwoman, that a doctor on his own,

whether he works privately or whether he works through a

community clinic, living in a rather isolated area, with no

medical personnel to give anaesthetics, or other medical

personnel with whom he can consult, or destined to be on call

24 hours a day, 7 days a week — I think it should be put on

record that just changing the machinery by which services are

provided is not likely to answer his problem.

Unless, of course, the Minister considers that there would

be some very definite incentive in various terms. We needn't go

into the details, but these could be paid holiday or paid

sabbatical leave, special opportunities for the doctor to

upgrade his training and go to post-graduate courses, some

guarantee of replacement so that he can go on holiday, and so

on.

I think it would be remiss if this point were not made quite

clear: it isn't just a matter of setting up another method of

delivering the service. In the remote areas, a great deal more

is involved.

I think, frankly, from the number of times that I've

discussed this with other doctors, it's also a question of the

doctor's wife. The doctor may be quite willing to go and spend

two years — I spent four years in the north country in Ontario

- but the fact is that you have your wife and family to

consider also. If your wife and family have interests in music

or culture or some of these other areas beyond medicine,

they're not available in the more remote areas. I think we're

just kidding ourselves if we take refuge in some such phrase as

"community clinic" as being the solution to the problems of

these areas which don't have enough medical care.

In terms of the Medicare plan itself, I'd like to say, Madam Chairman, that

with the exception of these areas that we've just discussed, on the whole the

Medicare plan is working extremely well, all things considered. It's not perfect,

but I would like to say this: both in terms of government administration of

the plan and professional freedom in the plan — I'm sure neither side feels

they have all they would want — certainly compared to other systems that I have

practised under, by and large I would say that in British Columbia the citizen

is getting as good and as efficient and as available treatment as he would receive

anywhere, either in British Columbia or certainly in Ontario, where I've practised,

and above all in the much vaunted British system of the National Health Service.

Too often I feel a little disappointed that the Government

perhaps — I seem to be on a promotional kick this afternoon.

I'm asking you to talk about venereal disease publicly. But I

think we tend to be too negative, Mr. Minister, through you

Madam Chairman. Some of the positive, very productive and well

worthwhile aspects of Medicare are not really mentioned, when

in point of fact there's always lots of time to complain and

there's quite a bit of coverage in the media of those

deficiencies. I am perhaps as guilty as anyone, by telling the

Minister the other day all the different things not covered by

Medicare which should be covered.

But that is meant to be placed in context. When we talk

about children with cleft palates or people with the oxygen

need and so on, they are still a minority. I think that if we

look at the total picture, British Columbia has a plan of which

it can be proud. I would feel that the spirit of cooperation

and the listening ear which the Minister has shown in his early

months of office, hold hopes that we can establish a wide, more

effective, and more economic Medicare programme in the

future.

MS. CHAIRWOMAN: The Hon. Premier.

HON. D. BARRETT (Premier): I'd just like to make a couple of

comments on this vote. I note that the Member did pass the

comment that it went through. I'm an MLA as well and I have a

couple of comments that I'd like to make. I rarely have a

chance to do this.

The $90 million vote did go by before debate started on it.

Yet 10 years ago in this country there was a major strike by

doctors against the first Medicare programme. It was a time of

great emotion and great concern. There were great debates

raised about the loss of freedom and the whole range of attacks

on "communist" governments, "fascist" governments.

It's interesting to note that we're very happy with the fact

that we have Medicare in this country. We're very happy with

the fact that all political parties now approve of our Medicare

system. I'm sorry that it had to be born in such travail, but

it's here and let's do everything we all can to improve it.

MS. CHAIRWOMAN: The Hon. Member for North Okanagan.

MRS. JORDAN: Thank you, Madam Chairman. I

[ Page 1314 ]

hadn't intended to speak under this vote at the moment,

because I think the Minister is trying very hard to meet some

of the very serious problems that there are in medicine today,

and he's trying to establish a good relationship with various

peoples. We want to give him fair time.

But when the Premier of this province stands up and uses a

$90 million health vote to perpetrate a political myth in

British Columbia, I object and this party objects. Medical care

came into Canada in the Province of Saskatchewan amid strikes

because it was the same type of steel-heeled socialist

government control there that that Government is trying to

bring into British Columbia today under another Act.

HON. MR. BARRETT: Vote against it, then.

MRS. JORDAN: The reason they had the problem was the same

reason that that Premier had to get up in this House today

under a health vote that is being realistically and calmly

debated, and make a political twist out of it. He's trying to

capitalize on the health care of the people of this province,

so that he can perpetrate more of his extreme socialist,

almost marxist, programmes in British Columbia. We won't have

it.

Medical care came into British Columbia with a cooperative

programme between government and the doctors. The doctors'

families in British Columbia put up much money through their

association to send a cross-section of doctors to travel around

the world in company with some specialists who were put up by

the government of British Columbia of that day, the Social

Credit government. Some of them were civil servants. They

travelled around and they studied many, many, many medical

programmes in the world. They came back and jointly — jointly,

Madam Chairman — made a recommendation to their respective

medical society and the doctors in this province and to the

Government of British Columbia.

They jointly brought in a medical programme to British

Columbia that gave people, as the Hon. Member for Oak Bay (Mr.

Wallace) just said a few minutes ago, the highest standard of

medical care for everybody, perhaps in the world. That

programme, Madam Chairman, did not cost one single private

agency in this province their livelihood or their capital

investment. It did not put one single medical health insurance

programme under a private agency out of business in British

Columbia. It was a voluntary programme, Madam Chairman — a

voluntary programme.

That is the way to bring programmes into a province. It has been successful

and it will be successful in the future, providing that it works on that basis.

It was made a compulsory programme, even though, I believe, 98 per cent of the

people of British Columbia were covered voluntarily, without loss to any individual

enterpriser. It was made compulsory by the federal government a few years ago

when they brought in the national medical care programme.

I point this out, Madam Chairman, because if the Premier of this province and

the Minister of Finance wants to play hash-haberdash politics with the health

of the people of this province, then someone's got to answer him. We say to

that Premier and that Minister of Finance that if he would handle the legislation

in the Province of British Columbia on a fair basis, with compensation to individuals

who are hurt by that legislation, on a cooperative basis with the industries

involved, then we wouldn't have people rioting outside this Legislature tomorrow,

AN HON. MEMBER: We're going to have a riot?

MRS. JORDAN: Demonstrating. I withdraw the statement

"rioting." Mr. Chairman, the Hon. Minister of Highways (Hon.

Mr. Strachan) knows all about riots because he's been involved

in instigating them. The people here tomorrow are concerned

about their individual rights, their rights to compensation. .

. .

MR. CHAIRMAN: Order, please. Would the Hon. Member proceed

with her comments relevant to the estimates. I recognize the

Hon. Minister of Health Services.

HON. MR. COCKE: Mr. Chairman, I think we should all keep our

cool at a time like this. I just don't see any reason for this

irrelevant attack on the Premier of the province.

,Mr. Chairman, I think I would like to discuss a little bit

of the history of Medicare, just for moment, in B.C. I

understand that no private agencies went down the tube. Let me

tell you a few: Fidelity, Fraser Valley, every life insurance

company that had a medical plan. She forgot that I used to be

in the business. I was there when it occurred. And there were

tears flowing down Granville Street and Howe Street such as you

never saw. That good old free enterprise Social Credit

government — don't give us that!

AN HON. MEMBER: No compensation?

HON. MR. COCKE: Oh, yes. The compensation was nil. Zilch.

Nil. Nothing. The reason this province went into Medicare was

because it was fought for by the NDP across this country. Yes!

The same with hospital insurance.

Interjections by some Hon. Members.

HON. MR. COCKE: No rubbish about it. And everyone across the floor knows

it. Those that are

[ Page

1315 ]

honest won't be making those kind of remarks in this

House.

Mr. Chairman, I'd just like to answer one or two questions

that the Member for Oak Bay (Mr. Wallace) asked about the

Hastings report.

I agree with you on the community health centre concept. It

is not necessarily the concept that will be best utilized in

the very isolated areas. I really feel that in those areas it's

going to have to be in some degree in cooperation with health

services. We could call these mini-health centres, but I don't

really think that that's what we want.

On the urban areas, Mr. Member, I agree with you. We want

freedom in this thing. We want to have the doctors operating in

the area in which they feel most comfortable. But I say this,

and I say it very loud and clear: those doctors and those

members of the community — consumers, patients, call them what

you — who wish to participate in this particular kind of

alternative method should be allowed to participate. As a

matter of fact I have announced clearly that they will not only

be allowed to but will be encouraged in every way we can,

because we need some alternatives at this time.

MR. CHAIRMAN: I recognize the Hon. Member for West

Vancouver-Howe Sound.

MR. WILLIAMS: Thank you, Mr. Chairman.

I am sure the Hon. Minister of Health Services and Hospital

Insurance is pleased to have this vote in his department now

rather than that of the Provincial Secretary (Hon. Mr.

Hall), where it was before. Under the previous estimates the

Provincial Secretary did have this in his responsibility, and

we had some breakdowns.

I wonder if the Minister could tell us: out of the $90

million proposed to be expended, how much will be received from

much will be received from the premiums of citizens who belong

to the plan, and how much will be contributed out of general

revenue from the province?

Dealing with the $90 million expenditure, once the government

gets all the money — the previous administration saw fit over

the past number of years to publish the information as to the

amounts paid to doctors or groups of doctors. This has,

understandably, caused a great deal of concern amongst doctors,

but also understandably a great deal of concern among the

citizens of British Columbia.

The Hon. Member for Oak Bay (Mr. Wallace) said that we get a

good standard of medical care in this province. I accept that

assessment. Certainly I believe it is acceptable in the larger

centres where extensive health care delivery facilities are

available. I'm not quite so sure about the outlying areas.

It always seems to me, Mr. Chairman, that the question of how much the doctors

are paid under the medical plan has too long been a debate between the department

and the doctors. The doctors get all concerned about it, and that's understandable

because it's their livelihood. The government gets concerned about it because

they've got to provide the money.

The debate has never really clarified, for me, at any rate — and I don't think any other Members in this assembly have any

better information — nor for any of the citizens of British

Columbia as to whether or not, dollar for dollar of the

expenditure of the $90 million, we are really getting the

benefits of medical care that we should be.

I know that the Minister's department is considering new

techniques for health care delivery. I would like to know

whether, based upon those techniques that are under

consideration, the citizen can expect to see the number of

dollars provided under this plan decrease, either on a

per-unit-of-care basis or otherwise. Will the medical

profession still see and continue to enjoy an acceptable

revenue so far as the practitioner is concerned?

I don't know what the answer is, because with the

information that is available to Members and citizens it's

impossible to tell whether or not doctors are overpaid. The

information that the government has published from time to time

would suggest that some doctors receive very large amounts of

money from the plan. But no one knows how many patients they

see; no one knows what the expenses of operating their

practices might be.

I think that the time has come — in fact it's long past — when this situation should no longer continue to exist. I hope

that if the Minister, as a result of the investigations that

are going on, can indicate that there will be some

stabilization of the cost so that it doesn't rise, it would be

possible to have the matter placed before a committee of this

House so that we could really get down and get some answers. So

that when a citizen, a constituent, approaches me and says, "I

see that Doctor So-and-so got so much money out of the medical

plan. Isn't that an awful lot of money for what he does?" that

we've got some answers that we can give.

I think we're entitled to have them. And I think the medical

profession is entitled to have the clearest understanding, on

the part of Members and of the citizens at large, of their

point of view that they are not overpaid for the services that

they perform. I think from everybody's point of view it would

be helpful to have the air cleared, if that is possible.

If it's not possible and if we find that there are abuses of

the medical plan, then I think that should be known too,

because it affects the citizen and it also affects the medical

fraternity. When one or more members of a profession seem to

take unfair advantage of some of the opportunities that

profession offers

[ Page 1316 ]

then the whole profession suffers.

I think it's time that we had the clear breeze, the bright

sunshine upon this subject which too long has been dealt with

murkily. I'm not criticizing anybody when I say that, but it's

been shadowy as to how much money is being paid and as to

whether we are getting the service for it.

HON. MR. COCKE: Mr. Chairman, I'll go back to the beginning.

You asked how much of the $90 million is federal. It's about

$70 million. We put up about $20 million for our share.

However, the total vote doesn't indicate the total amount going

into Medicare. Premiums make up the difference, up to $170

million. That's the total cost of Medicare in the province.

Interjection by an Hon. Member.

HON. MR. COCKE: Yes, another $80 million odd. As a matter of

fact I told the Premier one time that I've got the biggest vote

of all. I forgot that we didn't include the premium aspect of

Medicare under our estimates, but it's there nonetheless.

The $433 million goes up to $515 million or $520 million,

if you want to look at it that way. But he'd prefer not to look

at it any way when it comes to spending those kinds of

sums.

The decrease in this amount is very unlikely. Really, the

community health centre or all of these alternative programmes

are not aimed at reducing that particular vote. They're aimed

at reducing the utilization of hospital and other health

services. It's not very likely that this will be cut very much.

As a matter of fact I would suggest that we'd like to see this

sort of coast along without too many increases.

As far as hospitals are concerned, we can't expect any

reduction there, but we want to reduce the percentage of

increase that we've been enjoying for some time.

As far as the Blue Book and the whole question of putting

the health care and doctors' practice before the House are

concerned we could consider that.

MR. CHAIRMAN: I recognize the Hon. Member for Cariboo.

MR. A.V. FRASER (Cariboo): Mr. Chairman, through you to the

Minister of Health, while we're dealing here with a plan that

supplies, I hope, the majority of the money to the medical

profession, I'd like to know if the Minister has any knowledge

as to how much extra the doctors are charging over and above

the fees in the B.C. Medical Plan. I am quite concerned about

it.

I have a note here from a constituent saying that even the receptionist in

this certain doctor's office told her that the B.C. Medical Plan paid two-thirds

of the doctor's salary and the patient had to pay the other third.

HON. MR. COCKE: Mr. Chairman, we're discouraging it now.

There is a right to charge over and above the plan if they meet

certain criteria, which include: telling the patient first,

announcing how much it is, and informing the commission that

they're doing so. We're discouraging it.

If it becomes a wide practice, I'd consider alternatives. I

don't look with favour on anybody charging beyond what the plan

pays. Now we'll just see how things work out, but I think that

there are going to be some adjustments in their fees and so on.

We'll see how things work out. I don't look with favour at all

on anybody charging over and above the plan.

MR. FRASER: Mr. Chairman, to the Minister, maybe he didn't

understand my question: is there much of this going on now?

HON. MR. COCKE: Not a great deal, unless they're not meeting

the third criterion. Normally we're told, and I know of some

areas where it's happening, but it's not widely practised.

Vote 104 approved.

On vote 105: mental health services, general administration,

$3,037,180.

MR. CHAIRMAN: I recognize the Hon. Member for North

Okanagan.

MRS. JORDAN: Thank you, Mr. Chairman. Perhaps the Premier,

in issuing the vote, would use the title of which service it is

under in the future, please.

I would like to ask the Minister of Health one or two

questions in keeping with the policy of decentralizing mental

health services particularly for patients of a younger age and

also those who have up until now been treated in the lower

mainland in Riverview and in Woodlands. I fully support this

programme that was started by the Social Credit government to

bring these people back, hopefully to their own communities or

certainly to their own regions.

In doing so, there are problems that have been created. One,

of course, is not enough staff within the regions to cope with

the developing of programmes for these people when they come

back to the communities. It just isn't good enough to bring

them out of Woodlands or bring them out of care homes down in

the lower mainland and put them in boarding homes in the

interior of the province with no activity programmes for them,

no occupational programmes and no social programmes.

There are shelter workshops in many parts of the province. They are quite willing

to become involved

[ Page

1317 ]

with these people or have them become involved with their

programmes. I would think in many instances this is a desirable

solution.

The problem of money arises. There was an effort made by the

staff and various people to make a monthly grant to the

sheltered workshop where these handicapped were attending — I

think it was about $50 a month. I understand there were some

problems in financing this and in trying to get some help from

the federal government and also from the local government.

I would fully support a programme like this. There is just

no way the sheltered workshops can carry this extra load and

expand their facilities even with the one-third capital grant

they get.

My first question to the Minister is: Have you been successful in establishing a monthly stipend to the sheltered

workshops where these people are attending or are intending to

attend? Also where there are not sheltered workshops, have you

undertaken to provide through voluntary services, or to

stimulate through voluntary services, or hopefully with trained

personnel, some occupational activities and social programmes

for these people if they are in boarding homes and there isn't

a sheltered workshop that they go to?

Some of them really are just going to be able to respond to

motivational programmes. There is no great merit in taking

people into a boarding home in a small community and having

them vegetate in the garden. They must be out and 99 per cent

of them are quite capable of being out to local community

activities, fairs.

The sheltered workshop for the North Okanagan which is

Vernon took busloads of these students up to the Armstrong fair

in Shuswap constituency. They had a whole day and they

picnicked and they went around, saw the cattle and kibitzed

with the local people including the local MLA. This is a very,

very good thing.

These people, in most of these workshops, are attending

movies on their own. A lot of them are even working part-time.

They must still, even if they work, be kept in a sheltered

climate because these people, when they go out, sometimes are

very good workers. I know of one instance where a man in his

late 30s was probably the best masonry helper you could get — a

European told me he was. The people who were employing him

wanted to give him more money and the shelter workshop

intervened and said they couldn't. They didn't want this

because they didn't want him under the pressure that an

ordinary employee would be. In other words, he had to be free

to be there or not be there as his health situation

dictated.

This, I would think, is the danger if there is no professional help or at least,

people who are experienced in working with mentally-handicapped people — I don't

like that term; I wish I could think of a better one — in communities where

it isn't organized. They are capable at times of really producing well or accepting

responsibility. But they may not be the next time and should not be allowed

to get under this type of undue pressure.

Do you have any intention of expanding the formula for

teaching staff or supervisory staff in the sheltered workshops

in British Columbia? As it stands, the last time I knew, it was

$500 a month for the supervisor for a certain number of

students and $300 a month for an assistant. My understanding

from the people in these fields is that while the supervisors

would certainly like more money, if you had to make a choice,

they would like a large budget for assistants.

I take no pride in saying that I think these people who work

in this area who are very empathetic, who are called upon to

give a tremendous amount of themselves and do a marvelous job

are grossly underpaid. I would hope that in time this would be

one of the priorities.

I think it is important in doing this that you don't

preclude in any way the voluntary help that there is in these

centres. Whether it is a high school, a pre-school or an

elementary school type of programme, there is no question that

a volunteer who isn't under the pressure of employment can give

a great deal of understanding and, I think, a great deal of

wisdom.

It would be a shame to discourage community participation.

In fact, I think you should follow along, although helping as

much as you can, to stimulate the community to participate in

these areas. It is only by the community, sadly to say, having

some of their money in them that they learn themselves how to

handle themselves in these situations. Most of the problems in

a social situation where there is a mentally handicapped or a

physically handicapped person and so-called normal people is

that the handicapped people know how to handle the situation

but the so-called normal person doesn't.

If you have people who have perhaps never even seen in their

own lives handicapped situations, come in and work, whether

it's helping in carpentry or driving or whatever it is, this

is, in my view, the most effective form of public education

that you can have. It is not a matter of reading a leaflet and

then learning to adjust yourself. It is a matter of getting

involved as a citizen and understanding that these people

aren't afraid of you. Certainly they have a lot to give the

average person.

I would also ask if there is any thought of expanding or

undertaking some type of assistance for transportation to these

sheltered workshops. When it was a small group — I think most

of them ran around 30 to 50 students — volunteer drivers could

cope. Again, I think they should have volunteer drivers. I

[ Page 1318 ]

hope that is your financier up there you are waving to so we

I hope, that is your financier up there you are waving to so we

are going to get some more money in this area.

While you should still encourage volunteer driving, if there

are as many as 50, 75, or 100 people attending these workshops

at various times of the week, there should be some provision to

supplement an operational budget. I think you will find that

most garages in a community or the garages will get together

and donate a vehicle. Again I think this is an excellent policy

providing the vehicle is safe. It gets the business community

into the needs of the handicapped. If you could offer some type

of operating assistance for transportation, I believe they

would find this very helpful.

HON. MR. COCKE: Yes, Mr. Chairman, you are quite right. We

wish to decentralize this whole question of delivering mental

health care. One of the ways, of course, is the utilization of

sheltered workshops. The Minister of Rehabilitation and Social

Improvement (Hon. Mr. Levi) and whatever else he is Minister of — Minister of Welfare — takes care of the financing or the

operating costs of sheltered workshops.

We have activity therapists out now and we expect to move

them in a widening area across the province. Now the activity

therapists, so far, are working around the lower mainland and

in the Fraser Valley. We feel that is most important because,

as the Hon. Member was pointing out, the last thing that we

want to happen is that the new boarding homes or sheltered

workshops become the new back wards comparable to the old back

wards in the institutions. That could very easily happen. In

some instances, I am afraid, it has happened to date.

We are building a halfway house in Burnaby for people

getting out of Woodlands. All of these areas are very important

areas and certainly we want to move in that direction.

Naturally all of this work has to be done in very close liaison

with the Department of Rehabilitation because that is very much

their activity as well as ours.

As far as vehicles are concerned, I have already provided

one.

lnterjection by an Hon. Member.

HON. MR. COCKE: No. Federal government refused to admit that

mental illness is an illness. There has been no thought

whatsoever in Ottawa of moving into this particular area as far

as I can see.

MR. CHAIRMAN: I recognize the Hon. Member for Oak Bay.

MR. WALLACE: Mr. Chairman, I think this is an important part of the

total concept in trying to help people with emotional problems. The Minister

probably knows, but it should be made plain, that the acute facility in this

community, the Eric Martin Institute, is constantly overcrowded with patients

in the halls — sometimes 10 or 15 patients over and above the total capacity

of the hospital.

It was a hospital which was not well-conceived in terms of

its function, in treating the acutely ill person. As the demand

becomes greater and as many of the problems of drug abuse and

drug overdosage present themselves, the facilities of the Eric

Martin Institute are often taxed beyond their safe limits.

It does relate to the subject just mentioned by the lady

Member that many of the patients who have been in the Eric

Martin Institute have recovered from the more acute phase of

their emotional disturbance and could be discharged from the

acute facility if some other less acute level of care were

available. I know we touched on this when we talked on the

Minister's vote. But it really is so important and so vital, in

terms of getting the best treatment for the patient and the

most suitable kind of environment for the patient, and in

saving taxpayers' dol