2016 Legislative Session: Fifth Session, 40th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

official report of

Debates of the Legislative Assembly

(hansard)

Monday, May 9, 2016

Afternoon Sitting

Volume 39, Number

ISSN 0709-1281 (Print)

ISSN 1499-2175 (Online)

CONTENTS

Page

Routine Business

Introductions by Members

Statements

Trade with European Union

Hon. N. Letnick

Introductions by Members

Tributes

B.C. teams at National Aboriginal Hockey Championships

G. Hogg

Introduction and

First Reading of Bills

Bill M226 — Manufactured Home Park Tenancy Amendment Act, 2016

H. Bains

Bill M227 — Residential Tenancy (Protection from Renoviction) Amendment Act, 2016

M. Mark

Statements

(Standing Order 25B)

Streamkeepers societies in West Vancouver–Sea to Sky area

J. Sturdy

Contributions and role of nurses

J. Darcy

Mountaineering and mental health work of Brent Seal

J. Thornthwaite

Arts in schools and South Slope Elementary School production

R. Chouhan

Contributions and role of nurses

J. Yap

Ovarian cancer

A. Weaver

Oral Questions

Government response to youth death cases and placement of youth in care

J. Horgan

Hon. S. Cadieux

D. Donaldson

Youth death cases and implementation of report recommendations

C. James

Hon. S. Cadieux

Water quality in Spallumcheen area

G. Heyman

Hon. M. Polak

Health care worker layoffs at seniors care facility in Nanaimo

J. Darcy

Hon. T. Lake

M. Mungall

Hon. Michelle Stilwell

Petitions

J. Darcy

Orders of the Day

Committee of Supply

Estimates: Ministry of Health (continued)

Hon. T. Lake

B. Ralston

J. Rice

S. Hammell

S. Robinson

J. Darcy

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Natural Gas Development (continued)

M. Mark

Hon. R. Coleman

K. Corrigan

S. Robinson

D. Eby

B. Ralston

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MONDAY, MAY 9, 2016

The House met at 1:33 p.m.

[Madame Speaker in the chair.]

Routine Business

Introductions by Members

J. Yap: I have three constituents in the gallery today — Anthony Remedios; his wife, Christine Remedios; and their daughter, Isabella Remedios, who are not only constituents but practically neighbours of mine, living just a couple of blocks away from where I am. They are visiting the Legislature today. Would the House please give them a warm welcome.

J. Darcy: I have two sets of introductions today.

First of all, we are surrounded by nurses today, because it is Nursing Week in British Columbia and across Canada. Organizations representing the B.C. Coalition of Nursing Associations, representing five different groups of nurses — including the Association of Registered Nurses of B.C., the Registered Psychiatric Nurses Association of B.C., the B.C. Nurse Practitioner Association, the Licensed Practical Nurses Association of B.C. and the Nursing Education Council of British Columbia — and representing 55,000 nurses across British Columbia speaking with one voice. Would this House please join me in making them very welcome.

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We have some other very, very special guests in the Legislature today. They are workers who work at Wexford Creek care facility in Nanaimo. We have heard in this House about the fact that due to contracting out, they will be losing their jobs.

We have with us Wendy Chadwick, Samantha Lindsay and Brittany Marsden, who all care for our frail seniors at Wexford Creek park. Joining them are Becky Jacobson, a staff representative with the Hospital Employees Union; Mike Old, the coordinator of policy and planning; and the president of the Hospital Employees Union, Victor Elkins. Would the House join me in making all of these members very, very welcome today in the House.

Hon. T. Lake: As mentioned, it’s Nursing Week in Canada. Particularly here in B.C., we’re celebrating the approximately 50,000 practising nurses. This morning, I had the opportunity to meet with a number of nursing leaders. This is the B.C. Coalition of Nursing Associations, which is the first-ever organization of its kind in Canada, bringing together leadership from all four B.C. nursing professional associations and our nurse educators in one collaborative forum for discussion, action and advocacy.

The member organizations include the Association of Registered Nurses of B.C., the Association of Registered Psychiatric Nurses of B.C., the B.C. Nurse Practitioner Association, the Licensed Practical Nurses Association of B.C. and the Nursing Education Council of B.C.

This morning, I was joined by Zak Matieschyn, Tania Dick, Joy Peacock, Andrea Burton, Jacqollyne Keath, MaryAnn Machado, Tess Kroeker, Anita Dickson, Brenda Childs, Jack Teck, Kathleen Fyvie, Natasha Prodan-Bhalla, Bernice Budz, Suzanne Campbell and Janine Lennox. They are here with, I believe, about 58 other nurses in the gallery today. They’ll be meeting with members of the Legislature in the Ned DeBeck Lounge. Would the House please make our nurses very, very welcome.

J. Horgan: It’s coming on to 11 years since I was first given the honour to come and sit in this place. Someone who has been volunteering in my office every Friday, except for when he goes back home to the Boundary country, is a guy named Larry Fofonoff. As I sit here and look up, there’s Larry Fofonoff. It’s not Friday, so he’s not in my constituency office. He’s here in the Legislature to watch the proceedings.

What brings Larry here is not his love of politics, not his passion for debate, but, in fact, to see my colleague from Surrey-Newton table a piece of private member’s legislation that will provide more certainty and comfort for the people who live with Larry at the Hidden Valley manufactured home park and manufactured home parks right across British Columbia. Would the House make Larry very, very welcome.

Hon. S. Bond: I’m very pleased to be able to introduce a constituent today from Prince George–Valemount. He is probably the most important constituent I have, considering I have been married to him for well over three decades. His policy advice means a great deal to me. More importantly, his support allows me to do the job that I do.

As everyone in this House would know, we spend a lot of time apart, all of us in this work. I was delighted he tore himself away from our two grandsons to be able to come and spend a day or so with us here. Please make my husband, Bill, welcome today.

V. Huntington: It’s not often I have an opportunity to welcome my constituency assistants to the House. Would the members make Bernadette Kudzin and Yvonne Parenteau welcome.

Statements

TRADE WITH EUROPEAN UNION

Hon. N. Letnick: May 9 is celebrated as Europe Day. This year, we mark 40 years since the European Union opened its delegation in Canada in 1976, when Canada

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and the European Economic Community entered into a groundbreaking economic partnership agreement. In honour of this milestone, we are flying the European Union flag in front of the Legislature.

As an integrated bloc, the European Union represents Canada’s second-largest trading partner in goods and services. With the conclusion of the Canada-EU Comprehensive Economic and Trade Agreement, or CETA, our partnership will bring ever-greater prosperity to all our citizens.

Europe is one of Canada’s closest allies globally. We share a rich history of cultural, economic and social connections with many European nations. Would the House please join me in celebrating our vibrant relationship with the European Union.

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Introductions by Members

M. Mark: I’d like to introduce Roberta Robson, who is here to witness me bring forward a private member’s bill in this House this afternoon to bring greater protections forward for renters. Will the House please join me in welcoming this tremendous advocate.

P. Pimm: This afternoon I have in the House with me two guests. Jake Roorda is the CEO of Todd Energy. Jake looks after all of Todd Energy’s operations in the Fort St. John area. With him, Lynn Klein is also here today. Lynn is a Victoria resident and good friend. Would the House please help me make both of these fine people welcome.

A. Weaver: It gives me great pleasure to introduce two constituents, Katherine Farris and Kit Pearson. Both Katherine and Kit are local ambassadors for Ovarian Cancer Canada. In addition, they’re joined by my most amazing constituent assistants, Judy Fainstein and Teresa Hartrick, who are participating in the independent caucus constituency meeting at lunch today with the member for Delta South’s constituency assistant.

Finally, another group of individuals came today. They were the lucky winners of an auction at Oak Bay Preschool. The auction allowed them to get a tour of the Legislature by Richard Zussman, CBC host. I ended up meeting them and giving them the tour instead. Their names are Nelson Jewey, Roland Beauregard, Bob Beauregard and Mike Stacey.

Would the House please make all of these guests feel very welcome.

G. Kyllo: I’d like to introduce Dr. Stuart Edmonds, the vice-president of research, health promotion and survivorship of Prostate Cancer Canada. Prostate cancer is the most commonly diagnosed cancer among Canadian men. One in eight will be diagnosed over their lifetime.

I had the pleasure of taking

part in the prostate cancer Step Up Challenge this past February with one of my daughters, where we climbed a number of the tallest skyscrapers in downtown Vancouver. This event was also held in Calgary and Toronto and raised more than $600,000 for prostate cancer research and supportive care. Since 2001, Prostate Cancer Canada has invested over $20 million in research and survivorship initiatives in B.C.

Would the House please join me in welcoming Stuart to the House.

C. Trevena: I know that we’re celebrating Nurses Week here in the Legislature, and I would like to recognize a very special nurse who is here — Tania Dick, who comes from Kingcome Inlet. She is here. She’s a nurse practitioner. She’s a very, very strong and articulate advocate for aboriginal health. She is very excited to be here for at least the second year running — I know she was here last year — talking about nursing and how important it is for all of us. I hope the House would make Tania and all her nursing colleagues very welcome.

Hon. S. Anton: Also here as part of Nursing Week, I’d like to introduce three other people. It is an honour, first of all, to recognize and celebrate the nurses in our communities, whom we all depend on and appreciate, and these nurses, of course, around the province for their dedication to health care and the integrity and compassion with which they serve our citizens and families.

Today I’d like to introduce three additional women who are working to ensure that patients and families receive safe, competent care from nurses. They are leading the way to ensure that B.C. has a strong, responsive and forward-looking regulatory body for the nursing profession.

They are Kyong-ae Kim, the executive director for the College of Registered Psychiatric Nurses of B.C.; Michelle Molineaux, who is a College of Registered Psychiatric Nurses of B.C. board member; and Cynthia Johansen, the registrar and CEO of the College of Registered Nurses of B.C. They are part of the steering committee currently leading the effort to combine their regulatory colleges into a new one.

I will add a special add-on for Michelle Molineaux, who is my constituent, here from Vancouver-Fraserview. It’s always a pleasure to see people from Vancouver-Fraserview. Michelle is the co-founder and CEO of KoolProjects Media, and she is also the mother of Harrison, who is nearly ten years old and loves politics more than any other child of that age that I have ever met. It’s always a great pleasure to see Michelle and Harrison around in Vancouver-Fraserview.

Would the House please make these three members of boards and of these colleges welcome here today.

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M. Mungall: I appreciate all of the introductions for Nursing Week, but in my house, nursing week is every

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week. That’s because one of the nurses who is up in the gallery this afternoon is my husband, Zak Matieschyn. May the House please make him extra-special welcome.

Interjection.

M. Mungall: And yes, as the member for Esquimalt–Royal Roads pointed out, he is mighty handsome.

L. Throness: It’s my pleasure to introduce my beloved brother and sister-in-law, Leon and Carol Throness, today. They’re not only my closest relatives, but I also have the pleasure of having them as very close friends. They’re not always the same thing. As pastor of Chilliwack Alliance Church, Leon is also my pastor, and I must say he is an outstanding speaker and a gifted leader. Finally, it’s Carol’s birthday tomorrow.

Would the House please welcome them and wish Carol a happy birthday.

Hon. T. Lake: I feel obliged to stand up and apologize that I didn’t pronounce Zak’s last name correctly, as the member opposite did, and for failing to note that he is exceptionally handsome.

J. Shin: I think they’re just making their way in. I have the pleasure of introducing to the House the traditional Korean pottery and porcelain master Jung Hong Kim and his partner, Sang Soon Kim, along with some of their most dedicated students of the craft: Myung Sook Choi, Jin Yu Hwan, Kyung Sook Ha, Kyung Hee Han and Ji Sook Hwang.

Korean ceramics saw its most celebrated time during the three centuries of the Silla dynasty in the sixth century. Baekja wares is the highly refined white clay, and cheongja wares is the bit with iron powder that adds to its blue colouring, which is well recognized and celebrated around the world.

Master Kim has practised this art for over four decades now and, with his wife, brings their expertise and trade to countless enthusiasts and hundreds of students all across British Columbia as well as the west coast of North America. I’m very happy to have this time to be able to thank them for their passion in arts and culture as well as their community service.

Would the members please join me in making them feel very welcome.

Tributes

B.C. TEAMS AT NATIONAL ABORIGINAL

HOCKEY CHAMPIONSHIPS

G. Hogg: Canada’s best aboriginal midget-aged female and male hockey players have just returned from the 2016 National Aboriginal Hockey Championships in Mississauga, Ontario. Team B.C.’s male team won gold, and the female team placed fourth. This is the fourth year in a row that the male team has medalled, and it is one of the best results by the female team in the 15-year history of the championship. Team B.C.’s performance is a wonderful example of the success of the Aboriginal Sport, Recreation and Physical Activity Partners Council’s work to advance the development of aboriginal sport across B.C.

Would this House please join me in congratulating them and Team B.C. on their wonderful successes.

Introduction and

First Reading of Bills

BILL M226 — MANUFACTURED HOME PARK

TENANCY AMENDMENT ACT, 2016

H. Bains presented a bill intituled Manufactured Home Park Tenancy Amendment Act, 2016.

H. Bains: I move that a bill intituled Manufactured Home Park Tenancy Amendment Act, 2016, of which notice has been given in my name on the order paper, be introduced and now read a first time.

Motion approved.

H. Bains: It gives me great pleasure today to be introducing a piece of legislation that amends the Manufactured Home Park Tenancy Act to protect manufactured home owners from being evicted with no support when the site of their home is slated for redevelopment.

This group of people face unique obstacles and barriers when they receive an eviction notice due to the permanent nature of their dwelling and the high cost associated with relocating the manufactured home. Manufactured home parks exhibit nice, friendly communities where they look out for each other — neighbours helping neighbours.

During times when owning a home in B.C. is becoming almost a thing of the past, protecting manufactured homes becomes even more essential. By passing this bill, this House can help to protect the shrinking affordable housing stock. Manufactured home parks all across B.C. accommodate thousands of homeowners, most of them seniors and on fixed incomes. They need certainty and security that they will be able to live and enjoy the remaining years of their lives without the threat of eviction hanging over their heads. This bill goes a long ways to provide them with the certainty and security that they deserve.

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By amending sections 42 and 44 of the Manufactured Home Park Tenancy Act, this legislation provides protection for tenants in manufactured home parks in three primary ways: (1) requiring that a park owner provide 12 months’ notice of eviction when redeveloping land under any form of tenancy agreement; (2) requiring that a park

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owner, at the time of eviction, pay a tenant’s relocation expenses up to $30,000; (3) requiring that a park owner pay those tenants who are unable to relocate their manufactured homes because of the local building standards an amount equal to the fair market value of the manufactured home as compensation.

I move that this bill be placed on the orders of the day for second reading at the next sitting after today.

Bill M226, Manufactured Home Park Tenancy Amendment Act, 2016, introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

BILL M227 — residential tenancy

(PROTECTION FROM RENOVICTION)

AMENDMENT ACT, 2016

M. Mark presented a bill intituled Residential Tenancy (Protection from Renoviction) Amendment Act, 2016.

M. Mark: I move that a bill entitled Protection from Renoviction Act, 2016, of which notice has been given in my name on the orders, be introduced now for first reading.

Motion approved.

M. Mark: It gives me great pleasure today to be introducing a piece of legislation that amends the Residential Tenancy Act to provide more protection for tenants. It increases the amount of notice that a landlord must give a tenant in the event of renovations that require the tenant to vacate their residence and of conversion to strata title. It increases the compensation payable to tenants in these circumstances.

It also allows the tenant the right of first refusal, giving them the option of continuing residence following renovations or conversion and prohibits the landlord from raising the rent any more than would otherwise be lawful.

Finally, it allows the tenant increased time to pay overdue rent or dispute the eviction notice and increased time before eviction due to the non-payment of rent.

This act is an acknowledgment of the imbalance of power that exists between landlords and tenants, particularly with regards to many avenues available for landlords to eject tenants with very little notice and compensation. With this act, British Columbia recognizes and protects the rights and interests of tenants in a way that is fair and reasonable to landlords.

I move that this bill be placed on the orders of the day for second reading at the next sitting after today.

Bill M227, Residential Tenancy (Protection from Renoviction) Amendment Act, 2016, introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Statements

(Standing Order 25B)

STREAMKEEPERS SOCIETIES IN

WEST VANCOUVER–SEA TO SKY AREA

J. Sturdy: Streamkeeper volunteers in West Vancouver–Sea to Sky develop, promote and maintain best practices for protecting and sustaining fish populations in the creeks and tributaries across the region. Under the nationally recognized leadership of John Barker, winner of the 2015 Earth Day Canada Individual Hometown Heroes Award, the 200 members of the West Vancouver Streamkeeper Society focus their efforts on protecting and sustaining Pacific wild salmon stocks.

Members engage in many streamkeeping projects and work programs in the 22 creeks and tributaries in the district of West Vancouver. They manage a fish hatchery at Nelson Creek which produces 180,000 coho and chum fry each year for stocking in local streams. They work with elementary schools and include students in storm drain marking and habitat awareness. Secondary school students assist with spawner surveys in the fall and present their findings at municipal council meetings.

The Squamish Streamkeepers Society is also committed to Pacific wild salmon, but understanding and enhancing herring in Howe Sound is another important priority. Creosote pilings in wharves and docks are used by herring to spawn, but the creosote causes the roe to die. In partnership with Squamish Terminals, DFO and the municipality, the streamkeepers have maintained a program to protect herring eggs from creosote by wrapping the pilings. Their latest initiative is a new spawning float-line that is seeing huge success. In no small part because of the passion and actions of the Squamish Streamkeepers, these last several years have seen dramatic returns of Howe Sound herring runs.

The importance of the work of streamkeeper groups in West Vancouver–Sea to Sky cannot be understated. They bring attention to and focus energies on understanding and mitigating anthropogenic impacts on the marine environment, creating partnerships that focus on continuing ecosystem improvements and advocating and participating in citizen science, all to ensure that herring, dolphins, salmon and whales thrive as part of the future of Howe Sound.

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CONTRIBUTIONS AND ROLE OF NURSES

J. Darcy: Today is Nursing Week, and I would like to acknowledge every single one of B.C.’s 55,000 nurses. Nurses work in urban and rural-remote and indigenous communities in every corner of B.C. Today we celebrate all nurses — registered nurses, registered psychiatric nurses, licensed practical nurses, nurse practitioners and

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nurse educators, all of whom are here today. All of them play a critical role in all aspects of health care — in primary care, in the community, seniors care, public health, acute care, mental health and addictions, palliative care, and the list goes on.

Every single one of us has a story to tell about how nurses have made a difference in our lives and in the lives of our loved ones. Health care in B.C. would grind to a halt without nurses.

Nurses don’t just play an integral role in delivering health care; they also have so much to offer in improving health care. They can and should play a central role in the multidisciplinary teams that involve a wide range of health care providers that are so crucial to the future of public health care.

We could be utilizing nurse practitioners to a far greater extent to meet the primary care needs of all sectors of the population. Specialized teams that include RNs and LPNs are critical to innovations that can shorten surgical wait times. Registered psychiatric nurses could play a much greater role in caring for people living with mental health and addictions. Licensed practical nurses working to their full scope of practice can contribute so much in all aspects of health care. And all nurses can help us to refocus health care on prevention, not just on treating illness.

Today let’s thank the nurses who care for us every day with such compassion and skill. But let’s go beyond lip service, and let’s truly value their voices and their role in improving health care for all British Columbians.

MOUNTAINEERING AND MENTAL

HEALTH WORK OF BRENT SEAL

J. Thornthwaite: I would like to talk about a program close to my heart, the Edge high-performance wellness training program founded by trainer and adventurer Brent Seal, who, in his own words, is a dude that talks way too much about mental health and climbs mountains whenever possible.

In 2007, Brent was attending university when things took a turn and he found himself hospitalized in a psych ward. Brent would experience delusions and start believing stories he created, leading to an attempted suicide. Brent was diagnosed with schizophrenia. He was devastated and was no longer able to drive, go to school or hang out with his friends.

Despite his mental state, Brent held onto a dream of one day climbing Mount Everest and discovered that no person with schizophrenia had ever climbed it. This encouraged Brent to start climbing some of the world’s highest mountains and to compete in ultramarathons, while encouraging others who are struggling to turn their challenges into opportunities.

In February 2015, the Edge program was launched in six schools and two mental health programs across B.C., offering a six-week program of in-person and on-line training that provides students with tools to cope with high stress and hectic workloads, and high-performance wellness strategies to reduce stress and boost self-confidence.

The program provides a fun experience teaching students about mental health and ways to support themselves, friends and family. It has been a great success, allowing Brent to educate and empower more than 200 youth so far. It will be offered again in the fall of 2016.

Brent graduated as valedictorian from SFU’s Beedie School of Business and has spoken across the country at many high-profile events, including TEDx, where he has talked about his journey and how he went from feeling like he couldn’t do anything to being able to summit some of the highest mountains in the world.

Later this month, Brent will travel to Alaska to attempt to become the first person living with schizophrenia to climb Denali, North America’s highest mountain.

I ask the House to join me in thanking him for all he has done and in wishing him luck as he takes on his next challenge.

ARTS IN SCHOOLS AND SOUTH SLOPE

ELEMENTARY SCHOOL PRODUCTION

R. Chouhan: Sir Ken Robinson says that creativity is now as important in education as literacy and that we should treat it with the same status. Nowhere were these words more apparent than at the South Slope Elementary School in Burnaby during the week of April 19.

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Starting in January, Ms. Fiero, a talented music teacher for over 30 years, held auditions for the main roles to be cast in the musical production of The Lion King . Parents, grandparents, teachers, friends and relatives of teachers all put in a tremendous amount of extra hours to put on a production featuring over 250 costumed students from kindergarten to grade 7.

South Slope has an extremely diverse population, with over 31 low-incidence students, all of whom were involved in the play. The main cast also included three hard-of-hearing students, two autistic students, one student with severe social-emotional issues and a student with high anxiety, who shone while on stage.

The journey of producing a production of this calibre involved each and every staff member pulling together, collaborating, problem-solving and creating a polished product that will produce positive memories for the students. The importance of the arts in our schools is integral to the learning that goes on in classes during the regular school day.

One final quote from Sir Ken: “The arts are often seen as something that can be cut from the curriculum without adverse effects, and we have to justify the time we spend teaching the arts. Yet the arts speak to areas of children’s beings that are otherwise untouched.” Congratulations, everyone, for such a wonderful job.

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CONTRIBUTIONS AND ROLE OF NURSES

J. Yap: Seventeen months ago I received heart bypass surgery and spent two weeks in hospital. It was not easy. During my hospital stay, I was very thankful and blessed to have a team of professional health practitioners look after me. I especially would like to express my deepest gratitude to the team of nurses.

Providing day-to-day patient care continuously for 12 hours requires a lot of energy, compassion, patience and endurance. Some of the tasks are challenging and unpleasant, but nurses complete them in a professional manner. They not only provide care and help monitor patients’ conditions but also give emotional support to patients and their families. Nurses must be prepared to deal with any emergency situation at a moment’s notice and require great resilience, as well as observational, communications and people skills. Thank you to the team of nurses who took care of me during my stay in the hospital.

Nurses are a key pillar in our health care system. We need to support them to do this vital and challenging work. In March of this year, our government, in partnership with the B.C. Nurses Union, created more than 1,600 additional regular nursing positions to better support nurses on the front lines. We have also worked with the Health Employers Association of B.C. and the union to address overtime and workload issues and have been progressing well on that front.

Nurses in B.C. have been doing an excellent job taking care of British Columbians. I know that many of them are here today with us in the House in recognition of National Nursing Week, May 9 to May 15. Let us give them and all nurses a big round of applause.

OVARIAN CANCER

A. Weaver: Yesterday, May 8, was World Ovarian Cancer Day, and organizations around the globe shared what we need to know now about this disease. Ovarian Cancer Canada is the only national charity dedicated to overcoming this disease. Their members were meeting with elected representatives across the country in the lead-up to yesterday’s event. I was privileged to meet with Tracy Kolwich, director, Western region, for Ovarian Cancer Canada, and two local ambassadors for the organization, Katherine Farris and Kit Pearson.

Katherine, an ovarian cancer survivor, and Kit are volunteer advocates who, together with Ovarian Cancer Canada, are working tirelessly to raise public awareness of the need for (1) increasing funding for research; (2) ready access to new treatments as they become available; (3) improved access to genetic testing; and (4) genetic fairness to protect against discrimination based on genetic information.

In Canada today, approximately 17,000 women are living with ovarian cancer. It is the fifth most common cancer for women and the most fatal women’s cancer in Canada. Each year approximately 2,600 women are newly diagnosed, and every year ovarian cancer claims the lives of 1,750 Canadians.

Ovarian cancer is difficult to detect and can easily be overlooked because its symptoms can signal a variety of conditions, including abdominal discomfort. Because this disease is often caught in late stages, 70 percent of women diagnosed die within five years of diagnosis. There’s no reliable screening for ovarian cancer, and there is no vaccine to prevent it.

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Ovarian Cancer Canada undertakes a number of important initiatives, including providing support for women and families living with the disease; raising awareness and implementing education programs about ovarian cancer; providing and advocating for research funding, including through a new partnership with the Terry Fox Research Institute.

Please let me acknowledge the important work being conducted by Ovarian Cancer Canada. Please let me also applaud the ongoing efforts of two of my constituents, Katherine Farris and Kit Pearson, who continue to work tirelessly as ovarian cancer advocates.

Oral Questions

GOVERNMENT RESPONSE TO YOUTH DEATH

CASES AND PLACEMENT OF YOUTH IN CARE

J. Horgan: Time and time again, we’ve risen on this side of the House and asked the government questions about their approaches to children in care, the youngest, most vulnerable people in our society. And time and time again, the minister has said we should do better.

Whether it was the case of Alex Gervais, the case of Carly Fraser, J.P. or, of course, the case of Paige, it was always the same refrain from the minister. But we now have a report from the Children and Youth Representative entitled Approach With Caution , in which the representative lays out for the government and the public the concern she has: about a year after the Paige report, no progress has been made.

Although we don’t have complete information on the individual in question, the representative and, I understand, the ministry, as well, felt there was sufficient information to be released as a cautionary tale. I want to raise that with the minister today.

This young woman lived in a group home until the group home was closed. Then she was moved into a single-occupancy room in the Downtown Eastside until that didn’t work. Then, finally, she was placed in incarceration and jailed.

My question to the minister is: does she really believe that there are not better ways to address challenges for young people in British Columbia than putting them in jail?

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Hon. S. Cadieux: I agree with the representative that this is certainly a unique report, and I understand the representative’s intent here. But we must be cautious as we discuss this in the House, as the subject of the report is a child in care.

Now, the Paige report identified for the public something that our staff and service providers certainly know all too well — that there continues to be a group of young people in the Downtown Eastside of Vancouver, and in other parts of the province, that we consider to be high risk. This report certainly provides nothing new, no new information, in that regard.

The ministry does know what steps need to be taken, what steps will be taken. And I’ll have more to say on enhanced services for high-risk youth in the coming days. But it would be incorrect to allow the record uncorrected in the fact that nothing has changed or nothing has been done.

We have, as a result of what we’ve learned from Paige’s death and from other youth that we work with, brought in a rapid response team model in the Downtown Eastside to better coordinate the services that are delivered. We reminded all of the service providers in Vancouver and area of their duty to report.

We’ve examined across jurisdictions how others deliver services to youth in this age group and how our services stack up against that. As a result, as well, we now automatically review any death of a 19-year-old who was, in the past 12 months, in the ministry’s care.

Madame Speaker: The Leader of the Official Opposition on a supplemental.

J. Horgan: Again, I don’t know what record the minister is correcting. The representative said: “One year after Paige , the representative would have contemplated a complete revamp of the provincial approach to youth mental health, addictions and homelessness. Sadly, that has not materialized.” That strikes me as no progress.

The representative went on further. It’s a lengthy quote but, I think, appropriate for today. She said: “This young person was well known to the police and had periods of incarceration in youth justice facilities. This incarceration was not an effort on the part of police or the ministry to ‘punish’ the young person for their behaviours but was a well-intentioned effort to remove them from situations of imminent risk” — using only the most clumsy of mechanisms.

Now, I can understand, and I know the minister will full well express some empathy for the staff that are put in these precarious situations where they have to make a decision.

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But surely to goodness, after the years and years of raising these questions, the multiple years that that minister has been on the file, it is absolutely not appropriate, after Paige, to be able to stand in this place and say: “There are no group homes. There are no supportive services. The last resort is jail.” That’s not acceptable.

When will you actually deliver for these kids rather than just rhetoric in this Legislature?

Hon. S. Cadieux: For the member, let’s just provide a little bit of fact. The reality is that for any child or youth that comes into the care of the ministry, the best circumstance is a family setting with caregivers that are capable of providing for that child’s needs. But where there is an instance of a youth or child whose behaviours or individual needs or circumstances require more intensive or specialized supports than foster parents can provide, that support may be provided through a group home or other type of facility. In fact, just so the member is aware — because he suggests there aren’t any — there are currently 908 children and youth staying in 108 of those types of facilities.

I think what the member is trying to get at is the reality that despite the fact that there is a broad range of services available, in terms of child and youth mental health services across the province — residential treatment, community-based services, services of psychologists and psychiatrists, child and youth mental health counselling programs and so much more…. Despite that, the reality is that all of those services are voluntary.

It is widely agreed that voluntary services such as detox, residential treatment and mental health counselling are all most effective in addressing addictions and mental health issues when they are voluntarily accessed. Going beyond those limitations through the justice system, the Mental Health Act…. Those voluntary services would require specialized legislation authorizing the involuntary detainment of youth. If the member is suggesting that we move toward incarcerating youth who are refusing to access services, he should just say so.

Madame Speaker: The Leader of the Official Opposition on a supplemental.

J. Horgan: I’m not suggesting that. The children’s representative is suggesting that’s exactly what’s happening now. It’s the court of last resort for the ministry, for social workers. When they don’t have appropriate tools to address addiction and mental health, the last option is the justice system.

The representative, again…. This is the independent officer speaking here, and she said the following: “The youth justice system was used as a substitute for social services, something that is prohibited by the Youth Criminal Justice Act….”

Interjections.

Madame Speaker: Members.

[ Page 12844 ]

J. Horgan: I don’t know if I can get through this, hon. Speaker, unless the Minister of Health has something to add.

Interjection.

Madame Speaker: Minister. Minister.

Please continue.

J. Horgan: Thank you, hon. Speaker.

The representative went on to say: “Something that is prohibited by the Youth Criminal Justice Act but is, nonetheless, sometimes still used in practice to prevent life-threatening situations when no services are available.” The end result of that is that after years of reviews and years of reorganizations, we’re still at the same place we were when this government started 16 years ago. Children are at risk, and the services are not there for them.

My question to the minister is: isn’t it past time that we don’t appoint another Bob Plecas, that we don’t appoint another review and that we listen to what the representative has been saying since the day she arrived here and provide appropriate services for kids at risk?

Hon. S. Cadieux: Certainly, I believe that it’s important that we provide services to kids at risk, to vulnerable families. Hopefully, we’re able to intervene at an early enough point that those children never come into care and never require those very intensive services, but that is not always the case.

[1415]

The child- and youth-serving system, in terms of child protection and foster care, is well resourced. We have amazing social workers. We have amazing people on the front lines delivering those services. It is a system that is always evolving to the changing needs of the children and youth and families that we serve.

On the child and youth mental health side, the same is true. There are resources that are improving around the province all of the time to adapt to the change in the demands on the system, the change in the complexity of the children and youth presenting and their unique and individualized needs.

There will always be more to do. This side of the House is absolutely committed to continuing to see those improvements occur.

D. Donaldson: The most troubling aspect of the representative’s report is that we’ve heard it before. Despite countless promises by the minister to improve the child protection system, we are still faced with cases that are like Paige’s and like Alex’s.

The representative went on to say this about the young woman’s situation. “Attempts to provide foster placements were likewise short-lived and largely unsuccessful, with the young person being placed in a hotel when first brought into care because no resources were available.” She was placed in a hotel alone, just like Alex and just like Paige. Worse, she was sent to jail.

Can the minister tell the House how many times her ministry has housed youth in jail as a care option?

Hon. S. Cadieux: Again, I certainly understand where the representative was going with this report. As I’ve said, there is nothing in this report that is new or different. We have to…. I urge…

Interjections.

Madame Speaker: Members.

Hon. S. Cadieux: …the members opposite to respect that there is a youth, who is in care, who is the subject of this report. As the youth’s parents, the director of child welfare, along with the Public Guardian and Trustee, must ensure that that youth’s voice is heard and that best interests are addressed. As such, I think it is important that the members of this Legislature also respect that details of this report should be touched on very carefully.

That said, as I said, we have a robust system of services, a robust system of supports, and we will continue to make improvements to them.

Madame Speaker: The member for Stikine on a supplemental.

D. Donaldson: How robust is the system when you’re using jail as a form of care for children in this province? All we’re asking the minister is: how many times has she used jail as a care facility for children in this province? She can’t answer.

Let’s look at the minister’s credibility. After Alex Gervais died, she said no children in care were housed in hotels. It was against policy. Then she had to say: “Well, maybe there were a few.” Then her own report showed that over 100 children were housed in hotels. So then she said: “Well, the new policy is to say no hotel stays.” But apparently, jail is okay.

Why on earth is this minister still sending vulnerable youth to live alone in hotels? Or is this government’s solution to send them to jail instead?

Hon. S. Cadieux: Certainly, as we’ve canvassed in this House before and as I’ve said on multiple occasions outside of this House, a hotel is never the right choice for a child or youth in care.

[1420]

There are, unfortunately, some unique circumstances that occur. When a child or a youth is brought into care in the middle of the night on a weekend, in a province the size of ours, we have to find the most appropriate and safe place for that youth at that time.

[ Page 12845 ]

Again, there are resources around the province, comprehensive resources a around the province, to also care for children and youth with mental health and substance-use needs. All of those services are voluntary. We have to accept and understand that some youth are extremely resistant to those services. It is our job to continue to offer those services to them, to make them aware of what we can do to support them, so that when they are ready, they will access those services and supports.

At this time, we do not have the authority, unless that child or youth is in conflict with the law, to use the justice system as a way to provide treatment. At this point in time in British Columbia, we do not have legislation that allows for the involuntary incarceration of youth for mental health supports. If the member feels that is worth pursuing, he should say so, but we are constantly reviewing whether or not that would be a useful tool in British Columbia and whether or not we would choose to enact that.

YOUTH DEATH CASES AND

IMPLEMENTATION OF

REPORT RECOMMENDATIONS

C. James: I cannot believe I heard the minister actually say that there are comprehensive services for children and youth with mental health in this province. There have been reports after reports after reports that have pointed out that there are not comprehensive services. We are going to continue to speak out to respect those youth in British Columbia.

The representative makes it very clear that this young woman is facing many of the same challenges that Paige faced. She makes it clear that the B.C. Liberals have not done enough to make life better for youth like that. She says: “A year after Paige’s Story was released, the representative is discouraged that the work done to profile this cohort of vulnerable young people has not yet translated into action.”

I’ve heard this minister talk about changes being made. I’ve heard those words over and over and over and over again from this government. Those words are hollow to the youth who are not getting the care that they need and they deserve.

To the minister, why has she not implemented, fully, the Paige report?

Hon. S. Cadieux: Well, again, I guess they weren’t listening, because there has been a lot of work since the Paige report. In fact, we went beyond the recommendations of the Paige report in implementing the rapid response model in the Downtown Eastside so that we could better coordinate services, so that we could make sure that if there were improvements to be made, those recommendations on what was needed could come up.

This is not news — the fact that there are vulnerable children and youth living in the Downtown Eastside, the fact that it in fact acts as a magnet for some children and youth with high needs and high-risk behaviours. It is not news to us nor to all of the service providers and front-line workers in the ministry.

It is a reality in our society. It is something that they work with every day, working with those youth, trying to connect them to services, to have them step forward and say: “Yes, I want to accept that help.”

It is about being there. It is about repeating and repeating and repeating the offers of support, earning the trust of those youth. Our workers are doing that every day. As a result of the Paige report, we did a comprehensive review of over 120 kids in the Downtown Eastside, looking specifically both to ensure their safety and at what, if anything, could be done differently.

I said earlier in my answers that we know what steps need to be taken. We know where the gaps are. I will have more to say on enhanced services in the next couple of days.

[1425]

Madame Speaker: Victoria–Beacon Hill on a supplemental.

C. James: Well, it should be news, and it should be discussed every single day when we are failing children in care in this province.

Let’s remember. This is the government that got rid of the independent office for children and youth. This is the government that cut services and cut supports for vulnerable children. So excuse us if we don’t always believe this government when they talk about supporting children and youth.

We have heard action be promised before. What have we seen? We’ve seen nothing done to support vulnerable youth to make sure that they don’t age out without supports and without homes. We haven’t seen a discussion begin around secure care. We see a rapid response team that’s in place with no resources, no new resources, to actually help youth.

Once again, how many youth are going to fall through the cracks before this minister and this government will actually act for them?

Hon. S. Cadieux: So that the member understands the work on the Downtown Eastside, the rapid response team, in its very first few months of operation, had the opportunity to better connect with youth and ensure that 38 youth were able to access services that they either didn’t know existed or weren’t previously accessing. Some returned home to family in other parts of the province. Some accessed mental health supports, medical treatments, got their first government-issued identification.

The work on the Downtown Eastside with youth is complex, it is difficult, and it takes time. The supports

[ Page 12846 ]

that are available are intense. There are government service providers, government offices and supports through MCFD, service providers that offer outreach workers. There are housing options. There are mental health supports. There are health and wellness supports. There are plenty of supports and services, and as I said, we will be able to announce shortly some additional supports in that area.

WATER QUALITY IN SPALLUMCHEEN AREA

G. Heyman: Several days ago the Environment Minister repeated her claim that there’s no urgency to protect Hullcar aquifer drinking water with a moratorium because, she said, there’s been no manure spraying since last year. Yet area residents report the opposite. They say the largest dairy farmer in the area is spraying effluent heavily and repeatedly this spring.

The Environment Minister challenged the professional opinion of three Western Water Associates’ hydrogeologists. She quoted ministry staff, including biologist Carrie Morita. Yet in a ministry memo concerning Hullcar aquifer contamination, Ms. Morita herself made a recommendation that says, “A more definitive study would likely require the expertise of a hydrogeologist with experience in agricultural areas” — a hydrogeologist like the three who accused the ministry of insufficient concern for public health.

When will the minister make public health and the environment her foremost concern, stop ignoring evidence and experts and impose the moratorium that will end further contamination of Hullcar residents’ drinking water?

Hon. M. Polak: I want to be very clear that we believe that when people’s drinking water is being impacted, that is an urgent matter. It’s one of the reasons that we have around 18 of our staff in the ministry working directly on this file. The member may be interested to know that those staff certainly review any information provided to them, including the information provided from the hydrogeologists that sent in their letter.

[1430]

Far from ignoring the expertise that those individuals may have, what is important for us to do in the ministry is to pay attention to the years and years of experience represented by the professionals on our staff who are diligently working to try to find solutions for an aquifer that’s in trouble and needs to be improved.

HEALTH CARE WORKER LAYOFFS AT

SENIORS CARE FACILITY IN NANAIMO

J. Darcy: Very soon frail seniors at a care facility in Nanaimo, many of whom suffer from dementia, will have their care severely disrupted; 155 staff at Wexford Creek care home, three of whom are here today, are being fired. Why? Because the care at the facility — the services — are being contracted out because there is insufficient funding from Island Health, insufficient funding from this government.

We know that continuity of care is absolutely critical for frail seniors, that they form incredibly close bonds with the staff who care for them. And we know that these repeated rounds of layoffs are harming our frail and vulnerable seniors.

My question to the Minister of Health is this. Will he intervene today to ensure that care for these frail seniors is not disrupted by throwing these dedicated care staff out on the street?

Hon. T. Lake: The ability to contract out was confirmed and agreed to by both unions and health employers as a mechanism to ensure our system remains sustainable, but the quality of care and safety of residents is a priority for our ministry and for health authorities.

The reality is that the service agreement between Good Samaritan and Island Health was the result of an open and competitive process, and Island Health has advised me that it funds the society at an equivalent level to what other health authorities pay Good Samaritan for the same services in other health authorities.

We have changed the residential care services manual to ensure that should this type of change occur, the health authority ensures that the quality of care for the clients is maintained, and we work very closely with clients and their families to ensure that that happens.

AND TELEPHONE SERVICE

M. Mungall: For over a year now, the Minister of Social Development has insisted that the 1-800 number that people with disabilities call to get help with their supports has wait times of only ten minutes. Now, I don’t know why she says that, because her ministry’s own documents show, through a recently obtained FOI, that wait times are well over an hour. This January people with disabilities were on hold an average one hour and 47 minutes. Two years ago it was half an hour. While this minister claims that she’s on top of this, wait times have actually tripled.

My question is: why has the minister been saying that wait times are going down when, in fact, they are going up?

Hon. Michelle Stilwell: I’m acknowledging that the telephone system is actually there and put in place to help give our clients more flexibility in how they access the services that we have within the ministry.

I will note that I have made significant changes within the phone system to help with those wait times. In fact,

[ Page 12847 ]

we have hired 35 new employees at the staff centre. We have also changed the shift so that there is a shift that runs between four o’clock and six o’clock, after the phone lines have not received any more phone calls, so that we can get down the actual wait times in the callback features so that when the staff come back to work the next day, they are not working on the backlog of calls.

That being said, I would request that the member opposite perhaps look into the most recent, up-to-date wait times that we have, because we have seen significant decreases. In fact, I’ve had many results where the average wait time is only ten minutes.

Madame Speaker: The member for Nelson-Creston on a supplemental.

[1435]

M. Mungall: We’ve heard this ten-minute line before in this House. I’ll say the minister has made significant changes. We’re at an hour and 47 minutes now. That’s where we’re at.

Just imagine. You pick up the phone to get urgent help. One hour and 47 minutes later somebody actually answers you, and that’s if you were able to stay on the line, and that’s if you had enough money on your pay-as-you-go phone Talk Time card.

But if you had $25,000, you wouldn’t have to wait at all, because you’d be able to buy a seat right next to the Premier. For people with disabilities living in poverty, they get a bus pass clawback and they get increased wait times when they need to get on the phone, while the rich get a seat at the Premier’s dinner table, they get tax cuts…

Interjections.

Madame Speaker: Members.

M. Mungall: …and they get access.

My question to the minister: does someone need $25,000 just to get this government to pick up the phone?

Interjections.

Madame Speaker: Members. Members.

Minister.

Hon. Michelle Stilwell: Thank you, Madame Speaker.

The member opposite continues to spin things so that the story can benefit her in any way she wants. We have a callback feature. People don’t have to wait on hold. They can actually enter their number and wait at home and have a callback received. Our clients…

Interjection.

Madame Speaker: Member. Member.

Hon. Michelle Stilwell: …can also always come, face to face, to a ministry office to be treated by a staff member….

Interjections.

Madame Speaker: This House will come to order.

Please continue.

Hon. Michelle Stilwell: Again, we’ve hired up to 55 new staff members to help assist with the phone wait times.

I would be happy to assist the members opposite to give them the actual numbers that we have been receiving in the last several weeks — noticing that obviously there are cheque-issue days and other times of the month when we see increased calls. But on average, these days we’re seeing low wait times, anywhere from an average of ten minutes to 12 minutes.

[End of question period.]

J. Darcy: I seek leave to introduce a petition.

Madame Speaker: Please proceed.

Petitions

J. Darcy: I’d like to present a petition that calls on the B.C. Minister of Health and Vancouver Island Health Authority to intervene and stop the proposed contracting out of staff at Wexford Creek care home in Nanaimo and put the facility under direct administration, in the interests of preserving community continuity of care for residents.

Orders of the Day

Hon. M. de Jong: In both

Section A and

Section B, Committee of Supply — in

Section A, the estimates of the Ministry of Natural Gas Development and for Housing; and in this chamber, the ongoing estimates of the Ministry of Health.

[1440-1445]

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

The House in Committee of Supply (Section B); R. Lee in the chair.

The committee met at 2:49 p.m.

On Vote 29: ministry operations, $17,820,706,000 (continued) .

[1450]

[ Page 12848 ]

Hon. T. Lake: With me I have my deputy minister, Stephen Brown. I have the ADM for population and health, Arlene Paton, and behind me, Jen Erickson, who’s executive director in that division as well.

I look forward to the estimates this afternoon.

B. Ralston: I have a question I’m asking on behalf of Shirley Hill, who is a constituent in Surrey-Whalley, on behalf of her deceased husband, Jack Hill. I’m going to read briefly from a letter she wrote me and then pose a question.

“On February 21, 2013, Jack died of a perforated bowel a month after surgery at Royal Columbian Hospital in New Westminster to remove an adrenal tumour. Prior to surgery, Jack spent 31 days and nights sleeping in the halls at RCH. During his 31 days of roomlessness in the corridors, he had to unplug and drag his IV and find available public washrooms in the semi-darkness of the hospital corridors. Jack needed sleeping pills to be able to sleep under the stress.

“He fell twice in the hall. He was checked for concussion after the second fall. The bleeding and scabbing on his mouth were still present when he died.

“He had none of the privacy needed for doctor consultations or to make decisions or process the grief that came with his diagnosis.”

Jack told Shirley that if he survived his experience at the Royal Columbian Hospital — which, regrettably, he did not — he’d work to change the treatment for seniors. Jack was, in fact, a proud advocate for Canada’s public medicare system. He was cremated wearing his Seniors on Guard for Medicare badge.

The patient care quality office of the Fraser Health Authority did an investigation and wrote a report. Shirley Hill tells me that that report is completely inadequate and answers none of her questions that she posed to the investigators.

Will the minister agree to a further investigation of the circumstances surrounding Jack Hill’s death at Royal Columbian Hospital?

Hon. T. Lake: As the member knows, I’m always happy to meet with MLAs on constituency issues. In this case, this is the first that I’m hearing of this, so I’d encourage the member to certainly follow up with me in our office, and we can assist his constituent and him rather than using the estimates process.

I can say this. The Royal Columbian Hospital is undergoing phase 1 of a multiphase redevelopment, the first phase being almost $260 million. This is one of the busiest hospitals in the province. It’s undergoing a very large renovation over the next seven to nine years.

However, having said that, it also provides outstanding care. I’ve been to Royal Columbian Hospital. I know the people there do an outstanding job.

Now, having said that, it is not…. Health care is a complex matter. When there are concerns that are raised by patients or their families…. This is the government that instituted patient care quality offices, where those concerns can be heard. We also have the ability to do reviews, under

section 51 of the Evidence Act, to ensure that all of the appropriate information is gathered in a safe environment so that we can learn from any situation in which an error may have occurred. I’m not saying that it did in this particular case, but those are the options open.

If a family is not satisfied with the answer they get from the patient care quality office, they can take that concern further to the patient care quality review board, which are provincial boards which will review each and every one of these cases where the constituent or the patient or the family is not satisfied with the answer and the explanation provided by the patient care quality office.

J. Rice: My first question will be, to the minister…. Well, my questions are in regards to rural and northern health. Specifically, for the minister’s staff, the areas that I’m hoping to cover today are around patient travel, including the travel assistance program, the patient travel network, telehealth, rural surgery and maternity and particularly around child health as well.

My first question will be in regards to the minister’s service plan and objective 2.5: “Sustainable and effective health services in rural and remote areas of the province, including First Nations communities.”

[1455]

In regards to the goal “to implement a renewed approach to providing quality health services across rural and remote areas,” the three strategies, if the minister could comment on the three strategies. “Develop local community plans for rural and remote communities to create environments that foster healthy behaviours to improve the health of the population.” The second strategy: “Improve access to services through the establishment of regional and provincial networks of specialized care teams.” And the third strategy: “Improve timely recruitment and deployment of health professionals to rural and remote communities.”

My question would be: could the minister comment on those three strategies and where he’s at with that?

[1500]

Hon. T. Lake: One of the areas that the ministry looked at when we began our work in 2013 was to look at a number of priorities for the health care system, one of which was centred around rural practice and rural health care. We held a symposium at UBCM and sought input from local governments and presented the draft paper that we were creating and got some very positive feedback on that paper.

Of course, the Ministry of Health service plan reflects some of the major themes that came from that strategic paper, developing local community plans that help create environments that foster healthy behaviours. That’s a population-based approach that is very much on the prevention side of things.

[ Page 12849 ]

HealthyFamilies B.C., for instance, has HealthyFamilies B.C. Communities. It is an organization that brings together local governments; health authorities; First Nations and aboriginal communities; divisions of family practice, which are the physicians in the area; as well as non-governmental organizations in environments that help people plan to make healthier choices. There are a number of tools and training programs through its partners, like the B.C. Healthy Communities Society’s PlanH program and the Community Health Profiles, which has been developed by the community health services authority.

We’ve got about 97 incorporated municipalities, which is about 60 percent, that have partnership agreements with their regional health authorities to improve the health and well-being of the communities. About 50 percent are implementing healthy-living strategic plans in partnership with their respective health authorities. So that is a way of combining with local governments.

It can be around food security. It can be around planning to create healthier environments, make them more walkable — all of the different initiatives that can lead to a healthier population. Smoking policies that are enacted by local government would be another example.

We also have Healthy Schools B.C., which is, again, another initiative of the HealthyFamilies B.C. framework. It strengthens health-education partnerships and builds capacity of both sectors to implement healthy school initiatives using sort of a population-based approach. That includes things like the B.C. school fruit and vegetable nutrition program, which provides B.C.-grown fruits and vegetables to students in 1,464 registered schools, and also the farm to schools program, which is funded through the Provincial Health Services Authority.

That increases access to fresh, local fruit and vegetables in 126 different schools and also connects them to agriculture so that they understand the importance of that.

Those are the ways that we develop community connections with local communities, local school boards, to try to take a population-based approach to increasing the health of the population.

In terms of improving access to services, in our rural priority strategic paper that we looked at, we looked at all of the 64 health service delivery areas in the province of British Columbia and basically said: “If you’re in this size of a community, here’s what you can expect.” It created pathways for patients and service providers to understand what and how they could connect up through the continuum of care.

[1505]

If you’re living in a community like Vanderhoof, for instance, you will not have all of the levels of specialized care that you would have in a more urban centre that is relatively close, and that’s Prince George. So trying to connect those communities that…. Obviously, in Vanderhoof, you’re not going to have the level of surgeons and you’re not going to have the level of specialists that you would have in Prince George — so forming connections between the physicians in the smaller community, in this case Vanderhoof, with specialists in Prince George to make sure that the patient’s journey is as smooth as possible.

The other big part of connecting access to more specialized care is through the use of telehealth. Telehealth is an ability, particularly for follow-up care with specialists, to have facilities in the smaller community where a nurse may be sitting with the patient and you’ve got telehealth equipment that connects you directly with the specialist at the other end. When I was in Prince George, at UNBC, at the hospital there, I saw exactly how this was set up. The practitioners there were very complimentary about the way that service worked.

Interior Health Authority has also developed telehealth to an extraordinary level. They told me that the number of miles that they have saved for patients having to travel from more rural areas into more urban areas to seek specialist care would equal something like 64 trips around the earth. That tells you the level of time and, of course, inconvenience that has been saved by providing the opportunity for telehealth connecting more urban centres with more rural centres.

Another good example was demonstrated in Kelowna, where a neurologist, through the technology, was able to communicate with another neurologist in a hospital in the Kootenays. The practitioner in the Kootenays did not have the authorization to order a stroke-busting drug. These are drugs that are injected shortly after a suspected blockage in an artery to the brain is diagnosed. You want to make sure you’ve got the right diagnosis before you administer that drug.

Through the telehealth, the neurologist in Kelowna was able to talk directly to the patient, to look at the CT scan and to say: “Yes, this is one of those cases where you need to administer the drug.” Again, that’s an example of connecting specialist services into rural areas.

The last area was about recruiting and retaining health professionals in more rural areas. Now, that is, as the member knows, because we’ve had this discussion many times over the years in question period, a challenge. It’s a challenge for all areas of North America. But there are a number of programs that we utilize in order to attract people in health professions into those smaller communities.

First of all, we have a distributed medical health education program. We don’t just train physicians in Vancouver. They’re trained on the Island. They’re trained in the Interior. They’re trained in the north. We are seeing that physicians that go through that training often will practise in those areas. They’re not just all staying in the Lower Mainland. They’re actually practising in Northern Health. They’re practising in Interior Health.

Currently we have 12 family practice residents doing their two-year family practice residency program at Royal Inland Hospital in Kamloops. That was not there

[ Page 12850 ]

up until about two years ago. These family practitioners get to see how great communities like Kamloops are, and they do part of their rotation in the smaller communities in the area, so they understand what it’s like to practise in rural areas and often will choose to do that for the rest of their career.

Through the Joint Standing Committee on Rural Issues, which is a combination of the ministry and the Doctors of B.C., with money that has been injected through our physician master agreement — over $100 million, by the way….

These are rural programs that attract professionals in, including the rural retention program, the rural continuing medical education program, the rural emergency enhancement fund, the rural incentive fund, the recruitment contingency fund, the isolation allowance fund, the northern and isolation travel assistance outreach program, the rural GP locum program, the rural GP anaesthesia locum program, the rural specialist locum program, rural education plan, supervisors for provisionally licensed physicians and, of course, the Rural Coordination Centre of B.C., which is a forum to support rural physicians in their ongoing professional development.

[1510]

We also have loan forgiveness programs for other health professionals if they will practise in rural areas as well.

Finally, we are seeing the results of the work that has been very successful in our practice-ready assessment program. This is a program that is designed to take physicians that have been practising overseas, who may come here from another country, and they will work in a three-month rotation with physicians in one smaller community in British Columbia and then move to another smaller community for a period of, I believe, two to three years as a return of service for the practice-ready assessment program.

We’ve seen PRA physicians locate in Ashcroft recently and in Logan Lake and a number of other areas of the province that were experiencing chronic physician shortages.

J. Rice: I’m going to ask a question in regards to mental health and substance-use funding within the Northern Health Authority. The projections and the actuals have seen a downward trend of about 8.8 percent from the original estimated amount. The same trend was repeated in this fiscal again, where $54 million was originally projected in the 2012 service plan, but the actual amount spent decreased to $49.7 million, representing a total decrease of 8 percent from the original estimated amount in 2012.

My question would be, to the minister, twofold. Can he explain the justification for the decrease? And basically, why are we underfunding mental health services in northern British Columbia?

Hon. T. Lake: I don’t have the specific numbers as to budgeted versus actuals. I can tell the member that in 2012-13, Northern Health spent $50.574 million on mental health and substance use. That dropped slightly in ’13-14 to $48.794 and then increased again to $49.677 million in 2014-15.

[1515]

I can say that when you look…. One of the likely explanations is a recruitment lag. We talked about the challenges of recruiting health professionals to rural areas, and the north, of course, has more rural areas than any other health authority. It may be that positions are posted, the budget is there for those positions, but they can’t fill them, so the actuals aren’t as high as the budgeted amounts. And then we saw a rise from ’13-14 to ’14-15. So there may be a recruitment lag there.

I think what’s important, if you look at 2015-16, is the budgets per capita. If we look at the different health authorities and what their budgets for mental health and substance use are per capita, Vancouver Coastal is the highest, at $254 per capita for mental health and substance use. Northern Health is at $195 per person. That puts it in the middle of the pack. Island Health is a little bit above that, but Interior Health and Fraser Health are below that.

Northern Health is certainly spending a relatively high amount per person. Again, because of the distances involved in northern health delivery, it’s not unusual for them to have to spend more per person than the equivalent type of health authority in a more concentrated area.

J. Rice: I’m going to move on to the Patient Transfer Network. Could the minister explain how the B.C. Patient Transfer Network works and how the organization is structured?

Hon. T. Lake: B.C. emergency health services has taken over responsibility for the Patient Transfer Network.

[1520]

Unfortunately, those officials were here last week dealing with questions around B.C. emergency health services, so they’re not here to help answer questions.

I don’t have the complete history of when the transfer occurred. If there are specific questions the member has, I can certainly commit to providing those in writing.

J. Rice: I was unable to be here for part of last week. I do apologize for that. I would appreciate the questions and answers in writing.

My next question in regards to that is: how many vehicles, helicopters and planes does the B.C. Ambulance Service have available to use for patient transport? I’m not sure if these will be taken in writing or if the minister is able to answer any of these, but I welcome that. How does the BCPTN go about facilitating patient transfer with the B.C. Ambulance Service? Specifically, how does

[ Page 12851 ]

it make a determination about whether to use a vehicle or a helicopter or a plane?

I had a question specific to a particular area of our province. I wanted to know what method the B.C. Patient Transfer Network typically uses to transport patients from the Discovery Coast in the Bella Coola and Bella Bella area and why it uses that method.

One last question in regards to that was specifically around how…. I don’t know how to say it any simpler. What do they use to check the weather? I’ll just describe that. Basically, it’s been brought to my attention a few times that in Bella Coola, specifically…. There are sunny skies, blue skies. The scheduled flight is regularly landing and taking off, but the PTN is unable to be deployed because they’ve determined that the weather is too risky. So I had some questions around what they are using, specifically, to check the weather.

I’ve heard stories of physicians on the phone basically begging for a pickup of a patient, one who had a heart attack, but they wouldn’t deploy because their weather-detecting systems detected inclement weather. The physician was there looking up at the sky. It was blue, and a scheduled flight had just landed.

Those are my questions around the Patient Transfer Network. I’m not sure. Does the minister want to answer some of them now?

Hon. T. Lake: We’ll have to have B.C. emergency health services provide written responses through me to the member. I can only speculate that there are different standards for helicopters versus fixed-wing. Of course, there’s not just the weather at the site of the patient pickup. Obviously, the site of the patient arrival comes into play when these situations arise.

We will find answers to those questions and provide them to the member.

J. Rice: I’m going to ask some more questions around travel and transport — the inequity in rural and remote health, or one of the major ones, in my opinion.

In 2014, I asked the minister to adjust the TAP program, the travel assistance program, to alleviate the financial burden for families flying out of remote communities for medical attention. At the time, he said: “We are always reviewing the travel assistance program.”

Can the minister provide me an update on where the TAP review is at? Is the ministry planning on making any adjustments? Will people in communities such as Haida Gwaii and Bella Coola be provided more financial assistance to travel for medical attention?

[1525]

Hon. T. Lake: The patient travel assistance program is to help access, particularly, specialist services where those are not available in the patient’s local community. While it’s not feasible to cover all medical-related travel costs or all travel needs, they do help provide support to patients that do need to travel for health care. We talked about telehealth and how that’s really cut down on the need to travel as much. Regardless, there are still times when patients do need to travel, particularly to see a specialist, particularly for first-time assessments,

whereas you can use telehealth for follow-ups.

The travel assistance program. There are a number of aspects to this. There is a corporate partnership between the Ministry of Health and some private transportation carriers, and it’s coordinated by the Ministry of Health and those partners that agree to waive or discount the regular fees. Participation is voluntary on the part of the private transportation carrier. They are an important part of this program.

Now, the largest partner is B.C. Ferries. I believe we spent about $11.8 million in funding for the travel assistance program, and about 98.5 percent of that was in payment to B.C. Ferries. It’s no surprise, then, that most of the people accessing that part of the travel assistance program come from Vancouver Coastal, Vancouver Island and some parts of Northern Health as well, where they’re using ferries to get to the community where the specialist is located.

We also rely on other partners, air transportation partners, including Central Mountain Air, Harbour Air, Helijet, Hawkair, Orca Airways, Pacific Coastal Airlines and West Coast Air. They will provide a discount available as well.

[1530]

In more interior communities, what we’ve used is the Health Connections service, which is a partnership between health authorities and B.C. Transit. Collectively, since 2004-2005, Northern Health, Vancouver Coastal Health, Interior Health and Island Health have received $6 million annually to support Health Connections, which are reasonable transportation options. I’m sure the member has seen the large coach that is employed by Northern Health. It comes down to the Lower Mainland to take people to the higher level of care that they need to access there.

The B.C. family residence program is to provide assistance with the costs of accommodation and travel. That’s a subsidy that’s administered through Variety, The Children’s Charity. It’s available to families whose child requires medical care at B.C. Children’s Hospital or Sunny Hill Health Centre for Children.

There are a number of other organizations — the Canadian Cancer Society, Shriners — that also come to the aid of families needing travel assistance.

We have done a review of the travel assistance program, and there are some options that are potentially available. All of them, of course, require increased resources if we were going to build on the travel assistance program, which we tend to overspend in terms of its budget. We look to other parts of the ministry to help

[ Page 12852 ]

with the travel assistance program because we invariably spend about 10 percent more than we allocate for that program in each year.

It does come down to: if we want to increase it, where do we go in the ministry to find that money? Or where do we go in terms of other government services that would free up money to increase the travel assistance program? No decisions have been made around that. This will all be part of our plans going forward, in consultation with our colleagues at the Ministry of Finance and cabinet colleagues, as we look at the priorities across the continuum of services of government.

J. Rice: When was the TAP review conducted?

Hon. T. Lake: The review was conducted in March of this year.

J. Rice: The minister spoke about the TAP program facilitating transportation to specialist programs. Under the TAP program, are psychiatric or mental health supports considered a specialist program that would qualify for a TAP subsidy?

Hon. T. Lake: Yes, psychiatrist appointments would qualify an individual for the TAP program.

J. Rice: A lot of rural communities don’t have access to an actual psychiatrist, so are other types of mental health clinicians or mental health appointments covered under the TAP program?

[1535]

Hon. T. Lake: Psychiatry is within the top ten of the types of appointments in which patients utilize the travel assistance program, comprising 2.46 percent of all patients.

In terms of other mental health and substance-use supports, if it’s not a…. This program is meant to access specialties so, generally, would not be covered. You know, there are exceptions made from time to time but generally would not be covered. We try to bridge that gap by providing supports either in community or through the use of telemental health, which is, more and more, proving to be very effective at helping people manage some of the mental health challenges that they face — and of course, increased training for general practitioners.

There has been a lot more training for GPs, family practitioners, nurse practitioners in the area of mental health. Of course, the Child and Youth Mental Health Collaborative is another way of connecting people, through various means, to increase their ability to assist patients that have mental health challenges.

J. Rice: On the topic of telehealth, my question is in regards to the rural and remote communities that are seeing increased use of the telehealth services. What supports are in place for facilitating the use of telehealth? I mean specifically around the IT: who’s setting up the systems, and who’s facilitating the appointments? If you could answer that.

Hon. T. Lake: The IT facilities are the responsibility of each of the regional health authorities. When we’re looking at First Nations communities, Health Canada has partnered with Health Infoway for some of the infrastructure that’s necessary for IT.

I know, in my travels around the province, that everywhere I go, almost every hospital and every community health centre have a capacity to undertake telehealth. In fact, there were 125 communities with 260 enabled locations providing over 70 different clinical services in 2015. That is significant, I would say, that we are certainly well connected, far more than we were five years ago.

We also have created telehealth fees in the Medical Services Commission fee

schedule so that physicians can bill for telehealth conferences. Of course, it’s one thing having the equipment there, but it’s another to have the incentives that would allow physicians to utilize that equipment.

One other thing I wanted to mention is HealthLink B.C. It is actually the largest telehealth service in British Columbia. It might be considered fairly low tech versus some of the other types of telehealth equipment that’s being used, but HealthLink B.C. handles 1,200 texts and calls daily from patients and families, and it connects them to nurses, dietitians and pharmacists.

[1540]

There’s no other HealthLink in the country that bundles all of those services of nurses, dietitians and pharmacists under one umbrella. It sometimes gets forgotten because it’s a little bit lower level in terms of the technology involved, but in terms of the impact it has, HealthLink B.C. is extremely important.

J. Rice: The minister is aware…. Well, we’ve had many discussions around elevated lead levels in drinking water in Prince Rupert and other B.C. schools. We know that even slightly elevated levels pose a risk to developing babies, the unborn, and for young children. The younger the child, the higher the risk with even low levels of exposure to lead, leading to lower IQ scores and behavioural disorders — attention deficit disorder, some other social problems.

My question to the minister is: are all B.C. schools testing for lead in their drinking water?

Hon. T. Lake: As the member well knows, the Minister of Education wrote to all health authorities. I don’t want to speak on behalf of the Minister of Education, but I know that that letter was sent. He provided me a copy of that letter. He would be best to answer the question of whether all school divisions are, in fact, testing the water in their schools.

[ Page 12853 ]

The issue of lead in water has been around for quite a while, because before 1989, plumbing fixtures in the building code were able to have at least a small amount of lead in the solder that was used to join the plumbing infrastructure. Of course, older buildings would have had actual lead pipes in them years and years ago.

In the ’90s, this became an issue. The building code was changed in 1989, so there was a lot of talk about it in the ’90s. I think what happened is people probably forgot a lot about the fact that there is still some lead in the solder of the plumbing of older buildings, and people became complacent.

When this was brought to the attention of the health authority and Northern Health, it became, obviously, an issue that we wanted to make school districts, generally, and the public, generally, aware of. If there are buildings that are older than 1989 that serve the public particularly, but even private homes, it’s not a bad idea to test that water. It’s not a bad idea to flush the water, particularly in the mornings, until it runs cold. Often the problem is that the lead, overnight or over a weekend, will settle in the system if it’s not being flushed through.

School districts throughout the province are engaged in testing water and putting in mitigation plans to make sure that lead not a problem. The provincial health officer, Dr. Perry Kendall, tells me there’s no evidence that British Columbians are routinely exposed to levels of lead that put their health at risk. In fact, testing over the years has shown that generally British Columbians are not at risk for increased levels of lead, and in fact, levels have been going down steadily over the years.

J. Rice: The minister speaks about the fact that this is not a new issue, that we’ve known about this issue for some time. He talks about the fact that plumbing and plumbing fixtures prior to 1989 had a high likelihood of lead being used in the materials. But he said that people have likely forgotten and been complacent.

I think that’s exactly what’s happened in communities in the northwest, where we live in a temperate coastal rainforest with a low-pH, high-acidic water, meaning that our water is aggressive. That, combined with the fact that we have the oldest housing stock in British Columbia…. The double whammy of those two factors has actually put people at risk and, particularly, vulnerable people such as babies and children.

[1545]

I introduced a bill recently that would actually deal with the fact that people have forgotten and been complacent. My question would be, to the minister: would he consider mandatory testing and reporting of all B.C. schools for lead in their drinking water?

Hon. T. Lake: Well, I’ve outlined what we have done. The Ministries of Health and Education are working together. On February 24, a letter was sent to all schools reminding them that older buildings should be testing their water. We see that happening around the province. Mitigation plans are put into effect, and testing has shown, at the population level, that British Columbians are not at risk for exposure to lead in drinking water.

But it is a good reminder to not just school districts. It’s a good reminder to all public buildings, all businesses, all private homes that if they were built before 1989, it’s possible that some residual lead occurs when water settles, particularly when the community water source is of a low pH and allows the lead to come out and be incorporated into the water.

There is no plan to have mandatory testing, at least from the Health Ministry’s point of view. We’re satisfied that we see good cooperation between health authorities and school districts to monitor and to mitigate issues around lead.

J. Rice: The minister says that it’s a good reminder that we should be testing and possibly flushing homes and public buildings and other private entities. My question is…. Particularly considering the risk to babies and young children, I want to know what measures public health has taken to inform and to educate pregnant mothers and preschool-age children’s parents that elevated lead levels are experienced in the northwest of British Columbia.

Hon. T. Lake: Northern Health conducts prenatal programs through their public health initiatives, and they have made a point of making sure that prospective parents are thinking about this issue, informing them of their options in terms of obtaining any testing kits. Obviously, this is their own private property, so they have the responsibility to do that testing. The health authority will assist them with any

interpretation or planning of mitigation, should that be a problem.

I do want to say, too, that the drinking water officer in each health authority always has the ability, under the Drinking Water Protection Act, if they feel that the right steps are not being taken, to put in orders in terms of school districts. That has not been needed to date. I think that speaks to the cooperation between health authorities and school districts over this issue.

J. Rice: I could go on, on this topic, but in the interests of time, I would like to speak to the child health report that was recently released by Northern Health, the Chief Medical Health Officer’s Health Status Report on Child Health . I have numerous questions on this, but I might have to submit them in writing.

[1550]

The Northern Health chief medical officer recently released a troubling report about child health in northern British Columbia. It found, among other things, that children in the north are not as healthy as other children

[ Page 12854 ]

in the province. Northern B.C. has higher rates of infant mortality, and northern children have higher rates of poor oral health than children in other communities.

Can the Minister of Health outline any specific programs that have been put in place or will be put in place to address the poor health outcomes of children in northern British Columbia?

Hon. T. Lake: The child health report from Northern Health certainly points to what we have known for some time, and that is that there are determinants of health in areas of the province and areas of Canada where the health outcomes are below those of the rest of the population.

We know that First Nations communities generally have lower health outcomes than non–First Nations communities, and certainly, this report would reflect the higher First Nations population in the north. We know that income and education are two important social determinants of health, and that becomes a factor when we’re looking at child health as well.

In terms of specific programs, we have been focusing and working in partnership with our aboriginal partners on safe sleep programs to ensure that the sleeping arrangements do not put young babies at risk. That’s something that needs to be done in terms of honouring the culture of First Nations and making sure that we work closely in terms of helping moms provide the kinds of supports they want to, to their babies, but at the same time looking at the physiological needs that will keep babies safe when they’re doing that.

Oral health is a big problem in areas where there’s a poor level of income and education. Dental hygiene, of course, is something that is very important in the early years.

[1555]

Communities, over probably the last 15 years, unfortunately have bought into some really bad information in terms of adding fluoride to water. I know that in my own community of Kamloops we’ve seen a deterioration in childhood oral health because of decisions to remove fluoride from water.

We are looking at targeted fluoride varnishing programs, which will provide the benefit of fluoride without having it in the water. But we’re always encouraging communities to look at the science and look at the overwhelming evidence that fluoride, incorporated into the drinking water, improves oral health, particularly for young children.

There are of course a lot of other initiatives through the office for the early years. We have Baby’s Best Chance . We have public health officials that work with communities and provide education for young moms and for families. But it is an ongoing challenge, for sure.

Northern Health has now hired a lead for child health — I think that’s an important step — someone that has responsibility. They’re beginning a consultation about child health, I believe starting next week, to hear from communities, to look at the supports that are working in communities and supports that may still be required. The report has been well read and well absorbed by Northern Health and by the chief medical health officer, Dr. Sandra Allison. There are a number of initiatives that will be coming out of them.

J. Rice: Thank you for the overview on that. My question is in regards to the infant mortality rate. It’s astonishingly high. It’s 20 percent higher than the provincial average. I’m wondering what Northern Health–specific programs have been brought in to address that and how much is being invested in those programs.

[1600]

Hon. T. Lake: Some of the programs would be administered by the First Nations Health Authority, so I can’t speak specifically to initiatives that they have on their own.

I did speak to the Honouring Our Babies program, which is a provision of training, through safe sleep cards as a training tool, to help new moms learn the potential dangers of certain behaviours around babies from one month to one year. That’s a partnership between First Nations Health Authority and the Provincial Health Services Authority. It’s about things like sleeping arrangements. It’s things like tobacco smoke around babies. It’s things like breastfeeding. So those programs are in place.

Also, Northern Health Authority does have a nurse-family partnership, attaching public health nurses to families to do intense education with young moms. I don’t have the number of dollars that they spend on that program. I can make further inquiries with Northern Health and provide those details as a follow-up to the member.

[R. Chouhan in the chair.]

J. Rice: The report outlines that mental health concerns such as depression and anxiety are prevalent in northern B.C. women during pregnancy, but we know that many northern communities have few, if any, mental health services. What is being done to improve the government’s response to the mental health concerns of northern B.C. women?

Hon. T. Lake: I answered this question earlier — it was framed in a very similar way — when we talked about the travel assistance program.

It is difficult to provide the same level of services in a rural area as it is in a metropolitan area. That is not a surprise to anybody. It’s hard to provide the same level of policing services in a rural area as you would have in a metropolitan area. So we try to accommodate the ability to access service in different ways.

We have provided and, through the Doctors of B.C., continue to provide education programs around mental

[ Page 12855 ]

health for family practitioners, for nurse practitioners. We provide telehealth and telemental health to provide those supports in areas where we simply don’t have the same level of expertise that we would have in a more metropolitan area.

J. Rice: One of the concerns raised by the report is the lack of “transportation infrastructure that allows citizens to move freely between communities without undue financial or physical compromise.” We know that this is a significant barrier for many northern women who are pregnant. Their local maternity services have often been removed by this government, and they have to spend significant time outside their communities before giving birth.

While they have access to transportation through Northern Health Connections, depending on their location, their families don’t. They spend, often, a very significant amount of their time, their pregnancy, alone. This doesn’t help…. Well, I mean, telehealth can address this issue, so I guess my question is: what is being done to address the inequities that are caused by local maternity services being removed from rural northern communities?

[1605]

Hon. T. Lake: Again, to provide services to all areas of the province at the same level is difficult.

What is particularly challenging is to ensure that you have backup when you need it. You can imagine that pregnancy and childbirth is something where you need to have a plan in place in case something goes wrong.

We are addressing rural maternity services in a number of different ways. For instance, Haida Gwaii. The community there came together and, as a community, agreed that they wanted to have a level of child delivery services available. They were able to overcome a lot of the barriers by working together. Midwife services are available for low-risk cases, and the local health care team has made that commitment to on-island births. In fact, they’ve increased the number of births on island to 33 percent.

If something goes wrong, you need a full surgical team. If you’ve got a high-risk pregnancy, you need a full surgical team to perform C-sections, to provide pediatric intensive care if necessary. That is a barrier, when you’re looking at rural areas, if you have a higher-risk pregnancy. Often families have to make the decision that, if it’s a higher-risk pregnancy, they need to travel to another location.

In Northern Health, only 5 percent of women travelled more than two hours for their delivery. So it’s 5 percent, but it’s still…. If you’re one of those moms, one of those families, obviously that is concerning, and it comes at a level of commitment and cost that wouldn’t be there if you were having a low-risk birth or if you were in a larger metropolitan community.

But we are making some advances in midwifery. For instance, midwives deliver about 13 percent of the province’s babies each year. That’s well in excess of the average 2 percent for Canadian deliveries. Last year, there was an 8 percent increase in the number of midwives delivering care, so that is an alternative for rural areas. In fact, the rural midwifery locum program and the midwifery rural practice and support grant that was established in 2012 support midwives to practise in more rural areas.

I mentioned Haida Gwaii. We also have the aboriginal doula program, which is for aboriginal moms to have some supports. The birth doula and postpartum doula services receive funding from this partnership between the B.C. Association of Aboriginal Friendship Centres and the First Nations Health Authority, with funding of over $2 million from the Ministry of Health.

There are challenges, as I said. Communities have to come together, including the medical professionals in that community, to make a shared decision on the level of risk that they’re willing to undertake in order to have births in community — always knowing, of course, that for high-risk births it may necessitate travel to a larger centre.

J. Rice: I appreciate the minister’s comments on rural maternity care, so I’ll go into more questions on that topic.

I do think Haida Gwaii is quite the exception. It could possibly be a model for other parts of rural British Columbia. I do think that for a population of 5,000 people to not only have one but now have two employed midwives, that would be deemed quite a success. However, there are a lot of other rural communities in British Columbia that aren’t so lucky to have a midwife, let alone two midwives.

[1610]

The integrated primary and community care model proposed in the rural health services policy paper envisions clinicians with expanded skill sets helping to increase access to care in rural B.C. This includes family physicians with enhanced surgical skills and advanced obstetrical training. As the minister has just spoken about the C-section backup, sustaining and reinvigorating rural maternity care is linked to access to C-section backup.

My question to the minister is: what work is being done by the government through the General Practice Services Committee to increase the complement of GPs with enhanced surgical skills and advanced obstetrical training?

[1615]

Hon. T. Lake: I’ve got a host of bits and pieces here that I hope will provide a comprehensive response. One of the initiatives, as we mentioned, coming out of the rural paper, was to work with Doctors of B.C.; the Joint Standing Committee on Rural Issues; the Rural Coordination Centre of B.C.; the UBC faculty of medicine and CPD, the continuing professional development department, to better elaborate and support, through training, generalist

[ Page 12856 ]

models of physician practice in rural communities — so to try to reach out and provide more skills.

One of the things that the Rural Coordination Centre of B.C. does is promote closer-to-home continuing professional development. As one can imagine, if you are a physician in a smaller community, access to professional development can be challenging. So for the Rural Coordination Centre, one of their goals is to increase support, including the CARE course and the wilderness medicine course, but also, funding through the Rural Coordination Centre, the UBC Rural CPD travelling courses.

Those include the shock course — managing shock, of course, sometimes related to trauma but other reasons; point-of-care ultrasound; obstetrics; and hands-on ultrasound skills enhancement. They support the annual rural continuing professional development events, such as the Rural Emergency Continuum of Care Conference for rural and regional practitioners.

Some of the initiatives for rural maternity care services and advancing midwifery include enhancing surgical skills for GPs. As of May of 2014, there were an estimated 39 GPs with enhanced surgical skills across rural British Columbia, supported by 86 GP anaesthetists. That is an effort to try to get more GPs to take training.

There’s only one training program for the enhanced surgical skills, at the University of Saskatchewan. Again, it is not easy, because a physician has to take time out and travel to Saskatchewan to do the training to have those enhanced surgical skills. But we also, in the meantime, provide general practitioner locum programs to spell people off so that they can go and do that kind of training.

There are also incentive programs. The member mentioned the General Practice Services Committee, which is a partnership between the Ministry of Health and Doctors of B.C. to encourage physicians to offer maternity services. These incentive programs include the maternity care network payment. That covers the cost of group or network activities for the care of obstetrical patients. Last year 600 doctors participated, costing $4.7 million.

There’s also the general practitioner obstetrical program. This will provide a 50 percent incentive fee on four delivery items. Last year 677 doctors participated, providing maternity care to over 11,000 women in their communities at a cost of just under $3 million.

Finally, the maternity care for B.C. program, which supports physicians to refresh and regain their obstetrical skills and supports additional obstetrical training for graduating family practice residents. Last year nine doctors were approved for funding, with a total program spending of about $21,000. So quite a few programs to incent both enhanced obstetrical skills, enhanced surgical skills, so that those services can be provided closer to home.

I do believe the member said that Haida Gwaii is a great example. I do believe it is a great example, and there are communities there — Burns Lake, for instance, at the new Lakes District Hospital…. I know there’s been talk in the community about looking at what Haida Gwaii has done as a medical community and perhaps replicating it there.

[1620]

It seems to me that that brand-new hospital and community health centre there would lend itself to that. I’m encouraged that people are thinking about that, because I know the residents of the Lakes District would love to have that service closer to home.

J. Rice: I think I might have caught this answer. I’m sorry if I’m repeating the question, but how many participants in the maternity care for BC initiative practise in rural communities? Did you answer that?

Hon. T. Lake: For the maternity care network payment, there were over 600 doctors, and under the general practitioner obstetrical program, 677 doctors. Maternity care for BC, which is supporting physicians to refresh their obstetrical skills and providing additional obstetrical training for graduating family practice residents — there were nine doctors in that program last year.

J. Rice: Okay, I’ll move on to a different question. The rural health care policy paper admits that there is a need to define the role of the rural physician to identify the distinctive skills rural GPs require to serve smaller remote communities. This definition can help improve recruitment and retention, because it would inform better training that would build confidence and competency and put in place the supports for a rural physician’s ability to fulfil a distinct role in the health care system.

What steps are being taken to fully define the multifaceted role of the rural physician in the integrated primary community care model proposed under the government’s white paper?

[1625]

Hon. T. Lake: The issue of developing rural generalists for family practice in rural B.C. is something…. I know there are a lot of champions — Dr. Alan Ruddiman, Dr. Granger Avery, to name a couple that I have met with in the not too recent past. We are developing policy with the Faculty of Medicine at UBC, looking at what a curriculum would look like to specifically educate and train rural generalists so that they would have that right mix of medicine, surgery and other skill sets that are required in smaller communities if you’re going to provide services closer to home.

An important part of that is making sure that you have other services available to support those physicians. That means the ability to transfer patients out quickly, should the need arise. It’s looking at using telehealth to support those physicians. I’ve mentioned the experience I had

[ Page 12857 ]

at Kelowna General Hospital with the neurologist communicating with a practitioner in the Kootenays.

We are looking at the establishment of a chair of rural health at UBC to give focus to this initiative. That chair holder will be responsible for providing academic leadership at UBC for rural health care, developing robust research and education programs that focus on the current needs of rural practice, looking at the standard of care we have today — not the same as it used to be 30 years ago. That work is ongoing with the UBC Faculty of Medicine — I think quite an exciting initiative.

I would say that when you have a dedicated champion that’s embedded in the Faculty of Medicine, that’s when you will start to see real changes occur and an excitement build that will attract practitioners to those rural areas. It’s an initiative that we really haven’t sort of talked about publicly yet because we’re doing a lot of policy development around this. But this will be formulated and coalesce into this chair of rural health at UBC.

With that, I would move that we take a short break, if possible.

The Chair: The House will be in recess for ten minutes.

The committee recessed from 4:29 p.m. to 4:45 p.m.

[R. Chouhan in the chair.]

S. Hammell: I just have a few questions and have been given a few minutes with you, so I’ll start off. I’m going to be referring to the Alex Malamalatabua case. I’ll just read it. You’ll pick up.

“Parents have to be fierce advocates often and make difficult decisions as part of their efforts to get their children the mental health care they need. In the case of Alex Malamalatabua, his mother made the difficult decision of assigning a voluntary care agreement in hopes of getting her son the mental health services he desperately needed. Then her son tragically died while at a B.C. hospital’s adolescent psychiatric unit.

“The coroner’s investigation into the death uncovered more concerns about the care he was receiving as an in-patient. For example, the coroner discerned that he was cheeking his medication, and the coroner reported that given the concentration that was found in Alex’s blood, compared to the dosage he was prescribed, it was estimated he’d saved up his medications for approximately six weeks prior to his death. It was unknown where the medication was stored or stashed, as Alex’s room had been searched regularly.

“At the conclusion of the report, Coroner Lambert recommended that the Representative for Children and Youth conduct a review. Yet the representative has encountered resistance from the Ministry of Health, as it will not provide her access to the internal review that the PHSA conducted in Alex’s case, due to the B.C. Evidence Act.”

So, Minister, if you can’t provide the representative the information she seeks for this review, will you answer the following question? Has Children’s Hospital made the necessary changes to ensure that what happened with Alex does not happen to another adolescent in-patient?

Hon. T. Lake: This was indeed a tragic event. Any time something like this occurs, we want to learn. This was indeed a tragedy.

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When something like this happens, we always want to learn what we can from it, which is one reason we have

section 51 of the Evidence Act, which allows a safe environment for care providers, health professionals — whether they’re nurses, pharmacists, physicians or others — to be able to tell the story of what happened with no fear of reprisal whatsoever.

We’ve learned, over the years…. This is not uncommon, to have this provision in legislatures across the country. It’s been there for some time here in B.C., going back decades. Preserving that ability to have a safe environment to tell a story and learn from that is critically important.

The child and youth representative wanted PHSA and Children’s Hospital to do something that they could not do, according to the law, and there’s a reason that it is the way it is. Having said that, we know that there was a full investigation by PHSA and a

section 51 investigation.

I should note, too, that the coroner’s report did not make any recommendation for B.C. Children’s Hospital directly. In fact, I believe it said, as the coroner found, that the circumstances of the patient were seemingly stable, and his care plan was progressing to the point where he could return to a non-hospital setting. However, a suitable environment proved difficult to find.

Coming out of this, PHSA has provided a

summary of actions that they’re taking as a result of the lessons learned. Those do include reviewing and updating, where needed, policies and procedures on medication administration.

The member mentioned that there was a conclusion drawn that in order to have the levels of medication in this patient’s bloodstream, he may have been cheeking the medication. I’m not sure that we could say for certain that was the case. I’m not privy to the investigation, because it’s covered by

section 51, so I don’t get to see all those details.

Having said that, PHSA is reviewing and updating, where needed, policies and procedures on medication administration to make sure that that does not happen in the future, if in fact it happened in this case. Also, return-from-pass checks. When a pass is provided to a patient like this one, that returning and verification of passes is reviewed.

There’s an ongoing dialogue with MCFD on how to effectively meet the needs of young people with highly complex mental health concerns during hospital admission — also looking at the ongoing needs of highly complex youth transitioning to community from hospital.

It is not unusual to have a highly complex patient that’s dealing with mental health issues in hospital, and then finding the right supports in community can be a challenge. It is not an easy transition. We just announced the opening of the HOpe Centre at Lions Gate for concurrent

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disorders, for young people with comorbidities of mental health and substance use. Again, that’s a hospitalized environment. Then, reaching out into community to provide those community supports is an ongoing challenge — an ongoing dialogue with MCFD on how to provide those for children in care.

PHSA is reviewing policies and procedures related to the provision of passes for all in-patients. Also, any information that has been learned through this process will be shared with other health authorities, particularly related to site safety in regards to construction sites that are in close proximity to hospitals. I am advised, from PHSA, that 50 percent of the recommendations from the review have already been implemented.

S. Hammell: Minister, I’ll take a switch. Thank you for your comments. They were very thorough, and I appreciate that.

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I want to just slip to a small discussion around schizophrenia as a particular form of mental illness. I’ve received a letter from someone who I think is fairly well informed. I think you may have received the letter also. It is from Mary-Jo Melnyk. She describes a number of things that I think are well worth reviewing with you. She’s particularly focused on the recovery of people who have schizophrenia. She documents….

It largely comes from a study by Torrey in 2013. She also has one by Liberman and Kopelowicz from earlier — I think 2011. Of a population of 100 people who are experiencing schizophrenia, around 65 to 68 percent of people can and do recover, and that’s the best. There’s still about 32 percent, or about a third, who do not recover and continue to need a high level of support.

In Surviving Schizophrenia , Torrey states that in the schizophrenic population, after 30 years, 25 percent completely recover, 35 percent are much improved and relatively independent, 15 percent are improved but require extensive support, 10 percent are hospitalized and unimproved, and 15 percent are dead, most from suicides.

If you think about this, at least 10 percent of schizophrenics will require a licensed mental health care bed. They are at that end of the spectrum. They haven’t committed suicide. They’re still with us, and they require that kind of care. If we don’t provide that care, they don’t disappear, that 10 percent. They sort of haunt us. I’m using her terminology. It’s absolutely a very well-written letter. They haunt us through addiction, through homelessness, crime and the institutionalized.

In fact, that group of people, that population, is quite detailed in terms of the description. So 6 percent are homeless or live in shelters; 6 percent live in jails or prisons — I’m just talking about one particular mental health issue; 5 to 6 percent live in hospitals; 10 percent live in nursing homes; 20 percent in supervised housing and so on. Some live with family, and some are independent.

My question I’m getting to — excuse the long discussion here — is…. We don’t have the licensed care beds for this population, let alone other populations that need that kind of care. I understand, from the discussion with the critic from New Westminster, that we are looking at adding 280 beds in the next year, and they may be various forms. Does the minister think that, given the actual facts of on the ground, we have enough resources headed for registered or licensed care beds for the mentally ill?

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Hon. T. Lake: This is a very challenging area, but I must say I always find the discussion with my critic on this topic enlightening. I appreciate the concern that she has for a very vulnerable population. I would answer the question in a couple of ways.

First of all, I want to point to the early intervention efforts that we have. The early psychosis intervention is a specialized approach that provides services to young people when they are first identified, at the first appearance of psychotic symptoms. I don’t want to pretend that I’m an expert in this, but I am told that the signs of schizophrenia and other mental health challenges often occur in the late teens and early adult years. The identification and intervention early on, obviously, is the very best response if we can identify and get people into those programs.

If we do get early intervention, studies indicate that it reduces the suffering and danger caused by acute psychosis. It results in better short- and long-term symptomatic and functional outcomes, less hospitalization and less use of antipsychotic medications. Obviously, it’s cost-effective and also would provide greater satisfaction for clients and families. Currently there are six full programs, six developing programs and six early-psychosis-intervention-informed programs, where one clinician or a small number of clinicians are attempting to provide services to early psychosis clients.

These are often in rural or remote areas, because they don’t have the same critical mass of health care professionals. They’re trained through the provincial early-psychosis-intervention training program and the EPI community of practice. We did an evaluation in September of this year. It shows that most programs are systematically addressing the important areas covered by the guidelines. That’s getting early.

Now, an important thing, and we’ve had this discussion of it in question period earlier today, is that the family and the patient need to agree to treatment. This is a particular challenge with some forms of mental illness: the person that is affected doesn’t always (

a) acknowledge that they have a challenge or (

b) accept the help that is offered. I just wanted to say that that is always a challenge when we’re dealing with individuals in this context.

In terms of the number of beds that we have for mental health in the province of B.C., we have a number

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throughout each health authority. In IHA, there are 99 acute mental health and substance-use beds and 162 tertiary mental health and substance-use beds.

That would be, for instance, the Hillside Psychiatric Centre in Kamloops. I was there recently to celebrate the ten-year anniversary. This is a facility that was part of the reorganization and deinstitutionalization of Riverview so that patients were returned to communities. For patients with the highest needs, purpose-built facilities like Hillside Centre were created for those patients.

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Fraser Health Authority has 206 acute beds, 267 tertiary beds; Vancouver Coastal, 215 acute beds and 213 tertiary beds. Island Health has 158 acute beds, 178 tertiary beds.