1989 Legislative Session: 3rd Session, 34th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

FRIDAY, APRIL 14, 1989

Morning Sitting

[ Page

6109 ]

CONTENTS

Routine Proceedings

Tabling Documents –– 6109

Private Members' Statements

Fair distribution of forest wealth. Mr. Kempf –– 6109

Hon. Mr. Parker

How to best provide community family services. Mrs. Gran –– 6111

Ms. Smallwood

Columbia River Treaty downstream benefits. Ms. Edwards –– 6112

Hon. Mr. Davis

Sports. Mr. Loenen –– 6114

Mr. G. Hanson

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Dueck)

On vote 35: minister's office –– 6116

Ms. Edwards

Ms. Smallwood

Mr. R. Fraser

Mr. Perry

Mr. Blencoe

The House met at 10:04 a.m.

Prayers.

HON. MR. RICHMOND :

It's indeed a pleasure for me to introduce the new chairman of the

British Columbia Housing Management Commission, who is in the gallery

today. Since he is about to conclude a sale of his company, we thought

he needed something to keep him busy. I would like the House to join me

in welcoming Mr. Peter Thomas.

HON. MR. VEITCH : In

the gallery today is a person who has done a tremendous amount for the

Social Credit Party in British Columbia. He's a very hard worker and,

as a matter of fact — no, not you, Mr. Provincial Secretary (Hon. Mr. Reid) — to such an extent that the party has made him an honorary life member. I'd like your help in welcoming Mr. Paul Keenleyside.

Hon.

S.D. Smith tabled the annual return of the official administrators,

1988, pursuant to

section 51 of the Estate Administration Act.

Private Members' Statements

FAIR DISTRIBUTION OF FOREST WEALTH

MR. KEMPF :

In August 1986 1 was appointed by the Premier of the day as Minister of

Forests and Lands for British Columbia. That was the most fulfilling

day of my life. Having been involved in logging for more than 20 years,

I felt that I could serve my province in a very positive and real way.

We had an industry that for 50 years had had its own way — that's half a century —

an industry that controlled government rather than the other way

around. Its primary concern was to turn a huge corporate profit, profit

that did not stay in this province but rather lined the pockets of

fat-cat executives on Bay Street and in Portland, Oregon, and

elsewhere. These profits were at the expense of small logging

operators, the very backbone of the free enterprise system. These

profits were at the expense of every British Columbian who had to make

up the difference, the difference for taxes that were not applied or

asked for.

As minister I was determined that proper, fair

forest practices should apply, practices that would ensure a proper

silviculture program, a full return of fees for licences granted, a

fair and proper stumpage paid. I was determined, Mr. Speaker, that

there would be a fair and equitable distribution of forest wealth in

the province.

In late February 1987 Doman Industries approached me, as Minister of Forests,

for the further extension of a ten-year-old contract, a contract of which the

terms had been continually breached and the responsibilities not adequately

met. I turned down that request. I believed and still do that a minister of

the Crown is directly responsible to the province and the people who elected

him. That responsibility does not diminish in relation to the pressure applied

by big business.

This

is not an attack on Doman Industries. They grew from humble beginnings,

as do many free enterprisers. Herb Doman deserves a great deal of

credit for his willingness to do the right thing. In my opinion

Members, listen and you just may learn. In my opinion he was and still

is a British Columbian who has contributed a great deal to this

province. The blame must be laid directly at the feet of government and

all the successive Forests ministers who pandered to the forest company

bosses who were on side.

Through you, Mr. Speaker, I want to tell this house that Doman Industries is not — I repeat, not —

an isolated case. The ride is not yet over. Policies which permit the

mighty to run roughshod over this province are coming to light, to the

detriment of that minister and the government he represents.

less than seven months after taking office, this minister had reversed

the Doman decision. He claims no knowledge of that rejection. Was he

not Parliamentary Secretary to the Minister of Forests of the time? Did

he not seek advice from the Deputy Minister? Did the principal

secretary to the Premier not brief him on the situation? If he went

ahead without seeking advice, he was a fool; if he went ahead in

disregard of that advice, then he was even a bigger fool.

This

minister is a straw man who has proven that he is incapable of

independent thinking, one who responds promptly to those who pull the

strings.

Interjections.

MR. KEMPF : He'll feel sorry, all right.

The

forest giants must be forced to adhere to the practices that will

ensure the survival of the forest industry in British Columbia. We must

ensure that the little guys, small business, are given an opportunity

to share the wealth, or they will be all eaten up, creating even

further loss of jobs than we saw recently with the Fletcher Challenge

Canada experience.

My mandate, as I saw it when minister,

was a strong regrowth of the industry abused for far too long. I sought

fairness and equity for everyone involved in the industry. It's not too

late for this

MR. SPEAKER : I regret to inform the member his time is up under the standing orders.

MR. KEMPF : I'll have a lot more to say in this chamber about this subject. I'll leave it for the moment.

HON. MR. PARKER :

The member's comments on development of the forest industry in the

province are, in part, correct. Over the years we've seen an evolution

from the old temporary tenures — the timber licences, the special pulp and timber leases — that, to some extent, still exist from the turn of the century. In a lot of cases they make up

schedule A

[ Page 6110 ]

lands and tree-farm licences. In many cases they're stand-alone licences and have been sold over the years.

The

evolution of the business in the province has basically been that some

people elected to stay in the business and some people elected to get

out. Those who decided to stay acquired the licences of those who

wanted to get out. Over time we saw the evolution of things like the

Powell River Co., B.C. Forest Products, Canadian Forest Products, and

what is MacMillan Bloedel today but started off as MacMillan Export Co.

back in the early part of the century.

We got into the

public working-circle regime in the forties and fifties when the

sustained yield management of the forests became very much a part of

the philosophy in British Columbia. A number of operators were

allocated annual allowable cut, called quotas. Again, a number of

people decided to stay in the business and a number decided to get out.

Those who got out sold their interests to those who stayed in, and the

evolution continued.

[10:15]

A number of offshore investors bought into B.C. businesses and

injected capital. We saw the evolution of a world-class forest

industry; we're selling into the world. We have world investment in and

world sales out. We're part of a global economy. It's up to us in the

Forest Service to sustain that. That's our mission, and that's what

we're doing: sustainable development. We're living proof of sustainable

development in British Columbia. This ministry is a decentralized

ministry, and it works throughout the province for the betterment of

forest management in the province.

I take umbrage at the

member for Omineca's statements about Doman Industries. He tells us

that he told Doman Industries he would be cancelling their licences. On

February 6, 1987, a letter to Doman Industries Ltd., attention J.R.

Frumento:

Dear Sirs:

Re: Strathcona forest licence A19237 and mid-coast forest

licence A16845.

Pursuant to clause 12.06 and 12.09 in the above forest licences,

an extension to a new date of December 31, 1987 is hereby granted.

Sincerely,

Jack J. Kempf,

Minister

That

was a responsible action, because it was important that Doman

Industries had the opportunity to create the new jobs that they had

promised. Jobs equivalent to what they had said, some ten years ago,

would be created by a pulp mill if they were to build a pulp mill.

Subsequently, it was agreed that a wood residue utilization plant would

be acceptable as long as the job creation was equivalent or better.

That was a responsible action by the minister of the day, but what he

told us in the House today was irresponsible.

MR. KEMPF :

Mr. Speaker, I thank the minister for providing me I would appreciate

it if he would table those letters with this House, because it

absolutely authenticates what I have been saying in the last two weeks.

It's all on this tape: an interview done by a person now working in the

Premier's office, Mr. Eli Sopow, who then worked for BCTV.

thank the minister very much for authenticating exactly what I said

with respect to Doman Industries last week, and I am going to have

copies of this tape made for the edification of the media. We can play

it around the province, and we can say: "See who's right and who's

wrong."

Again I say that I'm happy to see that the

Attorney-General (Hon. S.D. Smith) and the Premier are in the House

every time the Minister of Forests speaks, because somebody has to keep

him under control. But it's not too late; it's still not too late in

this province. I point that out to the present administration, to turn

it around, to get that revenue on behalf of the people of British

Columbia, to stop the waste, the plunder, the rape of our primary

resource.

Mr. Premier, it's still not too late. It's

growing near that. If the Minister of Forests wants to play games He

suffers from selective hearing, I guess you could call it, because he

doesn't seem to hear everything that's said, only what he prefers to

hear. But you can't discount history, and this tape was made by Mr. Eli

Sopow in an interview on March 4, 1987 –– 1 think the Premier, sitting

very seriously this morning, knows what happened two days after that. I

think he's quite aware.

But I'm happy that the minister

brought this up, and I'd love to have copies of those letters, because

they haven't yet been delivered under my door. I would ask that he make

them available through this House to me, Mr. Speaker. It's not too

late, but I guarantee that the people of this province will respond, if

the government does not, to the present calamity in the forest industry

of British Columbia. They will respond very positively on election day

with a message that cannot and will not be ignored in British Columbia.

HON. MR. COUVELIER : Mr. Speaker, I wonder if I might have leave to make an introduction.

Leave granted.

HON. MR. COUVELIER :

On behalf of my running mate the second member for Saanich and the

Islands (Hon. Mr. Huberts) and me, I'd like to ask the House to join us

in welcoming a visiting tour of 25 students and two teachers who are in

the House now, and another 25 students and two teachers who will be

joining us shortly, from our constituency's Mount Newton Middle School.

These

grade 6 French-immersion students are a typical example of the fine

calibre of student we have in our municipality, and I am very pleased

that their teachers, Mme. Leblond, Mme. Dingle, Mme. Goh and Mme.

Antonik, are accompanying these 50 youngsters. Would the House please

join us in giving them a warm welcome to our proceedings.

[ Page

6111 ]

Private Members' Statements

HOW TO BEST PROVIDE COMMUNITY FAMILY SERVICES

MRS. GRAN : My time in members' statements will not be political —

perhaps philosophical, but not controversial. I would like to take this

opportunity to present a view that comes from the community that I

share the representation for — Langley.

I want to talk

about how the public is best served as far as family services are

concerned. In Langley we have an organization called Langley Family

Services. They provide a wide and varying range of services for that

community.

Perhaps I could go into a bit of the history of

that organization. Langley, for a very long time, was almost completely

a rural community. About 15 years ago during a building boom, Langley

saw the migration of some 30,000 to 40,000 people to that community.

These people were used to having the kinds of services that were not

available in Langley. So for a period of time, there was a lot of

difficulty for the people who had come out there. There was also a lot

of difficulty for the rural people in accepting these new people, their

new ways and their new wants and needs.

During a period of

10 years, several organizations sprung up to provide the volunteer

services that are needed in a growing community. In 1971 Langley Family

Services was organized. A few years ago, all of the other organizations

through many trials and tribulations fell by the wayside. Langley

Family Services entirely took over the supply of family services to our

community.

I want to pay tribute to that organization and

to the wonderful job they have done. I would like to tell you that the

building they are in is a barn that belonged to a pioneer family in

Langley. It was acquired by an organization trying to organize a youth

centre. The youth centre failed and folded, and Langley Family Services

took over that barn with the help of Langley city and Langley district.

They moved it to the site it now sits on and added to it.

It's

a very homey building that a lot of people in the community are

familiar with. It's one that I am proud to say exists completely for

families and young people.

Langley Family Services is run by a board of directors. It is a volunteer organization with a second arm — a second society — which is Langley Family Services Foundation. That arm looks after the funding for that organization.

Last year the budget for Langley Family Services was $1.3 million, which is

a fair amount of money for one organization, particularly when they are dealing

mostly in volunteer work. Of that money, $559,000 came from the provincial

government — funding from various ministries for various programs. The remainder

comes from the two local councils and the United Way. Langley Family Services

itself raises 20 percent of the budget or $260,000 last year locally.

The

point I want to make here is the commitment that the community of

Langley has to the people who live there. They care enough to not just

donate money, but to donate their time. There are 34 paid staff in this

organization, but there are 250 volunteers. Those volunteers come from

all walks of life, all political persuasions and all religious parts.

There is never strife in this organization, because people work

together for the good of the rest of the citizens in the community they

live in. Last year some 31,000 people, including children, were served

in that community with 14 paid programs and 11 self-help support groups.

For

whatever remaining time I have left, I want to go through some of the

programs, because it is important for everyone to know that these

programs exist, that they are funded by the provincial government and

contracted out to this organization in Langley.

The crisis

line is one of them that operates from noon to midnight daily; the

family place is a drop-in program for parents and children. It's a

wonderful room; I've been in there. There are toys and comfortable

furniture, and there is always someone to talk to, particularly for

mothers who are on their own with their children and feeling

frustrated, for whatever reason. They can go there and have a cup of

tea and the children can play with the other children there. It's a

wonderful place to go.

There is also a food bank operating,

and it has operated very well. But being the kind of organization it

is, Langley Family Services is looking for a new way rather than a food

lineup. They're hoping to have a public market where the people who

come to the food bank can work and provide groceries for those in need

at a lower price and in a much better way than standing in line for

food.

A Langley school for parents operates there, which is

very important. It gives parents some insight into child-rearing, and I

think that's one of the things that's sadly lacking in our society.

People get married and have children and are totally ill-prepared for

that responsibility. There are ten classes in this program, and it's

done according to the different ages groups of the children you have.

It works extremely well and is taken advantage of.

[10:30]

MS. SMALLWOOD :

First of all, I'd like to thank the member for the compliments for

Langley Family Services. As a past employee of Langley Family Services

and the person who actually advised the board on the creation of the

foundation, I'm pleased, first of all, that the good work of Langley

Family Services is recognized.

However, I want to say that

I am always amazed at the government side. Given the history of this

government during the years of so-called restraint and cutbacks to

services, the virtual abandonment of community organizations such as

Langley Family Services, and the abandonment of families and in more

recent years the reduction of — or at the very least holding firm on — grants to agencies such as this,

[ Page 6112 ]

they

have basically shifted the responsibility for caring for families from

government to agencies like Langley Family Services and have made true

the adage about bake sales and bombs. They have created the situation

where caring agencies like this rely on gambling, on bingos, to be able

to keep together to pay for the services the community deserves and the

very security of being able to continue those services.

think, at the very least, and I will quote the member: "Your actions

are immoral and opportunistic." To tie the government's wagon to the

success of the volunteer groups of non-profit societies, I believe, is

less than moral. It is very clear that these groups are dedicated and

are delivering a needed service. What we need in this province is a

commitment from government, beyond fancy words and compliments, to

support them in the work. What we need is the kind of security for

these organizations for families that will ensure that these services

can continue and that these organizations do not have to go begging for

licences to hold bingo meetings so that they can be assured that

families will get the services they need.

MRS. GRAN :

I intend to continue taking the high road. I feel very sad for Langley

Family Services that the member for Surrey-Guildford-Whalley would

choose to criticize and demean the job they do, particularly if she was

involved. It really is a sad epitaph for that member. So I'll continue

talking about Langley Family Services in a positive way, because I am

appreciative of what they are. The community of Langley is appreciative

of the job they do, and, quite frankly, the community of Langley is

also appreciative of the funding that is offered and contracted out by

this government.

I think that Langley sets a good example

for other communities to follow to offer the help and the love, in many

cases, that people need in our society. Government cannot provide that;

government can only provide some of the funding. But when neighbours do

not care about neighbours any longer, the society we live in will be

colder and colder and the problems more severe.

In my view,

Langley Family Services provides the kind of service that every

community should have, not just Langley. I would wish for every

community in this province to have a service like Langley Family

Services. I want to congratulate the coordinator, Betty McClurg, who

has done a marvellous job. The members in opposition are happy because

Betty McClurg is not of the same political persuasion that I am. Yet

that woman has single-handedly — with the help of many volunteers — built an organization without using the groups in that organization and without bringing politics into it.

compliment her and congratulate her and the board for the wonderful job

they've done. I want them to know that not only do I support them and

will continue to support them but that this government supports them

and will continue to support organizations like Langley Family Services.

COLUMBIA RIVER TREATY DOWNSTREAM BENEFIT'S

MS. EDWARDS :

The Columbia River Treaty is not a simple treaty; it's highly complex.

Almost anything you talk about relating to the Columbia River Treaty is

fairly complex. I want to outline the pattern of where I want to go

with what I want to say today, and then I'll go back and try to flesh

in some of the parts, because if we lose the track, I think it would be

too bad.

The Minister of Energy, Mines and Petroleum

Resources (Hon. Mr. Davis) has been quoted in the paper very recently

as saying that he is interested in selling the downstream benefits,

which is the Canadian entitlement, from the Columbia River Treaty.

There is still some doubt in the people's minds as to how sure he is

that he wants to sell them, and we'll deal with that later.

What

he has done that is of interest here is tie to the possible sale of

those downstream benefits to the Americans other long-term export sales

that in fact would have to be returned to Canada at the end of a long

term. He has said that there needs to be a greater amount of energy

exported than what B.C. Hydro as a Crown corporation has already talked

about.

We need to know to what extent the minister is

talking about. In fact, both the downstream benefits and some of the

projects that have been proposed in expressions of interest for export

sales under the new subsidiary of B.C. Hydro that will sell that power

to the States are projects that are crucial to the 20-year resource

plan of B.C. Hydro dated March 1988. We know from that 20-year resource

plan, which does a fairly good job of laying out where Hydro thought it

would go, that without these projects — both the benefits and some of the projects that have been proposed for development for export —

there will be much greater needs in British Columbia for power, and in

fact, that there will be much greater costs for the power that will be

developed.

From what the resource plan says, and sometimes

from what the minister says, it looks like there will be a hey-day of

development of power projects. These seem to have been popped out as

though they were interchangeable at will from the size and the price

without looking into the environmental and social costs and without

consultation, as yet, with the public as to whether this process is one

that the public will agree to.

The final point is that

there is as yet no assurance, under a number of precedents that have

been set and a number of patterns that look like they are going to be

set up, that drawing back those particular power benefits to the United

States could be achieved when and if Canada wanted to withdraw what it

sells to the U.S.

I want to go back to the minister's

announcement on downstream benefits. At a recent meeting in Portland,

which was sponsored jointly by B.C. Hydro and the Bonneville Power

Authority plus a group of women voters in Oregon, the manager of

planning

[ Page 6113 ]

for

B.C. Hydro suggested that the downstream benefits are worth $1.3

billion in today's dollars. The 20 year resource plan that I've talked

about speaks in terms of $1 billion plus the need to borrow later $2

billion to $3 billion, and so on. The minister says that he would sell

the downstream benefits for $5 billion and says that he would want an

extremely good price for them. That makes you wonder whether the

minister wants to sell the downstream benefits or not.

You then see that he ties to that sale — which is a maybe —

the export of other privately developed power projects. To what extent

is he talking in that case? When we began talking about power export in

this province, B.C. Hydro and the minister were talking about 400 to

600 megawatts of power that would go basically to two Pacific northwest

companies: Washington Water Power, as I understand it, and Puget Sound

Power and Light. Of course, the government has been talking about

exports to California all along, but now this is all being tied in and

immediately you see this huge jump — obviously — in the mind

of the minister as to how much export power is to be exported under

this new proposal, and the new possibility for selling the downstream

benefits tied to the export power.

All of this, as I say,

is in doubt. We don't know where it is. But we do know that the

downstream benefits and some of the projects.... I will use one project

in particular as an example, the Murphy Creek project, which is being

proposed for private development under the power export request for

expressions of interest. These things are extremely crucial to B.C.

Hydro's plan. I quote from this plan talking about the downstream

benefits: "B.C. Hydro's recommended resource plan relies on the return

to the province of the Canadian entitlement to the Columbia River

Treaty downstream benefits." Later it says: "The unavailability of the

Columbia River downstream benefits would have by far the largest

financial impact of all the scenarios investigated." You certainly have

to wonder where the minister is when he's talking about selling those

benefits.

Another quotation: "Given the sensitivity of the plan" — the 20-year

plan —

"to the availability of the Columbia River downstream benefits...." A

crucial foundation to what Hydro had planned was to have the return of

the downstream benefits. The Murphy Creek dam is as crucial; in fact,

it is one of the cheaper and pre-planned ones. It says: "The following

projects appear to be the most economic available to meet the

additional domestic demands," and Murphy Creek is included there.

Murphy Creek is considered crucial to the flexibility of the plan, and

it's all laid out.

With

those things known, why is the minister pro posing that these plans

that Hydro had done all the work on...are they now to go to export

power so that the supply of domestic power that had been lined up is no

longer protected?

MR. SPEAKER : I have to inform the member he time is up under the standing orders.

MR. KEMPF : Mr. Speaker, I seek leave to make an introduction.

Leave granted.

MR. KEMPF : In the gallery this morning it's my great pleasure to

introduce, from my hometown of Houston, nine grade 12 students from Houston

Senior Secondary School, and with them, Mr. Walter Gotzy and Mr. Candido Guerreiro.

I ask the House to make them very welcome.

HON. MR. DAVIS : First, I would like to thank the hon. member from the

Kootenays for raising this important subject of downstream benefits. This is

a multibillion-dollar asset that belongs to the people of the province. It does

not belong to B.C. Hydro. There is no panic; no decision has to be made in the

next few months — indeed, in the next couple of years — as to the ultimate designation

of use of the downstream benefits.

The

New Democratic Party is now interested in the downstream benefits. Up

to a few years ago, they said they didn't exist. They believed that the

Columbia River Treaty was a sellout, that the downstream benefits was a

figment of the imagination of those who negotiated the treaty; and they

have proven to be wrong. Now they are taking a great proprietary

interest in the multi-billion-dollar asset.

I believe the downstream benefits, which are greater in amount than any Site

C or similar mega project in the north, are extremely valuable. They're

probably the best power asset the province has or will ever have: first, because

the generation is in the United States, they must be returned to the inter national

boundary at no cost to the province; and there is no environmental downside.

So it's zero cost power, greater in amount than Site C, available at no

environmental cost.

[10:45]

any plan for supplying the future requirements of the province,

downstream benefits are the prime single first-in asset. There are

interconnections be tween B.C. Hydro and other utilities with the

utilities in the northwest. I'm not one who really believed we were

about to sign, or indeed were within years of signing, any long-term

export arrangements for new source power in the province. Those,

however, are possibilities. Were we to bring the downstream bene fits

back, we do create a market — if I can put it that way — in

the U.S. for an equivalent amount of energy. We withdraw a resource

from their capability and commit it to our use. So a market will be

created if we bring the downstream benefits back in any case, and there

may be economics in our generating some thermal power and selling it to

the Americans long term.

There might even be a case for harnessing some hydro resources in this province

for a term, the resources ultimately returning to the province. But the downstream

benefits management comes well ahead of any long-term exports otherwise. I suggest,

though, that in the interplay between Hydro and those utilities to the south,

there may be a case for

[ Page 6114 ]

each

of us building some projects and cooperating to a greater extent than

before, because there are economies in that kind of arrangement.

would say that the number one downstream benefits are extremely

valuable. The replacement price in the United States is a multiple of

the figures we've heard. That is why I talk about $5 billion and not $1

billion. They are greater in amount than Site C, for which, in today's

terms, we would have to put $1.5 or $2 billion in the bank in order to

build. The downstream benefits are greater in amount and capacity. At

American replacement prices, it is a multiple of our costs. It's a big

asset of the order of our provincial debt. How we manage this is very

important, and I welcome any debate on this subject. We will make

decisions about it in a few years' time.

MS. EDWARDS :

I would like to assure the minister that, like him, we on this side of

the House are very practical politicians. The very fact that the

Columbia River Treaty is there — and what the causes are — is

what we are trying to deal with now, whether we agreed with it earlier

or not. I think the minister as well has a history of having some

thoughts on whether or not the Columbia River Treaty was adequate.

However, the point is that we are now trying to deal with what is there.

The

minister says that there is no quick decision needed. I assure the

minister that I am told frequently in public meetings, by Hydro, people

and by people who know, that we need a decision almost immediately on

what's going to happen to the downstream benefits. It has to be known

by 1992. The calculations are so complex that it really has to be known

by 1990, and we are a third of the way into 1989. We don't have any

time left.

A number of people suggest that we're talking

about a very tight schedule. If the minister believes that the power

belongs to the people of B.C., does he see some way that the people of

British Columbia can have some input as to whether or not we are going

to export power from some of the projects developed by B.C. Hydro, put

them into private hands and command them to export for 20 years? Is he

going to let the people make some response on that? Is he going to do

some investigation of all the particular agreements that we are going

to be into, such as the free trade agreement, and the complex matter of

trying to get anything back that we commit to export? What is the

likelihood of us being able to get it back? Certainly the experience of

Ontario exporting to Vermont and then not being able to get it back is

a matter of some concern.

The minister might also look at — and the public demands that it be looked at —

thermal generation from coal. The Northwest Power Planning Council is

doing a lot of work and talking about not allowing the generation of

power by coal. They are suggesting even going back to nuclear power,

rather than setting up more coal-generating plants. If they are so

against using coal to generate power, what is the difference? How does

this fit into what British Columbia plans to do?

Those

matters have to be dealt with. The environmental and social costs have

not been considered adequately. The public needs to know what the

minister wants to do and then have the opportunity to put its feelings

on record. The minister needs to do that very soon because the

timetable under the Columbia River Treaty for deciding what is to

happen to the Canadian entitlement is very short.

SPORTS

MR. LOENEN :

Mr. Speaker, this morning I would like to talk about sports. We are

immediately reminded of the great victory that made all of our province

proud last night when the Vancouver Canucks defeated the Calgary

Flames. Indeed, all of us here want to encourage them, and we want to

assure them that on Saturday evening all of B.C. will be rooting for

them. The Rocky Mountains, high as they are, will not stop our

enthusiasm from reaching Calgary, because we are with them, and we wish

them every success.

They must have known that I wanted to

speak on the importance of sports, because that win last night was a

terrific example of what sports can do to people and to our community

to bring us all together. It's teamwork, and that was a beautiful

example.

I want to talk about amateur sports, and what that

means for our communities and its people, including youngsters. It is

at the amateur level that it all starts. That excitement of reaching

for the top that comes from young people developing their talents,

potential and team spirit has great benefits for our communities and

our young people. You know, since ancient times people have looked for

that ideal of having a sound mind in a sound body.

Competition

brings out the best in all of us. Therefore I just want to stress,

underline and put our focus on the importance that sports plays in our

community. It is true for all of us, but I would say it is especially

true for my community of Richmond. It is difficult to find, I submit, a

community where sport is more important, where people are more sports

minded and sports-oriented, and where there are more participants in

amateur sports than in Richmond.

Just look at the stats.

The Richmond Sports Council represents 58 sports organizations. All of

them are healthy and well run. They reach out to the people,

particularly the young people, in our community. Just think of soccer:

we have some 150 youth soccer clubs. In addition to that, we have 75

girls' soccer clubs. Altogether there are between 6,000 and 7,000

youngsters in soccer. If you look at baseball and softball in our

community, we have 200-plus boys' and girls' teams and 100-plus adult

teams.

Over the years our municipality has invested heavily

in parks, facilities and all the infrastructure that makes it possible.

I want to congratulate them for having done that, for having had that

foresight and building it up. If you look at the parks and the

utilization rate, which stands at about 110 percent, you will see that

there is absolutely tremendous par-

[ Page 6115 ]

ticipation.

The Richmond Sports Council estimates that they reach out to some

40,000 people in our community. In 1987 volunteers devoted 78,000 hours

to provide recreation for our community.

We have a very

impressive list of major sporting events which have been hosted by our

community. It includes the following: B.C. Summer Games — 18

different events, 3,200 athletes, 40,000 spectators; the international

youth soccer tournament, involving some eight different countries; the

National Bronco Baseball Championships for two years running, with ten

provinces involved; and the world masters' 10K and marathon. involving

some 36 countries, 650 athletes and 15,000 spectators.

The list goes on: the B.C. elementary school track and field championships —

every year we put that on; the B.C. disabled games, with 25 world-class

disabled athletes involved and some 12,000 spectators; the B.C. Special

Olympics; the B.C. youth soccer championships; the Canadian youth

soccer championships; and the international bronco baseball friendship

games of 1987, involving some 14 countries, that being the first time

it was held outside of the U.S.

Of course, we are looking

forward to hosting this August the 1989 Canadian foresters' games for

the physically disabled. This province is investing some $100,000 in

staging those games, and I know that is an encouragement to the people

involved. I want to assure the members here that that money will be

well spent.

What I am leading up to is this: Richmond is

the outstanding candidate to be awarded the 1993 Canada Summer Games.

Our track record is superb. Our people are ready. For instance, the

Friends of the Games Society has been formed, and so far 10,000 people

have signed up. We are ready to raise $2 million in private donations.

We will supply the 5,000 volunteers necessary. Expo 86 taught our

community to be SuperHosts. Building on all of that experience, we will

be host to Canada in 1993 so as to do all of British Columbia proud.

The

impact on tourism, on drawing people from all over Canada, will be

immense, because those people will come back. I just want to say that

the $2 million of taxpayers' money that this province will invest in

these games will, if given to Richmond, be money well spent. It will

pay dividends in the lives of hundreds of young people for decades to

come.

MR. SPEAKER : Unfortunately, under standing orders the member's time is up.

MR. G. HANSON :

It's a pleasure to respond to this subject. I, too, on behalf of this

side of the House want to congratulate the Canucks for their

performance last night. I am sure we can take either the Kings or the

Oilers, whoever comes forward in that contest.

I want to direct a few remarks to the member around sport, and I want to use

different categories. I want to talk about character. I want to talk about ethics.

I want to talk about pride and about leadership. These are the kinds of categories

or labels that I think sport has to be seen in.

is easy to pat ourselves on the back for the amount of athletic

participation that occurs in different parts of this province, but in

actual fact we lag far behind other jurisdictions in terms of

facilities, coaching or having any kind of coordinated or integrated

sports system. With the arrival of the Commonwealth Games in 1994 we

have a chance to plan, leading up into that five-year project, to

develop a coordinated sports system for this country.

want to read into the record a quote from de Coubertin, who was the

father of the modern Olympics. This is a well-known quote: "The

important thing in life is not the triumph, but the struggle. The

essential thing is not to have conquered, but to have fought well." In

that quote is a sense of the development of the character of people in

society through sport and through participation, through competing in a

fair way.

We know right now, with the Dubin inquiry, what

sort of expos has occurred with amateur athletics in the country. I am

sure the recommendations coming out of the Dubin inquiry will

reverberate around the entire world, and the sports community

internationally will be well served by Mr. Dubin's efforts.

When

I say that we lack an integrated sports system, one of the greatest

mistakes that was ever made in the school system here in British

Columbia was in the mid-eighties, when compulsory physical education

was taken out of grade 11 and senior high school. That was a mistake

that we see now, just a few years later. In retrospect, we see the need

for activity for health purposes, the need for participation for

leadership development, the need for competition in terms of developing

character and a spirit and a sport ethic around participation. I'm not

for making children participate in activities that they really don't

want. I believe, though, that there is such a range of potential

activities, whether jazz dance, low-impact aerobics, team sports or

other kinds of individual events, that children would benefit in terms

of their health and their character development. What happened in 1985

was that there was a decision to make consumer education compulsory,

and so to meet university requirements, physical education had to be

bumped off the compulsory curriculum. I thought that that kind of an

equation was really foolish. I think any physician would certainly

agree with me.

What we need is a sport-for-all concept, so

that no matter what level of participation citizens wish to involve

themselves in, they can have some ability to get physical activity. If

they choose to try to excel or increase their skill levels in things,

there should be coaching and facilities available to them.

know I have a very brief amount of time in this kind of response. I

just want to tell you that I was recently made aware of a study done of

native Indian facilities and coaching or lack thereof in the province.

Most don't have the facility for team sports. Most don't have a

recreational director with any training. Most don't have any access to

coaching. Yet there is a

[ Page 6116 ]

strong desire for sport and for competing for the health and character reasons which I have outlined.

MR. SPEAKER : I regret to Inform the member that his time is up under the standing orders.

MR. LOENEN :

I would just like to invite the member for Victoria to support the 1993

Summer Games bid that has been put in by the Richmond community, just

as we supported Victoria and wish you well in staging the 1994

Commonwealth Games. We need your support, and I know the member's going

to support us, because he is a very gracious person whom I had the

pleasure to meet in Montreal when we went to bid for the Commonwealth

Games.

[11:00]

As a province we do invest in sports. We do so very handsomely and

very generously. If you look at the sports administration centre that

is being built on Broadway, what a great thing it is for amateur sports

to be all housed in one facility. Over $600,000 of provincial money

goes into the operation of that year after year.

Yes, we

can make improvements, but there are many ways in which the province

can hold up its head and be proud of what we are doing.

Coming

back to my own community of Richmond, as shown by the list of

accomplishments I read off earlier, we have been in the forefront of

amateur sport development in this province. We have taken a leadership

position. We have catered and hosted all kinds of provincewide events.

We will continue to do that whether we get the '93 games or not.

have made our facilities and our resources available to the athletes of

this province. What I'm saying is that we can do so much more and so

much better if we recognize that there's a community that needs the

support and stimulation, which would come from an event such as the

1993 Summer Games. I just want everyone to know that the money will be

well spent and that it will pay dividends for residents, not only of my

community but for young athletes from every quarter of our province,

who will benefit from the new facilities that will be a legacy after

the games have been staged and have run their course. That, of course,

is the important part of these events.

In brief, we have

the enthusiasm, the capabilities and the confidence that we can do a

super job of hosting the 1993 Canada Summer Games. We have a beautiful

city to host the games. We have the people and the resources to plan,

organize and implement a most successful games, and I hope that those

qualities will be recognized and that the decision will reflect well on

all of British Columbia as a result.

HON. MR. REID :

First of all, I want to compliment the member's statement this morning

and correct one thing for those people who use Hansard for bedtime

reading. Mr. Eli Sopow in public affairs comes under the Ministry of

Tourism and reports to this minister, not the Premier's office.

Mr. Speaker, I call Committee of Supply.

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

ESTIMATES: MINISTRY OF HEALTH

On vote 35: minister's office, $333,960 (continued).

MS. EDWARDS :

I have a couple of issues that I want to question the minister on this

morning and see if I can get some answers on them. I want to go back

first of all to the $5 user fee on private physiotherapy clinics. This

fee is not imposed on visits to hospital physiotherapy units but only

on private practices. Just to clarify, so that we can get our question

straight, the fee is $5, and it represents 40 percent of the amount

allowed through the Medical Services Plan. That amount is $12.60. The

physiotherapist gets $7.60 from the Medical Plan and the $5, if the

physiotherapist collects it from the patient.

Also under

the plan, the number of visits covered by the Medical Plan are

restricted to 12 in a calendar year. That's only in private clinics.

For hospital outpatients, there is no user fee and, in fact, there is

an unrestricted number of visits for each patient. I would like the

minister to respond to this, perhaps not right away, but it's one of my

questions. I believe this figure is correct. The cost has been

estimated at $53 per visit, according to the Kristianson report; that's

basically what a physiotherapy visit averages at. That's the amount

charged to non-insured, out-of country visitors. That is the comparison

between what it costs the Medical Services Plan if a patient visits a

hospital compared to what it costs the plan if that patient visits a

private physiotherapy clinic. I'll let the minister answer that now if

he would.

HON. MR. DUECK : The cost per visit in hospital, if I understand it correctly, from out of country —

is that what you were referring to, someone coming in who is not

covered under the plan? In other words, what it would cost a hospital

to deliver that service and physio, I imagine, is what you are

referring to. I'll have to get that information from my office. I

haven't got it broken down.

MS. EDWARDS : As I

understand it, the amount charged out-of-country visitors is $53. That

amount came from a report made by a person by the name of Kristianson.

That is basically what a physiotherapy visit would cost under the

Medical Services Plan. I'll leave that with you.

colleague from Surrey-Guildford-Whalley would like to do some

questioning now. I think we can come back, because I haven't really got

into this yet.

MS. SMALLWOOD : In the response to the

budget speech and the throne speech in this session and in previous

sessions I have outlined my concerns about the problems at Surrey

Memorial Hospital. At that time I asked the minister to look into the

situation and be able to answer some of my concerns. I wonder if the

minister has done that and whether he can tell me about the status of

Surrey Memorial.

[ Page 6117 ]

HON. MR. DUECK :

I think something dealing with an individual hospital is much better

done person-to-person or in writing, but I can certainly take the time

and go over every hospital, if you so desire.

At Surrey

Memorial the pressure of the growth rate has been quite tremendous. I

think the member is very well aware of what's happening there. I don't

think I have to go into detail, but I will. You make a visit to the

hospital, you've got all the answers and all the particulars of what

should and shouldn't be done, and perhaps some of the things you wish

would happen I probably would like to see happen too. You know it takes

a while to build a hospital and get staff in place. But I will give you

some of the information you want about Surrey Memorial.

The

ambulatory-care centre will be completed in October '89, to the tune of

$15.6 million. These new and expanded areas will provide the diagnostic

treatment and support services necessary for expansion of an

acute-care-bed hospital. Psychiatry, 30-bed addition, $4 million,

currently in planning, expected completion of construction 1991.

Acute-care expansion, 80 beds, $18 million, currently in planning,

expected completion of construction '92-93. In addition to the 80 beds,

the project includes a retrofit of space vacated as a result of

ambulatory care. The completion of these projects will increase

operating costs. In other words, there will be an annual increase of

$11.5 million for operations.

[Mr. Rogers in the chair.]

Some

time ago Surrey Memorial Hospital Society requested an operational

review. When you asked, in your response to the budget or to the throne

speech — I'm not quite sure which — I said it was being

looked after. They got an adjustment, and I believe it was something

like $1.7 million. The current staffing and funding levels will be

appropriately covered by that. The regional team is now finalizing

their recommendation. They've been in and gone over it line by line in

this particular hospital.

[11:15]

Based on '87-88 year-end workloads there's an outstanding $558,113

owing the hospital. The September quarterly review indicates a further

$448,664 will be owing due to the workload increase in the first six

months of fiscal '88-89. The increase in workload is predominantly in

out-patient, day care and surgery work.

My staff is aware

of the financial situation, of course, and from time to time we review.

We do not fund the deficits. We give hospitals global budgets. We make

it very plain at the beginning of the year that that is the money

they're going to get, that's what they have to work with, and they

receive that money.

You've been talking about how unhappy

they are. Sure, they could stand more money and they could use more

money, but I want you to know — and I want to read this into the record —

of a letter written by the chairman of the board, talking about their

hospital funding. We take our direction from the chairman; we do not

take our direction for how hospitals operate from the opposition member

who tries to criticize one hospital. I couldn't possibly operate in

that way. We take it from the chairman; we take it from the hospital

itself, with our senior people that go in and review the operations,

and we're fair. We try and look at their workload. I want to read this

letter into the record:

The Ministry of Health has been

very supportive of the hospital over the years. In fact, the Minister

of Health has approved almost $40 million of capital projects during

the last three years. One of these projects is a 110 acute-care-bed

addition, which will help alleviate the hospital's bed shortage.

addition to capital improvements, the Ministry of Health has made

significant adjustments to the hospital's operating budget; however,

the adjustments have not kept pace with the increased demand for

services at the hospital by a growing population. To assist the

hospital, officials of the ministry have been in constant dialogue,

which has resulted in a budget review that is currently underway.

reinforce the comments of our president and chief executive officer,

Roger Bernatzki, when he states that we are very confident that the

funds will be added to our operating budget in recognition of the

hospital's increased workloads due to the population growth in Surrey.

Any individual who comes to Surrey Memorial Hospital for care can be

assured, and feel confident, that the care which they will receive will

be of high quality.

On behalf of the entire board of trustees, I wish to inform all the citizens of Surrey and North Delta that all parties — the Ministry of Health, board of trustees, medical staff, hospital administration staff — are working at providing additional beds and increased funding, because we all care.

MS. SMALLWOOD :

Coming from an appointed board and chairperson, perhaps that is to be

expected. I would imagine that given the circumstances in Surrey, and

the need for services there, the government is feeling a little

sensitive.

I'm a little concerned about the minister's

double standard. The minister talks about family and children's needs

and says they will be dealt with on an individual basis. Yet when asked

to deal with hospitals and their needs on an individual basis, his

statement is something to the effect that we need to deal with them

globally.

However, Surrey has specific needs, and I am

going to again reiterate the fact that Surrey Memorial, and I believe

other hospitals in that region, are in jeopardy. The health care in

that region is in virtual crisis, because the government has not acted

to date. We can look across the river, for instance, at Eagle Ridge

Hospital, which was built to deal with the growth that was known to be

on-line in that community. I think this is a very logical question. Why

didn't that happen south of the river? Why are we in a situation in

Surrey Memorial where we have only half the number of beds by

population? Why are we in a situation where this hospital runs at over

capacity with increasing frequency?

The minister has been

unable to answers those questions. I'd like to look at the future. What

does the minister intend to do about that situation? His

[ Page 6118 ]

answer

is that we have global budgets and do not finance deficits, which I

find to be very disconcerting because unless the ministry does

something about the situation in Surrey Memorial, we will have deficits

each and every year.

Interjection.

MS. SMALLWOOD : The minister will have an opportunity to answer that,

and I will look forward to that information. The minister provided money to

top up last year — and perhaps he can clarify this for me If I'm misunderstanding.

The minister provided $1.7 million to deal with the operations of the hospital

up until April of this year. I'm hoping he's not saying that's money

for the '89-90 year. It does leave the hospital with a $500,000 shortfall.

I'd

like to hear what the minister plans on doing for Surrey Memorial to

recognize the shortfall in services and bed allocations to our

community. On top of that, the minister talks about the construction

that is underway at Surrey Memorial. I have a specific question to the

minister: the new construction will provide 80 new beds plus 50 —

there are two different categories that the new construction will deal

with. With the money allocated for this construction, if the hospital

can actually provide additional beds, will the minister fund those

beds? I think the existing formula is 80 plus 30, and the hospital is

saying they have a program in place that will actually provide

additional beds for the same money in construction. Will the minister

provide money for operations if they are able to do that?

MR. R. FRASER :

I always like to come in and talk about the estimates for the Ministry

of Health, because every time I've done that I've had the opportunity

to listen to a member of the opposition party. It never fails to come

to my attention that the socialists never seem to care what things

cost. They always want to spend more of what taxpayers send us, and it

doesn't seem to interest them in any way who is paying the bill. Guess

who is paying the bill? The people of the province who are out there

working. I would like sometime to see an opposition member talk about

health care in this chamber and say: "Mr. Minister, what are you doing

to contain the costs of health care while delivering health to the

people of the province? What are BCMA officials and members doing about

making sure we have the most efficient medical care delivery system in

the country?"

By the way, where's the critic? He's a member

of the profession, and I presumed that his interest would be

demonstrated by a constant attendance in the House while the minister's

estimates are up. But we're not there.

I've had a chance to

look at some of the salaries doctors make, and I like to talk about

this every year. When I talk about doctors, of course, I see one

occasionally myself. I happen to like the doctor I go to, and he does

good work. I know what he makes; it's not one of these monstrous

salaries that I see going by. I wonder if it ever bothered the

opposition that one doctor billed the system for some $1,600,000 in one

year. I wonder if it ever bothered the opposition that some doctors

have billed the system for $500,000 or $700,000 in one year.

I'm not saying the minister can tell whether a doctor is over billing or not, but it does seem extraordinary —

$1,600,000. What is he doing? How is he doing that? Doesn't anybody

want to know? I want to know what he is doing. Is he running four

clinics and looking at a lot of pictures? Is he in the operating room

night and day? What's happening out there?

MR. JONES : Name names.

MR. R. FRASER :

I could name names; in fact, it's printed in the book. You could read

it yourself, and I think you might find it interesting. If you want to

heckle, you've got to do it intelligently or it's not worthwhile.

The

average specialist makes $182,000, says the minister, and the average

general practitioner, $143,000. I know those are gross amounts. I know

they have to pay their nurses, their rent, medical liability insurance.

I know all those things. What I don't know is what's a reasonable

amount of money for a doctor to gross — or even to net — in a year.

Maybe

they're all worth $150,000 on an average; maybe they're not. But I've

yet to hear BCMA say that one person, one woman, a doctor, billing

$300,000, $400,000, $500,000, $600,000 and $700,000 is unrealistic.

They've never said that. The minister should be provided with some help

from that organization.

MR. DAVIDSON : We want answers.

MR. R. FRASER :

We want answers. I mean, if the public is going to pay, they're going

to deliver. Maybe there are doctors who are really great at surgery,

technically marvellous. They're so good that they should be in the

operating room all the time.

But maybe surgery isn't the

answer. Health care is not surgery; health care is talking to the

patient from time to time. Maybe there are other ways. Maybe the

doctors could operate as a group: some do the counselling and others do

the surgery, and they can average it out. Maybe that's the way it

should be done. But it constantly worries me when I see a very

privileged group, whose education is paid for by the taxpayers, who

seem to think whatever they earn is a given right; and for me it isn't

given.

One of the things in this industry that really troubles me is that there's no competition in the medical practice field —

none. The pharmacists are now having a little trouble because their

dispensing fee is being lowered in some big stores and not in little

ones. The interesting thing we're going to find about the particular

circumstance is that the smaller stores which charge a full

pharmacist's fee are still going to do very well because they can give

a level of service that a big store can't. There are lots of small

companies and lots of big ones. The little ones always survive if they

do the service work that they claim they do; that's why they live. So

they will be fine.

[ Page 6119 ]

In the field of medicine, who are we competing with? No one. The fees are fixed.

Interjection.

MR. R. FRASER :

The fee for service is fixed. Everything they do is fixed. Everything

is done. Who are they competing with? The answer is: nobody. I wonder,

while we have this federal law that says you can't price-fix, if in

fact every province in the country is in contravention of that law,

because they price fix.... Every government price-fixes with every

doctor. There's got to be another way to solve this problem.

Fee

for service is not necessarily a good idea. It's called piecework in

other businesses. It's rejected by everybody in other businesses

because it seems to give some people the impression that it works

people too hard. Piecework generates a level of activity in some

ministries that is disturbing.

In the field of medicine, as

I say, we find such a huge disparity between the average working

person, who competes like everyone else, and a highly sophisticated and

privileged group that can walk in and take that taxpayer's money. From

the time I've been here, the Ministry of Health has had an

ever-increasing budget. It has never gone down. Surely there must be

some way we can deliver the service without breaking the back of the

taxpayer who's funding it. It is not government money; it's taxpayers'

money.

As I said yesterday, there must be some way. Maybe

we could use paramedicals. The critic, who is not here, suggested that

I, as an engineer, am having difficulty with technicians. No, I'm not;

nor should a doctor have any trouble with nurses. Technicians don't do

engineers' work. Nurses don't do medical work, but they can get

involved in the medical field and do very well. Some nurses are

wonderful, and they could do a terrific job with patients that doctors

don't need to see.

[11:30]

I want some emphasis from that. I want to hear about it from the

BCMA. I've been invited to have dinner with a Vancouver doctor, and

he's going to tell me something about the BCMA. He wrote me a letter

about the master agreement we heard about recently. I said: "I

understand you are having trouble with the master agreement."

"Cancelled unilaterally by the ministry." Yet when I got in touch with

the ministry, what did I find? The minister, in a meeting with the

BCMA, advised them months in advance of the minimum time, which was a

year, that the agreement was out of date.

He said: "We

should fix it." I understand that the BCMA said: "Yes, we should." Now

we get these letters from doctors saying that the government has

unilaterally cancelled it. Maybe what the minister should do the next

time he wants to upgrade the master agreement for the benefit of the

people of British Columbia, through the doctors of the province, is

insist on having a joint notice about upgrading the master agreement. I

don't know that he would be as critical of the doctors if they decided

they wanted to change the master agreement. If they decided they were

going to unilaterally, as they put it, cancel the master agreement, I'm

sure the minister would say: "You want to change the master agreement?

Let's talk about it." I think it's time we had a whole lot more

cooperation from the BCMA, the political arm of the medical profession,

in helping the minister solve the problems of delivering health care to

the taxpayers of British Columbia.

MS. SMALLWOOD : I

just want to clarify some numbers for the minister before he has an

opportunity to respond. The existing construction deals with 130 beds.

The administrator of the hospital is asking — to provide a little more information, 80 is new construction; 50, I understand, have been approved over the north wing —

if the hospital, with the same amount of money, can provide for 200

beds. Recognizing that there is a drastic need and that we have only

half the province's average, will the ministry give the okay for the

hospital to do that and allow them support for the additional beds?

It's a cost saving to the ministry in that it will provide an

additional 80 beds to a hospital which I believe the ministry

recognizes to be in need of those new beds.

HON. MR. DUECK : I believe we're getting into operations of hospitals

now, and we could talk of that at length. I don't think I take my cue from

you as to how hospitals are run. You say they tell me what should be done. I

take my cue from the board and from my ministry. We fund hospital beds; we approve

hospital beds. We fund hospital beds when they come on-stream, because that's

all done in a coordinated, controlled way.

When you are talking about fewer hospital beds per thousand, you're not listening. You asked a question, so you'd better listen.

MS. SMALLWOOD : I'm listening.

HON. MR. DUECK : When we're talking about hospital beds per thousand,

you cannot compare that with the figures of the province, because we take the

total catchment area. There are many from Surrey who have procedures done at

VGH or Grace or what have you, so we can't take that figure we use for the

provincial average.

You

say that Surrey Memorial is out of control, and that if we use global

budgets, somehow that is a sin, and that we should fund....

Interjection.

HON. MR. DUECK : Just a minute now. You asked a question; now let me answer.

MS. SMALLWOOD : Point of order. The minister has quoted me incorrectly. I never said that Surrey Memorial is out of control.

MR. CHAIRMAN : That's not a point of order; it's merely a disagreement. There is lots of opportunity

[ Page 6120 ]

in Committee of Supply for you to rise when the minister has finished. I recognize the minister.

HON. MR. DUECK : Perhaps you didn't use the words "out of control," but you insinuated that if we used global budget, the crisis — yes, you used the word "crisis" —

in the hospital would be tremendous. I'm telling you that you are

completely out of touch with how hospitals operate in our current

environment.

We have a global budget for each hospital. We

will only fund a deficit if it's something that is not in the control

of that particular hospital. Other than that, they must manage the

funds they get under that global budget. We make no bones about it. I

also get a global budget for the total province, and I cannot go back

to the Minister of Finance and say: "I'm sorry, I need a few extra

dollars." Only if a situation arises that is not in the control of the

hospital....

We are operating under global budgets.

Hospitals can and do function under global budgets. I will just give

you an example of Jubilee or the Victoria Hospital Society. There was a

tremendous problem in Victoria just a few years ago. They had people in

the hallways. They had emergency that was overflowing. They were really

having a problem. They put in the Vi-care program. They are now

operating with the Victoria Health Project. We now have vacancies. They

are managing. They have far more out-patient, which Surrey is doing

also.

I'm not saying that Surrey is operating

inefficiently. They have pressure on them because the beds are not

available. But I am telling you we are correcting that; it takes years

to put that in place. We have recognized that problem for some time. I

have talked with the board and administrator, and I would take their

word and their overview of the hospital's operation any day before I

listened to you telling me how that hospital should operate. You are

not in a position to do that. You go there for one day, and you come

back and you are an expert. It really blows my mind to listen to you

come back and say: "I know how that hospital should operate. I think

you should do this; you should do another thing."

MR. CHAIRMAN :

Mr. Minister and other members of the committee, the normal routine in

Committee of Supply is for those persons speaking to address the Chair.

Listening to the remarks of the minister and also of the member for

Surrey-Guildford-Whalley... You tend to be addressing one another on a

personal basis. That's not the way it's supposed to work here, and I

would like it if you would address the Chair.

MS. SMALLWOOD :

I've shared this story with the minister and with the House before, but

the minister seems to not understand the situation in Surrey. This is

not a situation of being a health expert or an expert on doctors, but

merely of understanding the community and the community's needs. I

would suggest that as the representative for Surrey-Guildford-Whalley I

may have some insights into our community that the minister may not

directly share.

Again, for the record, I will share with

you a crisis situation. I use the words "crisis situation" because I

believe it is a crisis when any hospital.... First of all, it's

recognized as the busiest emergency hospital in the province. It has 13

emergency beds and 200 visits a day. They were in a situation last

month of going on emergency alert, which is where they are unable to

deal with the demands on that hospital, where they set up a special

team to go around the hospital and discharge patients early to provide

beds, where they cancel all surgery for the day and bring in new staff,

and where they go on diversion and send all ambulances coming to that

hospital to other hospitals in the region. Because of the growth and

the demands on the hospital, they find that all hospitals they are

sending ambulances to are indeed on diversion as well. This says to me

that we have a crisis situation. It says to me that we are unable to

get the health care needed. As I have said to the minister in previous

conversations, that situation is only going to get worse.

am trying to deal in a constructive way with the needs of Surrey

Memorial and with our community's needs for health care. I have asked

the minister if he, first of all, recognizes the pressure, given the

fact that Surrey has taken 75 percent of the growth of the lower

mainland in the last year and one half of the growth for the total

province. Will the minister recognize that we are a special situation

and that there needs to be special attention paid? I have repeatedly

asked the minister for that.

I have now asked the minister

for specifics. How is the minister dealing with this crisis? What

programs has the minister put in place to alleviate the pressure? Is

the minister recognizing the needs of the hospital for increased budget

demands? We're talking about the deficit that has been created by the

increase in the demands brought about by growth. Specifically, will the

minister support the hospital's project that will provide more beds for

the same amount of money the ministry has already committed? Those are

specifics that deal with my community's and my hospital's needs, and I

ask the minister to deal with my request for information in a serious

manner.

HON. MR. DUECK : Mr. Chairman, thank you for telling me to address the Chair rather than an individual.

get emotional when certain people become instant experts and try to get

on record and make their community more uneasy about health care. You

can get people very uneasy and afraid when you keep talking about

crisis. In fact, we work with the hospital administration very closely;

we've had many meetings; we're aware of the growth in the community;

we're addressing it in every possible way. Some of these issues cannot

be addressed overnight; it takes a while to do so.

I would

gladly sit down any time and tell the individual exactly where we're at

and what we're doing from time to time. But I knew she would bring this

[ Page 6121 ]

at this time because it makes good stuff for the record and she can go

back to her friends and say: "I really waved the flag. Boy, I told them

where it's at and how to do it."

I mentioned this earlier. When we talk about beds per thousand....

MR. ROSE : Be nice.

HON. MR. DUECK : I am nice! But when I get attacked, I cannot help but respond the same way.

The

ministry has identified the acute-care and extended-care bed

requirements of the Surrey area, and I've said this before. We're

proceeding in a rational and very pragmatic manner to address this

issue to meet the needs.

We are doing some very significant

things as far as buildings are concerned. We've addressed the shortfall

that was no fault of that particular hospital, and we've addressed it

by giving them $1.7 million for the current year.

To reduce

the number of long-term-care patients in acute-care beds, 150

extended-care beds for the Surrey-Richmond area are currently in

planning. An additional 100 extended-care beds will also be provided in

the Langley area to improve the situation. To meet the estimated need

for acute-care beds, an ambulatory-care centre is expected to be

completed, which I mentioned to you earlier, in '89-90, and this will

provide new emergency radiology and medical care for that particular

area. These new expanded areas will provide the diagnostic treatment

and support services necessary for the expansion that is underway.

[11:45]

It has to be done in a pragmatic, rational manner. You can't come in

here and say it's a crisis. There is no crisis, Mr. Chairman. We've

addressed that. We've talked to the board and the administrator. That

doesn't say they haven't got concerns; that doesn't say they haven't

got a problem. You will never, ever have hospitals that can address

ambulance or emergency services at any given time. It comes in peaks

and valleys, and there will be crisis times when one hospital can't

take it and it has to be diverted to another hospital.

Sometimes

even by air there are times when they haven't been in communication

with the other hospital and received information in advance to find out

that other hospital was also filled. That can happen. I'm not saying

that people are infallible. Mistakes are made. Sometimes they have

taken a patient to one or two hospitals and didn't realize that that

hospital also couldn't take that overload. That should be corrected,

and we shouldn't put up with that.

I also want to

give you a little insight into what the auditor-general has said. I

haven't gone through this very carefully, because we just got it the

same day you did. Of the hospitals he says: "We found that the ministry

has acted to control the total amount it spends on hospitals. Also it

has organized the hospital system in a way which should, in general,

encourage efficiency." That is also part of my mandate. It isn't just

throwing money at it when something comes up: "Give them another $1

million; somehow that will solve all of it." If we took your advice and

just blew money.... Would you believe that we could add another $1

billion to my budget and people still wouldn't be satisfied?

says further: "The ministry's most significant action on costs has been

capping hospital budgets. That is, it fixes a budget for each hospital

and only increases it for costs outside of the hospital's control.

Capping began in 1981...." There's a graph shown here, and it went up

absolutely dramatically. Then we started capping and it levelled off.

We are going down on beds per thousand in the hospital for acute care

beds because we're doing so much out-patient and other forms of health

delivery, which is good. We're keeping people at home longer. We have

more facilities and more resources for the elderly; we don't have to

hospitalize them. A few years ago everybody went to a hospital, and we

expect and demand that the hospitals manage. It's like any other

business; they manage. They don't keep people in there longer than

necessary.

We found, in 1981, '82 and '83, when capping was

first introduced, that hospitals said: "It cannot be done." Later on

they came to me, since I have been minister, and said: "You know, we

thought it couldn't be done. We are delivering better health care than

we did at that time. People are not sicker; they are healthier, because

we developed a different system of looking at health. We are trying to

keep them out of the hospital and not bring them into the hospital."

Once

you realize that, you'll know that we are delivering a health care

system second to none in Canada. They come here from other provinces

and ask us. Ontario has just recently announced that it is going to cap

hospitals. They are going to put in global budgets for every hospital,

and that is what we're doing. We're doing it in a rational, caring way;

we are not being hard-nosed about this. When they have situations out

of their control, we will recognize that, and we do. That's why they

got the $1.7 million at the end of the year.

Another thing I would like to say to the member: they knew they were getting

that money months ago, because we told them. It wasn't public knowledge.

We didn't know yet what our budget would be, but we recognized it, and if

at all possible we would be giving them that extra money, and we did. They are

quite happy, as I told you, in that letter.

MS. SMALLWOOD :

I'm constantly disappointed that the minister, rather than dealing with

legitimate answers, is more interested in putting forward his own

political propaganda. These are legitimate questions that the people of

Surrey are concerned about and want answered. The minister again has

either refused to answer or doesn't have the answers for the questions.

The

minister says that he recognizes the needs of the hospital, and the way

he has done that is by providing $1.7 million. This is the second year

in a row that the minister has dealt with a shortfall at Surrey

[ Page 6122 ]

Memorial

with an ad hoc band-aid response. In the previous year, the minister

all of a sudden found some money to provide for additional costs for

hospitals around the province. At that time I asked the minister to put

in place a program that recognized the situation in Surrey and dealt

with the specific needs of our community, given the realities and

pressures of growth. I asked the minister to fast-track some of the

programs so that we wouldn't be in a situation year after year dealing

in an ad hoc way with budget deficits.

I have again this

year asked the minister to advise me on what he is doing on behalf of

my constituents. I am unclear on what the minister thinks his job is

during estimates and in this House, if it is not to answer the

questions of legitimately elected representatives of the people. If the

minister feels that the only way to deal with these problems is quietly

behind closed doors, then I would suggest to him that that approach is

exactly what got us into this mess in the first place. If indeed the

problems were being talked about, nobody knew about it, and there was

no action.

Again, Eagle Ridge and that community had a

hospital built to deal with the increased growth; we have had no

recognition. I have asked the minister and will do so for the record

for the third time: what are you doing? Again I emphasize that this is

a cost saving to the taxpayers and the ministry if you will allow the

hospital, with the same money already allocated for the increased beds,

to build additional beds. There would be no cost to the province for

that construction and a cost saving that will build 200 beds instead of

130. If the minister recognizes the pressure, then why not recognize

this cost saving? I don't expect an answer; I haven't got one the last

two times I have asked the question.

[Mr. Pelton in the chair.]

closing, because I am disappointed with the minister's lack of answers,

I'd like to, ask the minister if and when he will call for elections of

the board at Surrey Memorial. Surrey Memorial has been an appointed

board for almost ten years now. At what time will the minister lift the

trusteeship and allow the community to have a legitimate say and an

accounting of what is going on at our hospital?

HON. MR. DUECK :

The member first asks a lot of questions. She said for the third time,

and then she will no longer ask because she figures she will not get an

answer. I would like to tell you that I've tabled today a full report

on Surrey Memorial on the written question that you had in the Orders

of the Day. You'll be receiving that. I don't think the House is

interested in going over the details of that. Furthermore, when we're

looking at estimates, if you want to get into the operation of an

individual hospital, we could be here for 12 months of the year.

I'm

telling you that Surrey Memorial Hospital is not in a crisis situation.

We've met with the chairman, the administration and the board of Surrey

Memorial. They have pressures, which we have recognized, and they have

concerns, which they should have, because if they operate a hospital

there are always concerns. Surrey is a big operation.

We do

not allow a hospital to build beds because they have a shortage, and

somehow we will then fund them whether we have money or not. It is not

the physical structure of the hospital that costs money; that is

nothing. I spend $155 million a year in capital expenditure, but I

spend $4.3 billion on operations. It has to be done in a rational,

pragmatic fashion. You say we're operating ad hoc. We have five-year

plans, ten-year plans. Sometimes these plans don't quite work out;

there will be a shift in population, pressures in another way. So

sometimes the plan has to change.

Obviously you don't know

the operations of a hospital. You only go into them to find some way to

criticize so that you can come here and put it on the record. I'm very

sorry to hear that. You and I don't get along in that respect, although

you are smiling. I'd like to take it the same way and I'll smile back

at you, but we don't agree on certain issues.

Interjection.

HON. MR. DUECK : Just sit down. You asked a question, I want to answer the last question you asked.

The

member asked about the elected board versus the appointed board. You

know the history as well as I do, why it was appointed. We have given

it serious consideration and we're looking at whether in fact we should

go back to an elected board.

MS. EDWARDS : To return

to the physiotherapists, I have only one independent physiotherapist in

my riding, but I think he is representative of a number of the private

physiotherapists who were affected significantly by the $5 user fee.

His report to me is that the implementation of the $5 fee caused a 30

percent decrease in attendance at his clinic during the first six

months compared to the previous three years' statistics. That is a

significant drop in the number of patients he could treat. The other

problem he had is that overhead costs increased. Overhead costs, this

physiotherapist tells me, are 70 percent of his gross receipts.

The

new fee structure has more than halved his earning capability and put

him near bankruptcy. Bankruptcy is not an unusual experience for

independent physiotherapists, he tells me. As he understands it, eight

clinics have been closed since the implementation of the fee, and the

rumours are that approximately ten more are on the brink of bankruptcy.

The physiotherapist in my riding is one of them.

He points

out that it takes approximately $100,000 of equipment to establish an

independent clinic, and a whole lot of work. These people are paid only

$12.60 out of the Medical Services Plan, compared to approximately

$53.00 that it costs the Medical Services Plan for each treatment in a

hospital bed. There are other limitations for the physiotherapist. It

seems

[ Page 6123 ]

that this is not cost-effective as far as the ministry and the Medical Services Plan is concerned.

recognizes, but I think it is interesting to point out, that the

public's reaction to the deterrent user fee is one of public

indignation. They have expressed that indignation by going to the

hospitals. They may agree to pay their dentists and so on, but they do

not agree to pay their physio therapists $5 a visit. Therefore they are

going to hospital physiotherapy departments as out-patients, frequently

waiting for four weeks, and in some hospitals across the province up to

eight weeks for treatment. That is complicated, as I said, by the

limitation of the number of visits a patient can have to a private

clinic to 12 in a calendar year.

He suggests that there are

significant problems in collecting the $5, because even after 18 months

of implementing this fee, the average patient still arrives without the

$5 in his pocket. This creates what he calls "unnecessary and

frustrating office administration time"; I'm sure you would agree. He

says that "if you consider that a letter might cost $8" — and I think that's not an outrageous amount to suggest — "it's not worth a letter to try and collect a $5 fee."

says that on average two out of every ten people required to pay the

fee don't have the money in their pocket, so one of those will end up

being uncollectible. Also, in order to try and collect them in the ways

that he does — I'm not sure how that is — he has a 20 percent increase in his secretarial costs to cover what he calls "an administrative nightmare."

[12:00]

These increases, which can be directly related to the imposition of

the user fee, are on top of the "increased overheads for equipment,

cost of living and so on that have happened since 1982, when costs have

gone up 100 percent, although the income of physiotherapists working

privately has not." He also points out, as a comparative figure — Mr. Minister, you might know this, or if you don't know, you might be interested to know —

that in Alberta, which is only 80 miles from where we live and where he

has his clinic, the government pays $20.20 per visit, with unlimited

treatment access to private clinics. It seems to be far more reasonable

than what the Medical Services Plan allows in British Columbia.

This

physiotherapist asks for a review of the imposition of the fee. He says

the fee should be removed. He suggests that the visit limitations

should be removed: "If these things happened, the Medical Services Plan

would in fact be saving itself considerable money, because in fact

there are long waiting-periods for patients at the hospitals, the cost

of the hospital visits are high and...20 percent staff shortages across

the province in hospital physiotherapy departments."

would like the minister to respond to those points. Why would the

minister continue with the $5 user fee plus a limitation on the number

of visits for private physiotherapy clinics, when in fact it costs the

province more than it would if the fee were removed and if the

limitation were not there?

HON. MR. DUECK : To begin

with, I would like to state that British Columbia has the most

universal coverage, when we talk about alternative care or

supplementary services. A lot of provinces don't have the same coverage

as us. It is really the best coverage of all provinces in Canada.

The

issue of the $5 user fee.... That may be the opinion of one. I've met

on a number of occasions with the executive of these various

alternative-care providers, and they're quite happy with the user fee.

They don't think it is a problem.

I don't think collection

should be a problem. If someone comes to a service station and hasn't

got $5 in their pocket, I suppose they would have to go back and get

that $5. Do you believe that people in business should not have a

receivable, that everything should be handed to them? No. We can't do

it with the other services, of course, because of the Canada Health Act.

You

said that the fee

schedule is too low. I could perhaps argue that it's

too low; maybe they should be paid more. That is done by negotiation,

as you well know. It's not done by me in some fashion that I wake up

some morning and say they should get paid more.

You talk

about physiotherapy. I haven't got Alberta here, but I'll have you know

that British Columbia pays $18.55 and Ontario pays $10.40. For

chiropractors, it's $18; Ontario, $10.75; Alberta, $12; Saskatchewan,

$15; and Manitoba, $10. In podiatry British Columbia pays $22.40;

Ontario, $13.60; and Alberta, $23.90. In podiatry they pay more than we

do.

MR. PERRY : What about Ministers of Health? How much do we pay and how much do they pay?

HON. MR. DUECK : Let me see now. BCMA doctors — now what do they get? I haven't got that column here.

Physiotherapy,

$18.55; Ontario, $10.40. I haven't got Alberta at this time. I just

show the rates for five-minute intervals, where we pay per session. I

don't think we stack up too badly compared with the others, although

I'm not going to argue that their fee is high enough or should be more.

That is done at negotiation time. I've spoken to them many times, and I

think they're on the low side of the totem pole. Maybe we should look

at it, and I am sure they will make a good case when they do their

negotiations. I understand they are doing their negotiations now.

cover, for example, naturopaths and massage therapy. No other province

in Canada covers that. We cover that because we believe that the

alternative provider of health care is important. We can argue that it

should be more. I have to balance the amount of money we have for

health care with the amount of money we spend, and it's not easy. We

walk a very thin line.

I have to also deal with my colleague the Minister of Finance (Hon. Mr. Couvelier). When he gives me a budget — it's a good budget; there's a lot of money there — it has to be allocated. Sometimes I think I should take it away from some of the people who

[ Page 6124 ]

earn big incomes — like the medical doctors — and put it into nurses. Oh, I got the attention of somebody there.

Maybe

there is an imbalance. The fees are negotiated with all these

practitioners: medical doctors, nurses and the supplementary services.

They are negotiated fees, and hopefully when that's all watered down

and the dust is settled, everybody is going to say: "It's not enough,

but it's fair." If we can do that, even if both sides aren't completely

happy, I think we've struck the middle of the road, and we will be

happy.

MS. EDWARDS : Could the minister tell me what the out-of-province fee is for a physiotherapy treatment in British Columbia?

HON. MR. DUECK : I'm sorry, Mr. Chairman, I can't chew gum and

walk at the same time. I didn't hear the question.

MS. EDWARDS :

The question is the one that I asked when I was up previously. What is

the fee for people from out of province for a treatment in

physiotherapy?

HON. MR. DUECK : The information I have — and I think it's correct —

is $50.50. That's in a facility. But generally it's different

physiotherapy than you get from physiotherapists operating on their

own. Very often physiotherapy in a hospital is perhaps a half-hour

session, because they are in there for some particular reason, and it's

not a matter of coming in and doing a quick physio treatment. It's very

often an acute-care patient, and very often it's a much longer....

Therefore, for an out-of-province patient who isn't under the plan, we would charge up to 35 percent extra for overhead.

MS. EDWARDS : I think you made my case, Mr. Minister. My point is: if that is what you charge people for a physiotherapy treatment — it's $50.50 plus 35 percent of that, I presume, for overhead — then

that's closer to what the cost of a physio treatment is. You're paying

the physiotherapists less than that by a considerable amount. You're

paying $18 and something for a physio treatment.

Why would

you not consider the problems that are created? I can't, of course,

address all of this, but I will tell you that in the smaller cities in

the Interior, there are not a lot of physiotherapists, and they don't

have a lot of people.... I can assure you — and I think this applies right across the province —

that physiotherapists are not going to go out to their waiting room and

tell the people sitting there that if they don't have $5 in their

pocket, they're not going to get treated. They don't do that.

So,

Mr. Minister, I think that suggestion is a little foolish. I wonder if

the minister could confirm the suggestion that there is a shortage of

physiotherapists to staff the hospital facilities in British Columbia.

HON. MR. DUECK : Again I wasn't paying any attention. It must be getting close to lunchtime. Could the member be kind enough to repeat it?

MS. EDWARDS : Mr. Minister, could you confirm that there is a shortage — and what size the shortage is — of physiotherapists to staff the facilities in hospitals in British Columbia?

HON. MR. DUECK :

Yes, there is a shortage of physiotherapists, and there has been for

some time. We have programs in place to attract more, and we have

received many more in the last year and a half since we had some of

these changes. One is the bursary program whereby they can go to school

and become a professional in this area, provided they will in turn

enter into an agreement to serve the province for every year that we

pay the $5,000 one-year service at their rate — in other words, not for free but at the going rate.

have caught up with many of them. I think the shortage is a lot less

now than it was, although when it comes to some Isolated areas, It is

much more difficult to attract people. They all like to practise in the

metropolitan areas — in the lower mainland and in Victoria. It's

very difficult to get them away from the more desirable areas. It's not

too bad right now. It was much more serious a year and a half to two

years ago.

We are also allowing in people who aren't

trained to the same level as in Canada. We gave them another

designation so they could practise in this province in the interim and

then upgrade their status. That was an amendment to the

Physiotherapists Act to facilitate recruitment of foreign trained

physiotherapists, which was brought into force January 29, 1988. As of

March 1989, 57 physiotherapists have registered under this provision:

52 temporary registrations and 5 permanent registrations. It has helped

a lot.

I can see that the problem with physiotherapists is

not going to be as acute as it is with some other practitioners,

especially critical-care nurses. I think the problem is much more

serious in that area.

MS. EDWARDS : Mr. Minister, I

cannot understand why, if it costs considerably more to treat a patient

in a hospital than it does in a private clinic, and if there is a

shortage of physiotherapists; in private clinics, the minister would

insist on not looking at the $5 user fee and limiting the number of

visits to private clinics. It seems to me that it discriminates against

the patients, who are the citizens of British Columbia.

HON. MR. DUECK :

I disagree, of course. When we say $53, or $50.50 plus $35, we are

taking into consideration the total operation of a hospital. I mean,

it's not just the individual physio — and that's for out of the

country. When we take the cost to do physio for someone in the

hospital, it isn't $50 plus $35, as you stated. We are talking about

someone coming from out of the country and using our hospital. The

charge is far greater. We don't pay anything, of course.

[ Page 6125 ]

Interjection.

HON. MR. DUECK :

No. We then take into consideration the physical plant, the light and

all the services, and that provides our costs. You are asking why

physiotherapists in private practice don't get that kind of fee. Let me

tell you, we can't even attract them out of their private practice into

a hospital, because they prefer it. They make more money.

Interjection.

HON. MR. DUECK : No, there aren't. They have easier patients; they prefer being in business for themselves.

You

have some information about some disgruntled people who say they are

very unhappy and are going to go broke. It could be. I feel sorry for

them. By and large we are getting all kinds of new people from other

provinces and from out of the country. Why would they come to this

country to go bankrupt? I don't understand it.

They will be

negotiating, and they are in negotiations now. I said that perhaps they

are on the low end of the scale, and that will be considered in the

negotiations. I wish everyone working in the health care field was

happy and had a good return for the services they provide. It is a

service that we all need, and we must have it. I appreciate them — every one of them. I hope through negotiations they will be able to develop a pay scale that they are happy with.

MR. BLENCOE :

My colleague from Burnaby wants to get on very quickly. I have been

listening to this debate. It's fascinating when it's through the Chair.

[12:15]

I have a question for the Minister of Health that I suddenly thought of. The issue of medical staff —physiotherapists or nurses —

not being available in more remote areas of the province. I was

wondering if the Minister of Health has had any discussions about, or

has thought of, the idea of, when these people are doing their

training, some incentive program for schooling, some forgiveness of

fees or some allowance in return for serving in those remote areas for

two to three years — some return to the community. I wonder if (

a) that is in place, and (

b) if some consideration has been given to it.

hear constantly that more remote communities have trouble attracting

professionals in the medical fraternity. It seems to me that there

might be an idea there to.... Medical training is expensive for those

who undertake it out of their own finances. I'm wondering if the

minister, and the Minister of Advanced Education (Hon. S. Hagen) and

others involved, have considered some sort of program for fee

forgiveness and living allowances where in return those people would

agree to serve for a couple of years in those remote areas, or two or

three areas. It's just a suggestion; I'm wondering if the minister

would respond.

HON. MR. DUECK : When you're talking

about medical people who serve in the medical field, we also have to

talk about physicians, and you know the sorry lot that we got into with

physicians. We had, not a perfect method, but at least one method of

controlling, and this was, of course, ruled illegal and we lost that

case. But I have been approached by many medical doctors who say they

are very sorry we lost the case, because they are very worried. They

are now going to have to share with all the new people who are going to

come into this business or get imported from other provinces because we

have a very desirable place to live — the lower mainland and Victoria — and they want to live here.

When I talk about the medical profession — I'm not talking about physios and nurses and the total gamut you said, so I'll start with this —

then yes, we're very much aware that it is a problem. We tried to

address it, and we lost the case, so we're going to go another route,

as we did in the past, with a contractual agreement of total budget for

three years. We will hopefully do the same again, and we are in

negotiations now. We know that if we don't, we will spend a fortune. We

know exactly what's happening; we can gauge it on the computer.

When

we talk about other professionals in the health care field, such as

physios, nurses.... I told you yesterday and I think I told the House

what we're doing with the shortage of critical-care nurses, which is a

very serious matter from time to time, although it's not a 2,000

shortage. We are at any given time maybe 400 nurses short throughout

the province, and there are some 20,000 in the province. It is a

problem, but it is not as serious as people sometimes want us to

believe.

We do believe that with the Minister of Advanced

Education, and having these universities throughout the province, we

will go a long way by educating people in their own hometown. For

example, if there is a university in Prince George and students go into

the nursing field, or whatever field of health care they want to enter,

they will more than likely stay in that area. Your point is well taken.

We're looking at that whole area now.

As far as bursaries

are concerned, of course, we're doing that. Incentives for doctors:

we're doing that. There's a premium. We even offer physicians salaries

up to $100,000 if they'll go into a certain area.

I had

locums come into my office a year and a half ago.... They were doctors

who at that time, when we had restricted billing numbers, could only

get a billing number if they went to an area of our choosing. I had

five or six of these locums come into my office complaining that they

couldn't get a permanent number. I sympathized with them, because these

are the young people who come out of college really eager to practise

medicine, and those are the ones we need. But we have such a tremendous

oversupply. I asked them: "Would you consider going to an area of our

choosing, on salary or otherwise? They're not isolated hick towns;

they're pretty good towns." Unanimously they said: "Absolutely not. We

want to practise in

[ Page 6126 ]

Vancouver." This is the problem. It's not an easy problem.

engineers, when they graduate from school and somebody comes along and

says, "We'll guarantee you a job"...? No. Do teachers? My son had to go

to Fort McMurray to get a job.

It's not simple. It is very

complicated, and we have to deal with it in a very pragmatic way. We

want to deal with it in a way that will not hurt the profession and

will keep them on side and happy with the arrangement. But we must take

certain action; otherwise costs go out of control.

Your point is well taken, and we're certainly looking at that.

MR. PERRY :

I don't want to interrupt my colleague from Kootenay for terribly long,

but a number of important issues have been raised which require a

response for the record.

Mr. Chairman, the minister was

warned well in advance of Bill 41. As we all know, he was warned by,

among others, the Chief justice of the Court of Appeal of British

Columbia, Mr. Justice McEachern, that the proposed legislation would be

illegal, as was subsequently found.

I'd like to serve

notice to the Attorney-General (Hon. S.D. Smith), my esteemed

colleague, that I will be asking him during his estimates what the cost

to the taxpayers was of defending Bill 41 against legal challenge. I

know that the cost to the citizens of British Columbia — let's remember that physicians are also citizens of this country —

was substantial. It didn't happen to come out of my pocket; it came out

of the pockets of the Professional Association of Residents and Interns

and other medical organizations. But it was a substantial cost to

private citizens to defend their rights, which were eventually

recognized by the court under the constitution of Canada.

The

minister and his colleagues the Attorney-General and the preceding

Attorney-General were well advised by the lower court that this would

be the outcome of their legal proceedings. In my view, they wasted a

lot of taxpayers' money on an ill-advised course.

The minister is still arguing....

Interjection.

MR. PERRY :

Oh, it was clearly a political decision of the minister to pursue Bill

41, and a very ill-advised one. I spoke yesterday of some of the less

excellent advice the minister has received over the years. I think this

is a prime example of a bill no doubt conceived with good intentions,

but which historically has been shown to have had the opposite effect

from what was intended, in that it in fact reduced the supply of

physicians to remote communities.

This was also predicted

by physicians before the bill was passed: that the bill, by depriving

physicians of their right to compete — and I will use the F-word, the FE-phrase —

in a free enterprise manner in British Columbia.... That's what Bill 41

was about: depriving physicians of their free enterprise rights to

compete in an open market, just like the engineers or any other trade

or profession. The bill backfired. We all know that; I think the public

knows it. The real question is how much money the government wasted,

Let

me come back to a couple of other issues that were raised in the last

few minutes. One is how one would constructively encourage physicians

and other health specialists like physiotherapists to locate in remote

parts of the province. I commend the government, the minister and

previous ministers for some of the solutions they have sought over the

years. I personally served as a consultant, for example, in Prince

Rupert under the government's program to provide consultant services to

smaller, more remote areas. It's a very good program, and in many

respects it works extremely well.

There are gaps in the system. For example, to my surprise, I was informed the other day — I haven't had time to confirm this; maybe the minister can — that

there are currently no physicians in the town of Fort Nelson. I found

that incredible. I don't know whether it's true or not. If it is, it's

a serious problem for the people of Fort Nelson. Fort St. James has had

a similar chronic problem of supply, and some other small communities

face this problem. I don't think we have achieved a solution.

I'd

like to respond to the minister's comments a few minutes ago about

young doctors not being willing to serve in the remote parts of the

province simply by citing one example of a young doctor I know — in fact, I know him quite well.

MR. LOENEN : Name names.

MR. PERRY :

His name is not mentionable in this House. He happens to be the second

member for Vancouver-Point Grey. I do know him quite well. This

physician wrote to the former Minister of Health, the member for

Richmond, when that minister announced his mobile doctor team plan to

serve remote communities. I thought that was a wonderful idea. I

thought for a physician it was a wonderful opportunity, or it would

have been. I wrote him the same day it was announced in a news

conference. I forget if that was 1981 or 1982, but it was a time when I

was free to pursue that role. I never received so much as an

acknowledgement from the minister for that letter.

I assure

you that was not a political letter. Perhaps the current minister would

be able to find it somewhere in the remote back files of the Ministry

of Health. That was a program that was announced. Expectations were

created around the province. I'm sure other physicians were interested

in serving in it. The program never materialized. The applications were

not even acknowledged.

I think it would be unfair to

suggest that physicians, physiotherapists, nurses, occupational

therapists or audiologists are not interested in serving the more

remote parts of the province. I just think that's completely wrong.

It's not true. The real question, which I think the second member for

Victoria (Mr.

[ Page 6127 ]

Blencoe) was getting at, is how do we actually stimulate professionals to serve in those areas?

The net effect of Bill 41, unfortunately, was to make physicians, rightly or wrongly — I think more rightly than wrongly —

feel that they would be locked into practice in a remote area, that

they would never be allowed to move back to their own hometown and

compete for employment, just like anyone else in a free market economy.

Interjection.

MR. PERRY :

Mr. Chairman, my train of thought was just interrupted for a minute. I

want to finish that point, if I can come back to where I was. The

member for Victoria made an interesting suggestion which has been

considered in other provinces — Quebec and Ontario, to some extent — as a program with similar intention. I just slipped my point; I will have to come back to it later.

MS. EDWARDS :

I am going to resist the urge to discuss remoteness and desirability of

community right now; I will do it another time. I want now to ask the

minister about some concerns of the Canadian Diabetes Association. As I

understand it, the deputy has met with this group over these issues,

but I want to make sure that this is on the record and to ask some

questions.

The questions relate to the blood-glucose-monitoring pilot project which was put in place on December 21, 1988 — is that correct? —

in order to assist three specific groups. First are pregnant diabetic

women, second are pregnant women developing gestational diabetes in the

third trimester of pregnancy and third are children under 19 years of

age.

[12:30]

In order for these glucose strips to be given and to come under the

program, the person who was receiving them, or a guardian, had to have

a valid certificate of training to apply the strips. None of the

benefits would be available to a patient before the starting-date of

the certificate of training or after its expiry date. The pilot project

applied only to blood-glucose-monitoring strips and only for these

particular types of diabetics.

The program has been

declared a major disappointment by the Canadian Diabetes Association.

They point out, among other things, that women who experience

gestational diabetes have to buy $300 worth of monitoring strips before

they can get to the point where the program helps them. Simple

arithmetic tells you that they will have given birth before they become

eligible under the program.

I know that the minister has

responded to this concern in one letter by saying that the $300

deductible applies to the whole family and therefore other medical

expenses will be included. However, the point is still there. I don't

think you can avoid the point that it cannot help a woman with

gestational diabetes if, in fact, she is the only person and if it is

the only kind of medication that she requires under the plan. It simply

avoids helping that woman unless there are some other circumstances

there.

Some other problems have been brought up in relation

to this, and the executive director of the Canadian Diabetes

Association suggests that the program should be extended to include all

diabetics, that the $300 deductible should be removed and that the

purchase of insulin and syringes must also be covered under the

Pharmacare program. The diabetic should be allowed to pay the 20

percent deductible amount under Pharmacare, rather than having to pay

the full purchase price, submit the claim and wait for the

reimbursement, which can be a lengthy process.

The minister

is certainly aware of a case where this happened and affected a child

in a community in British Columbia. Ms. Williams, who is the social

issues chairman for that association, wrote to the minister in January

describing a situation where a mother phoned to say she had gone to a

day care centre and got the training certificate to obtain the

blood-monitoring supplies for the child. On presenting them to the

local pharmacist, she got the strips but was presented with a bill for

$210. This woman had difficulty coming up with $70 a month for the

supplies that she needed for the child. To be asked for the $210 in

cash was a major difficulty for her.

Ms. Williams said to the minister in her letter: "I can see no way of

this program succeeding if it is implemented in this method. Would it not be

better for a person to sign a slip for their three-month supply and pay the

20 percent required under Pharmacare at the time they pick up the supplies?

That will relieve a considerable amount of the difficulty for some people."

[Mr. Rogers in the chair.]

will refer to a letter from a woman in Surrey who wrote on February 1.

She is a diabetic who does not come under the program. She needs the

blood-glucose monitoring machine, and the cost is not covered for her

because she is not 19 years old or under, she's not suffering from

gestational diabetes, and she hasn't developed the diabetes during her

pregnancy. It's imperative that she know her blood glucose level, and

the cost for her is approximately $75 a month. She suggests that this

machine is a diagnostic tool and therefore compares it with other

diagnostic tests such as x-rays, lab tests and ECGs. She asks why the

B.C. Medical Plan pays for those kinds of diagnostic procedures and

doesn't pay for her diagnostic procedures simply because it is done at

home. She asks why you discriminate in this program according to age.

In your response to Ms. Williams for the association on February 13, Mr. Minister,

you did advise that you would be reviewing this program, and that the "...self

blood-glucose-monitoring program will be reviewed by my advisers from time to

time, and some of those difficulties" would be addressed." Could the

minister tell me when that review process will go in, and whether some of these

problems are the ones that may well be addressed positively — to my mind positively

and certainly to the mind of the Canadian Diabetes Association?

[ Page 6128 ]

HON. MR. DUECK :

It is strange that when you go into a new area to assist people who

have medical problems, you get criticized. Until September 1987, 1

believe it was, we had no program whatsoever. I wasn't criticized at

all in the House when the estimates came up. I've been working on this

ever since I got in, and said: "These poor kids who have diabetes —

can we not start some type of program to alleviate the pressure?" I was

able to scrounge enough money to at least do the kids under 19 years

old and women during pregnancy. I was downright proud that we were able

to do at least that and put it under the Pharmacare program. I think

that's an advantage.

When I spoke to the diabetes

association, at the River Inn I believe, there were roughly 200 people.

When I made the announcement I got a standing ovation. They knew it was

limited, but it was a start.

What I am saying is that it is

easy to criticize after the fact, but we are making progress. It is

under Pharmacare, true, and there is a deductible, but that deductible

is not just for strips; it is deductible for the total family for all

the prescription drugs that the family might need in other areas too.

There are some more things that come under the Pharmacare program:

drugs, insulin, syringes, essential ostomy supplies, permanent

prosthetic devices, and on and on. So a lot of families will in fact

get past the deductible.

We also made a change, which you

mentioned, that we hadn't thought of when the program was first put

into place. Let's say a pregnancy occurs at the end of a calendar year

and carries over to the next year. We are now looking at having one

deductible so that at least it doesn't affect that individual. We are

looking at that very seriously. We are doing a review. Whether we can

expand depends on limited funds; the resources must be available. I

personally believe it's an area we should look at. When I look at these

kids that have diabetes, it is tough. It is tough for the family. Very

often it really requires hospitalization, which is not acceptable in my

opinion. It costs money

I am going as fast as I can in some of these areas —

as a matter of fact, sometimes faster than I can because I'm stealing a

little from another program to be able to put some of these things in

place. I think they are very important and very necessary.

What

will we do? We are reviewing, and when that review is complete we will

then either make a change or carry on the way we have been up to this

point. Resources being available, I would like to expand on the program

because I think it's a very, very important program. I feel very proud

that I was able to at least make that breakthrough and commence paying

at least a portion of that. Up to that point we did nothing, but I

wasn't criticized. I do something and you say: "Oh, why don't you do

more?" Right you are. But I can't do it all at once. I need the dollars.

Mr.

Chairman, due to the travel commitments of many members on the opposite

side and on this side, I would like to move that the committee rise and

report progress.

Motion approved.

The House resumed; Mr. Speaker in the chair.

The committee, having reported progress, was granted leave to sit again.

HON. MR. RICHMOND :

Mr. Speaker, I'd like to take this opportunity to wish everyone a very

pleasant weekend and advise them that the House will resume sitting on

Monday at the normal time.

Having said that, I move that the House do now adjourn.

Motion approved.

The House adjourned at 12:41 p.m.

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