British Columbia Committee Hansard (Blues) — 23 July 2020, p.m., Issue 13 (41st Parliament, 5th Session) (20200723am CommitteeC n13)

20200723am CommitteeC n13

British Columbia — Debates (Hansard)

Fifth Session, 41st Parliament REPORT OF PROCEEDINGS (HANSARD) COMMITTEE OF SUPPLY ,

SECTION C Virtual Meeting Thursday, July 23, 2020 Morning Meeting Issue No. 13 Presiding Officers: RAJ CHOUHAN, DEPUTY SPEAKER SPENCER CHANDRA HERBERT, DEPUTY CHAIR, COMMITTEE OF THE WHOLE ISSN 2563-352X

PROVINCE OF BRITISH COLUMBIA (Entered Confederation July 20, 1871) LIEUTENANT-GOVERNOR Her Honour the Honourable Janet Austin, OBC Fifth Session, 41st Parliament SPEAKER OF THE LEGISLATIVE ASSEMBLY Honourable Darryl Plecas EXECUTIVE COUNCIL Premier and President of the Executive Council ............................................................................................................... Hon. John Horgan Deputy Premier and Minister of Finance............................................................................................................................Hon.

Carole James Minister of Advanced Education, Skills and Training..................................................................................................... Hon. Melanie Mark Minister of Agriculture.........................................................................................................................................................Hon. Lana Popham Attorney General.................................................................................................................................................................Hon.

David Eby, QC Minister of Children and Family Development ............................................................................................................ Hon. Katrine Conroy Minister of State for Child Care...................................................................................................................................... Hon. Katrina Chen Minister of Citizens’ Services...................................................................................................................................................Hon.

Anne Kang Minister of Education ............................................................................................................................................................ Hon. Rob Fleming Minister of Energy, Mines and Petroleum Resources ..................................................................................................... Hon. Bruce Ralston Minister of Environment and Climate Change Strategy............................................................................................. Hon.

George Heyman Minister of Forests, Lands, Natural Resource Operations and Rural Development ..............................................Hon. Doug Donaldson Minister of Health .....................................................................................................................................................................Hon. Adrian Dix Minister of Indigenous Relations and Reconciliation ......................................................................................................... Hon.

Scott Fraser Minister of Jobs, Economic Development and Competitiveness.............................................................................Hon. Michelle Mungall Minister of State for Trade...............................................................................................................................................Hon. George Chow Minister of Labour ...................................................................................................................................................................Hon.

Harry Bains Minister of Mental Health and Addictions............................................................................................................................ Hon. Judy Darcy Minister of Municipal Affairs and Housing.................................................................................................................. Hon. Selina Robinson Minister of Public Safety and Solicitor General ........................................................................................................... Hon.

Mike Farnworth Minister of Social Development and Poverty Reduction..............................................................................................Hon. Shane Simpson Minister of Tourism, Arts and Culture.....................................................................................................................................Hon. Lisa Beare Minister of Transportation and Infrastructure................................................................................................................ Hon.

Claire Trevena LEGISLATIVE ASSEMBLY Leader of the Official Opposition................................................................................................................................Andrew Wilkinson, QC Leader of the Third Party .................................................................................................................................................................Adam Olsen Deputy Speaker................................................................................................................................................................................

Raj Chouhan Assistant Deputy Speaker............................................................................................................................................................. Simon Gibson Deputy Chair, Committee of the Whole ................................................................................................................ Spencer Chandra Herbert Clerk of the Legislative Assembly ...........................................................................................................................................

Kate Ryan-Lloyd Law Clerk and Parliamentary Counsel.............................................................................................................................. Seunghee Suzie Seo Clerk Assistant, Parliamentary Services...........................................................................................................................

Artour Sogomonian Clerk Assistant, Committees and Interparliamentary Relations ..............................................................................................Susan Sourial Senior Research Analyst ................................................................................................................................................................. Jennifer Arril Senior Research Analyst ...................................................................................................................................................................

Karan Riarh Acting Sergeant-at-Arms..................................................................................................................................................................Greg Nelson

ALPHABETICAL LIST OF MEMBERS Ashton, Dan (BC Liberal) ......................................................................... Penticton Bains, Hon. Harry (NDP)................................................................ Surrey-Newton Barnett, Donna (BC Liberal) .....................................................Cariboo-Chilcotin Beare, Hon. Lisa (NDP)..............................................

Maple Ridge–Pitt Meadows Begg, Garry (NDP) .......................................................................Surrey-Guildford Bernier, Mike (BC Liberal) .........................................................Peace River South Bond, Shirley (BC Liberal)...........................................Prince George–Valemount Brar, Jagrup (NDP).......................................................................Surrey-Fleetwood Cadieux, Stephanie (BC Liberal)........................................................

Surrey South Chandra Herbert, Spencer (NDP) .......................................Vancouver–West End Chen, Hon. Katrina (NDP)...................................................... Burnaby-Lougheed Chouhan, Raj (NDP) .................................................................Burnaby-Edmonds Chow, Hon. George (NDP).................................................Vancouver-Fraserview Clovechok, Doug (BC Liberal) ..................................Columbia River–Revelstoke Coleman, Rich (BC Liberal) ................................................................ Langley East Conroy, Hon.

Katrine (NDP)...........................................................Kootenay West Darcy, Hon. Judy (NDP) ............................................................. New Westminster Davies, Dan (BC Liberal) ........................................................... Peace River North de Jong, Michael, QC (BC Liberal) ..............................................Abbotsford West Dean, Mitzi (NDP)................................................................ Esquimalt-Metchosin D’Eith, Bob (NDP) ................................................................Maple Ridge–Mission Dix, Hon.

Adrian (NDP)....................................................... Vancouver-Kingsway Donaldson, Hon. Doug (NDP)...................................................................... Stikine Eby, Hon. David, QC (NDP).............................................. Vancouver–Point Grey Elmore, Mable (NDP).........................................................Vancouver-Kensington Farnworth, Hon. Mike (NDP) ........................................................Port Coquitlam Fleming, Hon. Rob (NDP) ......................................................

Victoria–Swan Lake Foster, Eric (BC Liberal).............................................................Vernon-Monashee Fraser, Hon. Scott (NDP) ..................................................Mid Island–Pacific Rim Furstenau, Sonia (BC Green Party) .............................................Cowichan Valley Gibson, Simon (BC Liberal) ...................................................Abbotsford-Mission Glumac, Rick (NDP).........................................................Port Moody–Coquitlam Heyman, Hon. George (NDP) ................................................Vancouver-Fairview Horgan, Hon.

John (NDP) ................................................ Langford–Juan de Fuca Hunt, Marvin (BC Liberal) ........................................................ Surrey-Cloverdale Isaacs, Joan (BC Liberal) .......................................... Coquitlam–Burke Mountain James, Hon. Carole (NDP).................................................... Victoria–Beacon Hill Johal, Jas (BC Liberal).................................................Richmond-Queensborough Kahlon, Ravi (NDP)............................................................................... Delta North Kang, Hon.

Anne (NDP)......................................................... Burnaby–Deer Lake Kyllo, Greg (BC Liberal)..............................................................................Shuswap Larson, Linda (BC Liberal) .............................................. Boundary-Similkameen Lee, Michael (BC Liberal) ........................................................Vancouver-Langara Leonard, Ronna-Rae (NDP) ..................................................... Courtenay-Comox Letnick, Norm (BC Liberal).............................................

Kelowna–Lake Country Ma, Bowinn (NDP) .....................................................North Vancouver–Lonsdale Malcolmson, Sheila (NDP) ........................................................................Nanaimo Mark, Hon. Melanie (NDP) .......................................Vancouver–Mount Pleasant Martin, John (BC Liberal)....................................................................... Chilliwack Milobar, Peter (BC Liberal)..................................... Kamloops–North Thompson Morris, Mike (BC Liberal) ........................................... Prince George–Mackenzie Mungall, Hon.

Michelle (NDP)......................................................Nelson-Creston Oakes, Coralee (BC Liberal) ............................................................ Cariboo North Olsen, Adam (BC Green Party)............................ Saanich North and the Islands Paton, Ian (BC Liberal).......................................................................... Delta South Plecas, Hon. Darryl (Ind.) ........................................................... Abbotsford South Polak, Mary (BC Liberal) ............................................................................. Langley Popham, Hon.

Lana (NDP)............................................................... Saanich South Ralston, Hon. Bruce (NDP) ............................................................Surrey-Whalley Redies, Tracy (BC Liberal) .......................................................Surrey–White Rock Reid, Linda (BC Liberal) ................................................. Richmond South Centre Rice, Jennifer (NDP) ............................................................................. North Coast Robinson, Hon.

Selina (NDP) .........................................Coquitlam-Maillardville Ross, Ellis (BC Liberal)................................................................................... Skeena Routledge, Janet (NDP) ....................................................................Burnaby North Routley, Doug (NDP) ................................................. Nanaimo–North Cowichan Rustad, John (BC Liberal) ................................................................Nechako Lakes Shypitka, Tom (BC Liberal) ..............................................................

Kootenay East Simons, Nicholas (NDP) ......................................... Powell River–Sunshine Coast Simpson, Hon. Shane (NDP)..................................................Vancouver-Hastings Sims, Jinny (NDP) ........................................................................ Surrey-Panorama Singh, Rachna (NDP) .........................................................Surrey–Green Timbers Stewart, Ben (BC Liberal) ................................................................. Kelowna West Stilwell, Michelle (BC Liberal)...............................................

Parksville-Qualicum Stone, Todd (BC Liberal)..........................................Kamloops–South Thompson Sturdy, Jordan (BC Liberal)........................................ West Vancouver–Sea to Sky Sullivan, Sam (BC Liberal)................................................ Vancouver–False Creek Sultan, Ralph (BC Liberal) ...........................................West Vancouver–Capilano Tegart, Jackie (BC Liberal) ................................................................. Fraser-Nicola Thomson, Steve (BC Liberal)......................................................

Kelowna-Mission Thornthwaite, Jane (BC Liberal) ...............................North Vancouver–Seymour Throness, Laurie (BC Liberal) .......................................................Chilliwack-Kent Trevena, Hon. Claire (NDP) ................................................................North Island Wat, Teresa (BC Liberal) ................................................. Richmond North Centre Weaver, Dr.

Andrew (Ind.)................................................Oak Bay–Gordon Head Wilkinson, Andrew, QC (BC Liberal) ................................Vancouver-Quilchena Y ap, John (BC Liberal)............................................................Richmond-Steveston LIST OF MEMBERS BY RIDING Abbotsford-Mission............................................................................Simon Gibson Abbotsford South....................................................................... Hon. Darryl Plecas Abbotsford West......................................................................

Michael de Jong, QC Boundary-Similkameen...................................................................... Linda Larson Burnaby–Deer Lake....................................................................... Hon. Anne Kang Burnaby-Edmonds................................................................................Raj Chouhan Burnaby-Lougheed .................................................................... Hon. Katrina Chen Burnaby North .................................................................................

Janet Routledge Cariboo-Chilcotin .............................................................................Donna Barnett Cariboo North.................................................................................... Coralee Oakes Chilliwack ............................................................................................... John Martin Chilliwack-Kent ...............................................................................Laurie Throness Columbia River–Revelstoke .........................................................

Doug Clovechok Coquitlam–Burke Mountain.................................................................. Joan Isaacs Coquitlam-Maillardville ...................................................... Hon. Selina Robinson Courtenay-Comox................................................................... Ronna-Rae Leonard Cowichan Valley .............................................................................

Sonia Furstenau Delta North.............................................................................................Ravi Kahlon Delta South ..................................................................................................Ian Paton Esquimalt-Metchosin ..............................................................................Mitzi Dean Fraser-Nicola .........................................................................................

Jackie Tegart Kamloops–North Thompson .............................................................Peter Milobar Kamloops–South Thompson..................................................................Todd Stone Kelowna–Lake Country .....................................................................Norm Letnick Kelowna-Mission ..............................................................................

Steve Thomson Kelowna West ..........................................................................................Ben Stewart Kootenay East.......................................................................................Tom Shypitka Kootenay West........................................................................ Hon. Katrine Conroy Langford–Juan de Fuca .............................................................. Hon. John Horgan Langley .....................................................................................................

Mary Polak Langley East.........................................................................................Rich Coleman Maple Ridge–Mission.............................................................................. Bob D’Eith Maple Ridge–Pitt Meadows............................................................Hon. Lisa Beare Mid Island–Pacific Rim................................................................ Hon. Scott Fraser Nanaimo......................................................................................

Sheila Malcolmson Nanaimo–North Cowichan............................................................... Doug Routley Nechako Lakes........................................................................................ John Rustad Nelson-Creston ................................................................... Hon. Michelle Mungall New Westminster........................................................................... Hon. Judy Darcy North Coast ...........................................................................................

Jennifer Rice North Island.............................................................................. Hon. Claire Trevena North Vancouver–Lonsdale................................................................... Bowinn Ma North Vancouver–Seymour........................................................Jane Thornthwaite Oak Bay–Gordon Head............................................................Dr.

Andrew Weaver Parksville-Qualicum.......................................................................Michelle Stilwell Peace River North ................................................................................... Dan Davies Peace River South ................................................................................ Mike Bernier Penticton ................................................................................................. Dan Ashton Port Coquitlam...................................................................... Hon.

Mike Farnworth Port Moody–Coquitlam.......................................................................Rick Glumac Powell River–Sunshine Coast....................................................... Nicholas Simons Prince George–Mackenzie....................................................................Mike Morris Prince George–Valemount ..................................................................

Shirley Bond Richmond North Centre..........................................................................Teresa Wat Richmond-Queensborough.........................................................................Jas Johal Richmond South Centre ......................................................................... Linda Reid Richmond-Steveston ...................................................................................

John Y ap Saanich North and the Islands .............................................................Adam Olsen Saanich South .............................................................................Hon. Lana Popham Shuswap...................................................................................................... Greg Kyllo Skeena........................................................................................................... Ellis Ross Stikine....................................................................................Hon.

Doug Donaldson Surrey-Cloverdale ................................................................................ Marvin Hunt Surrey-Fleetwood.....................................................................................Jagrup Brar Surrey–Green Timbers........................................................................Rachna Singh Surrey-Guildford......................................................................................Garry Begg Surrey-Newton ..............................................................................Hon.

Harry Bains Surrey-Panorama ...................................................................................... Jinny Sims Surrey South ................................................................................ Stephanie Cadieux Surrey-Whalley ......................................................................... Hon. Bruce Ralston Surrey–White Rock .............................................................................. Tracy Redies Vancouver-Fairview.............................................................. Hon.

George Heyman Vancouver–False Creek........................................................................ Sam Sullivan Vancouver-Fraserview...............................................................Hon. George Chow Vancouver-Hastings ............................................................... Hon. Shane Simpson Vancouver-Kensington....................................................................... Mable Elmore Vancouver-Kingsway..................................................................... Hon.

Adrian Dix Vancouver-Langara................................................................................ Michael Lee Vancouver–Mount Pleasant..................................................... Hon. Melanie Mark Vancouver–Point Grey ............................................................Hon.

David Eby, QC Vancouver-Quilchena........................................................Andrew Wilkinson, QC Vancouver–West End .....................................................Spencer Chandra Herbert Vernon-Monashee ....................................................................................Eric Foster Victoria–Beacon Hill.................................................................. Hon. Carole James Victoria–Swan Lake.................................................................... Hon. Rob Fleming West Vancouver–Capilano...................................................................

Ralph Sultan West Vancouver–Sea to Sky................................................................Jordan Sturdy Party Standings: BC Liberal 42; NDP 41; Independent 2; BC Green Party 2

CONTENTS Thursday, July 23, 2020 Morning Meeting Page Committee of Supply Proceedings in

Section C.......................................................................................................................................................... 231 Estimates: Ministry of Health Hon. A. Dix N. Letnick

THURSDAY , JULY 23, 2020 The committee met at 9:32 a.m. [S. Malcolmson in the chair.] Committee of Supply Proceedings in

Section C ESTIMATES: MINISTRY OF HEALTH On Vote 31: ministry operations, $22,042,385,000. The Chair:Good morning, members of Committee of Supply. We are in

section C. I want to begin today by recognizing that I am parti- cipating from the homeland of theLək̓ ʷəŋin̓ əŋ-speaking people, the Esquimalt and Songhees. We express our appreciation to them for being able to carry out the busi- ness of the Legislature on this territory. I recognize, also, that members from all over the province are participating from their own home bases and their own territories. We are meeting today to consider the estimates of the very hard-working Ministry of Health. Minister, do you have any opening remarks? Hon. A. Dix:Just a few.

First of all, I want to say hello to my colleague the opposition critic, the member for Kelow- na–Lake Country; to the Green Party Health critic, the member for Cowichan Valley; and to members of the Legislature. As I think people know, I’m a passionate believer in public health care.

This has found expression in lots of the things that we’re trying to do in the Ministry of Health at the moment in primary care, putting into place team- based care, which I think will make an extraordinary dif- ference for patients, an extraordinary difference for people in health care, allowing our unbelievably skilled health care workers and professionals to work to the full extent of their skills.

I believe tomorrow I’ll be engaging with the member from Richmond east, the opposition critic for seniors, about seniors issues — the fact that we’ve raised, I think, the standard of care in long-term care, and the significant moves we’ve made to increase home care hours, assisted- living hours, to focus on respite care and to focus on mak- ing life better for seniors.

Changes have been made with respect to surgeries and diagnostics, especially the utilization of the resources of the health care system to their maximum, as exhibited by the increase in the number of MRI machines that we use 24-7; the changes to PharmaCare that have made life more affordable to people and given access within the existing PharmaCare program to many people, to get access to the care and to the prescription drugs that they need that are so important to them; and the ambulance service and so much more have been part of what we’ve been trying to do. [9:35 a.m.] The efforts of the Ministry of Mental Health and Addic- tions.

I think we’ll canvass a little bit with the member from North Vancouver, the opposition critic there, I understand, tomorrow. Obviously, at a time of a public health emergency in the overdose crisis, that’s been a cent- ral responsibility of health authorities, and while that debate has already occurred in the Legislature, I’m sure there’ll be more questions for me. I wanted to say, as well, that we want to, obviously, make the health care system better in every way.

We may have an opportunity to canvass, but if we don’t, the review that’s being carried out by Mary Ellen Turpel- Lafond to address issues of racism in our health care sys- tem and in our society…. In short, I’m a believer in public health care. I think, of course, public health care has to change in the 21st century to provide the care it needs, but I think it has shown its true value during this period of pandemic, this period of COVID-19.

This is where our public health care system, its organizing, its engagement with people and people’s con- fidence in that system have allowed us to do things in Brit- ish Columbia that are truly extraordinary. I’m joined in my office today by some of the officials in the Ministry of Health. I know many of them are over in the ministry building on Blanshard Street, as well, fol- lowing the debate and assisting with the debate, but I’m joined here by Deputy Minister Steve Brown, by our asso- ciate deputy minister, Peter Pokorny, and our provincial health officer, Dr. Bonnie Henry.

All of them are here in the minister’s office to help respond to questions. Finally, I just wanted to acknowledge the excellent work of the opposition critics, the member for Kelowna–Lake Country and the member for Cowichan Valley, especially in this time. We’ve worked together, as you know, on a reform of health professional colleges that I think is groundbreaking in our country and reflects the extraordinary commitment of those two members to that process of making it work. We’ll have, all of us together, more to report on that soon.

During this period of COVID-19, I think members of the Legislature from all sides of the House have provided me, as Minister of Health, Dr. Henry, as the provincial health officer, Mr. Brown, as deputy minister, and every- one in the health care system extraordinary support. I’ve talked every day and receive regular advice from the mem- ber for Kelowna–Lake Country, for example. That advice has not just been heard but been implemented in case after case after case. I am grateful and appreciative of that.

I’m also appreciative of other members of the Legis- lature as we tried to provide, especially, supports for seni- ors living at home in this time. I asked my colleague the member for Kelowna–Lake Country to find some volun- teers in his caucus, and the member from Prince George– 231

Mount Robson and the member for Richmond-Steveston stepped up in that discussion, as did members on my side: the Parliamentary Secretary for Seniors, the member for Courtenay-Comox; the member for Burnaby North. They made an enormous contribution in designing and working with the seniors advocate in providing services to thou- sands of seniors in a time when those services were required. I think this pandemic has obviously had a terrible, dis- ruptive effect on our health care and on our economy. Of course, there’s still no cure, and there’s still no vaccine. We have to continue that effort together.

But I think it’s also exhibited, in many respects, the best in our province. I’m very proud of the work that members of the Legislature on all sides have done on it, and I wanted to express that appreciation at the beginning of estimates. I think with that, 14 hours and 55 minutes to go, I’ll hand it back to the member for Kelowna–Lake Country. The Chair:I recognize the member for Kelowna–Lake Country as the opposition Health critic and invite you to make any opening comments you’ d like. N. Letnick: Thank you to the minister for his com- ments.

It is extremely interesting times that we are living through right now, doing estimates via link. I am in my home riding of Kelowna–Lake Country right now, but obviously thinking very carefully about all the health chal- lenges of British Columbians all across our great province. I want to echo what the minister has said regarding the ability of all three parties in the Legislature to work together on issues that are important to British Columbi- ans, especially on the health care of British Columbians. [9:40 a.m.] This is not something that started with the pandemic.

It started about 2½ years ago when we did estimates back then, and the minister and I agreed that we should work together, where possible, to advance the priorities of health for all British Columbians and to put health first rather than sometimes the partisanship that could occur in some ministries — and in Health in prior years, to be honest. The minister and I, with the addition of the Third Party critic for health care, the member for Cowichan Valley, I think have had a great relationship.

It’s been very product- ive in all kinds of areas: the dense breast issue, the measles issue and, of course, when the minister called to work col- laboratively on the professional health act issues and mak- ing sure that people in our province were adequately pro- tected and served by our health professionals. It didn’t take long for the three of us to get into our stride, working with the great staff that we have at the Min- istry of Health — Stephen Brown, of course, David Byres and the team.

It was something that I think should be emulated for years to come, if not in all ministries, which might be difficult, of course, then at least in the Health Ministry. This kind of model that we’ve developed and used over the last few years I think goes a long way to help British Columbians to have faith in their political leaders and in government. That has, of course, been shown brightly during this pandemic, where it was very clear at the outset that we should be fighting the pandemic and not fighting each other.

I think kudos go to all members in the Legislature in all three caucuses that adopted that philosophy and really turned out to support the decisions of government and the decisions of the chief medical officer, Dr. Bonnie Henry, and her teams across the province. We are in this together. We are in this together as a people all throughout B.C., and we’re in this together as their representatives. I think we need to celebrate that. I believe firmly that that attitude, that political grouping together and articu- lating what the science says and what our chief medical advisers tell us….

At the end of the day, there are some decisions that government has made that we might not have always agreed with, but it’s important for the public that they get the one message. I think that’s shown brightly compared to other jurisdic- tions elsewhere in the word. I won’t name anybody in par- ticular, but I think people know. The results have shown that we’ve had good success in bending that curve down. We’ll have to continue to work together to keep that curve as flat as possible as we move forward. Y ou know, the fall is coming. The flu season is coming.

If you’ve learned anything from past pandemics — recent ones as well as the Spanish flu back in 1918 — the fall is actually harder or was harder than the initial introduction. So we have to be very careful. We have to work together as a province, as a people, to make sure that we continue to articulate and continue to walk down the path together as all British Columbians so that we can leave our province in the best possible state healthwise, so that our businesses and our workers can enjoy at least some state of new normal, so they can keep their businesses viable and keep their employment viable.

The state, obviously, can’t afford to carry five mil- lion people financially, because that is the people who’ll pay the taxes. It’s really important that we continue to work out a path forward on the health side that finds the balance to make sure that we continue to support our chief medical officer and our government, but at the same time, continue to see proper rules and regulations that will ensure that our busi- nesses can remain viable and our people remain employed, as much as possible, through this very difficult time. With that, it seems like a long time ago that we did our last estimates.

In the last estimates, just for those that are watching for the first time…. Usually estimates work where the critic gets to pop a question on to the minister, and the minister then usually has to consult with the staff to come up with an answer and then provide the answer, and then we go around and around like that. 232 Committee of Supply,

Section C Thursday, July 23, 2020

[9:45 a.m.] With the Minister of Health and I, it’s been a little differ- ent. The Minister of Health is very capable to answer most of the questions himself without consulting with staff, but sometimes there is that opportunity as well. In the past, what I’ve done is I’ve provided the staff, through a briefing, with the topics that we would be discussing. This time, because of the pandemic and the…. I wanted to make sure that the minister and staff had every oppor- tunity to get some detailed answers for the questions. For this time, I actually provided the minister and his staff with the actual questions.

This way, it is my hope that we can cover a lot of ground in the day that we have today, which is about 7½ hours, minus my speech, and that tomorrow, we’ll hit off with the critic for Mental Health and Addictions, who has an hour to follow up on some questions that she needed to from her role as critic of Mental Health and Addictions. Also, we have the critic for seniors health, who has 100 minutes to discuss seniors health issues. Predominantly, of course, long-term care would be there.

Then we will go through the other MLAs from the offi- cial opposition and the Third Party, who will walk us through their questions on a local basis throughout the rest of the day. We’ll end up with one hour for the Third Party critic or, actually, the Third Party — it could be more than just a critic — for them to conclude the questions. Having said that, I will get into the questions very soon. Just to say to those that are watching, if there are other questions that come out of the initial 76 questions, I believe, I’ve sent ahead to the minister, then what we’ve agreed to do is to put them on the side.

We want to get through the first 76 questions, hopefully, if we can, and then we will address those other new questions that pop up based on the minister’s response at a later time, either through time available tomorrow, if we have it, or through a written response. With that, my last thank-you is to you, Madam Chair, for being there where you are, and also to thank all British Columbians for their support of our efforts to combat COVID-19 and also their support for continuing to sup- port public health in B.C. All parties, all members of the Legislature support pub- lic health.

We want to see it thrive and grow. Major invest- ments were done under the previous government. The pre- vious government also started the ball rolling on many of the initiatives, which the current government is continu- ing with and expanding on. I think all governments should be congratulated for the work on the health care file. With that, the first question or series of questions is on PharmaCare. There are five questions. I will not read them all out at the same time. I’ll just read one out and wait for the answer and then read two, three, four and five. Here it goes.

The PharmaCare budget has increased by approximately 6 percent. That’s $90 million since last year. Does the minister know if this increase will be spent to directly benefit patients by listing the backlog of drugs that other Canadians are able to access on their public plan? Hon. A. Dix: Thanks to the member for his question. I just note to the member for Kelowna–Lake Country that his opening statement was longer than mine, which means that many members lost a bet.

In any event, on PharmaCare, which is obviously an issue of significant concern to everyone, we have a slightly different number: an increase in the budget of $62 million this year or 4.6 percent. All of that, of course, goes to Brit- ish Columbians.

We have a very efficiently run Pharma- Care system in B.C. that delivers very little in terms of administration and a great deal in terms of benefits dir- ectly to people. [9:50 a.m.] Approximately two-thirds of that, or $39.5 million, essentially deals with inflation, increases in the cost of existing drugs, increases in the number of people in the program, aging population — all of those things — and $22 million of the increase has been set aside for the listing of new drugs.

That’s not the limit to the listing of new drugs money because we have also created some space through the list- ing of new drugs through an initiative called the biosim- ilars initiative, which we may have an opportunity to talk about later. This, essentially, has moved some categories of biologic drugs to what are called biosimilar drugs and has reduced costs — which allows us, in every case, to invest all of that money into new drugs.

I did want to say that this year — this may be of interest to the member, because we haven’t been making as many announcements in the times of COVID-19, in terms of announcements that we might make on other elements of health care — we have, in fact, listed a number of new drugs, including seven new drugs. They deal with a series of areas, of conditions. If the member would like, I can list those drugs off or provide them to the member over the lunch hour. The most important and significant one of those drugs…. Just looking at the total number, annualized, the cost of those seven drugs is $16.97 million.

Some of them have just been listed in July. The annual cost for this year is in the neighbourhood of $10 million. The largest group of those drugs deals with chronic obstructive pulmonary disease. This is an important change. We did a full review of that category of drugs, and as a consequence of that review, there have been changes in listing policy and access. This is a significant issue of public health care. That set of drugs in this year alone is $5.4 million.

Annualized, the cost would be in the neigh- bourhood of $8 million, as that listing has just occurred in the month of July, and those changes, the COPD supports, have occurred just in July. We are significantly…. Over the course of the year, we’ll be continuing to list new drugs. We’ll be talking about Thursday, July 23, 2020 Committee of Supply,

Section C 233

some of the drugs that are candidates in a little while. That’s kind of the structure of where we’re going. Obvi- ously, as the member will know — we’ll talk about this when we talk about national pharmacare — there’s extraordinary inflation in terms of what are called expens- ive drugs for rare diseases, which is a challenge for all health care systems. But we are setting aside significant resources to both increase the quality and the number of drugs provided to British Columbians. N. Letnick:Thank you to the minister for that.

That was another piece, I think, that was very important to support: the biosimilar-biologic piece, something that has occupied me and my caucus for, probably, the first year after becom- ing the critic. I’ d like to congratulate the government on the rollout of that. Obviously, with limited time….

Probably not here today, but at some point, it would be interesting to see a report of some kind that looks at the successes and chal- lenges with the implementation of the biosimilar-biologic change so that we can not only learn from it for future B.C. governments but also, perhaps, share some of that know- ledge with other governments across the country. The second question. B.C. has historically been a leader in oncology research and access to new treatments. From the budget documents, it is not transparent to what extent the B.C. cancer drug budget is being resourced year over year.

Can the minister please provide clarity by letting us know what share of the PHSA ’s budget goes towards life- saving oncology drugs? Hon. A. Dix:This is one of the most expensive parts of the work done by the B.C. Cancer Agency. In fact, it’s a growing share of the cancer budget and has been for the last 15 years, growing exponentially in this time. For onco- logy drugs in the system, the drug budget was $343 mil- lion, and the actual expenditures were $349 million in the ’19-20 fiscal year. I will provide the member with what the budget will be for this year.

I just want to put it in context, because it’s an important context in the discussion of all Pharma- Care issues. The rest of the PharmaCare program budget is becoming more like the cancer drug budget, which is essentially filled with expensive drugs, whether cancer is defined as a rare disease — expensive drugs for rare dis- eases. [9:55 a.m.] In 2015-16, which was four years ago, the actuals in the oncology drug budget were $235 million. They are now $349 million. That’s four years. That’s an inflation of well over 10 percent a year, and there is no end in sight with that.

That reflects some of the improvements and services provided, but it also reflects the extraordinary increase in the cost of that. As the member will know, those drugs are reviewed by CADTH, which is the national drug review process that provinces are partners in, but also the Canadian oncology drug reviews. All those decisions are informed by the evid- ence, but if you go from that $235 million in ’15-16, $250 million in ’16-17, $283 million in ’17-18, $308 million in ’18-19 and $349 million this year, that tells you that that is an increasing share of the B.C. Cancer Agency’s budget and a cause for concern.

We have to, I think, as the member has suggested, rig- orously assess that expenditure against other potential expenditures we can make in dealing with cancer and with an understanding that because of an aging population, we’re likely to see, within 20 years, more than twice as many people — an improved outcome — living with can- cer, principally cancer which could be called age-related. N. Letnick:Thank you to the minister for the response. Can the minister describe what, if any, measures are being taken to measure the province’s return on invest- ment in pharmaceuticals? Is it possible? Hon. A.

Dix:As the member would know, and as we’ve discussed it before, both in the CADTH process and in the B.C. Drug Benefit Council process, which are both involved and make recommendations around the listing of new drugs in our PharmaCare system and in our cancer system, all of that analysis involves a detailed clinical review but also a review of the economic value of a drug. For example, no one would dispute that aspirin is an effective drug, but if someone were charging $1 million a tablet, then obviously that wouldn’t meet the test.

That’s an extreme example of the detailed work that’s done, at the pre-approval stage, on the economics of new prescription drugs to be listed in the health care system. Where, I think, we do less work, and I think the member is right to raise this point, is after that fact. That’s not always true. For example, we were discussing the biosim- ilars question earlier, and in advance of the decision pro- cedure of the biosimilars, it had been, in fact, one of the member’s suggestions that we need to do, as we’re doing the biosimilar initiative, a review of both clinical and eco- nomic outcomes.

We are engaged in that review now so that we can assess the impact — both clinical, on people’s health, and on the health care system — of those changes. That has happened on a number of occasions in the past, those kinds of reviews. I referred to our work on COPD recently, which resulted in the listing of new drugs and the expansion of coverage. The member will recall in…. I believe it was in 2008 or 2007, really at the initiative of the Premier at the time, Mr.

Campbell, when there was what was called the Alzheimer’s drug project, which involved a comprehensive clinical and economic review concurrent with the approval of new drugs, and that review resulted in significant reports. So we had a situation where the government had decided to list the number of drugs which hadn’t met, wouldn’t ordin- 234 Committee of Supply,

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arily have been listed — but decided to essentially do a broad clinical study of those drugs. So I think we can do more of that work. Those kinds of economic analyses and work on pre- scription drugs are the kinds of things that we do period- ically and we are doing periodically now. There are other drugs in question and drug decisions where we’re doing that, but not systematically after listing. N. Letnick: Thank you to the minister.

I understand that you are doing the reviews periodically, and I appreci- ate all of the conversations that we’ve had over the last few years. [10:00 a.m.] I can understand that at three o’ clock in the morning, it must be difficult for you and for any health minister, think- ing: “Do I fund that particular drug? Do I put more money into the drugs versus into acute care or into primary care or mental health or…?” All of these different challenges that a health minister has. So I have lots of sympathy for you. But at the end of the day, you do have to make some decisions. That’s the big challenge that you have.

How do you do that? How do you compare the return on investment for British Columbians for investments in the pharmaceutical side of things to other investments that you can make in health care? Hon. A. Dix: I think these are challenging questions. But I think it is, by following the evidence, consistent. On the individual drug decisions, there has, I think, only on one occasion, if memory serves…. It involved a drug called Duodopa, which is a drug that treats multiple sclerosis. The previous minister, Mr. Lake, approved that drug in the absence of a CADTH recommendation.

That was the only time that that’s really occurred since the CADTH process was put into place, combined with the Drug Benefit Council process. What health ministers are saying there is that we are going to follow the evidence so that the decision we make — there are budget decisions to make — is to follow the evidence in every case. This is very challenging sometimes because, of course, as soon in the drug approval process Health Canada makes a decision to essentially allow a drug to be sold in Canada…. But they’re only judging that drug against a placebo. They are not really analyzing the value of that drug.

That’s left to provincial governments in terms of listing decisions that provincial governments make. That’s why we follow the evidence rigorously. In addition, I think, in the PharmaCare division, the pharmaceutical services division in the Ministry of Health…. Our assistant deputy minister, Mitch Moneo, and his team — including Eric Lun and others who the member will have met — do, I think, some the most extraordinary work in Canada. They are leaders. They are the people that other Canadian jurisdictions look to, to lead price negotiations on new prescription drugs.

This is the challenge that we have to, as a country — and we are doing this as a country — come together as provinces. We do this in the negotiating process to ensure that we get value for drugs. As a practical matter, a drug may not have value at a higher price but would have value if we can get a better price for, of course, taxpayers. This is where sometimes there is a challenge, because the natural inclination of groups that are advocating for new prescription drugs is to ally themselves with the industry. They want the drug, and I understand that.

But we also, as a society, have to work as a public health care system and as public health care systems push back to allow us to get the best possible deal. I’ll just give one final example of that that’s sort of outside of the PharmaCare system directly, although it’s involved with it. The decision in the process led by Dr. Julio Montaner, who is associated with St. Paul’s, of course, and has been a leader in the world in research on HIV/AIDS….

Our efforts to provide PrEP to people in B.C., which has had an extraordinary effect, a life-saving effect, and to do so in an affordable way is an extraordin- ary success. This is the work of staff every day. I believe it’s my job as the Minister of Health to, of course, advocate for broad access, including the limits on deductibles and other things, but to support the evidence and to be committed to supporting the evidence even when sometimes it might be politically uncomfortable, because you want to say “yes, of course” politically all the time. N. Letnick: Thank you to the minister.

I understand the process that drugs need to go through before they’re approved with Health Canada, CADTH and the other systems. I guess what I’m asking here, and it might come up later in one of the other questions, is…. Once that process is done, the decision at the end of the day is to fund or not to fund. Can the minister tell us if there are any drugs that are currently being offered by other provinces? I guess that’s a leading question, because I know there are.

Can we discuss why drugs are being covered by other provinces that have followed the evidence and looked at the value for money but are not yet being covered in Brit- ish Columbia? [10:05 a.m.] Hon. A. Dix: Y es. There are, of course, cases where the reverse is true — where drugs have been involved in a negotiating process led by British Columbia and where other provinces have not picked those things up. We do operate within budget constraints.

So there are drugs — the member is quite right, and I think I’ d be happy to provide him with a list of some of those drugs — that are available in other jurisdictions or are approved through CADTH processes that aren’t yet listed in British Columbia. Thursday, July 23, 2020 Committee of Supply,

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This may be because we have a different assessment of the value of the drug in those processes or we are man- aging our budget in such a way as to allow that to hap- pen or we’re dissatisfied with the negotiations that have taken place at the PCPA or those negotiations haven’t arrived at a successful result. Other jurisdictions operate in different ways. I won’t say a less rigorous way than we do but a different way. It has been consistently the case that there are drugs in Canada — and this has been true for a long time — which are listed in other jurisdictions and not listed here. Duodopa is an example of that.

It’s a case where CADTH had rejected — I think in the neighbourhood of 2008 or 2009; I’m not sure — that drug for listing by provincial health systems. Nonetheless, a number of other provincial health systems decided to proceed with Duodopa. In 2017 — and this would be an unusual case — because other provinces had experiences and then had a clinical experience with the drug, very limited access to it was provided in a decision that was essentially directed from the Ministry of Health.

We assess every drug, both through the common drug review process but also through our own Drug Benefit Council, and sometimes those recommendations are dif- ferent. Of course, we adhere carefully to the Drug Benefit Council recommendations as well. That’s one reason why they could be different. Other reasons may be a different assessment of the value of the drug. Sometimes the recommendations of the com- mon drug review are more nuanced. In other words, it might be a drug to be listed but only at a certain price or at a lower price. The question is: when do you achieve that price?

And different demands in different jurisdictions. We are unusual in the sense that we manage our drug budget within a budget, and within that budget, we focus on evidence-based decisions. I think that system serves us well. Y ou might say the one significant increase in Phar- maCare that we’ve made since I became Minister of Health was the dramatic reduction and elimination of deductibles or the reduction in family maximums in the program for, essentially, the 140,000 lowest-income households in the province. I think that was the right decision.

Again, the evidence there showed that people who are earning an after-tax income of $17,000 to $30,000 a year were picking up their prescription drugs less than the rest of the population, which told us the effect of the deductible. That was an evidence-based process that made prescription drugs more affordable for more people. So you’ve got to follow the evidence all the time. We do operate within a budget. This year that budget increase is, as noted, a significant budget increase — well over the rate of inflation but nearer to the rate of inflation for prescription drugs. That’s how decisions get made. N.

Letnick:Thank you to the minister for the answer. Just a note to the minister that the 30 people that are currently watching us in estimates…. Probably we just lost half of them because the Premier is just doing a live update on COVID-19. We might have to spice things up to increase our competition with your boss. Question No. 5. B.C. PharmaCare beneficiaries are approximately 15 percent of the province’s population. The federal government has spoken of a national phar- macare program, yet little has been announced.

I know we discussed national pharmacare before, and I did provide the minister with my qualified support for get- ting to the next step, whatever the next step is. But of course, the devil is in the details. One of the details is how we’re going to pay for it. Does the minister support the notion of a universal public program where government would take on costs of the bulk of British Columbians who are covered by their employer’s private insurance plans? [10:10 a.m.] Hon. A. Dix:Well, it’s very brave of the member to ask this question.

The last time he asked it, I answered in 15 minutes — he’s clearly encouraging me to go back down that road — which is, for people watching at home, the maximum I’m allowed to speak on any question. Let’s start here on where the process is at. In my man- date letter, when I was made Minister of Health…. Obvi- ously, working with the federal government on a national pharmacare program was part of that mandate letter. In principle, of course, we support an increased federal role in funding PharmaCare. The member is right.

Some people receive private drug coverage, but there is a significant number of drug costs that aren’t picked up by any plan. Whether it’s the public plan, which covers slightly over 40 percent, or the private plan, which covers a similar amount, there’s a significant and large amount of prescription drug costs that are simply picked up by members of the public, either through the amount they pay in deductible, in advance of being covered by PharmaCare, or through other means. So it does have significant value.

It’s also true that most other countries with medicare- type systems have more expansive prescription drug cov- erage than British Columbia. The larger our market, in terms of buying prescription drugs, and the larger our ability to pool that market, the better deal we can get for prescription drugs. All of those provide value and are reas- ons why costs for people…. The need to reduce the over- all costs for prescription drugs is why national pharmacare has been seen as a positive alternative. The federal government has indicated, over the last dec- ade, at various points, an interest in national pharmacare.

There was a report that was…. There was a panel. It was chaired by a former Ontario Minister of Health, Eric Hoskins. Mr. Hoskins reported in the middle — I’m think- 236 Committee of Supply,

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ing June — of 2019 and, essentially, put out a report in favour of a single-payer system of national pharmacare. In the budget in March 2019, which occurred before the 2019 federal election, the federal government announced its interest in moving in that direction, although the prin- ciple moves in that direction that they suggested were to give the federal government more power over things such as formularies. They have no experience, essentially, in developing formularies, or very little experience.

So increase and create a national system but maintain the cur- rent financial structure — for a while, anyway, until the fourth year of the plan — of payment. Right now the federal government pays just under $1 billion in prescription drug costs for the military, First Nations, Indigenous people and others who are covered under federal prescription drug plans. The provincial gov- ernments pay roughly $13 billion. Really, the question would be: is the federal government prepared to match provincial spending in this area?

I think the member will note that the federal government’s fiscal situation has changed, as has the provincial government’s fiscal situation, dramatically in the last few weeks and months. Never mind where it was before. Are they pre- pared to do that and get involved? What I said to them is…. I’m prepared to meet with them and work on that any time they wish to call me. I have to say that we haven’t had a lot of discussions about that in recent times. The federal government seems to con- tinue to be determined to go on that path, though they have not accepted the recommendations of the Hoskins’ report yet.

Here is what I would say, though. The reason I want to be involved is…. I think we’re facing a period in the next ten years of a significant inflation in prescription drug costs, and I think there can be a role for the federal gov- ernment, especially with expensive drugs for rare diseases. We talked about economic analyses of drugs a few minutes ago. Those have a dramatically different context, when we’re talking about expensive drugs for rare diseases with relatively few beneficiaries. We made a change to increase access to a drug called Kalydeco, which is a cystic fibrosis drug, in February of this year.

It was a significant and expensive change, and it added three people to the number of people who had access to that drug. It’s not insignificant for those three people, driven by the evidence. If you want to look at the future of expensive drugs for rare diseases across disease areas, then take a look at the inflation we have seen in can- cer drugs over the last ten years, and you’ll see the future. [10:15 a.m.] I believe there can be a role for the federal government, particularly since they play a role in approving drugs to be sold in Canada, to address particularly expensive drugs for rare diseases.

When I met with Mr. Hoskins, I emphasized this point.

Finally, I’ll just say what the provincial position is as well — the one we put forward and the Premier had accepted at Premiers’ meetings — which is four basic principles for our approach to them, should there be a negotiation: (1) that the focus should be on removing cost barriers for patients; (2) that the development should be based on the best available evidence — potential benefits, risks, costs and reliability of supply; (3) that the design and delivery of public drug coverage must remain the responsibility of the provinces; and (4) that the federal government must provide funding that’s long term and secure — in other words, that we can’t have a situation where we have an agreement and then the federal government bails, leaving provincial taxpayers with very difficult choices in terms of maintaining pro- grams.

We’re prepared to talk about it and supportive of it. But realistically, I’m not going to allow the search for perfec- tion in PharmaCare coverage or in a national pharmacare program to stop us from making improvements that are good for people in B.C. now. N. Letnick: Thank you to the minister. I concur. It’s important for us to continue to improve our system for our own citizens, especially in light of the current fiscal situ- ation of the federal government. I guess I’ll put that to the minister as a question.

Has the minister heard anything since the beginning of the pan- demic from his counterpart in Ottawa regarding advan- cing the agenda on national pharmacare? Hon. A. Dix: We haven’t discussed it in any detail. There’ve been, as the member would expect, weekly calls of health ministers across the country.

In fairness, the issues around COVID-19 have been the central question and have been the focus of federal and provincial discussions, obviously — significant discussions around cost-sharing, around the applications of policies, around very detailed questions, such as, for example, the outbreak in the Mission Institution, which remains the largest outbreak in B.C., which is in the federal jurisdiction and where most of the services ultimately were provided by the Fraser Health Authority. I think the more apt question is: has there been extens- ive discussion in the period since the election?

The ques- tion is not whether COVID-19 has dominated the discus- sion now — obviously, it would have and would put aside some other priorities — but whether there was a lot dis- cussion of it since the federal election. I think the answer to that question is no. The federal government still has the plans it put in place in its February 2019 budget, to essentially work towards a national drug system and a formulary. They did make commitments in the out-year of that budget to provide money for expensive drugs for rare diseases. That’s some- thing that we continue to pursue with them.

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had some specific discussions on drug issues such as ones that we’ll talk about tomorrow, perhaps, with other mem- bers of the opposition, around the availability of a vaccine for influenza and other questions. We’ve had pharmacare-related questions for the fed- eral government in this time, but we haven’t had, really, a discussion of national pharmacare since the middle of January, when we launched our emergency response to COVID-19. N. Letnick:Switching to a new but related topic: cover- age for contraception in British Columbia. I’m going to say the question, and then the

preamble will come afterwards. So I guess it’s not a

preamble anymore. There is currently a hodgepodge of programs that cover some people in different circumstances. Rather than this patchwork approach, will government fund all prescrip- tion contraception at no cost to the user? Ideally, this would cover all available and federally approved methods, including IUDs, pills, injections and any other prescription methods. Choice here is important. As not all methods work for everyone, it would be prob- lematic to make only a narrow range of options available to people at no cost.

It would have the effect of, due to finan- cial constraints, potentially forcing people to use a method which resulted in undesirable side effects. As long we rely on a patchwork of different programs, individuals will continue to fall through the cracks, face barriers associated with navigating various programs and completing complicated paperwork or be forced to choose between privacy and access to contraception. [10:20 a.m.] This patchwork of programs also comes with high administrative costs. It is much simpler and more efficient to offer all prescription contraception at no cost.

I return back to the question. Is there currently any plan on the part of government to fund all prescription contra- ception at no cost in British Columbia? Hon. A. Dix:Thank you to the member for his question. Obviously, such a decision would have significant cost implications, and it would involve a slightly different approach to the ones that governments have been system- atically taking with respect to access to prescription drugs over time. I’ll give you an example of the one I gave recently.

In the 2018 budget by the Minister of Finance, $105 million was the cost of the effort to reduce deductibles and to make prescription drugs more affordable for people who have low incomes. That decision costs, roughly annual- ized, between $40 million and $50 million a year in the third year when it was to be fully applicable, which is this year. So that’s one way of addressing questions because, of course, like contraception, there are many other essential drugs out there. I sometimes use insulin as an example, because I use it.

There are many, many people who might argue there should be first-dollar coverage for insulin for people with type 1 diabetes because should they not have access to insulin, then they would, obviously, not be able to live. So it’s fundamentally essential, as are hundreds of other pre- scription drugs in our system. Our approach in that case was to take the expenditure of tens of millions of dollars and provide a benefit to a group of people in society that included, by the way, access to contraception because PharmaCare covers a number of contraception products right now in its sys- tem.

Those decisions made contraception within the PharmaCare system much, much more affordable for people with low incomes. The question would be: do we deal with that as a class? In other words, do we create first-dollar coverage for spe- cific things, or do we use the same amount of money to continue to raise deductibles? That would be the public policy choice.

There’s been a strong public lobby, and the member’s question reflects it, in proposing free contracep- tion in B.C. society and arguing that there are benefits to that, as there are to other things for women in B.C., and avoided costs in terms of health care costs, when such products are available for free. The member is right that we have, in addition to the PharmaCare system, a very significant number of places around the province where free contraception is offered at clinics — in Metro Vancouver and, I believe, in Kelowna and other places in the province. So it’s something, as a proposal, to be considered.

I think the consideration is: how do we want to engage in the next traunch of improvements to PharmaCare? Do we use the money to potentially expand drugs out- side of what we’re covering now? Do we use the money to reduce the cost of prescription drugs and address the issue for contraception and other drugs of all people of lower income to make them more affordable and to stop the economic impediment for people getting access to the drugs they need, which would include contracep- tion? Or do we go to what you’ d call first-dollar coverage for particular drugs? We have done that in a number of circumstances.

For example, the HIV/AIDS system, which is first-dollar cov- erage. Members will know that we led Canada on the issue of access to Mifegymiso, which is the abortion drug that has expanded access to abortion services. The argument there was that it gave, obviously, more power to women. It also avoided for many people the search to get appropriate abortion services and so on. In that case, we provided first- dollar coverage. This is not something that we reject out of hand. It’s one of the things that we’re reviewing. It’s a very active and interesting campaign. Those are the kinds of choices that we have to make.

Do we focus on particular types of drugs? In this case, the economic argument for contraception and the bring- ing together, as the member has said, of a number of gov- 238 Committee of Supply,

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ernment programs into just a clear, free coverage, or do we continue to expand access for low-income people? These are some of the choices we have to look at and make in the coming years. [10:25 a.m.] N. Letnick:Thank you to the minister. My question to follow up on that was going to be: at what point does he expect government to have a decision on whether to fund or not fund. He ended the answer with “in the coming years. ” Is the minister saying that there’s no answer for the question within this fiscal year that we are debating this budget? Hon. A.

Dix:Certainly, I’ d say to the member that we’re talking about a proposal that costs in the tens of millions of dollars. That is not a proposal that’s funded within this budget year, but it’s obviously an issue under active review, as are issues around the affordability of prescription drugs for low-income people and the costs of other categories of drugs. It’s been a very effective campaign. Certainly I’ve heard what people have had to say, including not just the eco- nomic cost but the economic value of such action.

That’s something that we’ll be considering in this fiscal year, but would await a future budget year, because it’s not funded in the current year’s budget. N. Letnick:Thank you to the minister for clarifying that for me. We’ll switch now to ALS. We have a few questions under the ALS category — three, specifically. ALS patients are seeking a commitment that provincial health plan cover- age of therapies approved by Health Canada can be accel- erated. Radicava was approved by Health Canada in Octo- ber 2018. I always love drug names. I don’t know where they come up with them. Maybe the minister can answer that too.

It was approved by Health Canada in October 2018, then tied up in the pan-Canadian alliance negotiation pro- cess to April 22, 2020. ALS patients in B.C. are still waiting for approval of Radicava. There are only three provinces left who have not approved this drug. Can the minister give us a date when the approval of Radicava may occur in British Columbia? Hon. A. Dix: I know the member knows this, but I wanted to take him back through it. With Health Canada, when it says there’s a Health Canada approval for a drug, what that means is that the drug has been approved to be sold in Canada.

It means that in the view of Health Canada, it’s safe, better than a placebo, and it can be sold in Canada. That’s not a listing decision. In every case, there’s a pro- cess to make a decision as to whether it meets the clinical test and the economic test to be listed in a provincial drug plan. In the case of Radicava, initially the common drug review in Canada, at the price that had been offered for it, which I believe was in the range of $110,000 per patient per year, did not meet that test.

However, we have engaged in a negotiation through the pan-Canadian process, with other jurisdictions, that arrived, at the end of April, in an agreement. Since then, we develop, as does every other jurisdiction, product agreements. Some jurisdictions have not offered Radicava yet but announced their intention to do so. We’re very close to making a decision on that. I expect the decision to be made between now and the end of the sum- mer. Obviously, we were very, very involved in the pCPA process and the negotiation around this.

We understand the terrible and ongoing challenges of people with ALS and the value that they ascribe to this drug, Radicava, which is, I think, a drug of value that offers value and hope to that community. There are about 400 people in British Columbia with ALS. There are just under 200 of those where Radicava might be an option for them in their circumstances and in their course of the disease. That’s something that we’re looking at soon. We’re almost finished our analysis of that, and a listing decision should come fairly soon. [10:30 a.m.] N. Letnick:Thank you to the minister for that positive answer.

As the minister has said, many people are strug- gling in B.C. with ALS, a very debilitating disease. I wouldn’t wish this — or any other disease, obviously — on anyone, but this is one especially harmful. Recently the Health Ministry issued a news release announcing a $1 million gift of matching funds from the B.C. government to help fund a new B.C. ALS centre of excellence. This was welcome news. Having the full $5 mil- lion, which is to be held in an endowment fund, will then set into motion the recruitment of an expert clinician dir- ector to oversee it and the ability to host clinical trials.

However, the ability to realize the $5 million goal remains mainly on the shoulders of ALS families, who are dealing with the progression of the disease, and the hoped for gen- erosity of other donors. As everyone knows, it’s hard to fundraise during COV- ID. I just added that last piece. Can the minister provide those living with ALS, and looking ahead to those who may someday face this dia- gnosis, with a commitment that the opening of a centre of excellence will not be impeded by the lack of private fun- draising? For people with ALS, this truly is a case of time being of the essence. Hon. A.

Dix:It was more than a news release. There was a very, very moving event, which I was able to participate in through Zoom, that was attended, I believe, in person Thursday, July 23, 2020 Committee of Supply,

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by the member for Richmond East, the member for North Vancouver–Seymour and others. The $1 million request in support was the request from the ALS Society. They had raised $1 million. They asked us to match that. Obviously, this is an extraordinary ven- ture, and we’re very, very positive about the potential — and they’re very positive about their potential — to raise the remaining funds and to make it happen. The member is quite right about the number of people with ALS and the challenges that people with ALS feel. They do have an enormous reservoir of support in the community.

I’m sure that he and I and many members who are with us now have attended events of the ALS Soci- ety in recent years. Here’s what I’ d say. I’ d say that we’ve provided the $1 mil- lion. They’ve raised $1 million so far. They believe they can meet their ambitious goal, and I’m hopeful that they can too. I think we’re absolutely prepared to consider future contributions — and there will be the need for ongoing operating and supports for the centre once it’s launched, in any event — to support them in their venture.

If it proves to be too difficult to raise the $5 million and people get to $4 million, I think that any provincial gov- ernment would consider stepping in and providing further supports. I absolutely don’t rule that out, although they’re very confident about their ability to reach that goal. As you know, as you’ve suggested, it’s a small com- munity. They’re doing extraordinary work. We’re partner- ing with them in all kinds of different ways. I’m very proud of that association, but also, I think provincial govern- ments would be prepared to step forward with further contributions should they be required. N.

Letnick: Again, thank you to the minister for that positive answer for the ALS community. I’m sure it will be well received out there. Can the minister provide a timeline for moving the clin- ic from the bowels of the G.F . Strong to the Centre for Brain Health, where clinics for other neurodegenerative diseases are located? Hon. A. Dix:First of all, I think “the bowels” is…. How one describes that, I guess, is evocative. The ALS program is provided out of two floors at G.F . Strong. Having it at G.F . Strong, of course, has some value. Services are provided there.

As well, there’s a concurrence of interests at the Centre for Brain Health at UBC. There really isn’t the space to make that move at the moment, and there is value in having it there. This is something that has been proposed by the ALS Society. We’re actively engaging with them now as to how we should best go forward in this period, as we work together to establish the new centre. It’s not some- thing under consideration right now. There is some value in it being at G.F .

Strong, in terms of the bringing together of both the research component but also the very active supports for people in the community that take place at G.F . Strong. [10:35 a.m.] It’s something that we’ll consider. There isn’t really room at the Centre for Brain Health now to make that move. We’ d have to look at space allocation there, should that be a site considered, but that’s something we’re going to engage with the ALS Society on. N. Letnick:Again, thank you to the minister. We have a couple of questions under the category of cystic fibrosis or CF , for short.

Does the budget include funding to the PHSA, specifically for the provincial integ- rated care model, for people with cystic fibrosis, including full implementation of the standards of care and mental health support programs? Hon. A. Dix: Obviously, the struggles of people with cystic fibrosis, their aspirations and the extraordinary improvement in outcomes for people with cystic fibrosis, even in the last ten years, in terms of life expectancy and so on, are something that the community around people with cystic fibrosis, the clinicians that work with people with cystic fibrosis can be very proud of.

It’s an extraordin- ary achievement and an extraordinary challenge. There are very particular challenges. As the member will know, at year-end, we provided $160,000 to Cystic Fibrosis Canada to support the con- tinuing efforts in improving the lives of B.C. residents who live with cystic fibrosis. This is in the context of other such contributions, I believe — $20,000 in 2014-15, $30,000 each year in 2015-16 to ’17-18, and so on. In March 2012, $100,000 was provided to support the development of a business case for the B.C. cystic fibrosis program. The proposal, I believe, was made in 2019.

The business plan was put forward, and it’s something that PHSA is looking at. I want to read to the member from the PHSA executive mandate letter, which includes the following: “The PHSA will create a health improvement network for cystic fibrosis, which will include the development of cross-pro- fessional reference advisory groups, including physical health professionals and patients linked to distinct service areas. The work undertaken must be responsive to the diverse geographical, local health and community health service areas served by the B.C. health sector. ” That means metro, urban and rural.

The PHSA is also developing a tiers-of-service model to better integrate CF care into the broader health system. As you know, currently there are four multidisciplinary CF outpatient clinics in B.C. and two more that are linked to that in different parts of the province — one at Children’s, one at St. Paul’s, two on Vancouver Island. Then they are linked to outreach services in Northern Health in Prince George and Interior Health in Kelowna. From my vision and the vision of developing primary 240 Committee of Supply,

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care networks, I think linking those clinics to services in the community is an important aspect of what we’re asking the PHSA to put into place, as they consider the proposal from CF Canada. N. Letnick:Thank you to the minister for that. The second question on cystic fibrosis is: does the budget include funding for PharmaCare to include access to CF disease modulators Kalydeco and Orkambi, which have been approved by Health Canada, should the current pCPA negotiations be successful, and if not, when will it? Hon. A.

Dix: As I mentioned, I think, in the answer to a previous question, we have expanded access to Kalydeco, which is available in a limited way in British Columbia right now. We did so in February of 2020. With respect to Orkambi, this is an issue that has been canvassed in previous estimates, but I’m happy to respond here. As the member will know, Orkambi was approved. He says it was approved by Health Canada. It was approved by Health Canada, again, for sale in Canada in 2016. [10:40 a.m.] It went through the common drug review process. It was not approved.

It was reviewed by the common drug review and then, on appeal, reviewed again, as it was by the Drug Benefit Council, I believe, here in British Columbia. The decision of the common drug review back in the fall, I believe, of 2016, was to not approve the listing of Ork- ambi. As the member will know, the list price is $250,000 per patient per year for that drug. In March 2017, the Ministry of Health decided — obvi- ously, Minister Lake was the minister then — not to list Orkambi.

In the period subsequent to that, the member will know, in the summer of 2017, a number of cases emerged of people who had received Orkambi, covered through private health plans, who were being cut off by their private health plans, and the issue became an issue of public discussion.

It has since, again, been reviewed by the common drug review and by the independent evidence-based processes that have been in play and has again not been approved for listing in the country by provincial drug plans, although some provinces are moving forward, at least, through some discussions with the company — which is a company called Vertex — to address this question. The member will know that the listing of Orkambi has been an issue around the world at different times and has involved a fairly intense public discussion.

The member will also know that, consistent with policy dating back a long time, we follow the evidence in British Columbia, and we follow evidence-based processes. Even in the case of the exception, which was Duodopa, that exception took place after some years, on a drug that had been covered in other drug plans, after a refusal by the company to submit itself again to the common drug review process. It was at that time that Minister Lake and the pharmaceutical services division of the Ministry of Health made that decision. So those questions haven’t changed.

For the specific answer, we don’t really have a budget. We have an overall budget for specific drugs, but we don’t have a budget for Orkambi or a specific budget that says, “We’re going to list that drug, ” because that would make that a political decision, in a certain sense. Of course, I support the decision and the recommendation of the evid- ence-based experts in the pharmaceutical services divi- sion, of the common drug review and of the Drug Benefit Council in B.C. not to proceed with Orkambi at this time. It should be said that there are other cystic fibrosis drugs that are under discussion in Canada.

There’s a drug called Trikafta, which is also — there’s considerable interest and excitement about that — a new therapy. But that drug has not yet received a notice of compliance from Health Canada. So it’s not under active consideration, although I expect it to be in the coming years. N. Letnick:To the minister, since he brought up Trikaf- ta. I understand that Vertex has not applied to have the drug available in Canada. Could the minister, if that infor- mation…? I know it’s not one of the questions I sent him ahead of time.

Could the minister update us on what the situation is with Vertex and whether or not there’s actually an application in Canada for that drug to be even reviewed? Hon. A. Dix: With respect to Trikafta, no. If that’s the question about Trikafta, it hasn’t gone through that pro- cess yet. Obviously, Vertex has applied with Kalydeco, because it has limited coverage in B.C. and other jurisdictions. It has applied with Orkambi, and as just discussed, the process for Orkambi is well understood and has occurred over the last four years. I don’t believe it has applied with respect to Trikafta yet.

We’re not through that part of the process yet. So it’s not really available for consideration. There’s obviously lots of optimism for those drugs, and we’ve said that this is a very challenging area, I think: the issue of expensive drugs for rare diseases. I won’t recan- vass all the things I’ve said before. I’ve engaged with lots of people in the CF community around this question, and lots of people have engaged with me. As you know, I believe — I’m not sure if it’s being pursued or not — there’s a legal action on the question.

Of course, I’m answering questions about the specifics today, although I can’t about the legal action. [10:45 a.m.] What I can do is endeavour to get the member more information about Vertex’s intentions, but our intention would be to treat that as we would any other drug. N. Letnick:This is my last point on this with the minis- Thursday, July 23, 2020 Committee of Supply,

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ter. Is there any role for the provincial government Health Ministry to encourage pharmaceutical companies — like Vertex, in this matter — to apply for their drugs to be accessible in our country? I’m concerned — and so are the CF people and, I guess, just broadly, people who are looking for drugs — that there are many, many countries in the world that are provid- ing listings for drugs like the ones we’re talking about, and some companies, like Vertex, might not be that enthusiast- ic about listing their drugs in Canada.

Is there a role for us to play, as British Columbia, in encouraging private companies to apply for listing in our country, or are we really order takers at the end of the day, and wait until they go through the process, and then, at that time, we make our determinations? Hon. A. Dix:I think we do play a role, and we do engage with companies all the time. This is particularly true of our pharmaceutical services division here. We’re engaged in negotiations all the time and so on.

I think it’s fair to say that there is a debate around the role of pharmaceutical companies in the world and the prices that they try and set and then adhere to for the value of prescription drugs. For us to have effective PharmaCare systems that provide broad coverage, provinces and coun- tries have to come together to ensure fairness in this pro- cess and ensure that the very effective and evidence-based processes that we undertake….

The amount we spend as provinces on prescription drugs is in the tens of billions, remember, every single year — well over $1 billion now in British Columbia and growing towards $2 billion — just as provincial gov- ernments. Then, as Canadians, through private health plans, which we want to stay in place — private insur- ance plans, which we want to stay in place and to be affordable and accessible to people and cost individuals — those are significant as well. Countries, provinces and jurisdictions have to stay together to give a message that we want, of course…. We must have research.

We can imagine, at this time, the value of such research in terms of vaccines for COV- ID-19. Not just COVID-19 but for other issues and other illnesses in society, the value of a vaccine — the value of cure — is profound. We want to encourage that, while at the same time ensuring that taxpayers and public health systems ultimately don’t pay an enormous and unaccept- able price where the extension of intellectual property rights of pharmaceutical companies allows them to set whatever price they want, leaving patients in the middle. I think there is a role, and we do engage with it all the time.

But sometimes, companies make their own decisions in this regard, and that can be very challenging. Whether that’s the case with Vertex or not, I wouldn’t want to say. But this is a company we have, as you would expect, engaged with regularly over the past number of years. N. Letnick:Thank you to the minister. We’ll switch now to the arthritis topic. Again, for those that just joined us, I have pre-submitted all these questions to the minister and the staff. So the minister has at his fingertips — probably not necessary, because he seems to know a lot about all these topics — all the details he requires.

These questions come to me, as the critic, from groups all around British Columbia all throughout the year. It’s a matter of trying to fit all these many questions from our citizens around B.C. in the limited time that we have. [10:50 a.m.] I think the minister’s answers are to the point, and I’ d like to congratulate the minister for being as succinct as he is. Thank you very much for doing that. It will help us get through all these questions. Arthritis. Many people have lost their jobs and their private insurance during COVID-19.

To manage their condition, it is critical that people living with arthritis con- tinue to have access to their medications without financial barriers. The challenge, of course, is: how do we do that? What they’ d like to know is what the government is doing to address the immediate challenges posed by COVID-19 to arthritis patients? Hon. A. Dix: I think what I’m saying now applies for arthritis patients and for many others with chronic dis- eases who are facing significant economic challenges.

This is something members of the opposition and the member and I discussed, in March and April, around the availab- ility of prescription drugs, around the limits that were, in some cases, being placed on the distribution of prescrip- tion drugs to patients at pharmacies around B.C. I want to say a couple of things. First of all, there is a Fair PharmaCare income review application process. It’s avail- able to anyone who has lost income due to COVID-19. This has been the case before, but we’ve rarely seen so many people losing more than 10 percent of their income as we have now.

They’ve long been available, but anyone whose income has dropped more than 10 percent in the last two years can see if they can adjust to lower the deductible and the family maximum. It’s important that people know about that. We’ve made some efforts. I know, and appreciate, all of the MLAs on the line and in their offices who have made efforts to make that understood to people in the province. If they’ve seen an income loss, they can have a reapprais- al, essentially, of their income level, which may have been based on last year’s income but has no relevance now.

In other words, if your income has dropped a lot, you can get a reappraisal and get a lower deductible. There’s also a specific question around 2020 income loss. We have a new income review application that includes an option to estimate income for the rest of the year, essen- tially, to get access and to see a levelling of costs throughout that year for people who have prescription 242 Committee of Supply,

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drug costs. So there are two sets of options that are avail- able to patients — people with arthritis and people with other chronic diseases — to deal with the economic chal- lenges they face. Thirdly — I think this is important; this is something, I believe, we’ll likely discuss later — we’ve seen a dramatic expansion of virtual care in this period of COVID-19. For some people with arthritis, for context, this has some advantages, where people have been able to access care in ways that are more efficient, maybe, than they did before.

It’s also critically important at a time when regular visits and regular care are required and where that care has not been available because of the circumstances of COVID-19. We’re going to continue to pursue those options. Certainly, with respect to the Arthritis Society, I am happy and open to engage with them on specific issues that are being faced in this COVID-19 period for people deal- ing with arthritis. N. Letnick: This would be the last question based on arthritis.

During these challenging times, charitable organizations that support research are struggling to maintain programs that will bring new innovations and improved quality of life for patients. The Arthritis Society is the largest charitable funder of arthritis research, but they cannot do it alone. It is imper- ative that they stay the course when it comes to priority investments in research that will improve diagnosis, treat- ment and prevention. The question is: what investments into arthritis-related research is planned for this fiscal year? Is it more or less than in prior years? Hon. A.

Dix:I can give it for within the past five years, if that works for the hon. member. The Ministry of Health provided $3 million in 2013-14 to Arthritis Research Canada, and $2 million in 2016-17. We’ve provided in 2018-19, at the end of that fiscal year, a further $2 million to Arthritis Research Canada. [10:55 a.m.] While there’s nothing budgeted specifically for that, there are ongoing requests for budget. I think there’s a sub- stantial request that’s in the neighbourhood of $35 mil- lion, if I remember the letter correctly, for a future year.

While there’s nothing budgeted for this year, it’s something that we’re reviewing. The pattern of providing that $1 mil- lion a year in larger sums, I expect, will continue to be the approach the government takes, at minimum, in the com- ing years. N. Letnick:Thank you to the hon. minister for that pos- itive answer. We’ll switch to something that the minister has known for many, many years: diabetes. He’s publicly declared that he’s a type 1 diabetic many times, so I have no issues with mentioning that here. I’m sure he’s going to mention it as well.

Advanced glucose monitoring technologies, as the min- ister knows, represent an evolution in the self-manage- ment of diabetic disease, as they provide richer, more accurate and more timely data to patients about fluctu- ations in their blood glucose — in particular, about time and range, a metric that denotes the proportion of time that a person’s glucose level is within a safe range. This means fewer life-threatening highs and lows, fewer emer- gency room visits and, over the long run, less kidney dis- ease, heart disease, cardiovascular disease and blindness.

Investing in advanced glucose monitoring technologies will not only improve the quality of health and the life of those living with type 1 diabetes; it will produce savings over the long term that will more than make up for the cost. Just coincidentally, my mum, when she was alive, had type 2 diabetes, and I saw the impact that that had on her life and on the lives of people all over our province that have type 1 or type 2 diabetes. Will the minister support funding either continuous glucose monitoring or flash glucose monitoring for all with type 1 diabetes? Hon. A.

Dix:This is an issue, of course, that I hear about during my annual visit to my endocrinologist — and many others. I hear about it all over the community of people liv- ing with diabetes. The group that was recently formed, called Y oung and T1, was a really strong advocacy group for insulin pumps, initially, and has become a strong advocacy group for con- tinuous glucose monitoring. Then, in addition to them, obviously, there’s the Canadian Diabetes Association, the Juvenile Diabetes Research Foundation and many in the larger diabetes community. The member will know, obviously, that I’ve been an advocate.

I think successive governments have seen the effect of advocacy on access to what you’ d call diabetic equipment, delivery systems or monitoring systems. We currently spend, I think, in the neighbourhood of $50 mil- lion to $60 million on diabetic testing equipment — test strips, principally. That amount was reduced somewhat in recent times. There was a decision made in 2016, I believe, by the previous government to bring an evidence-based approach to the coverage around insulin test strips. He’ll also know that I’m certainly an advocate.

I was the opposition Health critic at the time in 2008 that access was given for young people, children with type 1 diabetes, to insulin pumps. That was extended in 2013-14 to people up to the age of 25, by the government then. That’s something that I had advocated for then, so I was very happy to see it, as Leader of the Opposition, and so on. Then in 2018, we expanded that coverage of insulin pumps to all British Columbians. That was a very proud day indeed for people in B.C. — and for me personally, having been an advocate for that policy.

Interestingly, the night that we approved insulin pump coverage for all British Columbians was the first night I Thursday, July 23, 2020 Committee of Supply,

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received a specific outreach advocacy around CGM, con- tinuous glucose monitoring. That, as the member says, is a more effective method than the ones we’ve had, which themselves had been quite effective over time in monitor- ing blood sugar levels, to summarize it a little bit colloqui- ally. Obviously, it has value. [11:00 a.m.] So what have we done? Again, we’re applying the value of evidence to the question around cost and so on.

The B.C. health technology advisory committee has delivered a report, has finished a report on the efficacy and cost-effect- iveness of CGMs and FGMs, flash glucose monitors, and provided their recommendation. We’ve engaged CADTH in this process to provide a funding recommendation as well as implementation advice on CGMs and FGMs, and we’re working with other jurisdictions — Health Quality Ontario and the Institut national d’ excellence en santé et en services sociaux, INESSS, in Quebec. We’re looking at a synthesis of the recommendations made by all of those bodies and to, again, follow the evid- ence.

We’re also conducting our own budget impact ana- lysis and looking at different funding scenarios and pre- paring for the inevitable final part of that, which is stra- tegic options around what kinds of negotiations might occur with companies producing CGMs, to get the best possible deal, should that approval go through, for the people of B.C. and for people living with diabetes in B.C. That’s the process. That’s where we are right now on CGMs. Obviously, it’s an area of great personal interest. I should say that I don’t use a continuous glucose monitor, although people tell me all the time I should start. N.

Letnick:I’m not anywhere near qualified to advise the minister as to whether he should start to use CGMs or FGMs. But given the process, am I to conclude that there is no money in the current fiscal plan that we are look- ing at in estimates today for funding of continuous CGM or FGM monitoring for type 1 diabetics but that in future budgets, however, there may be? Hon. A. Dix: No, I don’t think that’s quite the accurate conclusion. I think that we’re actively reviewing the ques- tion now. What will have to happen is that it would have to take place….

Any action we would take, whether it would be to do a pilot project or other actions that might be recom- mended from the evidence and from this very important process of review that’s taking place both across Canada and here in B.C., would, of course, have to fit in our exist- ing budget room under the PharmaCare program. But I wouldn’t exclude that happening in this budget year. It’s something under active consideration. N. Letnick:Again, the light of hope is put out there for another group. Thank you. We’ll switch now to ME and CFS. During estimates last year, Minister, we covered the topic of ME and CFS.

By the last count I have, there are about 77,000 British Col- umbians who live with the disease. Seventy-five percent of people living with ME are unable to work, and 25 percent are housebound or bed-bound. They are among the most severely disabled in our community. Last year I asked if the government would agree to develop a provincial strategy to address unmet health care needs for British Columbians living with ME. I also asked: would the government commit to timely implementation of diagnostic and billing codes for ME? I’ve been asked to ask the same questions again.

So those two questions and one more, if I may. Would the minister agree to launch an educational ME campaign for doctors? Hon. A. Dix: Thank you very much to the member for his question. As he may be aware, subsequent to that, there have been meetings by the ME/FM Society and the Min- istry of Health on some of the questions they’ve raised, and that process continues. As he will know, there are no specific tests confirming diagnosis at this time for ME or chronic fatigue syndrome.

The symptoms for these conditions are similar to many other illnesses, and diagnosis is determined from a med- ical exam by the patient’s doctor or health care provider. The absence of other identifiable diagnoses responsible for patient symptoms often results in this diagnosis, and it’s a significant condition facing people in B.C. [11:05 a.m.] I would say with respect to…. We continue to work on these questions.

The complex chronic diseases program, a program of the Provincial Health Services Authority, is a provincial referral centre providing comprehensive and evidence-based care for adults with complex chronic dis- eases such as…. I would say on the question of billing codes, the mem- ber may know that they’re developed for medical ser- vices or procedures and not for conditions. Existing billing codes are available to doctors to support diagnos- is and care to patients with these conditions, but it’s unlikely that we would develop a specific billing code, principally because that’s not how the system works.

The member will also know that we’ve had some meetings, and we’re going to continue to have a process of engage- ment with the society. On the issue of education, the member will know — he may even be interested in this himself — that in August, the International Association for Chronic Fatigue Syn- drome and ME is providing a virtual research conference for all biomedical and behavioural professionals, including clinicians, researchers and educators with an interest in ME/CFS and its associated co-morbidities. Continuing medical education credits for physicians and nurses will also be provided.

People affected by ME/CFS and their supporters are also welcome to participate in this process. I would note that in June, 2019 the guidelines and pro- 244 Committee of Supply,

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tocols advisory committee added a new partner guideline on identification and symptom management of ME/CFS to detect key symptoms and manage these symptoms over the long term. And of course, the government of Canada is currently and actively engaged, through Health Canada and the Canadian Institutes of Health Research, to support the work of the national network to improve the quality of life of people living with ME. There’s a significant amount of research, engagement and education happening right now. That engagement is available to doctors and nurses in the B.C. health care sys- tem. N.

Letnick: Thank you to the minister for those answers. Is there any way to identify how many physicians have taken up the professional education piece that’s going to happen in August around ME? Hon. A. Dix: I’ll endeavour to find an answer to that for the member. Also, I’ll endeavour to send, to him and other members of the opposition and the government side here who might be interested, more information about that process. N. Letnick: Thank you to the minister for that. We’ll switch now to prosthetic and orthotic services.

There is an urgent need to improve access to prosthetic and orthotic care in a timely manner, providing devices in order to create a timely, effective and streamlined ser- vice that is not crippling British Columbians with financial burden, leaving many of them with no option than to go without. The cost of providing prosthetic and orthotic care has gone up significantly over the past 20 years, and without increase in government assistance, there exists a growing gap between what is funded and what services cost, which leaves British Columbians left to cover the dif- ference if they can afford it. B.C.

PharmaCare spent $9.1 million for prosthetic and orthotic programs in 2019. However, the professional rate for services has not changed since 2000. Increasing this funding to reflect 2020 costs of services is estimated to cost the government $5.3 million and would relieve the finan- cial burden on thousands of households and British Col- umbia residents. The first question of three is: when will the government increase current prosthetic and orthotic funding levels? Hon. A. Dix: As the member will know, B.C. is the only province to link drug program deductibles to pro- theses and orthoses.

Most provinces have separate pro- grams, so sometimes there’s been confusion about whether we’re funding them or not. We are, of course, in B.C. The member notes the amounts.

In the 2018-19 fiscal year, which is the most recent I have with me right now, it was $8.04 million for protheses for 4,790 claims and $1.6 million for orthoses for 1,116 claims, for a total of $9.68 million on 5,906 claims. [11:10 a.m.] We increased coverage of prosthetic devices on October 1, 2019, for all transfemoral amputees who have under- gone osteointegration surgery and require prosthetic osteointegration components, so there have been increases in access. There are more details about that, but I think I’ll stick more specifically to the member’s question.

As the member knows, the last time PharmaCare increased reimbursement rates for prostheses and orthoses was December 14, 2010. That timed off said inflation. So it hasn’t happened since then. Specific changes at that time included an increase to the fee provided for fabricating a prosthetic socket and establishing a defined fee

schedule for orthoses. That is what occurred then, and it hadn’t occurred up to that point since 2004. The association has, as the member suggests, presented us with new annual fee guideline prices for both devices. I think it’s fair to say that it’s true that device providers are charging patients more than PharmaCare’s reimburse- ment rates, increasing patients’ out-of-pocket costs. That’s why we’ve had regular meetings with the Prosthetic and Orthotics Association of B.C. on this question.

We’re continuing to do work, as recently as a meeting in May 2020 with the POABC, to collect data in support of ongoing discussions around the fee increase. N. Letnick:Thank you, Minister, for that answer. B.C. is the only province in Canada that does not provide funding assistance for orthotic devices for adults living with physical impairments. A B.C. study by Diabetes Canada in 2015 shows that providing off-loading devices as a treatment for diabetic foot ulcers to prevent ampu- tations is estimated to yield a net direct cost savings of between $14 million to $24 million per year.

In light of that, will the government join the rest of the country and allow B.C. adults with a disability but without extended health care benefits to qualify for funding assist- ance for orthotic coverage? Hon. A. Dix: The member refers to the report by Dia- betes Canada. I think he, as with other members, met with Diabetes Canada the last time they were here. I referred to them as the Canadian Diabetes Association, which just shows how out of date I am and how long I’ve had diabetes. It’s Diabetes Canada, of course.

What the pharmaceutical services division has done this year is commission an evidence review of off-loading devices through our health technology assessment com- mittee. The results of that review will be completed by the fall of 2020. There’s a discussion of who is “the only” and everything else. We’re the only province in Canada to link these drug program deductibles to prostheses and orthoses. Most other provinces have separate programs. Sometimes, be- Thursday, July 23, 2020 Committee of Supply,

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cause it’s integrated into an existing program, there’s some confusion about that. We help eligible patients pay for the costs of eligible prostheses and orthoses subject to the rules of the Phar- maCare plan, including any deductible requirement. B.C. residents of any age are eligible for that coverage and for related supplies and services that support clients in achiev- ing and regaining and maintaining basic functionality. B.C. residents aged 18 and under are, of course, eligible, as well, for coverage of orthoses and related services that sup- port clients in doing those very same things.

This is, obviously, an area that we are doing significant work on, work that’s reflected in our discussions with the POABC and our review of the policies. We’re looking at a response for fall 2020. N. Letnick:Thank you to the minister for the answer, and thank you for continuing to work with POABC on these important issues. The current coverage limit for emergency repairs is $400 per day per limb, the non-preapproval rate. For someone affected with two limbs, this, essentially, reduces their repair limit to $200. This rate is too low and disadvantages individuals with multiple involved limbs.

Emergency repairs need to be done immediately, and this rate limits how much can be repaired without having to apply and wait for a repair approval. [11:15 a.m.] POABC, as the minister says, is asking for an increase to the current $400 non-approval exception to $650. This should be per affected limb, rather than as a daily maxim- um per client per day. Will the government implement this increase from $400 to $650? Hon. A.

Dix: As noted in answer to the previous ques- tion, we’re currently considering POABC’s request to increase the current $400 amount to a higher amount, $150, and we’re engaged in that process right now. N. Letnick:We have one question on bariatric surgery. Can the minister please tell us what the wait time from referral to surgery was prior to the pandemic and the number on the wait-list? What is it now, and what are the projections for the future? We have three questions. From referral to surgery, what was the time prior to the pandemic? What is the number on the wait-list?

What is it now and projections for the future, please? Hon. A. Dix: First of all, just to put this in context. These are important medically necessary surgeries. The good news, I think, is that we’ve been doing more of them. The number of surgeries completed in 2016-17 was 365. The number of surgeries completed in 2019-20 was 423, which is a significant increase, I think the member will agree — something in the neighbourhood of 15 percent in that time. There is, of course, more demand than that, and we’re seeing increased wait-lists.

I got some detailed wait-list numbers, which I’ll also share with the member otherwise, because people tell that me I read statistics too quickly to be understood by humans sometimes. So I appreciate that. As of the P13, 2019-20, there were 106 patients on the wait-list, and 32 percent of those patients were over the clinical benchmark. So that’s a consideration that we put. Wait times for the 50th percentile of cases have improved between 2016 and P13, 2019-20, from eight weeks to seven weeks. From 2016-17 to 2019-20, wait times at the 90th percentile have improved from 29.8 weeks to 18.4 weeks.

Those are significant improvements. However, we’ve obviously lost some ground because this was one of the class of surgeries that was postponed for a couple of months under COVID-19. That has meant that we have lost some of that ground that we’ d made up in the past number of months.

We are expecting, though, because of increased demand for surgery, that in spite of the fact that we’ve had a 60 percent increase in the number of surgeries, the increased demand for surgeries is such that it’s our expectation, and this is part of what we’re reviewing in our surgical plan, that we’ll see an increase in the number of people on the waiting list, not simply because of COVID-19 but because of an increase in demand that has exceeded the very sig- nificant increase in the number of bariatric surgeries that have taken place in B.C. Those are some of the detailed numbers.

Actually, I have more detailed numbers which I propose to share with the member on paper. N. Letnick:Thank you to the minister. I look forward to receiving those details. We’ll now switch to the issue and concern of deaf chil- dren and their families in B.C. Successful use of hearing aids and cochlear implementation is dependent on habitu- alization programming for profoundly deaf children that utilize cochlear implementation.

By the time the surgery is completed, the sound processer turned on and the child’s brain begins to make sense of the sounds they are hearing, the funding for early intervention supports and services runs out through the early hearing program. This two-year funding window is highly insufficient and only serves to provide the initial medical interventions but falls short on therapeutic intervention. While MCFD provides some funding for early intervention, the number of families requiring and accessing these services has more than doubled in the past ten years.

However, the funding has remained the same. [11:20 a.m.] Unfortunately, in the current birth-to-five model, a high percentage of deaf children are still entering kindergarten with severely delayed language levels. In this case, the sys- 246 Committee of Supply,

Section C Thursday, July 23, 2020

tem must fail these children. The lack of sufficient early intervention services has significantly contributed to the creation of disability in these children where no cognitive disability existed before. The question to the minister is: will the Ministry of Health, in partnership with MCFD, provide appropriate funding for deaf children from birth all the way to age five, or kindergarten entry, to ensure successful transitions to kindergarten and beyond and ensured access to language as a right of all children? Hon. A. Dix:I just want to talk about the broad issues in general.

I do this knowing that someone who knows even more about this than I do, the Minister of Children and Family Development, is on the committee, so she’ll be test- ing my answers with respect to the MCFD portion of ser- vice. The member is quite right that this is a shared area, that we work in partnership with MCFD. I just want to put in context what some of the Health services are. We’re abso- lutely and consistently engaged with MCFD on improving access to services. As he knows, these are critical services both in screening and then in actions to support children who are struggling to hear.

I should say that before COVID, there was no wait-list for cochlear implant surgeries. This is an important ques- tion, which I usually get asked by the member from West Vancouver, who has a significant interest in this area, an ongoing interest. I’ve discussed it with him on a number of occasions. It should be said that no CI surgeries took place dur- ing stage 2 of the shutdown of surgical services. Two sur- geries have taken place since the reopening of elective slates. Currently, there’s no wait-list for CI. That’s one set of news.

Through the Provincial Health Services Authority, as the member will know, two years of supplementary rehab — he spoke of this — and therapy are provided to help children with or needing cochlear implants to help them learn to hear with the new implant. Services are delivered by not-for-profit, community-based services with some health authority and school district support. The B.C. early hearing program is a provincewide screening program that checks the hearing of babies born in B.C. Apparently, 97 percent of babies are screened at hospitals or through public health community screening clinics.

BCEHP provides integrated services for newborn hearing testing as well as early language support following an identification of hearing loss. It also provides support to families through parent guides and deaf and hard of-of hearing mentors. BCEHP also provides the first fit of hearing aids, as well as ear moulds and batteries for the first three years when the child meets eligibility requirements. All children may access hearing testing through their local public health audiology clinic at no cost.

Most health authorities also provide coordinated early childhood hearing screenings for preschool- and/or kindergarten-aged children. This is combined…. This issue was raised during, MCFD estimates. My colleague the Minister of Children and Family Development confirmed that the funding was absolutely mainta

Document details

Collection	British Columbia — Debates (Hansard)
Citation	20200723am CommitteeC n13
Type	hansard
Volume / chapter	20200723am CommitteeC n13
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	db58df9ec5c4a51b2fb7b4f09951496cb85d31f3

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