Manitoba Hansard — 16 April 1992 (Sitting 48, 35th Legislature, 3rd Session)

35-3-48

Manitoba — Debates (Hansard)

4G-8048 Third Session - Thirty-Fifth Legis lature of the Legislative Assembly of Manitoba DEBATES and PROCEEDINGS (HANSARD) 39-40 Elizabeth II Publish8d under the authority of The Honourable Denis C. Rocan Speaker VOL. XLI No. 48 ·1:30 p.m., THURSDAY, APRIL 16, 1992 Printed by the Office of the Queens Printer. Province of Manitoba ISSN 0542-5492

MANITOBA LEGISLATIVE ASSEMBLY Thir ty-Fifth Legislature Members, Constituencies and Political Affiliation NAME ALCOCK, Reg ASHTON, Steve BARRETT, Becky CARSTAIRS, Sharon CERILLI, Marianne CHEEMA, Guizar CHOMIAK, Dave CONNERY, Edward CUMMINGS, Glen, Hon. DACQUAY, Louise DERKACH, Leonard, Hon. DEWAR, Gregory DOER, Gary DOWNEY, James, Hon. DRIEDGER, Albert, Hon. DUCHARME, Gerry, Hon. EDWARDS, Paul ENNS, Harry, Hon. ERNST, Jim, Hon. EVANS,Ciif EVANS, Leonard S. FILMON, Gary, Hon. FINDLAY, Glen, Hon. FRIESEN, Jean GAUDRY,Neil GILLESHAMMER, Harold, Hon. HARPER, Elijah HELWER, Edward R.

HICKES, George LAMOUREUX, Kevin LATHLIN, Oscar LAURENDEAU, Marcel MALOWAY, Jim MANNESS, Clayton, Hon. MARTINDALE, Doug McALPINE, Gerry McCRAE, James, Hon. MciNTOSH, Linda, Hon. MITCHELSON, Bonnie, Hon. NEUFELD, Harold ORCHARD, Donald, Hon. PENNER, Jack PLOHMAN, John PRAZNIK, Darren, Hon. REID, Daryl REIMER, Jack RENDER, Shirley ROCAN, Denis, Hon. ROSE, Bob SANTOS, Conrad STEFANSON, Eric, Hon. STORIE, Jerry SVEINSON, Ben VODREY, Rosemary, Hon. WASYL YCIA-LEIS, Judy WOWCHUK, Rosann CONSTITUENCY Osborne Thompson Wellington River Heights Radisson The Maples Kildonan Portage Ia Prairie Ste.

Rose Seine River Roblin-Russell Selkirk Concordia Arthur-Virden Steinbach Riel St. James Lakeside Charleswood Interlake Brandon East Tuxedo Springfield Wolseley St. Boniface Minnedosa Rupertsland Gimli Point Douglas Inkster The Pas St. Norbert Elmwood Morris Burrows Sturgeon Creek Brandon West Assiniboia River East Rossmere Pembina Emerson Dauphin Lac du Bonnet Transcona Niakwa St. Vital Gladstone Turtle Mountain Broadway Kirkfield Park Flin Flon La Verendrye Fort Garry St.

Johns Swan River PARTY Liberal NDP NDP Liberal NDP Liberal NDP PC PC PC PC NDP NDP PC PC PC Liberal PC PC NDP NDP PC PC NDP Liberal PC NDP PC NDP Liberal NDP PC NDP PC NDP PC PC PC PC PC PC PC NDP PC NDP PC PC PC PC NDP PC NDP PC PC NDP NDP

2296 LEGISLATIVE ASSEMBLY OF MANITOBA Thursday, Aprll16, 1992 The House met at 1 :30 p.m. PRAYERS ROUTINE PROCEEDINGS PRESENTING PETITIONS Mr. Oscar Lathlln (The Pas): Mr. Speaker, I beg to present the petition of Phillip Buck, Lloyd Easter, Leonard Naskapow and others requesting the government to show its strong commitment to aboriginal self-government by considering reversing its position on the AJI by supporting the recommendati ons within its jurisdiction and implementing a separate and parallel justice system. Mr. Gregory Dewar (Selkirk): Mr.

Speaker, I beg to present the petition of June Phillips, Monika Hansen, L. Olafson and others requesting the Minister of Family Services (Mr. Gilleshammer) consider a one-year moratorium on the closure of the Human Resource Opportunity Centre in Selkirk. READING AND RECEIVING PETITIONS Mr. Speaker: I have reviewed the petition of the honourable member for Radisson (Ms. Cerilli), and it complies with the privileges and practices of the House and complies with the rules (by leave). Is it the will of the House to have the petition read?

The petition of the undersigned citizens of the province of Manitoba humbly sheweth that:

WHEREAS the Dutch elm disease control program is of primary importance to the protection of the city's many elm trees; and

WHEREAS the Minister of Natural Resources himself stated that, "It is vital that we continue our active fight against Dutch elm disease in Manitoba," and

WHEREAS, despite that verbal commitment, the government of Manitoba has cut its funding to the city's OED control program by half of the 1990 level, a move that wi ll jeopardize the survi val of Winnipeg's elm trees. WHEREFORE your petitioners humbly pray that the government of Manitoba may be pleased to request the Minister of Natural Resources (Mr. Enns) to consider restoring the full funding of the Dutch elm disease control program to the previous level of 1990. As in duty bound your petitioners will ever pray. *** I have reviewed the petition of the honourable member for Transcona (Mr. Reid).

It complies with the privileges and practices of the House and complies with the rules. Is it the will of the House to have the petition read?

The petition of the undersigned citizens of the province of Manitoba humbly sheweth: THAT the bail review provisions in the Criminal Code of Canada currently set out that accused offenders, including those suspected of conjugal or family violence, be released unless it can be proven that the individual is a danger to society at large or it is likely that the accused person will not reappear in court; and The problem of conjugal and family violence is a matter of grave concern for all Canadians and requires a multifaceted approach to ensure that those at risk, particularly women and children, be protected from further harm.

WHEREFORE your petitioners humbly pray that the Legislature of the Province of Manitoba may be pleased to request that the Minister of Justice (Mr. McCrae) call upon the Parliament of Canada to amend the Criminal Code of Canada to permit the courts to prevent the release of individuals where it is shown that there is a substantial likelihood of further co nju gal or family vio lence being perpetrated. PRESENTING REPORTS BY STANDING AND SPECIAL COMMITTEES Mrs. Louise Dacquay (Chairperson of the Standing Committee on Municipal Affairs): Mr.

Speaker, I beg to present the Third Report of the committee on Municipal Affairs. Mr. Clerk (William Remnant): Your Standing Committee on Municipal Affairs presents the following as its Third Report.

2297 LEGISLATIVE ASSEMB LY OF MAN ITOBA April 16 , 19 92 Your committee met on Tuesday, April 14, 1992, at 8 p.m. in Room 255 of the Legislative Building to consider bills referred. Your committee heard representation on Bill 45, The City of Winnipeg Amendment, Muni cipal Amendment and Consequential Amendments Act ; Loi modifiant Ia

Loi sur Ia Ville de Winnipeg, Ia

Loi sur les mun icipalite s et d'autres dispositions legislatives, as follows: Deputy Mayor Dave Brown - City of Winnipeg Mr. John Bock - Private Citizen Mr. Marcel Taillieu - Private Citizen Mr. Don Reming - Private Citizen Ms. Elizabeth Reming - Private Ci tizen Mr. Jarl Johnson - Headingley Taxpayers Association Your committee has considered Bill 45, The City of Winnipeg Amendment, Munic ipal Amendment and Consequential Amendments Act ; Loi modifiant Ia

Loi sur Ia Ville de Winnipeg, Ia

Loi sur les muni cipalites et d'autres dispositions legislatives, and has agreed to report the same with the following amendments: MOTION: THAT the proposed subclause 4{1 )(b) (i), as set out in

section 3 of the Bill, be amended by striking out "town, village or". MOTION: THAT

Section 3 of the Bill be amended by adding the following after the proposed subsection 4{3): Study of Impact required 4(4) The Lieutenant Governor in Council shall not exercise the powers under subclause {1 )(b)(

i) or (ii ) unless a study of the im pact of the proposed incorporation or the proposed transfe r of part of the city has been conducted and made public. MOTION: THAT the proposed clause 4.1{a), as set out in

section 3 of the Bill, be amended by striking out "town, village or". MOTION: THAT the proposed

section 4.2, as set out in

section 3 of the Bill, be struck out. MOTION: THAT the proposed subsection 38.1 (1), as set out in

section 10 of the Bill, be amended {

a) in the proposed clause {a), by striking out "town, village or"; {

b) in the proposed clause {c), by striking out "new town, village or rural muni cipality or the part of The City of Winnipeg transferred to the adjoining municipalityn and substituting "new rural municipali ty or the part of The City of Winnipeg trans ferr ed to the adjoi ning municipality or to persons in that new rural municipality or part of The City of Winnipegn, and by striking out "new town, village or rural munic ipality or adjoining munici palityn and substitu ting "new rural muni cipality or the part of The City of Winnipeg transferred to the adjoining munic ipality or to persons in that new rural municipality or part of the City of Winnipegn•; (

c) in the proposed clause (d), {

i) by striking out "town, village orn where it first occurs, {ii) by adding "under and in accordance with The City of Winnip eg Act, The Municipal Assessment Act and any other Act of the Legislature and any regulation under any of those Actsn after "perform the dutiesn, and {iii) by striking out "town, village or rural municipalityn before "to make paymentn and by substituting "rural municipality or its inhabitantsn; (

d) in the proposed clause {e), (

i) in the proposed subclause {iii), by striking out "mayor or", (ii) in the proposed subclause {vii), by striking out "town, village orn in the English version, {iii) in the proposed subclause (viii), by st riking out "to wn, vil lage orn and substitu ting "newn. MOTION: THAT

section 1 0 of the Bill be amended by striking out the propo sed su bsection 38.1 {3 ) and renumbering the proposed subsection 38.1{4) as subsection 38.1 {3). MOTION: THAT the proposed subsection 38.3(1 ), as set out in

section 10 of the Bill, be amended by striking out "town, village orn wherever it occurs. MOTION:

April 16 , 19 92 LEGISLATIVE ASSEMBLY OF MANI TOBA 2298 THAT the proposed

section 38.4, as set out in

section 10 of the Bill, be amended by striking out "town, village or". MOTION: THATthe proposed clause 38.6(1 )(a), as set out in

section 10 of the Bill, be amended by striking out "town, village or". MOTION: THAT the proposed subsection 38.6(2), as set out in

section 10 of the Bill, be amended by striking out "town, village or" in the English version. Mrs. Dacquay: Mr. Speaker, I move, seconded by the honourable member for La Verendrye (Mr. Sveinson) , that the report of the committee be received. Motion agreed to. *

(1335) MINISTERIAL STATEMENTS AND TABLING OF REPORTS Hon. Donald Orchard (Minister of Health): Mr. Speaker, I have a min iste rial statement on the report of the CT Scanning Committee and our radiologist consultant's report-copy of the state ment, copy of the two

summary reports for my honourable friends. Mr. Speaker, in addressing issues related to the health of Manitob ans, I have made a commitment and demonstrated an approach which seeks the widest possible consultation and the best advice available in formulating policy and programs aimed at maintaining and improving the health status of Manitobans. New technologies are reviewed in terms of appropriate protocols, cost effectiv eness and contribution to health statu s outc ome, including issues of safety and public protection.

Examples of this commitment include the research from the Centre for Health Policy and Evaluation and the report of the Working Group on Breast Cancer Scree ning. In this context the government of Manitoba and all governments across Canada are concerned about the ris ing cost of technology and proliferation of technolog ical options and choices available to our consumers and health professionals alike.

The demands being placed on our system have to be evaluated in the context of questions such as: Can the technology improve the health stat us of Manitobans; how can it be inte grated into the delivery system; and what are the future operating costs? These qu estions mu st be posed to determ ine whether this expenditure of scarce resources will achieve a greater improvement to general health status than other new spending options regularly presented to the ministr y of Health. The provincial radiology consultant, Dr.

Douglas MacEwan, provided us with a report entitled An Analysis of the Current Clinical Activity to Assist in Policy Development Regar ding the Purchase and Operation of Additional CT/MRI Equipment in Manitoba. Dr. MacEwan reports that Manitoba has an adequate supply of scanners in operation now, and following a review of the scanner usage and waiting list, he concludes at this time Manitobans have appropriate access when scanning is required. Manitoba currently has six CT scanners in operation for a population of one million people which is comparable to the Canadian average. Dr.

MacEwan's report says there were nearly 34,000 CT examinations performed for patients in the last year covered by his initial study. He states such significant usage shows that with the six CT scanners currently in operation, the public has reasonable access to imaging services. Since 1976, Mr. Speaker, costs for medical imaging have risen from $16 million to $68 million.

In the past three years, four urban hospitals, four rural and northern hospitals and the Manitoba Cancer Treatment and Research Foundation have requested permission to purchase and operate CT scanners in additi on to the six scanners currently in operation. I am gravely concerned about the proliferation of new CT scanners without appropriate cli nical justification and access protocols. My foremost consideratio n is for the health statu s of Manitobans and the protection of patients. I was concerned that Dr. MacEwan's report be reviewed by a cross

section of experts and for this reason the CT Scanning Committee was formed. Today I am pleased to provide you with the report of the CT Scanning Committee. The work done by this committee challenges the escalating costs and choices associated with the technology and has developed recommendations based on scientific data and on an analysis of the services which are being provided in the context of the health needs of our citi zens.

2299 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 16 , 19 92 I accept the report and the recommendations of the CT Scanning Committee which states: 1. That available funds cont emplated for an additional CT scanner installation be used for patient needs at the present sites, and that no money be allocated for the acquisition or operation of additional CT scanners at th is ti me; and secondly, that an ongoing committee be established to deal with all future issues regarding com puted tomography and magnetic resonance imaging scanning.

Given the challenges, both financial and program reform, facing all governments today , including the go vernm en t of Ma nitoba, I accept the recommendations and will take immediate acti on to implement them . *

(1340) In taking this decision, I want to acknowledge the various fundraising efforts directed to CT scanners. Manitoba Health endorses community fundraising for new hospital programs, but at the same time, government must proceed cautiously to ensure that these actions are integrated into overall provincial planning for opti mum health care delivery. It is understood that CT scanners have been purchased by community hospitals and are planned in rural hospitals based on public fundraising and support. Our older policy allowed such action if no new costs were to be incu rred or actual savings were anticipated.

This has been the basis of similar hospital actions in the past. Manitoba Health has found that almost all such optimistic projections have been wrong and accep tance of the recommendation of the CT Scanning Committee means a change in policy. We will not approve the acquisition or operation of additional CT scanners at this time and will await the recommendations and advice of the CT Scanning Committee to deal with all future issues regarding imaging services.

To achieve such antici pated benefits, Manitoba Health will require the implementation of protocols for patient access to all existing provincial CT scanning services including those not approved. Frequent financial state ments from all hospital scanner services will be required to ensure that there will be no impact on approved budgets or cause closure of beds or layoff of staff . No funds will be committed to the operation of additional scanners without the prior input and advice of the provincial CT and MRI committee and the final approval for operation by the Minister of Health.

Today I am announcing the establishment of a provincial CT and MRI committee which will have the responsibil ity to deal with all future issues regarding provincial scanning programs. Dr. Blake McClarty, Director of MRI at St. Boniface Hospital has agreed to chair this committee which will begin its work immediately. I have requested that the comm ittee in clude in its early deli berations investigations and advice on the operating practices of all the current CT centres, continue the ongoing assessment of the Imaging waiting lists and develop protocols for utilization of imaging services.

In addition, I would also like to announce further action taken by the ministry in response to the report of the CT Scanning Committee. We will establish a Man itoba Imaging Adv isor y Comm ittee to co-or dina te the activities of all the ima ging subspecialties including CTIMRI Committee, the provincial Ultrasound Advisory Committee, the Nuclear Medicine Advisory Committee and the Radiology Advisory Committ ee.

This new overview comm ittee will include representatives from the clinical, hospital and professional bodies and the chairs of the designated subcommitt ees, which will better enable the development of health imaging policies for the future of Manitoba. I will ask the comm ittee to emphasize patient access and benefits and to provide an overall provincial program which establishes the context for approving future capital and operating imaging dollars. In the future, there has to be a priority to introduce new technology as a replacement of existing technology and costs as opposed to add on costs and services.

Our difficulty in the past has been a proliferation of technology and related costs whenever new services are intro duced. As I mentioned earlier, costs of imaging in this province have increased 450 percent since 1976, and this cannot conti nue or it will place at risk our ability to deliver all our health services to the people of Manitoba. The CT Advisory Committee will be directed to immediately address the question of how the current global dollars can best be spent and reallocated if this is deemed more appropriate.

In closing, I want to thank the chairman and the members of the committee for the professional and technical advice which they have provided to us In addressing this very complex and important policy issue. Committee representatives will be present today at 3:15 p.m. in Room 254 to present their

April 16 , 19 92 LEGISLATIVE ASSEMBLY OF MANI TOBA 2300 findings and respond to questions. All of us are aware, Sir, of the benefits which can be derived from the appropriate use of available technology in the diagnosis and treatment of illness. This governmenfs commitment is to the health and well-being of all our people. This government is committed to ensure that all of our health programs are kept in balance and that they are managed in a way which preserves the integrity of the spectrum of all services necessary to maintain and improve the health status of Manitobans. Thank you. *

(1345) Ms. Judy Wasylycla-L els (St. Johns) : Mr. Speaker, let me say at the outset that I will not be making a definitive statement on the part of the New Democratic Party in response to such a detailed technical statement. This the first time we have seen this material. There is much to review, and we will be making further comments at some point in the future. I can say on a preliminary basis that we acknowledge this is one important part of a health care reform agenda.

We on this side of the House have always said that part of the need to change our system must be to get a handle on escalating costs tied to new technologies, new drugs, new treatments for which we have not done proper tests and determined if the outputs justify the expenditure. So, Mr. Speaker, let that be clearly noted since the Minister of Health (Mr. Orchard) and the associate Minister of Health like to leave the opposite impression. Let me say that this whole area of CT scanners is a very major one for our hospitals, for our patients, and our community services.

We know that there are a number of hospitals with CT scanners sitting, not being operated in their facilities. They are engaged in a number of fundraising activities to try to see those scanners operational, and they have requests before this government for operating those scanners. I do not know on the basis of this statement if those scanners now purchased will receive operational dollars through the provincial government. I do not know if the minister has included those scanners in the overall assessment of what is the optimum number of scanners.

I do not know if those communities have been told-and those community facilities have been told to stop your fundr aising efforts, we will en sure a comprehensive system and all patients' needs addressed through this proposal and this committee and the work of this committee. We do not know, Mr. Speaker, if this study has assessed the needs of those facilities to have standards in the context of the costs associated with transporting patients with nursing staff, with assistants, with medication and machinery to hospitals where that scanner is located.

We will have to assess all of those questions and this announcement today in that context. I want to say two other things. This is one small part of that whole issue of whether or not new technology is warranted vis-a-vis the outcome for patients. There are hundreds and hundreds and hundreds of tests and treatments and procedures and surgeries and drugs which are now being used for which we do not know if the output for the patient benefits the expenditure. What we hope for at some point in the near future is some idea from this government of how they will handle such a massive undertaking.

We believe that such a massive undertaking is really almost impossible without the benefit of federal government involvement and a federal health care policy role. That, Mr. Speaker, is one of the reasons why we have been so concerned about federal policy which will see the end of federal dollars for provincial health care systems in a few short years leaving our systems in serious disorder and without the universal principles we believe in.

How does it make sense for each province to be going off doing these separate expensive assessments with all these committ ees and using the time of professionals and experts when it could be done centrally by the federal government for the benefit of all provinces? One thing, Mr. Speaker, we would like to urge today is that this government once and for all speak up about federal cutbacks in health care spending, speak up to save medicare and in the process guarantee themselves a much more cost-effective, sensible way to go in terms of quality assurance of scanners, tests, procedures and drugs.

Finally, let me indicate that this from the basis of what we can see is a positive step. All too often, the minister and the liberal critic have suggested we have not been constructive in our approaches. When we have seen some sign of progress, when we have been presented with some plans, we analyze those as objectively as possible and, in this

2301 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 16 , 1992 case, on the basis of prelimi nary knowledge we can say that the government is moving in the right direction. However, Mr. Speaker, we remain concerned that we are still operating primarily in a vacuum without the benefit of an overall plan in terms of the continuum of care from commun ity-based services right through to hospitals. We need to know on an urgent basis the min ister's plans in that regard. We once again put to him our plea on behalf of all Manitobans to te ll us what is your plan and your vision for health care in Manitoba. *

(1350) Mr. Guizar Cheema (The Maples): Mr. Speaker, we are very pleased to receive this report. It says basically two things. First of all, the process is opening up. That is another example that the judgment call on all the health care reform has to be made by the public at large. That is one step. When the committee is going into Room 255, that will be another evidence that the people can have full knowledge of these reports that are very, very important. That has never been done in any part of this country so far. Mr. Speaker, the focus has to be the patient care, how we spend $1.8 billion.

As we have said for the last four years, we cannot deal with the fragmented part of the issues. We have to deal with first of all what is our Manitoba prospective, how we are going to deal with our own population here. All the policies ha ve to be based on our ex perie nce . Our experience in Manitoba, as it says from this report, says very clearly that the CT scanners, whatever we have right now are sufficient. I think we will let the expert be the judge, and with the battery of information the min ister has provided and the knowledge of these individuals, we have no doubt that they are doing the right thing.

Mr. Speaker, the issue here is how much we can afford and what is possible. The technolo gy, as we said from Day One, has its merits but also has some limitations. We have to see what is necessary, what we can afford, and not what is required all the time. The issue as I said many times is that in health care for us is how we are going to save whatever we have and then we can improve. That is another example. The mini ster has made a commitment that he is going to come up with two or three more reports by the end of this month .

We will ask him again to continue with his public education campaign, tell people how his government is going to spend their tax dollars. That is the essence of the whole matte r, rather than every day the patients in Manitoba right now would get information from the vested groups. They have their own interest. What we want to see is each and every group on the same table. Let them tell us how they are going to spend $1.8 billion, not what is good for each group. That is again, very important.

I will emphasize again that does not necessarily deal with this report but that is the basic issue, how we are going to spend the money in the long run. We want to make sure that this health care debate is taken out of the hands of politicians and that is one way of doing it, by having a public education campaign. The more information we have, the more informed judgment we can make. We will again commend the ministe r to conti nue to follow the process of opening the health care reform to all Manitoba ns.

It does not matter which party they voted for, absolutely, we have to work for all of them and that is our aim. We must keep one thing in mind, patient care is the most important thing and the money will and should move where the patient goes, not to any particular interest group in this province. Introduction of Guests Mr. Speaker: Prior to Oral Questions, may I direct the attention of honourable members to the gallery, where we have with us this afternoon Mr. Obie Baizley, who is the former member for Osborne. On behalf of all honourable members, I welcome you here this afternoon here, sir.

Also, with us this aft ernoon, we have from the Teulon Collegiate, thirty Grade 9 students. They are under the direction of Mr. AI Reisch. This school is located in the constituency of the honourable member for Gimli (Mr. Helwer). On behalf of all honourable members, I welcome you here this afte rnoon. ORAL QUESTION PERIOD Federal Government Untendered Contracts Mr. Gary Doer (Leader of the Opposition): Mr. Speaker, Manitoba has been working for decades to maintain its aerospace industry in Canada. We have had ups and downs in our aerospace industry and jobs connected to the aerospace industry. We

April 16 , 19 92 LEGISLATIVE ASSEMBLY OF MA NIT OBA 2302 have had terrific development that has taken place in our province. We have also seen the removal of the Air Canada maintenance base and we saw the tragic result of the federal Conservative government tendering process with the CF-1 8 decision awarded to Quebec without any merit at all being considered. *

(1355) Mr. Speaker, today again we are advised that a company that was given a $245-million grant from the Canadian taxpayers to the province of Quebec to establish a Bell helicopter company was given a $1-bill ion untender ed contract from the federal Minister of Defence and the federal Conservative cabinet, Marcel Masse and the Cons ervative cabinet in Ottawa, for a contract for helicopters that is double what was anticipa ted to be necessary by the department of Canadian def ence. This, of course, has implications for Manitoba.

Any time we see a situation where there are absolutely no tenders available for othe r players in the aerospace industry is a tragic situation, Mr. Speaker. I would like to ask the Mini ster of Rnance, what action has this government taken dealing with their federal Conservative counterparts on the process which has absolutely no tendering to award a very important contract in the aerospace industry to the total neglect of other companies in Canada and in Manitoba? Hon. Clayton Manness (Minister of Finance): Mr. Speaker, I suppose I should probably take the question as notice .

I have been on the plane this morning back from Toronto, and I am not conversant with that particular issue at this point in time. I can indic ate to the member opposite, however, that cer t ainly we are concerned about all untendered contracts from the federal perspective. We have always sought balance with respect to Government of Canada or defence provision of services by way of contract. I would say to the member opposite that given his information and given the representation he makes by way of questions, I am sure the Minister of Industry, Trade and Tourism (Mr.

Stefanson) will want to inquire as to the federal government. I remind the member, it was a decision that was made in Ottawa. It was a decision obviously not ma de in the cou ncil chamber s within this government, and I think his question would be more appropriately addressed to probably a federal member. Federal Government Untendered Contracts Mr. Gary Doer (Leader of the OpposHion): Mr. Speaker, there are Manitoba companies located within this province that have to have the benefit of Manitoba representatives from Manitoba's cabinet that sits opposite us here today .

So the question is very much in order as many other decisions of the federal government affe cting jobs in Manitoba and the position of one of our most important industries. The aerospace industry has been identified by all sides as a very important industry in this province, an industry which quite frankly we are always on constant vigil to protect because of the preferential treatm ent of the federal government, not just this federal government but the previous Liberal government as well, with the change in the Air Canada maintenance base.

I would ask the Deputy Premier, given the fact that the contract was awarded without tender on April 7, can the Deputy Premier advise us, has the Chair of the Economic Committee of Cabinet, the Premier (Mr.

Film on), picked up the phone and talked to the Prime Minister of the country about a tendering process that does not allow for other companies in Canada to be involved, a tendering process that was no tendering process, a process that doubled the purchase of equipment and may have some long-term harm for our own companies in terms of the existing overhauled contract for Hue y helicopters that are being performed in the province of Manitoba ? Hon . James Downey (Deputy Premier): Mr.

Speaker, as far as any details of the question are concerned and any contacts that have been made or discussions, I will take this as notice from the leader of the Opposition. But I can assure the member that this government, on behalf of the aerospace industry or any other indus try, are prepared to take on their behalf to the federal government their argument and our argument in support of all the activities possible in this province, and we do believe in the fairer open tendering process. *

(1400) Mr. Doer: Mr. Speaker, I would ask again the Deputy Premier, in light of his state ments: Has this government been alerted by our Ottawa office about

2303 LEGISLATIVE ASSEMB LY OF MAN ITOBA April 16 , 1992 the lack of tendering process in this area? Has the government been in touch with Brist ol? Bristol is obviously very worried about raising this publicly because obviously the federal government is their major client, so they have to be very diplomatic in their comments. Our information from Bristol is that they are very worried about the future maintenance because the size of the contract has been doubled now for new helicopters. Have they been in touch with Bristol? Have they been in touch with their Ott awa offi ce?

Did we get an early warning, and was the Premier (Mr. Filmon) in touch with the Prime Minister of the country about another example of preferential treatment in this country in the aerospace Industry at the potential detriment of Manitoba? Mr. Downey: Mr. Speaker, we were informed that it was an untendered process that was carried out after the fact. Health Care System CT Scanner Fundralslng Ms. Judy Wasylycla-Lels (St.

Johns}: In the Mini ster of Health's stat ement today, the Minister of Health acknowledges that there are a number of fundraising efforts happening in communi ty and rural hospitals pertaining to either the purchase and/or operation of aC T scanner. I wonder if the min ister today could share with us the information concerning how many CT scanners have been purchased by community urban hospitals and rural hospitals which are not operational. What will be the status of those CT scanners in the context of this policy? Hon. Donald Orchard (Minister of Health}: Mr.

Speaker, I am informed that there is one scanner purchased and currently in operation without the approval of the provincial government in the city of Winnipeg. That ins tal lation, because it is not approved, the facilit y has not asked for, nor have they received operational funding for that scanner. That is exactly the issue that the CTIMRI Committee will come around in terms of att empting to put budg etary par am eters ar oun d our glob al expenditure for CT imaging in the province of Manitoba.

What has tended to happen in the past, when new technologies have been introduced, when first intro duced-a nd certainly this was the case, as my honourable friend will recognize-in 1979, when we were last in government and the first CT scanner was inst alled, there were very effective protocols put in place for patient access to that im aging technology. They worked, but with the proliferation of more scanners, those protocols tended to be, as obser ved by Dr.

Ma cEwan , our provincial radiologis t, not effect ively adhered to and hence the statistic that I shared with my honourable friend, the 450 percent growth in imaging cost . So the committee is trying to come around the global budget for CAT scanning in the province of Man itoba so that we do not simply use the technology because we have more of it available. Ms. Wasylycla-Lels: Let me just try to ask this question again in terms of some specific examples because I am still not quite sure how it is going to work.

We know that at Concordia Hospital, there is aC T scanner sitting, having just been purchased and waiting to be operational. What will happen now? Has the mini ster approved the operation of that CAT scan in the context of this plan, or will the community be allowed to procee d to fundraise for that CAT scan? Where does it fit in terms of this plan? Mr. Orchard: The installation referred to, it is my understanding that commu nity fundraising has already supported the capital cost of the purchase of that scanner.

Hence, the scanner has been purchased, but there has been no approval given to the installation and the budgetary commitment to operate that scanner. The case made by this facility, I believe, is that they can operate this facility from within their current global budget. That is why, Mr. Speaker, I have indi cated in my ministerial stat ement, and possibly I might quote directly from my state ment because I think it summates-we are asking for frequent financial state ments from all hospital scanner services.

This will be required to ensure that there will be no impact on approved hospital budgets or cause closure of beds or layoff of staff by diversion of budget to unfunded operations such as the CT scanner. In other words, Mr. Speaker, we are not prepared as government to accept criticism that we are not providing enough money within the global budget when som e of it is able to be diver ted to nonapproved operations, Sir. Ms. Wasylycla-Lels: Well, that does beg the question that we have been asking for months-what is the overall budget policy for hospitals in urban

April 16 , 19 92 LEGISLATIVE ASSEMBL Y OF MAN ITOBA 2304 Manitoba? Howe ver, I am not going to get into that now. We will pursue that later in Estim ates. Let me ask this question giving anoth er example. Seven Oaks General Hospital is involved in a community fundraising effort to purchase a CAT scanner, I believe, unlike Concordia where it has already been purchased. What direction will this mini ster give Seven Oaks? Will it be encouraged to carry on the fundraising? Will it be directed to try and- Mr. Speaker: Order, please. The question has been put. Mr. Orchard: Mr.

Speaker, that is why I recognized in this statement that for a number of purposes in our hospital system , fundraising efforts are underway. Some of them are focused on the acquisition of CT scanners and I say that, Sir, with the full knowledge that provincial approval for the installation of that was required. Mr. Speaker, I applaud the volunteer effort and the voluntary contri bution toward fundraising by Manitobans. Currently, the tri-hospital lottery is ongoing.

Two of the three hospitals are wishing to dedicate those dollars, those profit dollars from the lottery, toward the acquisition of CT scanning capacity. That is exactly where the policy of this government has to come down in terms of funding. We have indi cated that within the global budget that is currently there for imaging via CAT scanning, we will want to assure that needs are met, not wants.

As I have indic ated in my earlier answer, when new technologies have been intro duced, they have been used propitiously but with proliferation of the technology, protocols for access have gone to the side, and we are insisting that those protocols be established and adhered to by the advisory comm ittee we are set ting up un der the chairmanship of Dr. McClarty. Health Care System Out-of-Province Patients Mr. Guizar Cheema (The Maples): Mr. Speaker, my question is for the Minister of Health.

According to the information provided by the mini ster during the Estimates process, there is about $80,000 per year for the last three years of uncollected bills by the patients out of this country who have not paid their bills and have been getting treatment from our hospitals. Taxpayers' money must be treated with respect. Can the min ister tell us what measures he is going to take to ensure that the $80,000 per year tax drainage out of this country, out of this province, will not happen ever again? Hon. Donald Orchard (Minister of Health): Mr.

Speaker, I would like to be able to say that we could give that assurance within the policy development that the hospitals adhere to. We dealt with this issue a couple of weeks ago in Estimates, and I think it is important to put in context the $80,000 per year that we have not been able to recover. We provide services to some, particularly American citizens, and where those services are prescheduled or electively booked, our hospitals or physicians make the recoveries of the charges appropriate.

Where our difficulty has come in with these approximately $80,000 per year, Sir, is these are American citizens and citizens from other countries who were involved in an accident and require emergency services. The compassion of our Canadian health care system applies here in that we do not check to see if the person is going to pay the bill before we provide the service.

That has left us in the difficult circumstance where up to $80,000 per year has been uncollected because afte r providing the service and recovery of the individual, they have left the country, and we have not been able to collect those dollars, as hospitals. Mr. Cheema: Mr. Speaker, can the minister tell us, what is the impact of these uncollected bills on particular hospitals because some of the hospitals were serving those patients? Mr. Orchard: Mr.

Speaker, the obvious first effect is that they are out the money, because they have provided those services and did not recover them from the person who was not a Canadian, so that the costs assigned to providing those services have been absorbed in previous years within the budgets of those hospitals. Mr. Cheema: Mr.

Speaker, can the Minister of Health tell us what measures are going to be put in place to make sure that only in the case of emer gency si tuations ther e could be compassionate reasons, but in other cases, where patients are getting treatment on an elective basis, they must pay their bills in advance? Mr. Orchard: Mr. Speaker, I think basically most of the out-of-country services are provided in that fashion. I cannot say that it is perfectly applied

2305 LEGISLATIVE ASSEMB LY OF MAN ITOBA April 16 , 19 92 because there may well be circumstances where advance arrangements for an elective procedure may be left unpaid after the fact, but those , I am told, have tended to be very few and far between. •

(1410) It is the very difficult issue where most of the dollars are uncollected and remain outst anding debts in the provision of emergency service caused by an accident wherein the person recuperating leaves the country. Those are the very di fficult ones because I think as cost-consciou s as we want the system to be, it is pretty difficult to make that judgment that if they are from out of country that we should get a cheque first before we provide the service, and that is always the quandary health professionals are in, Sir. Agricultural Land Taxation Levels Mr. John Plohman (Dauphin): Mr.

Speaker, while this government on the one hand talks about lower property taxes for farmers, it is with the other hand reaching deep into farmers' pockets to pay for the agricultural budget. They are reaching into hard-pressed farmers' pockets, Mr. Speaker, by shifting the burden of property taxation away from the residential category onto the farm category through portioning changes that have been made this year and by a reduction in the residential mill rate, thereby increasing the special levy to record levels.

The Minister of Ru ral Development is using Bill 20 as well to perpetuate an unfair assessment system and to stifle appeals to that unfair system. Why has this Ministe r of Rural Development abandoned the stated policy of this government of lowering taxation on farm land, and why has he chosen this duplicitous act on farmers to force them to pay more? Hon. Leonard Derkach (Minis ter of Rural Development): Mr. Speaker, I have to remind my honou rable frien d opposite that it was this government that removed the ESL on farm land for the farmers of ou r provi nce.

We were then compelled to do the reassessment and indeed to make up the revenues from general revenue. The farmers of our province have been able to access thems elves of a benefit in terms of having a reduction in the ESL and the school taxes on their farm land. Let me say, Mr. Speaker, that Bill 20 which is before the House at the present time in no way removes the right of a farmer to appeal if there are some extraordinary circumstances which impact on the value of his or her property.

When I go back to the discussions that were held in the assessment bill last year, it is evidentthatthe member who asked the qu estion was very mu ch on the same wavelength in committee when that matter was discussed. Mr. Plohman: Mr. Speaker, I am not in favour of the shift that is being made by this government now and secretly. I will ask the min ister a specific question.

Maybe this minis ter can explain why he has shifted a greater burden of property tax onto farmers by signi ficant reductions in the portioning on residential properties whic h results in a greater proportion of the property taxes being borne by the farm category, and that is clear in many munic ipalities. Mr. Darkach: Mr.

Speaker, the member knows very well that the reassessment was based on the 1985 value, and that as we move to reassessment in 1994, as is recommended in the proposed bill be fore the Legis lature, th at asse ssment pnte�ection) Well, it is 1993, true, but the effect will be in 1994- in fact, then we will be moving the value of farm land closer to the actu al time. There are adjustments that are going to be made in the process. The portioning is really meant to make sure that we indeed are more fair in the way we approach taxation from a global sense. Mr. Plohman: The special levy is at record levels, Mr.

Speaker. Will the mini ster now admit that he and his colleagues, the Minister of Finance (Mr. Manness) as well, are engaged in a secret act to claw back the meagre benefits that cash-strapped farmers are receiving under GRIP and NISA, that they are reaching back into the pockets of those farmers? That is what this government is doing. Mr. Darkach: Mr. Speaker, I would have to say that the suggestion is somewhat hideous. Let me say that special levies are not the responsibility of the provincial government. Special levies are set by local muni cipal organizations and indeed school boards.

Therefore it is the responsibili ty of those organizations to determine what their budgetary levels should be and how they should assess taxation from their perspective.

April 16 , 19 92 LEGISLATIVE ASSEMBLY OF MANIT OBA 2306 Agricultural Land Taxation Levels Ms. Rosann Wowchuk (Swan River}: Mr. Speaker, my question is also for the Minister of Rural Development and relates to Bill 79. When the bill was introduced, this was considered real tax reform. We were going to see educational tax removed from farm land and placed on residence as it should be, and farmers would be payi ng a Jesser porti on of educational tax. However, this is not true.

Councillors and farm groups have indic ated , as a result of a shift in portioning and increased special levies, taxes have increased dramatically. Taxes on a quarter of land have inc reased in some cases by $50 to $80 per quarter. Will the min ister admit that there is a flaw in the taxation system that has been implemented and as a result farmers are picking up a larger percentage of educational tax? Hon. Leonard Derka ch (Minis ter of Rural Development): Mr. Speaker, that question almost duplicates what was just asked a moment ago, but let me give the response in the same way.

Let me ind icate , fi rst of all , that it is this government that removed education taxation on farm land. I think the cost of that-a nd I stand to be corrected-was somewhere in the neighb ourhood of $22 million as the cost to the provincial Treasury, so that was a direct benefit to the farmers of this province. We have done everything we can to keep taxes down. As matter of fact , our fifth budget this year froze taxes, did not increase taxes to Manitoba ns. When the member opposite makes the allegation that we are shifting the tax burden onto farm families, indeed that is a false allegation. Ms. Wowchuk: Mr.

Speaker, can the minis ter confirm to the House that despite the adjustment, the ESL of one point, the tax burden on rural residents and in particular the farmers has increased signif icantly and that through the special levy, taxation will reach historical levels? Up to $300 million will be raised through this special levy in the 1992 tax year. How is the minister going to address this- Mr. Speaker: Order, please. The question has been put. Mr. Derkach: Once again , Mr. Speaker, the question is duplicated from that posed by the member for Dauphin (Mr.

Plohman) ,and I say to you again and to the House that indeed special levies are not something that are determined and set by the provincial government. The members opposite should understand that special levies are set by local municipalities and local school boards, and they have a responsibilit y in terms of addressing their budge tary requ irements and then assessing the tax levies from there. Education Support Levy Ms.

Rosann Wowchuk (Swan River): I want to ask the mini ster: How is he going to deal with the fact that although provision has been made to exempt farm properties from educational support levy, farm homes were added to the tax roll? All other farm buildings, including grain and storage bins, were supposed to be exempt, but they are being taxed with this school levy, and farmers are really being taxed doubly. Hon. Leonard Derkach (Mi nister of Ru ral Development): Mr.

Speaker, just a few days ago I was looking at Hansard and some of the comments that were made in the debate of Bill 79 and some of the commen ts that were made by memb ers opposite , and indeed from those commen ts I gathered that they supported the direction in which reassessment moved and that farm residents should be taxed. Is the member for Swan River saying now thatthat is wrong, that they have changed their position and that in fact residents should not be taxed? Agricultural Land Conservation Methods Mr. Nell Gaudry (St. Boniface): Mr. Speaker, my question is to the Minister of Agriculture.

The State of Canada's Environment report released last week by the federal gove rnment highligh ted some long-term threats posed to the continued viability of agriculture on the Prairies. The report says, and I quote: Agricultur�interjection] You will have your chance to answer. Agriculture may contribute to its own demise through soil erosion, productivity loss and saliniz ation unless conservation practices are increased. My question, Mr. Speaker, is for the minister. The report says that water erosion affects 12 percent of the improved land area annually, a farm economic

2307 LEGISLATIVE ASSEMBLY OF MAN ITOBA April 16 , 19 92 impact of $155 million to $197 million, and that wind erosion has an estimated annual impact of $213 million to $271 million on the Prairies. What is the impact in Manitoba, and what targets and time frame has this government set for decreases of economic losses due to wind and water erosion? *

(1420) Hon. Glen Findlay (Minister of Agriculture): Mr. Speaker, when this government came into power in the spring of 1988, we saw some of the worst water erosion Manitoba ever had up in the Swan River Valley which we corrected un der emergency measures. We had some of the worst wind erosion in southern Manitoba we ever saw. Subsequentt o that, Mr.

Speaker, this government signed a soil accord with the federal government, put in place a soil agreement of some $18 million , put in place in rural Manitoba some 44 soil and wate r associations, a small amount of money in the hands of local people to make the right decisions to promote conservati on, to decrease the degree of salinity, to decrease the loss of organic matt er. Mr.

Speaker, I would like to report that Manitoba has gone from a position of being about 15 percent summer fallow, down to this year's 7 percent summer fallow which helps to reduce the loss o f organic matter and helps to reduce the amount of wind erosion. We are on a very positive path with the programs in place, working with the farmers of Manitoba to improve the conservation of our natu ral resource, the soil in Manitoba. Mr. Gaudry: Mr.

Speaker, can the minister tell the House what action his department is undertaking and has undertaken to correct salinity problems resulting from irrigation and cropping practices which the report says costs the prairie provinces $104 million to $257 million annually? Mr. Findlay: Mr. Speaker, I believe I have already answered that question , because salinity is to a large extent caused by summer fallow, one of the practices that causes salinity. We have decr eased summer fallow.

We understand the principle bett er, increasing organic matter, and the conservation attitudes of Manitoba farmers through the various associations we have and the extension informati on that we are involved in in the Department of Agriculture is proactively addressing that. I am pleased to report to the House that farmers have a mu ch differen t attitude today about conservation of their basic resource than they had 1 0 years ago, and we feel very positive that we will continue to address it in an ongoing fashion. Sustainable Development Mr. Nell Gaudry (St. Boniface): Mr.

Speaker, when will the government recognize the sustainable agricu ltur e policy that is vital for long-term development, and could the minister tell us the amount of money that he has put in for it? Hon. Glen Findlay (Minis ter of Agriculture): Mr. Speaker, I think the member is fully aware of the efforts we have made. We have a round table on the environment and the economy here in the province of Manitoba led by my Premier (Mr. Filmon), the most proactive round table in Canada. It is a model for the other provinces of this country. Mr.

Speaker, as I said, we have the conservation initiatives that we are involved in that are positive. We have just put out a Vision for the 1990s document to show the proactive stance of our department. In the Vision for the 1990s, under the seven themes that the department is going to follow, is sustainable agriculture. So we are on that trai l, very aggressively working with the producers of Manitoba. Law Enforcement Review Agency Racism Investigations Mr. Dave Chomlak (KIIdonan): Mr. Speaker, my question is for the Minister of Justice .

A very unfortunate incident recently occurred in Winnipeg, whereby members of a university track team, some of whom were charged, have accused the Winnipeg City Police of racism in respect to the incident. Since the minis ter and the government have announced their intention to disband LERA, can the minister advise this House how this matter, this accusation of racism and related matte rs, will be investigated and dealt with adequately? Hon. James McCrae (Minister of Justice and Attorney General): Mr. Speaker, the Law Enforcem ent Revie w Agenc y has not been disbanded to this date.

Any matters coming before it are to be dealt with either by the present Law

April 16 , 19 92 LEGIS LATIVE ASSEMBLY OF MANITOBA 2308 Enforcement Review Agency or the mechanism that will be set up to replace LERA. Mr. Chomlak: My supplementary to the same minister: Can the mini ster assure this House that whatever new mechanism is going to be put in place to replace LERA will have the ability to deal with and investigate matters of racism? Mr. McCrae: It is proposed that the new structure will have the same powers as the present one. Mr.

Chomlak: My final supplementary to the same mini ster: Can the minister advise this House when that new structure will be in place and when we will have an opportunity to discuss it perhaps in this Chamber? Mr. McCrae: The changes require changes in legislation which will be brought before this House this session, and the honourable member and I can discuss details at that time. Crown Lands Act Wildlife Baiting Regulations Mr. Paul Edwards (St. James): My question is for the Minister of Natural Resources, Mr. Speaker. Some time ago, all memb er s of this House-[ interjection] We are after that farm vote.

Some time ago now, Manitobans were shocked, and I believe all members of this House were shocked, to learn of the slaughter of bears by certain individuals for commercial gain, leaving the bear carcass wasted in an inhumane and reprehensible fashion. At the time, the mini ster spoke out in condemnation of the trade in exotic animal parts that led to this slaughter. We certainly agreed with those sentiments, and he indic ated that action would be taken to curtail the practice. My question for the minister, Mr.

Speaker, is that I have been disturbed recently to learn that the practice of bear and elk baiting is still allowed in our province, although thank fully, not widely practised. Mr. Speaker, can the minister tell members why his department has not moved to prohibit the baiting of elk and bears, as well as other ungulates, at least on Crown lands, as the Province of Alberta has now done? Ho n. Har ry Enn s (Mi ni ster of Natural Resources): Mr.

Speaker, I first of all want to thank my col leagues, that is the memb ers of the Conservative caucus and cabinet, who made it possible for me to amend The Wildlife Act, so that I could outlaw unacceptable practices such as the bear holds. I remind Manitobans in the House that all Liberal members and all NDP members voted against that amendmen t. With that amen ded leg islation, regulations have been put in place that were put in effect as of April 1 of this year to prohibit the sale of animal parts in the province of Manitoba. Mr. Speaker, the honourable member refers to the question of baiting practices.

That is a question for ongoing review, although I might remind the member that the baiti ng practice in itself has some advantages in the sense that we pass specific regulations as to the kind of animals that may or may not be harvested from time to time. It quite often ensures that indeed is what happens. Mr. Edwards: Mr. Speaker, again for the same minister. As I am sure the minister is aware, The Crown Lands Act in this province prohibits the building of a structure, but not the building of tree stands which are classified as tem porary; most of them are taken down.

In fact, that adds to the problem of baiting. I wonder if the mini ster could comment, would advise members of this House, what investigation he has done into possible amendments to The Crown Lands Act, which would change the definition of structure and allow for the Crown to take a role in prohibiting the temporary erection of tree stands. Mr. Enns: Mr. Speaker, I invite the honourable member to engage in a wider-ranging discussion, as he may choose, during the consideration of my Estimates. I would have, on that occasion, expert wildlife people available to me. Mr.

Speaker, while I am on my feet, will nobody ask me why I am wearing this flower today ? *

(1430) Mr. Speaker: Here is your chance, Paul. Mr. Edwards: The mini ster's answers rarely have much to do with the question, so I am sure you will find time to explain that to us. Mr. Speaker, I have a final question for the minister. The mi nister mentions that there is ongoing conside ration about the problem with baiting. Leadership has been shown in the province of Alberta. Can the minister indic ate to members whether or not he is preparing a regulation to deal with baiting as other provinces have moved towards?

2309 LEGISLATIVE ASSEMB LY OF MAN ITOBA April 16 , 1992 In fact, the western provinces generally have been looking at this area. The province of Alberta has shown a lead. Mr. Enns: Mr. Speaker, I can indic ate to the honourable member that the issue of any number of practices that recreational hunters engage in, from time to time, are under constant review by the department. The question of what constitutes a bait is sometimes not that easily defined. A farmer leaving a round bale of hay in the field, does that constitute a bait?

So am I now telling my colleagues, as farmers, when and how, and how quickly to remove all hay off their fields? As I said on other occasions, it is sometimes a good management practice to have a bait in place rather than shoot at an animal where possible injury or lack of recovery is the case. So, Mr. Speaker, again I invite the honourable member for a more full debate when we consider the Estim ates of the Department of Natural Resources. Mystery Lake School Division Meeting Request Mr. Steve Ashton (Thompson): Mr. Speaker, my question is for the Minister of Education.

The school distri ct of Mystery Lake in Thompson is dealing with a difficult situation currently. It has announced cuts in terms of staff . It has announc ed cuts in terms of special needs programs, and concern has been expressed that in sufficient resources will be available to provide the .sufficient number of hours for high school students to receive accreditation for their high school graduation from the province of Manitoba.

I would like to ask the Ministe r of Education whether she has met with the school district of Mystery Lake, with parents or with teachers, to determine the impact of those kinds of decisions that have been brought out because of funding decisions by this government. Hon. Rosemary Vodrey (Minis ter of Education and Training): Mr. Speaker, my department is in touch with Mystery Lake, and I personally have met with each division that has requested a meeting and also each set of parents who have requested a meeting.

But I would like to remind the honourable member that the school district of Mystery Lake received an increase in their funding this year of 1. 9 percent. Funding Mr. Steve Ashton (Thompson): Mr. Speaker, indeed, in terms of the funding situation, I do not know if the min ister is referring to percent or figures that were announced by the government which were incorrect because of the change of form. The school district did not receive the increase that was publicized due to an error on the part of the school district in providing informati on, not the government.

I would like to ask the minis ter again whether she is then perhaps aware of the impact that the actual funding is having currently, to the point where high school students may not be able to receive accreditation for their graduation from the high school in Thompson due to inadequate resources. Hon. Rosemary Vodrey (Minis ter of Education and Training): Mr. Speaker, I think the member is quite confused. Let me start by saying, Mystery Lake school division has in fact received an increase. There are, according to our departmental guidelines, guidelines for contract hours.

However, it is within the local division's realm of responsibility to determine the number of contract hours, and Mystery Lake school division, according to the member, is making that decision. Mr. Ashton: Mr. Speaker, how could the minister avoid the bottom line here, which is the school district of Mystery Lake, given the resou rces provided by this government, is now having to cut staff, is going to have cut hours of instru ction, is going to have cut special needs programs?

How can the minister avoid the bottom line with her education funding that sees funding for private schools but sees these kinds of cuts in the public schools in Manitoba? Mrs. Vodrey: This has happened before. I cannot understand the member from the other side having such difficulty in understanding that we have Increased the funding to Mystery Lake school division, and there are local decisions being made. Mr. Speaker: The time for Oral Questions has expired. *

(1440) April 16 , 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 231 0 ORDERS OF THE DAY House Business Hon. Clayton Manness (Government House Leader): Mr. Speaker, I would ask you to canvass the House to det ermine whether there is a wish to do away with private members' hour today. Mr. Speaker: Is it the will of the House to waive private mem bers' hour? No, leave is denied. Mr. Manness: I would like to also have you canvass the House with respect to an issue that was discussed some time ago.

I am led to believe by party leaders and subsequently by those members of the parti es at LAMC, when a decision was made to present to the House a request that critics during Esti mates review would have the opportu nity to come down into the lower benches in the

section in the Chamber. To that end, I would like to formally read then that there have been discussions between party leaders respecting the desirability of permitting opposition critics in the

section of the Comm ittee of Supply meeting in the Chamber to be seated in the front row of benches during Estimates consideration and to allow ministers and members wishing to speak at that

section of the comm ittee to remain seated while doing so. I believe that if you were to canvass the House, Mr. Speaker, you would find there was unanimous consent to adopt these practices immediately. They would continue in effect for the remainder of the session. Agreed? Mr. Speaker: Is there unanimous consent to adopt those pract ices? Okay. I thank the House for that, but one final point before moving to other business, members are more spread out and less easy to seat in the Chamber than in the committee room.

Therefore, to assist the Chairperson in identif ying those memb ers who wish to speak, all such members should raise their hands to indicate clearly that they wish to speak and to ensure that they are seen by that Chairperson. Thank you. Committee Changes Mr. George Hlckes (Point Douglas): I move, seconded by the member for Swan River (Ms. Wowchuk), that the composition of the Sta nding Committee on Economic Development be amended as follows: Point Douglas (Mr. Hickes) for Brandon East (Mr. Leonard Evans), lnterlake (Mr. Clif Evans) for The Pas (Mr. Lath lin), for April 21 , 1992, for 10 a.m . on Tuesday.

Motion agreed to. *** Mr. Manness: Mr. Speaker, I move, seconded by the Minister of Environment (Mr. Cummings), that Mr. Speaker do now leave the Chair and the House resolve itself into a committee to consider of the Supply to be granted to Her Majesty . Motion agreed to, and the House resolved itself into a committee to consider of the Supply to be granted to Her Majesty with the honourable member for St. Norbert (Mr. Laurendeau) In the Chair for the Department of Health, and the honourable member for Seine River (Mrs. Dacquay) in the Chair for the Department of Family Services.

COMMITTEE OF SUPPLY (Concurrent Sections) HEALTH Mr. Deputy Chairperson (Marcel Laurendeau): Order, please. Will the Committee of Supply please come to order. This afte rnoon, this

section of the Committee of Supply, meeting in Room 255, will resume consideration of the Estimates of the Department of Health. When the com mi t tee last sat, it had been consid ering item 1. (

c) Evaluation and Audit Secretariat: (1 ) Salaries, on page 82 of the Esti mates book. Ms. Judy Wasylycla-Lels (St. Johns): As the minister knows, we have been trying persistently to piece together this government's agenda with respect to health care reform and to get some basic information about funding policies pert aining to health care facilities. The mi nister knows that I have asked this question at every sitti ng, that we have had no success for the last two weeks.

I indicated in Question Period today that we would continue to pursue this issue, and we are at the line that is quite germane to this whole issue of overall policy and funding guidelines. The line of Evaluation and Audit Secretariat is certainly a pertinent area to be raising questions again pertai ning to the funding of our health care facilities, the funding guidelines being recommended by this minister and the impact after

231 1 LEG ISLATIVE ASSEMB LY OF MAN ITOBA April 16 , 19 92 a process of evaluation and analysis on those funding decisions for patient care and quality of our health care services.

So I would ask the minister once again if he is prepared today to provide for us the breakdown of the per centage increases that this min ister is providing for each hospital in the province of Manitoba, and if he could indicate what is included in that percentage increase; in other words, what the hospital or health care facility is expected to cover with that dollar increase, and what is the evaluation of that funding policy in terms of the impact on patient care and quality of health services. Hon. Donald Orchard (Minister of Health): Yes. * (1 450) Ms.

Wasylycla-Lels: Would the minister be prepared to provide that information today ? Mr. Orchard: I have always indicated we would provide that information when I have staff here and we have reached the Hospital line. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, the minister knows that in the past, we have tried to appreciate that offer on the part of the minister and have suggested we move directly to the Hospital line and then come back to the other lines once we have dealt with that parti cular line. Is the min ister prepared to do that today? Mr. Orchard: Mr.

Deputy Chairperson, as I have indicated to my honourable friend before, the ministry of Health is a much more complex and diverse service delivery department and not solely fixated on the hospital s, as my honourable friend is. I prefer that we deal with the health care syst em, deal with Healthy Public Policy, Conti nuing Care, Mental Health Services, and our Health Services lines in this, and then when we get to Insured Benefits, we can have the kind of full discussion my honourable friend wishes to have on the hospital syst em.

That way, my honourable friend might be able to gain a greater appreciation that health care is not solely, as she seems to believe, hospital funding, but rather a diversity of funding. Ms. Was ylycla -Lels: Well, Mr. Dep uty Chairperson, the minister will know that he has used up a great deal of time in our Estimates process on details pertai ning to hospitals.

He has, in fact, responded on a number of issues pertaining to hospitals, and it appears that when those questions have noth ing to do with the more contro versial issue at hand today of funding levels, the minister is prepared to discuss and dialogue at length around those issues. When it has to do with funding matters, he is prepared to say we will deal with it when we get to the Hospital line.

The other day, at our last sitti ng of Esti mat es, the minister was prepared to use up most of that time talking about hospital policy, given the fact that the issue of Seven Oaks General Hospital had been raised by myself in Question Period and given the fact that there had been a discrepancy in the figures that I used with the announcement that day. He used up the time. He is prepared to talk about it.

It is absolutely ludicrous for him to suggest that we follow his direction and move along and get to the Hospital line and then he will provide the information, when he knows we have an urgent situation at hand, when in fact hospitals are trying to figure out what to do with some directions provided now. There is confusion out there, there is unease, there is uncertainty at all levels, from patients to professionals to adminis trators in the broader commu nity. We have tried everyt hing. We have raised it, we have asked questions in different ways.

We have suggested moving strai ght to the Hospital line, and I am afraid, Mr. Deputy Chairperson, we are gett ing nowhere. I am going to, therefore, move that this committee instruct the Minister of Health to provide today the specific funding decisions for each hospital in Manitoba and table the evaluation and analysis of the impact of those funding decisions on patient care. Mr. Deputy Chairperson: Order, please. Has the honourable member got that moti on in writing ? Ms. Wasylycla-Lels: I quickly scribbled it in my own handwrit ing right now. I hope you can read it. Mr. Orchard: Mr.

De puty Cha ir person , my honourable friend has made the allegat ion, in her atte mpt to fixate on hospital s only, that when I have had questions, I provided informati on. Even my honourable friend admitted to it, that where those questions involved policy, I gave an answer because this is the area where we discuss policy formulation, policy direction of government. The detai ls around spending that my honourable friend has been fixated on for some time are appropriately dealt with on the Hospital line as we move through the resolutions. We have always

April 16 , 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 2312 done it in that way, it has always worked quite well, and it has always allowed for the kind of discussion around the ministry that my honourable friend I think wants to have so she can gain an underst anding of what we do in this ministry. Mr. Oeputy Chairperson, to make the accusation that I had answers yesterday-not yeste rday, pardon me, on Tuesday regarding Seven Oaks, yes, I had answers given to me th at morning in the press release that Seven Oaks Hospital put out.

They were Seven Oaks' figures, as detailed in that press release and some of the initiatives they were taki ng. That was a reasonable discussion to have because I think it tried to focus in some ways, Mr. Deputy Chairperson, on the issue of policy around ma nagemen t of the hospitals. Ma nagement decisions were made at Seven Oaks Hospital for this fiscal year, this current fiscal year which looked seriously at their management levels in the hospit al.

I do not have the press release in front of me, but from memory, the most significant statement in that was that the board and administration of Seven Oaks Hospital were satisfied that this would not reduce either the volume or the quality of care delivered at Seven Oaks Hospital and that their budgetary savings were ones which were achieved without compromising patient care.

For a number of budgets now, we have tried to focus in and put our $1 .8 billion in context of funding services for the person requiring care, whether it be in acute care hospita ls, surgery, whether it be an outpatient service in a physician's office, whether it be personal care, home care, support services for seniors or programs under our mental health program, but we are trying very much to assure that when we dedicate monies, we see as many of those dollars reach the patient as possible.

Seven Oaks, in analyzing their budget for this year, found that they could achieve some pretty significant savings in the management structure of the hospital without compromising patient care. I say to you, Mr. Deputy Chairperson, the board and the management of Seven Oaks deserve to be congratulated for looking at the internal operations and stru ctu res of the hospital before doing anyth ing to compromise the quantity and quality of patient care. Now that gets us into the whole issue.

I am su rprised that my honourable friend, having responded in a positive fashion to a ministerial stat ement I made today, in terms of acquisition of CT scanning imaging as a technology desired by various hospitals, would not want to deal, from a policy standpoint, with the issues raised by Dr.

MacEwan, a pre-eminent scientist and provincial radiologist, in terms of the kind of recommendations that he made and the kind of in-depth scientific study he made of CAT scan imaging in the province of Manitoba, because those findings of our provincial radiology consultant were then put before our CT Scanning Committee. * (1 500) The CT Scanning Comm ittee had fairly wide membership, including the MMA-three radiologists on it.

They came to a recommendati on, two of them, in fact, very simple: that we, at this time, do not invest in new CAT scanning capacity, that we put any additional budgets, to serve patient needs, at the present sit es; and that we set up a committee to do the sort of system-wide approach on installation of new CAT scanning capacity. I know that this report, as I speak this afte rnoon, is causing consternation in several of the community hospita ls. I know that.

I know that this report is causing consternation in my home community because Morden and Winkler have a fundraising comm ittee for CAT scanning in the proposed regional facility that is in full planning in that area. These decisions, if one were to operate from a purely political st andpoint and not try to underpin one's decisions and policies with scientific analysis, one would simply say: okay, no holds barred; you raise the money, we will fund th em.

But surely, if my honourable friend would look at CAT scanners per million population , the graph that was presented , you will see that we are close to the national average right now. We are slightly below. One scanner would put us well above the na tional average, so we are just on that border line, but the nine other requests would put us in the position of being the most generously served province, in terms of CAT scans, in Canada. The report of Dr. MacEwan indicates that the six scanners currently in ope ration have a total operating budget of $9 million. That is $1 .5 million per scanner per year.

Even if you use two-th irds of that and you say that you might be able to operate at $1 million, or even at $750,000, by allowing those installations to proceed without any overall policy overview of government, those additional nine

231 3 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 16 , 19 92 scanners could add a minimum of $6 million to $7 million to our annual budget in health care . The question I have to answer on behalf of Manitobans is: Does that represent the most effective investment of new, scarce taxpayer resou rce in health care, or are ther e more appropria te places to spend all or part of that $6 mill ion and achieve a better health status improvement and care delivery outcom e by doing that?

I am surprised that my honourable friend today is so fixated on hospitals, and hospitals alone, that she wants to, obviously I think, disrupt the committee, cause a vote, waste the time of both committ ees, only to say to the public: I only care about hospitals in the NDP; I only have one concern in health care as the New Democratic Party, and that being hospitals. Well, I am sorry, I cannot accede to that narrowed perspective and view of health care in Manitoba. The ministry of Health is much bigger than hospitals.

It needs to be fully debated as a system providing care in the community and in other settings such as personal care homes. It needs to have a full review. My honourable friend is fixed in the New Dem ocratic Party only with the concerns of hospitals, and that is shameful in today's context. I cannot understand why my honourable friend on one hand will stand up from time to time in public and will say, I believe in health care reform. I believe that we should be moving budget from our institutions to the community.

I believe we should be reducing our overreliance on institutional care, and we should focus on commu nity care. Then when it comes to an opportunity to explain that, to discuss that, to debate that in Estimates, my honourable friend the New Democratic Party critic has one fixation and one fixation only and that is acute care hospitals. I mean, she cannot have it both ways. She cannot flip-flop, as New Democrats have done across the length and breadth of this country , and say one thing in one circumstance and completely the other in another circumstance .

Let us get on with debate of the ministry of He alth's Es ti ma tes, and let us stop this single-minded fixation by the NDP that hospitals are the only thing that matt er. Mr. Deputy Chairperson: It has been moved by the honourable member for St. Johns (Ms. Wasylycia-Leis) that the committee request the Minister of Health to provide today the specific funding decisions for each hospital in Manitoba and table the evaluation analysis of the impact of these funding discussions on patient care. All those in favour of the motion? Some Honourable Members: Yea. Mr. Deputy Chairperson: All those opposed to the motion?

Some Honourable Members: Nay. Mr. Deputy Chairperson: The motion is defeated. Mr. Steve Ashton (Thompson): I reques t a recorded vote, a formal vote . Mr. Deputy Chairperson: Can we just wait one minute? A formal vote has been requested . We will recess to the Chamber where the formal vote will take place. IN SESSION Madam Deputy Speaker: Call in the members. Order, please. It has been moved that this comm ittee request the Minister of Health (Mr.

Orchard) to provide today specific funding decisions for each hospital in Manitoba and table the evaluation and analysis of the impact of these funding decisions on patient care. A COUNTED VOTE was tak en, the result being as follows: Yeas 20, Nays 28. Madam Deputy Speaker: Order, please. The motion is accordingly lost. We will continue with our review of the Estima tes. HEALTH Mr. Deputy Chairperson: Order, please. When this committee was last sitting we were dealing with Evaluation and Audit Secretariat:

(1) Salaries, on page 82. Mr. Guizar Cheema (The Maples): Mr. Deputy Chairperson, I want to raise a few questions about the minister's state ment in the House. Before I do that, I want to go over some of the things which have happened this afte rnoon. It is very important that we see, and people should see, what is happening here. I mean, who is trying to undermine the whole process and trying to take advantage of situat ions? I will not object to any kind of motion which will lead us to make informed decisions and open debate. This motion which was put to us-even a politician like me, who does not

April 16 , 19 92 LEG ISLATIVE ASSEMBLY OF MANITOBA 23 14 have much political experience, can even say that this is irresponsible because if you want to make a decision, you should go through each and every line, and specifically when we are dealing with the very important issue of health care reform. The health care reform has to be dealt with as a package and the package must have all the informati on, and if somebody is saying we are not doing the right thing as the NDP, let them say it very clearly. Mr. Deputy Chairperson: Order, please. I would like to remind the honourable member that the debate has already been concluded on the motion. The motion was defeat ed. We are dealing with (

c) Evaluation and Audit Secretariat, and I would appreciate if we moved along to that line. Mr. Cheema: Mr. Deputy Chairperson, I will move along the line, I will follow your order, I will follow the rules, and that is what we were debat ing, basically the rules of the game here. The rules of the process was to follow the line by line, and now you are asking me, and I am not reflecti ng on the Chair, to follow the rules and that was the process we wanted to follow.

Within 12 hours, we discussed and we had gone through so many things, and basically, what happened in 1979, what happened in '82, what happened in '84. So back and forth , 48 minutes of debate . If the NDP wanted to reach to the bottom of the pro blem, to reach the issues-(inte�ection] Mr. Deputy Chairperson: Order, please. Point of Order Ms. Judy Wasylycla-Lels (St. Johns): I have a point of order. The member for The Maples is clearly reflecting, first of all, on the intentions and actions of a member in this House and imputing motives. Secondly, he is reflecti ng on a vote of the House, and I think, Mr.

Deputy Chairperson, both are out of order and he should withdraw, apologize, and if he has got concerns to raise about any of these substantive issues, he should get on with it. Mr. Steve Ashton (Thompson) : Mr. Deputy Chairperson, the member for St. Johns is quite correct. It is clear in our rules that the member should not reflect on a vote that has been taken in the House, other than to move a motion that might in some way rescind the impact of such a motion. In this case, of course, the motion that we had moved, because of the lack of support from other parties, was defeate d.

Now, if the member wishes to move another motion that states his view in contrary to what was moved, that would be in order. But it is not in order for the member now to debate after the vote was taken and afte r debate had concluded on the motion to try and explain why his party voted the way it did. That is absolutely in contrave ntion of our rules, Mr. Deputy Chairperson. I would like to ask that you call the member to order. Mr. Cheema: Mr.

Deputy Chairperson, let me just tell the members that I am not reflecti ng on any one of their issues, I am reflecti ng on the process about what we are talki ng right now. I am not talki ng about what they did, and everybody knows what they did. That is not the issue. The issue is I have still the right to get 20 minutes to speak on health care reform, and their agenda was a part of the health care reform. So do not I have the right to say that? I would like the Chair to explain to me whether I am in order to ask a question about the health care process on health care reform?

If I am not in order, I will sto p. pnte�ection] I am not debati ng, just wait; you know, I may not be here in 12 years, but I am not a bloody, stu pid man. Mr. Deputy Cha irperson: Order, please. The honour able memb er for St. Johns (Ms. Wasylycia-Leis) is correct, that we should not be reliving the issue of the motion brought forward in the House. At this time I would request that the committee move ahead to

section (

c) Evaluation and Audit Secretariat, so that we carry on in a manner that is appropriate for the House. *** Mr. Cheema: Mr. Deputy Chairperson, if that is your decision and that is the wish, I would proceed. But cert ainly, we st ill have 20 hours to discuss, and every time I get the opportunity I am going to say things which are not right, whether they are part of this process or not. I think the issue here is that-so that means that every time the member for St. Johns (Ms. Wasylycia-Leis) has to follow a line, she has to follow the line. I am going to demand equal time, I am not going to give any more time to her from now on. I want to make it very clear to the Chair.

231 5 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 16 , 19 92 Mr. Deputy Chairperson, can the minister tell us now that out of the report here released today about the

summary report on the CT Scanning Committee, the issue is how the process is going to go onward from today, and what kind of consultation they are going to proceed with the hospitals who are already involved in the CT scan project at this stage? Because, as the minister said in the House, that various organization have worked very hard, and they would like to know from the ministe r's point of view or specifically from the committee's point of view, what are their views on the CT scan which are already in the process of being installed, for example, at Seven Oaks and other hospitals.

So that the clear message should go to them , because I do not think anybody is going to be very happy if they get mixed messages from different sou rces, specifical ly from sources who can obliterate many of the things which are right. Most of the time things people convey they want to suit their own needs. I just want the minis ter to, at least, tell us in this committee how this committee is going to proceed? *

(1550) Hon. Donald Orchard (Minister of Health): Mr. Deputy Chair person, in terms of accepting the rec ommen dations from the CT Sc annin g Committee- Mr. Deputy Chairperson: Order, please. Mr. Orchard: To answer my honourable friend the member for The Maples (Mr.

Cheema), in accepting the CT/M RI comm it tee report, the fi rst recommendation of the committee, with fairly broad representation and certainly three radiologists on it, and I qualify this because when we established the committee it was thought that one more installation in the province, if you follow the graph, would bring us to just above the national average, so that one more would not put us significantly out of line with other national averages as the nine would.

In reality, the advice was sought in terms of, should we put in one more CT scanner and if so, try to give us the best advice as to where it should be placed. Let me tell you, that is a complex question because you have nine requests for community hospitals, all of them fundraising, difficult issues. The conclusion of the committee was that if we had available funds, we make them available to enhance the patient capacity at the existing CT scanners and that we do not approve any additional acquisitions at this time. That was recommendation No. 1.

The recommendation I think that has the greatest opportunity to guide this decision making and this process is the committee, and they recommended that we establish to undertake a province-wide implementation policy and program on both CT scanning and MR imaging. That committee is going to be chaired by Dr. McClarty who is currently heading up the MR program at St. Bon iface Research Centre and has developed protocols which are quite effective. What the committee is empowered to look at first off, because bear in mind, there has been the issue of waiting lists around CT scanning.

The waiting list was addressed by Dr. MacEwan, and we can get into that observation on page 4 of the

summary of his report, but basically waiting lists will be an im portant issue and then, consideration, as I indicated in my remarks, of how we might be able to utilize the existing budget. I will try to read the exact word, because it says it much better than I will probably recall it-w ell, basically, to take a look at our current budget and to see whether there is an opportunity for a more equitable distribution of that budget within the system. Now, two issues emer ge.

First of all, the community hospitals, and my honourable friend is well aware of this, have always felt as if the technologies, the emerging of new tech nologies have been concentrated in the tea ching hospitals. Certainly, that is where we put, in 1979, in our last government, the first scanner, at Health Sciences Centre. Subsequent to that, one was installed at St. Boniface. Where many of the community hospitals are critical is of a decision in 1984 to add a second scanner at each teaching hospital.

They believed that at that time a more appropriate decision would have been to place those additional scanners not in the teach ing hospitals, but in a choice of community hospitals and pick two of them out. It was not done for whatever reasons, and I am not even here to visit that issue, but the impression being that teac hing hospitals have sort of taken over the high- tech care delivery business and left the community hospitals without access to that kind of technology.

April 16 , 19 92 LEGISL ATIVE ASSEM BLY OF MANITOBA 23 16 I am sympathetic to that argument, but here is my overriding problem. We know that when you intro duce new technologies, particularly in imaging, it is used very extensively, and that is why this committee is mandated to look very closely at establishment of protocols, so that we do not see a ballooning of services simply based on capacity, but only on patient needs. That requires the professionals to work around the protocol issue, and I think that is possible.

There are some concerns about how it can be undertaken, but clearly the stat ement today is saying to our community hospitals, respecting the fundraising that they have done, that we do not want to put a damper on fundraising to support initiatives in our communi ty hospitals or our hospitals outside of Winnipeg, but there should be a co-operative approach so that that fundraising is focused on the needed improvements of the health care system.

One of the problems we have got with the CT scanner is this impression that you are second class if you do not have one, and the teaching hospitals have commandeered all the technology. I share that but, at the same time, allowing the CAT scanners to proliferate throughout five additional sites in Winnipeg, four currently requested in rural Manitoba , will put the cost of imaging service up by anywhere from $5 million to $7 million. I say to you that that would be an inappropriate use of scarce resources at this time in the health care system.

So the policy is that we will not be providing operating funding to the CT scanners to the communi ty hospitals that have fundraised and purchased without approval to have those CAT scanners become part of the funded system of the ir hospital operation. Mr. Cheema: Mr. Deputy Chairperson, can the min iste r tell us if he is going to communicate , through his committee, to these hospitals and explain to them how that kind of arrangement has to be put into place? Otherwise, by that time, they are getting two different kinds of messages, probably three or four are distorted messages.

It may do some more damage because a lot of individuals have worked very hard. They have raised money. All the volunteer organizations will be very upset if they do not get the right message at the right time. So I would ask the minister then if he would undertake to do that, and also could we get a copy of those communicat ions? At least, I would like to get a copy of the communic ation from the minis ter's office or the committee, which is sent to these hospitals. Mr.

Orchard: Basically, I can ind icate to my honourable friend that that process has already been undertaken because this morning, prior to the announcement, I met with the fou r community hospital representatives, and I gave them , in confi dence, the

summary report of the CT Scanning Comm itt ee, the summa ry of our rad iology consultant's report, and the att achment on the provincial CT comm ittee structure that was recommended from there. In addition to that, at 1 :30, as I was delivering my ministerial state ment, all facilities received a copy of my state ment, and I believe that all the other facilities in Winni peg- Victoria, St. Boniface and the Health Sciences Ce ntre- received the same communi cation . Mr.

Deputy Chairperson, I make no bones about it, we had a very lively discussion this morning, because there is a lot of attachment for the reasons my honourable friend has mentioned around the fundraising and acquisition of CT scanners in our community hospitals. *

(1600) We-I say this without offe nce-we agreed to disagree this morning over the direction of provincial policy, but yet I think we have come to an understanding. The hospitals-and I am not in any way saying that they agree-but they understand the challenge that the government has in terms of trying to manage the introduction of ever-increasing levels of technology in the hospit al. I under stand, because they reinforced again a long-standing argument they have made about the concentration of such technology at our teaching hospitals.

So that is why I have said to my honourable friend that the committee, in taking a look at waiting lists, protocols for access to service, will also-and it is in my speaking notes somewhere, the direct reference to-also looking at the current provincial envelope for CT funding, and whether it would be appropriate to reallocate that budget and make it available more widely in the system-bluntly put, to consider where the transfer of some of the budget from teaching hospitals might be accomplished to the community hospitals.

23 17 LEGISLATIVE ASSEMBL Y OF MAN ITOBA April 16 , 1992 I am not adverse to that, but I am certainly going to tell my honourable friend that the committee, chair ed by Dr. McClarty , will try to reach that decision with all players at the table. I do not suggest for any time that this is going to be an easily arrived at decision, but at least there is going to be the opportunity to put the respective cases of each facility around the issue and to consider a provincial perspective on that technology. Again, I will be very direct in terms of some of the conversation that I had this morning .

My concern is that with the technology becoming more readily available, that it will be used simply because the technology is there. That has been the pattern of new technology introduction into the system, and I made the case very directly to the indi vidual facilities that were at the meeting this morning that I would hope they do not reallocate resource from within their global budget and compromise other areas of service delivery in the hospital to operate a scanner that does not have the approval from the provincial government. Mr. Cheema: Mr.

Deputy Chai rperson, I will assume from the minis ter's answer that after there is communication to the hospital board, there is going to be com mun ication to the volunteer organizations because they have-for example, Seven Oaks Hospital's Research Foundation or the St. Boniface Research Foundatio n-worked very hard, so that they know that their time was worth putting into. I just want to go to page 4 ofthe report, Mr.

Deputy Chair person, the paragraph: "Currently a waiting list analysis is in progress.R It says: "Only one third of the patients were experiencing delay and almost all of them on study would not benefit medically by an earlier examination.R Probably the mini ster may not have full informat ion, but I would like to get more information on that stat ement.

It is a very sign ificant state ment in terms of the evaluation because it may not be in line with health care providers, others who have sent those patients or who have put those patients on a waiting list for this particular procedure, so I would like to get more information on that. Mr. Orchard: Mr.

Deputy Chai rperson, let me tell my honourable friend that when we got into the issue, and this is the second time I have been around the issue of CT scanners in community hospitals because a similar circums tance was inherited In 1988 when I was sworn in as Minister of Health, and we worked through a prolonged process of negotia tion to assure ourselves that we had some reasonable approach to the installation of a CT scanner in a commu nity hospital in the city of Winnipeg, so the next time, the stimulation behind this is, we knew we had these requests coming at us because we knew that various foundations were fundraising for purchase of CT scanners.

Dr. MacEwan, our provincial radiology consultant, agreed some time ago, and I think the outline of his timing-in May of last year he started and then completed an ini tial report by September. That report was 55 pages and was critiqued by the various hospitals, and in November the critique was integ rated, and it now turns into a 95-page analysis. One of the concerns I had, because I will tell you straight out that the sense from Dr. MacEwan when he started this investigation was that we had sufficient CAT scanning capacity, and it was being used appropriately.

But I asked the question , as my honourable friend is asking the question, I simply hear of too many stories of individuals waiti ng to receive a CAT scan. That is a hard sell, to put it to you bluntly, a very hard sell because people do not believe that we have sufficient capacity given that they have to wait for a scan. Well, that was one of the first things that Dr. MacEwan analyzed, was the waiting list. At the time he started, it was thought to be or considered to be or alleged to be, whatever phraseology you want to use, it was believed that there were 6,000 people on the waiting list.

His analysis showed that there was indeed only 2,500 patients on the waiting list, and a further detailed analysis of the 2,500 showed that two-thirds of the 2,500, as it says in that paragraph on page 4: "On analysis two thir ds of the patients had appointments requested by their physicians or at the patient's convenience.R Two-th irds of the 2,500, in effect, were able to pick the day that their physician wanted or that they wanted, so in essence were elective , and: "Only one-t hird of the patients were experiencing delay and almost all of them on the study would not benefit medically by an earlier examination.

R Now, that is a pretty direct statement because there was a three to eight week wait. Now, this is Dr. MacEwan's analysis, and he is probably the preeminent expert. He certainly is the preeminent expert in Manitoba and probably is one

April 16 , 19 92 LEGISLATIVE ASSEMBL Y OF MANITOBA 2318 of the leading scientists in radiology in Canada. So I take this analysis of the waiti ng list very, very seriously, and it has a significant impact on planning future capacity, natu rally. His opinion is that we are providing quite an appropriate level of service. Now,' one of the first things that the committee will be mandated to undertake is the "almost allw of the remaining one-th ir d who would not benefit medically.

It does not say "all,w so the "almosr is the one that the protocols- we want to assure the comm ittee can develop protocols which would assure that we could turn that state ment into all of them would not have benefitted medically by an earlier examination. In other words, what I am saying is that we hope the access to service that the committee would develop would give us the assurance that there is no compromise of individual medical condition through a three- to eight-week period of time of waiting which was experienced in Dr. MacEwan's analysis of the waiting list. Mr. Cheema: Mr.

Deputy Chai rperson, I do not think I got the answer because the mini ster may not have full information in terms of the stat ement, as I read earlier that: • .. . one-th ird of the patients were experiencing delay and almost all of them on study would not be nefit medically by an earli er examination.w That is a very bold stat ement.

That may not be what others are thinking, so I would like to have background information on that because I think that could be questionable from many points of view, because you have patients waiti ng from three to eight weeks or two to four weeks or two to six weeks, and some patients in an emergency situation may have to wait for at least sometimes for a day or two. That is the normal routi ne. This says a lot of other things which health care providers or some of the hospitals may not be in full agreement with.

I would like to have the information so that we can have a detailed analysis of the whole study because I think, as I said in the House, that we have no hesitation as long as data is available for us to make a judgment call and an informed choice. Also, the individuals who are going to be affected by this, the patients, should know through their health care providers that the decisions which are being made in our health care system are in line with an acceptable level of medical treatm ent, and that is my question again. * (161 0) Mr. Orchard: Mr.

Deputy Chairperson, yes, I will tell you what, I think the most appropriate discussion my honourable friend can have would be with Dr. MacEwan and to have to go through the 95-page report that Dr. MacEwan has, because I went through it, and I have to admit I was confounded by some of my lack of medical knowledge. Dr. MacEwan would be more than willing to go through that with my honourable friend because, I agree with him, this is one of the more sensitive areas that we get into. The CAT scan is sold as almost a miracle worker, and people, when they hear of the tech nology, want to access it imme diately.

That is not unusu al. You hear advertising all the time coming up from United States te levision on mammography, where they are recommending mammo graphy for 35-year-old women. That is more a drive of a for-profit health car e system and adver tising desig ned by manufacturers to sell product. It does not have a great deal to do with beneficia l dia gnostic procedures for the individual, and clearly that is what my committee came to the conclusion of when experts got around the topic in mammography. Similarly, I say to you that Dr.

MacEwan is not an uni nformed individual in terms of radiology and accessing CAT scanning services. His analysis did dispel some of the myths that are there around the waiting lists for access to CAT scanning in the province of Manito ba. Indeed, the list was less than half of what it was thought to be, and it was two-thirds elective , if you will, by physician and or patient appointment choosing the day, in other words. The other third, there was no evidence of any medical compromise by waiting a period of time of three to eight weeks. Further to that, we want to assure ourselves through the operation of Dr.

McClarty's committee that the ability for a physician and a patient to have access to the six scanners that are currently in service conti nues to assure this statement by Dr. MacEwan that it appears as if the access is appropriate and that we are not endangering or compromising anyone's care. Certainly there are people who advocate for more and more technology who would make exactly the opposite statement. That is always the quandary the public comes around in trying to come to informed decision making, and that is why again we

231 9 LEG ISLATIVE ASSEMB LY OF MAN ITOBA April 16 , 1992 have retained the service and engaged the best min ds that we could put toward this issue in Manitoba to arrive at the consultant's report and the comm ittee report on MR ima ging and CAT scanning. I would be more than pleased to have my honourable friend sit down for a period of time with Dr. MacEwan in the near future so that he can have the kind of assurance of what sort of analysis Dr. MacEwan went through to arrive at the statement made about the waiting list, to give my honourable friend comfort in the analysis and in the conclusions therefrom. Mr.

Cheema: Can the mini ster tell us, first of all, if we can get a copy of the report, if it is not only the interim report, if we can get copy of the whole process? Then we can ask somebody to have a look at the whole report. I think, as I said inside the House, that we are not going to be judging the credibility of the individuals. We are simply asking for more inf ormation, and that would be helpful to at least explain to the people when there is a waiting list and what are the reasons for the waiting list, and why this report think s that the waiting list may not be accurate.

We want to make sure we have full informa tion. Also, can the minister tell us what will be the im pact of this report on the communi ties, for example, in Thompson, Dauphin or Swan River, and how they are going to continue to be served in line with the new policy of having limits on the number of CT scans? Are they going to be put through a single chann el of testing or go through another process so that we do not have three or four different waiting lists? Sometimes that could be the case.

One thing will be to have a central waiting list out of the smaller hospitals and make sure that they are given equal opportunity for access to the services because often it has been the case that, for the sma ller communi ties, it is tough to keep on flying the patients and make those arrangements. As long as they have a protocol to follow, they have access to the information that would make their life easier, so I just want the minister to look from that point of view. Also, it is very interesting the CT scanners per million population in Canada. We are just above Saskatchewan per million. We have six or seven.

They are asking for eight more. Ontario has almost an equal number as us, so Newfou ndland, even Quebec, B.C. So it really shows that things that may seem to be may not be tot ally true. It really gives us more an idea that we are not far behind the national average. That is at least one positive inference we can draw from this report. I just want to ask the mini ster questions on other aspects on these lines, and if the NDP caucus has questions on the CT scan thing, they can proceed. I have no difficulty with that. Mr. Orchard: Mr.

Deputy Chairperson, I do not believe there is any difficulty in providing the full report of Dr. MacEwan. I just want to qualify that I do want to talk to him, that I would like to do that. So unless there is some reason that I am not aware of today that there is information that is of confidential nature within the report or something that like, I will just only put that qualific ation on it, but in general, I have no objection of my honourable friend having it.

You know, the interesting thing is, with the graph on CT scanners per million of population , Prince Edward Island, I think, th at represents one scanner for the island. Newfoundland, that is probably a total of three scanners in the province.

The original thought process was around one more scanner in Manitoba which would have put us above the national average if we had been funding seven, but when we are flooded with literally -and I think flooded is not an inappropriate word-with a request for nine more scanners, clearly, one can see that that puts us way beyond the technological capability of any other province. At a time when there are so many other alternate and competing demands for resource in health care, you have to ask the very direct question as I have asked: Is this the next best investment?

I tell you right now, I do not think it is, but I still am sensitive and un de rstand the concerns that community hospitals have, the public has, because the public has been most generous in supporting fundraising campaigns. We cannot be driven into approval of capital expansion in health care by the availability of volunteer cont ributions to purchase the capital if it does not fit in the overall system. I mean, to move in that kind of a process would truly be an unmanaged expansion of the system.

I know that this report is going to cause consternation amongst the community hospitals in rural Manitoba, but the committee, I am hoping, with good will and some expert focus on it, can come

April 16 , 19 92 LEGISLATIVE ASSEM BLY OF MANITOBA 2320 around the issue so we have what is perceived to be a fair policy of access in the province of Manitoba. That is going to require quite a little bit of give and take on everyone's side, from teach ing hospital right through to rural or northe rn hospitals. A

(1620) Mr. Ch eema : Mr. Dep uty Chair person, on Tuesday, when we left, I did not take my time that day, so I want to proceed with my questioning before I give to the other people because I think I try to keep it a very decent debate , but I think sometimes we are forced to follow certain things. Within the context of this Assembly, the rules have to be exercised, and I will try to take my time. I just wanted to raise the question here that I raised yesterday, in terms of the tray fee which we have in Manitoba right now.

It has been for the last many years, in fact, that every time the patient goes to-[inter jection] It has been for the last many years. Now it was not, in the previous NDP admin istrati on. It is continuing to do that. The patients, when they go to a doctor, sometimes, they have to pay a so-called tray fee. It varies from $18 to $20 or $30.

Whereas, if the same patient would go to hospital, he or she does not have to pay. So it is causing a lot of discomfort because the waiting list for some of the outpatient procedures in hospitals is longer so patients are in there wait ing. They are forced, in one way, to make a choice. I think it is unfair because when we have a system which is supposed to serve everyone, that is the way it should be. Yesterday, I asked the mini ster and the mini ster said that we are not in violation of the Canada Health Act.

I think we may be, because, and I will tell him, the province of British Columbia and two more provinces do not allow this kind of procedure because they believe that tray fee is, when it is used for insured services, a form of extra billing. So I would like the minister to proceed because practice is what has happened in the past. lt-[interjection) excuse me? Mr. Daryl Reid (Transcona) : We do support that. Thank you for looking. Mr. Cheema: Mr. Deputy Chairperson, I think the member for Transcona is trying to say something. Probably, he should get the floor after I am finished and- Mr.

Deputy Chairperson: Order, please. Mr. Cheema: Mr. Deputy Chairperson, I think I still have the floor. You are in charge, and if you think I should not be speaking, please tell me. I do not want any disturbance from right or left. Mr. Deputy Chai rperson: Order, please. The honourable member for The Maples has the floor at this time. If you will just carry on. Mr. Cheema: Mr. Deputy Chairperson, I will ask the min ister then: Could he clarify for us, what is the policy of this administration ? Mr. Orchard: Well, Mr.

Deputy Chairperson, I have been scanning my notes, because since my honourable friend raised the issue yesterday, I asked my associate deputy min ister to provide me with some additional information to clarify around the Issue. I cannot find it. I am just trying to get that for him. But my honourable friend is correct. I mean, there have been two or three issues that have been around since I came into the office as Mini ster of Health. Tray fees is one of them.

Cataract surgery on an outpatient clinic basis, that was in place in some other outpatient clinics that were providing services and asking for some contribution toward the overhead costs. Now, that had been in place, I guess, as far as we know, since back to '84 or '85, with the passage of the new Canada Health Act, possibly even before that. I simply have not gone back that far to analyze.

Because it was in place, I will be very direct, we had not, when we came into governmenHt was in place, that circumstance was going on-1 will be very direct, we have not done anyth ing to change that patient-physician relationship. To date , we have not had diffi culties, as I indic ated to my honourable friend yesterday, in terms of deemed contravention of the Canada Health Act in any subsequent action by the federal government or the federal ministry of Health. Mr. Cheema: Mr.

Deputy Chai rperson, can the minister then investigate the whole thing and see whether that practice is a legal one, actually, in Manitoba? Also, how many individuals have complained to the Health Services Commission, in terms of asking the Health Services Commission, that they have been paying for tray fees in various doctors' offices ? Mr. Orchard : Mr. Deputy Chai rperson, I will undertake to put together that information and

2321 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 16 , 19 92 provide that, hopefully when we resume Estimates debate on Tuesday. I might ask permission of comm ittee, if my honourable friend has other questions, to revert to, because I will have a little better sense of it, when I think I will get my briefing note from the associate deputy mini ster. So if there were other areas that my honourable friend wanted to deal with, I could provide and revert to that issue if information should arrive before we conclude comm ittee discussion this afte rnoon. Mr. Cheema: Mr.

Deputy Chai rperson, that is fine, I will wait for the information , and I will give the floor to the other members now. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, I have a couple of questions on the CAT scan issue, and then my colleague the member for Transcona (Mr. Reid) has a few on that as well. We have appreciated the information that the minister has provided to us on this issue, and we have a few outsta nding concerns. One general issue that I would like to just touch on is the question of the demand for CAT scans in the province of Manitoba.

Obviously, based on the chart that the mi nister has provided, there is a tremendous pressure building within this province for utilization of this particular piece of technology. Certainly I understand that some of this demand comes from indi vidual consumers and patients themselves, by hearing and reading about this technology and believing that it would help in their case, but I would expect that the bulk of the demand is generated through physicians and referrals for utilization of this technolo gy.

The mi nister has begun to address, or did address, this issue in this package by talking about protocol for usage of the CT scanner. Could the minister give of us some idea of where-and maybe that is in the package and I missed it-we are at with respect to a protocol, what kind of luck he expects to have with getting physicians to accept the protocol, the kinds of help he might get through the College of Physicians and Surgeons and how quickly we can see some patte rns of practice change as a result of that kind of position being taken by the province? Mr.

Orchard: I think many of the answers to my honourable friend's questions are part of Dr. MacEwan's summarization of his report. First off, the analysis of the clinical activity in hospital discharges should be based on the approval of newe r or expansion of existing programs. Basically, what he is saying is that there was over-we ll, there were 33,552 CT examinations for patients in the year that he studied, which was the mo st recent com plet e year, is my understanding, for 287 disease categories where CT examinations are important. *

(1630) He concludes by saying, these special studies suggest that the original CT scanners were appropriately placed and the public has reasonable access to services. I mean, that confou nds the sort of public impression that is out there. I know that the system is driven because, you know, there will be physicians who will indica te or patients who will indica te to a physician, I want a CAT scan. I have talked to physicians that have said that, that they have had patients come in who want and ask for a CAT scan.

The physician is deeply troubled because he does not see what would be considered to be clin ical in dications that wou ld, in his professional judgment or her professional judgment, lead to their recommendation of the patient for a CAT scan. The case is made that the patient who so insi sts will simply find a doctor until they do get the referral for the technology. I mean, that is one of the drivers of the system, the expectation that this is going to work miracles, it is going to solve all the problems, et cetera. In terms of my expectations for protocol, I think that is best explained in Dr.

MacEwan's point No. 6: A provincial plan to meet patient and physician needs, based on outcome analysis, should be developed by the proposed reactivated advisory committee, and he makes the point in here. This is what I indic ated to my honourable friend in Question Period. We were in government when Bud Sherman approved the first CT scanner in 1979 at the Health Sciences Centre, and I think Dr. MacEwan's observation needs to be read into the record that after the first CT scanner was instal led in 1979 there were clin ical protocols which were very effective in guiding patient referral.

Concerns over patient access, burdensome bureaucracy and radiology remu neration led to th eir removal , perhaps unwisely, as protocols for the first MRI scanner in Manit oba are proving very effective with only neu rosurgeons, neurologis ts and orthopedic

April 16 , 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 2322 surgeons able to request consultati on, some 2,000 per year. So what Dr. MacEwan is saying-and this is where you are going to get into the professional debate. I say to my honourable friend that I believe that Dr. MacEwan is very sincere and is using his substanti al experience and knowledge in coming to this conc lusion, but I know that est ablishment of protocols is not going to be an easy achievement because, you know, physicians basically have quite a range of opinions around the issue of protocol. I will tell you that we have the best opportunity to come around it in Manitoba and get that kind of protocol in place, because (

a) it existed once in 1979, and (

b) I think we have strong leadership. Dr. McClart

Document details

Collection	Manitoba — Debates (Hansard)
Citation	35-3-48
Type	hansard
Volume / chapter	35th 3rd hansardpdf 48.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	d607bec3f6c0de26dda0ad8196c56ebffde33081

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