1994 Legislative Session: 3rd Session, 35th 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)

TUESDAY, JUNE 28, 1994

Afternoon Sitting

Volume 17, Number 1

[ Page 12411 ]

The House met at 2:06 p.m.

L. Reid: I would ask the House to join me today in welcoming a colleague of mine, Mr. Ian McEown, who's visiting from Vancouver. Please make him welcome.

L. Boone: Today the caucus committee had the honour of meeting with a variety of representatives from some very important groups. Along with representatives from the B.C. Federation of Labour, there were representatives from the Canadian Farmworkers' Union, the West Coast Domestic Workers' Association and the Committee for Domestic Workers' and Caregivers' Rights. They are joining us in the House today, and I'd ask all members to give them a very warm welcome.

D. Mitchell: A constituent of mine, Mr. Bob Mussio from West Vancouver, is with us in the precincts this afternoon. Would members please make him welcome.

Oral Questions

APPEAL PROCESS FOR MOTOR CARRIER COMMISSION DECISIONS

W. Hurd: I have a question for the Minister of Energy. We understand that a U.S. transportation consultant was quoted earlier in the week, or last week, as saying that he was hired by Kimber Cabs to review its proposed operations, and he informed them, upon review, that in his opinion they were not profitable with their handicapped service. Could the minister inform the House whether, during her cabinet appeal, she reviewed this information from the consultant and why she would determine that the service was viable when this international consultant had determined that it was not?

Hon. A. Edwards: The review that I did was of the decision. A limited amount of information was put before me. No, I did not review that. I'll be very clear, again, that my decision was to look at the weight of evidence, and the weight of evidence I saw indicated that the decision of the commission could not have depended on the evidence it saw.

The Speaker: The hon. member has a supplemental?

W. Hurd: With respect to the weight of the evidence, the weight of the opinion of the U.S. consultant.... He was quoted as saying that his services were no longer required by Kimber Cabs once the new government was elected in British Columbia, as they were assured that their licence would proceed. That was the message from south of the border. Has the minister made herself aware of that opinion and is she now concerned about those allegations, in light of the decision she made, on appeal, about Kimber Cabs?

Hon. A. Edwards: Any of those statements -- any allegation that was made about what was needed and what was not needed by Kimber Cabs -- was certainly not something that I examined, that I knew about, or that I should have known about. Those are allegations that are currently being brought forward, and that's interesting information.

W. Hurd: Clearly, an opinion has come forward from a U.S. consultant who produced a report for Kimber Cabs which found that the service was not profitable. Can the minister explain why Kimber Cabs evidently did not produce this information at the hearing that she held, at which she granted a licence to this cab company? What happened to that report from the U.S. consultant?

Hon. A. Edwards: I don't know what happened, because obviously that information was not put to me on appeal. I would say again that the information that came to the appeal was very clearly weighed, and I made a decision which I stick by.

EMPLOYMENT MINISTER'S ROLE IN SPONSORSHIP OF SCIENCE CAMP

G. Farrell-Collins: I have a question for the Deputy Premier. For the last three years, the UVic Engineering Students' Society has organized a summer camp for students called Science Venture. It's cooperatively funded through a number of government agencies and corporations. Some of the sponsors of that program are Industry Canada, Xerox, Northern Telecom and Science World, among others. But it's interesting to note that the only member with an ego big enough to have his name splashed all over the back of the T-shirt is the Minister of Employment and Investment.

Can the Deputy Premier tell us why the Minister of Employment and Investment's ego is so big that he has to put it on the back of kids' T-shirts, when all the CEOs of all these other corporations and agencies don't seem to feel that need?

Hon. E. Cull: I'm appalled that again the Liberal opposition doesn't support a very worthwhile initiative, which is one that happens to be in my riding. I think it's an excellent initiative, and I think everyone should be supporting it, including this opposition.

DELETIONS FROM DOCUMENTS OBTAINED THROUGH FOI PROCESS

J. Weisgerber: My question is to the Minister of Finance. As the minister knows, under freedom of information, three months ago I asked for copies of ministry budget submissions. At the request of the Ministry of Finance, I agreed to start with the Ministry of Social Services. I now have a response that is 370 pages long. Would the minister tell me whether or not she has had an opportunity to review this material and if she agrees with the degree of censorship that is in that document?

Hon. E. Cull: I'm very glad to be able to clarify this matter for the member, because I want to make it absolutely clear that when freedom-of-information requests come to my ministry, I do not personally vet them, and I do not make the decisions about what is in or out. We have staff in the ministry who operate under the Freedom of Information and Protection of Privacy Act. I trust those officials to carry out their duties in a responsible and conscientious manner in accordance with the act. However, if the member disagrees with their application of the act, there is a process in place. If the member disagrees with what's there, I would encourage him to take advantage of the appeal process.

The Speaker: Supplemental, hon. member.

J. Weisgerber: I would encourage the minister to have a look, because in this claptrap there's not one shred of information -- not one sentence, not one paragraph, not one set of figures. There are 375 pages of blank material. Will the

[ Page 12412 ]

minister look again at the commissioner's ruling on release of information under

section 12 of the act and provide to me the information that I requested?

Hon. E. Cull: I encourage the member to use the act to determine that matter. In fact, if he carries out the appeal and determines that the sections that have been omitted from the information he requested were inappropriately omitted, then we will make sure that my staff understand that, and we'll apply the rulings of the commissioner.

EMPLOYMENT MINISTER'S ROLE IN SPONSORSHIP OF SCIENCE CAMP

G. Farrell-Collins: I have a supplemental to my last question. The Liberal opposition -- as does every party in this House, I'm sure -- certainly supports science and technology, and the education of young people. The question is: why does the Minister of Employment and Investment have some egomaniacal need to have his name plastered on everything, when all of the other Crown corporations, agencies and CEOs don't have the same need? Why are students being forced to advertise for the Employment and Investment minister?

[2:15]

Hon. E. Cull: It's really unfortunate the member regrets that his name is not on the back, but maybe we can take that under advisement next time.

FRASER HOPE BRIDGE

H. Lali: Mr. Speaker, I can assure you that my ego is not as large as that of the member for Fort Langley-Aldergrove.

My question is to the Minister of Transportation and Highways. Prior to this government being elected, the Fraser Region Transportation Task Force had identified the Fraser Hope Bridge as a number one priority in that region for a major overhaul. It was to be done in three phases.

The Speaker: The question, please.

H. Lali: Last year the former minister was able to find a million dollars' worth for understructure work....

Interjections.

H. Lali: Quiet down, will you? You'll get your chance.

The Speaker: Order, please. Would the hon. member please state his question.

H. Lali: The residents of Hope are waiting for phase two, $4.5 million, to do the top part of that bridge. The residents of Hope have been waiting for a long time. My question to the minister is: why is Treasury Board or cabinet dragging its feet on a decision? When can the people of Hope expect a decision on this project?

Interjections.

Hon. J. Pement: If I could speak over the member who keeps yelling, it would be nice.

Interjections.

The Speaker: Order, please. Hon. members, the practice in this House is to stand in your place and be recognized before you speak. The hon. member for Saanich North and the Islands has been speaking quite loudly from his chair. I would suggest to hon. members that if they read the statement that was presented to this House last week with respect to questions being put by parliamentary secretaries, they will realize that this is not unprecedented. In fact, over the years a large number of questions have been put by parliamentary secretaries. So if we are going to further the practices in this House, I think we have to respect that that is the basis upon which the Chair has to operate.

Interjections.

The Speaker: Order, hon. members. If members wish to make submissions with respect to the ruling of the Chair, they may do so.

An Hon. Member: I've done that.

The Speaker: Not from your seat, hon. member. I would request that you wait to be recognized before you proceed any further. The Chair has made it very clear that parliamentary secretaries have the right to ask questions. If members wish to change the rules or the practices of the House, there is a process by which this may be done. I would say to members in closing that while it is very rare that parliamentary secretaries have exercised this privilege, they have the right to under the practices of the House.

Hon. minister, please proceed.

Hon. J. Pement: Thank you, hon. Speaker.

First of all, I would like to say that the work we do with our regional and local governments and our task force is very important to the ministry. We work very closely in identifying the priorities and issues within a given region. Therefore the project that the member has brought up is definitely a priority of this government and of this ministry. We will be working very closely with that region to come to a positive result.

I'm really pleased that we had a question of some substance.

LEASE OF HANGAR BY GOVERNMENT AIR SERVICES

K. Jones: This question is to the Deputy Premier. A recent Treasury Board report points out that the air services branch recently locked into a ten-year lease, at $875,000 a year, for a hangar that is too big and that is now destined to be empty. The Treasury Board review estimates that this new, empty hangar will cost $7.1 million over those ten years -- a price tag that is 55 percent more expensive than comparable private sector hangars. Could the minister justify such a ridiculous amount of money being committed by the air services branch when it was common knowledge that this Treasury Board review was underway?

Hon. E. Cull: The member is incorrect, because the Treasury Board review was not underway when the decision was made with respect to the hangar. Nonetheless, the Treasury Board analysis shows that the overall costs of the air services branch are excessive compared to private sector services, and moving in this direction is a sound financial decision. We are doing so while looking at all of the options with respect to the hangar and other costs. The Treasury Board analysis shows that even with the hangar, it still makes

[ Page 12413 ]

ense to move in the direction that the government has decided on.

The Speaker: Supplemental, hon. member.

K. Jones: The present occupants of the old hangar did their modifications for about $200,000 instead of going to this kind of expenditure. Further, the government is dithering in this matter due to the increased pressure not to end the air services, and the BCGEU has attempted to undercut the findings of the Treasury Board review. Could the minister explain whether or not the Treasury Board review is, indeed, accurate? And could the minister explain what sources of information this government bases its decisions upon -- government documents or the

heavy-handed labour movement?

Hon. E. Cull: Well, again, I'm very happy to clarify the matter for this member. When our government makes a decision like this, we don't just do a report in-house and then refuse to share it with our employees. One of the first things we did as we began to implement the decision was to sit down with the employees of government air services and share the information with them. We worked through that, and there is a difference of opinion between us and the government air services employees with respect to all of the information in there. The government stands behind the report.

It is more cost-effective to move to a private sector solution in this regard, and that is what we will do. We are doing it in a thoughtful way. This is not a fire sale or an immediate shutdown. This is a very serious service,

particularly with respect to the air ambulance service, which has to be managed in a way that is in the best interest of everybody in the province.

FEDERAL-PROVINCIAL MUNICIPAL INFRASTRUCTURE PROGRAM

H. De Jong: My question is to the Minister of Municipal Affairs. Earlier this year, the Premier offered his moral and financial support and full cooperation to the federal public works program designed to stimulate new job-creating projects. Can the Minister of Municipal Affairs assure us that these moneys are not channelled through the

revenue-sharing programs normally carried out by the ministry?

Hon. D. Marzari: Yes, I can state unequivocally that $675 million will be shared across British Columbia between municipal, provincial and federal governments. There is not one municipality that won't have some share of this infrastructure program, a program that has been a long time coming.

I can also assure the member that municipalities across this province will not only have the benefits of the infrastructure program invested in their communities, but the benefits of a stable unconditional grant system, which has been renamed, reallocated and properly indexed in perpetuity. They will also have conditional grants for sewers that will be maintained this year and for years to come in this province. So actually, municipalities in this province have received the benefits of all three programs this year, in a way that this government intends to provide stability and security for financing local infrastructure.

The Speaker: Hon. members, due to the intervention in the regular question period, I will provide an extra two minutes for members to proceed.

WCB FIRST AID CERTIFICATION OF HOSPITAL WORKERS

L. Reid: My question is to the Minister of Health. The policy and procedures manual of the WCB looks at registering physicians and nurses in this province to be certified as having a first aid certificate. How can this Minister of Health, in times of stress on those budgets, justify asking hospitals to spend money to comply with a regulation that does not make sense for a hospital? First aid is what you get before you get to the hospital. Justify that expense.

Hon. P. Ramsey: Hospitals are worksites like any other, and WCB has the responsibility for ensuring the safety of those who work at those sites.

L. Reid: This is the government that promised no duplication. You are in fact asking those hospitals to duplicate that service. They are highly skilled technicians and professionals. Why will you not confer with the Minister of Labour and somehow suggest that tax dollars -- health dollars -- should be spent on patients, not on some ridiculous regulation?

Hon. P. Ramsey: I regret that the member opposite sees no need to ensure that health workers are working in a safe environment, as other workers in this province have the right to. It is the responsibility of the WCB to ensure that that happens, whether it's a hospital, ship or forestry camp. I'm glad the WCB is doing that for workers in B.C.

MINISTER OF ENERGY'S CORRESPONDENCE ABOUT POACHER

A. Warnke: My question is for the Minister of Energy. In a radio-collaring elk program in the minister's riding, of which she is regional minister, the minister replied to a letter that she believed a poacher was not convicted; in fact, the poacher was convicted in a Seattle courtroom. I'm wondering whether the Minister of Energy had been in touch with the Minister of Environment about the convicted poacher. Why did the minister respond the way she did?

Hon. A. Edwards: Indeed, you're correct. There was a mistake in that letter. As soon as we determined that there was a mistake, we contacted the correspondent and made clear what had happened and that the information we initially had was incorrect. We've made very clear that it was a mistake. So we've done everything that we can to correct a mistake that sometimes happens in correspondence.

The Speaker: The bell terminates question period, hon. members.

Before I recognize the hon. member for Fort Langley-Aldergrove, I'd just like to clarify that the Chair was in error in recognizing the member for Yale-Lillooet as a parliamentary secretary. He is not as yet, to my knowledge; nonetheless, the rule would apply generally to backbenchers on the government side as well -- just for the edification of the members.

The hon. member for Fort Langley-Aldergrove rises on a point of order?

G. Farrell-Collins: Earlier during question period, when the Speaker made a ruling with regard to parliamentary secretaries, he talked about past practice, the precedent set in this House and how that applied. I would ask that in

[ Page 12414 ]

determining the order and the length of questions and the number of supplementals, the Speaker also consider the practices of his predecessor in this House over the last two and a half years, and not make changes to that pattern without consulting all members of this House, to the benefit of all members.

The Speaker: Order, hon. member.

G. Farrell-Collins: Hon. Speaker, I do realize that it's much more comfortable for the government to receive questions from their own backbenchers...

The Speaker: Order, please.

G. Farrell-Collins: ...but that's not the intent of question period.

The Speaker: The hon. member is not making a valid point of order, and I'm sure the hon. member realizes this, as do all members of the House. The Chair was elected by the members to serve the members, using the members' rules, standing orders and practices. The responsibility of recognizing members, in any event, remains with the Chair. The Chair has always been available for comment, however.

Orders of the Day

Hon. J. MacPhail: First of all, I'd like to advise all members of the House that we will be sitting tomorrow.

Some Hon. Members: What time?

Hon. J. MacPhail: Upon adjournment we will advise the House of when we will sit tomorrow morning, as is the custom. But I certainly don't mind saying ahead of time to hon. members that the notice upon adjournment will probably be that we will sit tomorrow at 10 a.m.

Interjection.

Hon. J. MacPhail: Time and a half! I guess that will be according to the value that they contribute during those hours, hon. Speaker.

I now call the

summary of estimates for the Ministry of Municipal Affairs.

[2:30]

REPORT ON COMMITTEE A ESTIMATES: MINISTRY OF MUNICIPAL AFFAIRS

L. Fox: As has been evident in most estimates in Committee A, it is usually a good, forthright exchange of concerns and ministry issues, one that generally reflects mutual concern over mutual interests. That was no exception in terms of the Municipal Affairs estimates.

Over the course of the many hours of debate, we dealt with many issues about planning in terms of municipalities having a need to plan for school and infrastructure sites, and so on. There was general consensus that a mechanism has to be in place to allow municipalities to do that, but in that process we have to respect and honour the private rights of owning property and the rights of property owners.

We had a very good discussion in that area, and the minister understands that prior to addressing that issue in a planning way, there is a need for some protocol arrangement between the Ministry of Transportation and the Ministry of Municipal Affairs in order to allow municipalities that right.

We had a very lengthy discussion on taxation issues. From my perspective, there is a need to overhaul the taxation on residential properties. We have to find a taxation model that better reflects the ability to pay, in that there is a need to adjust it not only from a municipal perspective but also from a school district perspective. We had a considerable discussion about those issues, and I think there is some general consensus with this minister that the system isn't perfect. But I think there was a difference in philosophy as to how it might be fixed.

We also discussed Islands Trust issues at some length and the difficulties that surround the Trust in terms of various values on the different islands. We discussed what we might do in the future to respect those values and update the Islands Trust's policy so that individuals have an opportunity to put their values forward. Many options were talked about, including the option that some islands may wish to pursue forming a municipality to give them more direct planning and direct governance over their island.

The Speaker: Hon. member, your time has expired.

C. Tanner: This is the first time we've had an opportunity to talk to this minister in her new portfolio, and we had a very interesting philosophical discussion on a number of subjects. I should warn the minister that we let her off lightly this year, because we felt she was new and she should become more familiar with it. Next year things are going to be a lot rougher. And as long as she doesn't bark up this member, I won't bark up her.

There really is not an awful lot to report. As I say, we had a nice discussion, and next year we'll look forward to getting at the facts of the matter.

The Speaker: The hon. minister concludes the report.

Hon. D. Marzari: I'm very pleased to report that debate on the estimates for the Ministry of Municipal Affairs has been successfully completed within 1994. I spoke to the committee in the Douglas Fir Room about the ministry's commitment to community stability, because that's what this ministry is about. It's about giving proper and appropriate service to the Islands Trust and to municipalities and regional districts throughout this province. Our role is to provide legislative tools and policy direction and to provide financial support and appropriate advice about the Municipal Act that will help the people of British Columbia create and maintain prosperous and livable communities.

Our two most significant achievements this year were the introduction of a reformed revenue-sharing program, which will give greater predictability and stability in terms of local government grants, and the three-way infrastructure program that we referred to in question period which brings provincial, municipal and federal dollars together. I'm not alone in calling these achievements significant. The Union of British Columbia Municipalities has referred to them as major successes, and I'm proud of the win-win solutions that we've developed.

If the member thought that we got off lightly in estimates, I can only suggest it's because Municipal Affairs has done its homework and provided the service, and that in fact there is very little to complain about this year.

I'm also continuing our legislative modernization program to ensure greater local control at the community level. The amendments in this year's package in Bill 25 will respond directly to concerns expressed by local government. The sections in that act will respond exactly to what they have asked for over the last number of years. Of course, this

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year we brought in the new Library Act to create a solid foundation well into the twenty-first century for our libraries throughout the province.

Part of our mandate is to ensure safe communities. I was happy to announce funding for the B.C. Safety Training Centre for firefighters throughout the province, which will increase access to safe hands-on training at the Maple Ridge site. This funding from B.C. 21 is going to protect other investments in the province by reducing property loss due to fire, and it's going to save lives of our firefighters in training.

During the estimates, I talked about the future and the ways in which this ministry is working to create lasting stability for our communities. We're reviewing the province's building regulatory system to address issues such as training and local government liability and better access for persons with disabilities. We are now pulling together a committee that is looking for ways to encourage communities

through-out this province to properly implement

section 3.7 of the Building Code. That

section has basically been around since 1979, but many of our municipalities, design professionals and building inspectors have not yet found ways to implement it. This is basically an attempt to ensure that people with disabilities can get around their communities as easily as the rest of us do.

We are using existing programs to encourage communities and regional districts to think and plan regionally, to identify common growth-related problems and to work with their neighbours on solutions. Urban sprawl is our enemy in this province. We are undergoing mammoth redevelopment, and there are massive development demands down the east coast of Vancouver Island, throughout the GVRD, all the way up to Hope and in the Okanagan. Our communities will not be the same; they will simply not be livable if we do not act quickly to reduce the impacts that urban sprawl has brought.

My colleagues in this House are experiencing the impacts and deleterious effects of urban sprawl, and are witnessing the degradation of our environment and the disappearance of our agricultural lands.

One of the issues that we addressed -- and all parties came together in this discussion in the estimates debate -- was about how we manage growth for the future. We do not want to do away with growth but must accept it and understand that it's a natural part of what this province is: a rich, dynamic and prosperous province. We must ensure that we can afford it and that our communities remain livable. That has to be our mutual goal.

I found our estimates debate to be useful and educational. We exchanged a lot of good ideas across the floor. We certainly let each other know what was going on in our local communities, and we talked about some very constructive programs that we could engage in. I certainly had an open ear and listened to members of this House very carefully as they talked about their communities, whether they were in the far northeast, on the Island or in the lower regional mainland.

The purpose of this ministry is to maintain stability, promote safety, generate employment and make community life better throughout this province. I thank all members of this House who participated in the estimates debate for Municipal Affairs. If I may take this opportunity, I especially thank members of the UBCM; that is, representatives of the mayors and councils across this province who have been so helpful in generating topics for discussion, ideas for change -- legislatively and otherwise -- and new program ideas that this government can work with them on. So my thanks to the UBCM. And my thanks to the members of this House.

Hon. J. MacPhail: I now call Committee of Supply.

The House in Committee of Supply B; D. Lovick in the chair.

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 42: minister's office, $436,943 (continued).

L. Reid: Moments earlier we were chatting about hospital efficiency, cost savings to the system and, certainly, the question I just had the opportunity to pose to you in terms of the WCB regulation. To be absolutely clear -- because I'm not convinced that this issue doesn't bear some debate this afternoon -- we are talking about certifying, with a first aid certificate, a qualified emergency room nurse and a qualified emergency room physician. We're talking about $150 for a medical examination and upwards of $75 for a certificate.

I personally take some issue with that in terms of regard for a profession -- both professions, if you will. These people are the most highly skilled medical practitioners we have, and again, I see this as a hoop that your ministry is going to be pushing people through. It's going to cost hospitals. If we take the example of Kimberley, one hospital in this province, it will cost approximately $3,500 just to certify their staff -- emergency room physicians and emergency room nurses. That $3,500 multiplied by a hundred-odd health care facilities in this province is a great deal of money.

As the Minister of Health, how do you justify that it's a reasonable expenditure, to give somebody a health certificate? We're not talking about a course or any increased certification in terms of training; we're simply giving them a piece of paper when they send in their money. To me, that lacks judgment. Would you kindly comment?

Hon. P. Ramsey: Question period continues, hon. Chair.

L. Reid: As long as we get the answer.

Hon. P. Ramsey: Hon. member, I'm quite willing to look into this to make sure that inappropriate fees are not being levied by the WCB, but I want to reassert the principle that I stated during question period. Workers, regardless of the facility in which they are employed, have a right to be assured that they are operating in a safe worksite. Part of that safety is to ensure that prompt and certified first aid is available. The member raises a good point with regard to some personnel who work in hospitals.

There are many other areas of hospital operations where I think it is entirely appropriate to ensure that somebody on staff in those areas is available with appropriate training when employees are present.

[2:45]

L. Reid: We're not talking about employees in other sites, hon. minister. We are talking about regulation 15(1), which pertains specifically to emergency room physicians and emergency room nurses. I can't think of anyone more qualified, and I think the issue that we have to understand is that first aid is typically not something that you receive in an emergency room. Hopefully it is received on-site, where the injury occurred.

Interjection.

[ Page 12416 ]

L. Reid: Thank you, hon. member. If indeed there is some overlap, fine. But the extreme cost that will come to bear on every single hospital in this province seems to me to lack justification. Surely you've had some discussions with the Minister of Labour about why this is valid. I can certainly look at certifying all kinds of WCB worksites around this province, but an emergency room would not be one of them.

I certainly want to continue my discussion this afternoon from where we left off before lunch in terms of wait-lists in this province. We covered joint-replacement wait-lists and cardiac wait-lists. I would simply ask the minister to confirm whether or not the wait-list today for a CAT scan in this province is approximately five to six weeks, and whether there are indeed 2,800 patients in this province currently waiting for that service.

Hon. P. Ramsey: I don't have that precise information available to me now, hon. member. I will ask staff to provide it. Since we are going to be here for some time today, I hope to have it for you later today.

L. Reid: In terms of providing information, am I to receive the checklist of regional health boards this afternoon? If so, that would be most helpful.

Returning to the CAT scan question, if your staff needs some time to prepare, perhaps I can ask another question and they could respond at the same time. Since we began this afternoon on the WCB, it seems to me that with respect to the wait-list for patients for WCB and ICBC, if we are not going to provide them with an immediate and accurate diagnosis -- and certainly the research suggests that a CAT scan and MRI lends credibility to those kinds of diagnoses -- and ensure that those services are in place, the downside is that it simply costs us more.

People are off work longer and are not being put into the stream to receive services, because they are awaiting a diagnosis. That has been my experience with a number of WCB claims in this province. The number of people who are waiting is certainly statistical information that's available from ICBC. At the end of the day those all become health issues, because people are waiting for some kind of diagnosis.

When the minister has an opportunity to provide that information, I would ask if we could perhaps break down how many folks are waiting for ICBC and WCB. The cost to the health system is significant, because it also plays on the social services and judicial systems in this province. None of those other services can work if they are waiting for diagnoses which tend to flow from the Ministry of Health.

Hon. P. Ramsey: I share the member's concern for anybody who has to wait for diagnostic imaging, particularly those who are injured in the workplace or in an automobile accident. I will ask the staff to gather more detailed information. I do have some information. The WCB has estimated for the ministry that they have something like 120 cases a year requiring an MRI scan. That is a very small number, since one MRI unit operating one shift a day is capable of doing some 2,000 scans a year. So it's a very small requirement of the overall volume for MRI scans in the province.

I share the member's concern that this be dealt with promptly, since people are looking to get well and return to work. I'll leave that there and see if we can get some further details of CAT and MRI scans later.

To return to the member's first question about a checklist of the status of interim regional health boards, a document summarizing the status of every RHB in the province was delivered to the member's office at 2:15 this afternoon.

L. Reid: For the record, the list will no doubt appear at.... Thank you most sincerely. I will see if we can receive it in a timely fashion.

I would like to ask the minister to respond to questions as they pertain to the treatment of eating-disordered individuals in British Columbia. To continue with the wait-list theme, at St. Paul's there is a wait-list for initial assessment of up to a year and a half. I understand that is still a valid wait-list, supported by your ministry, because I believe that is where the statistics came from. There are 280 individuals on the wait-list at present. We have some concerns about that wait-list, because as the minister is more than aware, those kinds of services are urgent; they are immediately required.

To put somebody who is wasting away on a wait-list of upwards of a year and a half is not helpful.

I was present when the minister announced his new strategy for eating disorders on June 7 regarding the creation of a residential care unit. I would be interested in some definition and criteria about that, because my discussions with the minister certainly suggested that those criteria were months down the road. Is that still the case? Are we still looking to some time in October, November or December before we will have some sense of the patients who will be admitted to that program?

Hon. P. Ramsey: The member refers to the strategy for dealing with eating disorders, which I was very pleased to announce earlier this month. As the member noted in some of her comments, there are a variety of components to this. Yes, residential care is part of it. Yes, assessment is part of it. And moving assessment and prevention programs out into the regions, away from the tertiary facilities, is part of that strategy.

I want to focus on those very important tertiary facilities. The residential component is indeed part of that. As you know, we've established ten new beds to be associated with St. Paul's and a further ten beds that will be associated with Children's Hospital. Those are going to become operational in the next little while. Those who require that sort of residential facility at St. Paul's will have it available to them in the very near future.

The member asked specifically where we are in the development of standards for certifying private providers of residential care for eating disorders. Currently, we are finalizing the membership of the advisory committee on eating disorders. The first task that that committee will have will be to examine standards for residential care of people suffering from severe eating disorders. Without knowing exactly the tasks before it, I'm loath to speculate on an exact date when they will have their report in front of me. As I said earlier, I would expect it would be sometime this fall.

L. Reid: I want to spend a few moments this afternoon talking about the costs of this residential care. When asked during your press conference, if you will, the discussion centred around $250 a day per patient. I would be interested in how that figure was arrived at and where you're headed with it in terms of funding patients who may choose to be served by a private clinic -- whether you will fund them to that level as well.

Hon. P. Ramsey: The $250-per-day charge for residential care for somebody suffering from a severe eating disorder was one arrived at after discussion with St. Paul's Hospital, which was doing the on-the-ground work of establishing such a treatment facility. This is not a theoretical number, nor is

[ Page 12417 ]

it a charge from the hospital to us. This is the actual cost of delivering that sort of care in that sort of setting.

As time goes on and as St. Paul's Hospital and Children's Hospital gain some experience in operating such facilities, we may have further refinements of the cost per day. As I said earlier, I have not closed the door on funding private agencies who wish to offer residential care, nor have I established any level of funding for that care at this time.

L. Reid: I appreciate the minister's comment that $250 a day is the actual cost. The second part of my question was: is that the amount of money that individuals seeking care in a private facility can expect to be reimbursed?

Hon. P. Ramsey: Perhaps the member missed the last part of my response, which was that I've made no such decision. When the advisory committee completes its work and reports to me on standards and on appropriate means for funding private clinics, then I will make that decision.

L. Fox: I request leave to make an introduction.

Leave granted.

L. Fox: I note in the gallery some Prince George residents who are down enjoying this beautiful weather we're having in Victoria. Mr. Eisbrenner is a pharmacist from Prince George, who no doubt has great interest in the debates that are currently going on within the Legislature. With him is his wife, their two children and his mother, Mrs. Eisbrenner, who is very involved in the delivery of health care services to the elderly in Prince George. Would the House please make them welcome.

L. Reid: To come back to the minister's comment, I did hear your answer that you haven't made a decision yet. My concern is the number of individuals who do need that service. If a number of months elapse and they are uncertain about the funding of that service, there will be some fatalities in this province. There's no question about that. A number of people have died up to this point because of wait-lists and because they were not being served. This is not to suggest that this is something the minister is not acutely concerned about, because I know he is.

The issue is whether or not, today or in the next few days, this minister can give any assurances to the parents of those patients who are currently receiving service in private clinics.

Hon. P. Ramsey: I think it would be totally inappropriate of me to indicate whether or not this ministry would be funding private clinics to deliver residential services for eating disorders prior to receiving the report of the advisory committee, which is examining the standards and

circumstances for such funding and making recommendations to me.

L. Reid: Hon. minister, I am not asking you to fund the facility. I'm asking if the parents in this province can expect individual reimbursement for the services they are currently purchasing for their children. That is a very different question. I'm not asking you to give dollars to any private clinic.

[3:00]

I can assure this minister, as he well knows, that out-of-province services are often paid for by this ministry. Money goes to families that have put out dollars to purchase the service. If the service is not currently available -- and it is my contention today that waiting a year and a half renders a service unavailable -- will this minister, until his guidelines and evaluations are in place, come forward with an interim response to this question? I hope that will allow the less than 50 patients in this province who are currently in that scenario to have some reassurance that they can continue to avail themselves of that service. I think that's a vastly different question.

Hon. P. Ramsey: I'll try once more. We do not fund services that are delivered through private clinics unless those clinics have met the standards established by this ministry for that care. That pattern is true for home support and for long-term care, and that is the pattern that is going to be true for residential facilities dealing with eating disorders. This member is saying it is one thing to fund the facility and another thing to fund the person, and I think she is misleading this House with that sort of assertion.

If the funding is going to an institution, it is the responsibility of this ministry to make sure that the care provided by that institution meets the standards expected of it.

The Chair: Before I recognize the member for Richmond East, I caution both the minister and the member that the convention that we seem to be forgetting is to address one's remarks through the Chair. What that translates into, in the most blunt and basic terms, is: get rid of the second-person personal pronoun -- i.e., the word "you." I am the only "you" in the chamber. In other words, it's okay to point the finger at me and say "you," but not at each other.

L. Reid: This ministry is circulating materials from the Ministry of Health. Miss Tanya Haverstock requested payment for her eating disorder treatment in Texas. It is noted that $45,000 has been committed and allocated. I need some information on that. If you are suggesting that you cannot fund parents in this province who are in dire financial straits, yet $45,000 will secure that treatment for someone out of province, I find an incredible dilemma with that, hon. minister.

Hon. P. Ramsey: Hon. Chair, I always thought you were a ram, not a ewe, but we'll let that pass.

The answer to the member's question regarding funding for a treatment in Texas is as follows: yes, this ministry did pay $45,000 to a clinic in Texas to treat a B.C. patient suffering from a severe eating disorder. This was done largely to gain information about the treatment provided through that facility. It was the concern of the ministry that we did not have information in this province about a full range of treatments that might be made available to those suffering from severe eating disorders.

The clinic in Texas claimed that they had different sorts of treatment above and beyond what was currently being offered here. The deal was: we'll fund this patient to receive your services, in exchange for which you will provide us not only with the services for that patient but with full clinical records and full documentation of treatment received. That was the agreement. It was some time ago, and I believe it is a unique situation.

L. Reid: It may indeed be unique, but I can assure you it's incredibly distressing to patients and their parents in this province who are looking for $250 a day from this minister. So to spend $45,000 and then suggest somehow that this minister cannot move on a decision to ensure that patients whose wish is to receive service in this province are at least funded to the ministry maximum.... If the

[ Page 12418 ]

ministry maximum is $250 today, I have tremendous difficulty with what I see as a huge contradiction: that this minister can spend $45,000 out of province but cannot spend $250 per day per patient for British Columbia eating-disorder patients.

I would be interested in some background on this program and in what this province received for $45,000. I can assure this minister that the parents listening to this debate have serious concerns about the decision that allowed $45,000 to leave the province but which somehow hasn't allowed $250 a day to remain in this province for those individuals who are currently receiving service.

It's not because this ministry cannot offer the service today. With a year-and-a-half wait-list, that service is not available. So to deny them the funding to purchase a service that their youngsters desperately need leaves a great deal to be desired. I would ask the minister to comment.

Hon. P. Ramsey: The concern about eating disorders and about appropriate services being available to deal with those who suffer from eating disorders, as the member says, is not new. What is new is a comprehensive strategy for dealing with the issue and for making a range of treatment available to those who suffer from disorders, and that was announced earlier this month.

I'm sorry that we can't seem to distinguish here between funding of a private care provider on an ongoing basis.... I assure this chamber and everybody who is watching that this ministry does indeed fund a variety of private care providers when they meet the standards established for care. That is all we are doing in this situation as well. We're saying: "Let us make sure we have appropriate standards established; let us make sure that the clinics providing treatment meet those standards."

I am not prepared to shortcut that process. I think it is incumbent upon those who use tax money for health purposes to make sure that the care provided is of good quality. The spending of money for the clinic in Texas was done as a pilot project, as I said, to gain information about treatment provided there. The ministry has done similar pilots for a number of other conditions with other clinics, both across this country and in other jurisdictions.

This is not an uncommon way of gathering further information, but it is not, by any means, to leap from that to the assertion that somehow a set amount per day should be available for the use of any clinic to anyone who requests it. To bypass the establishment of standards and the certifying of care providers strikes at the heart of what this ministry attempts to do in ensuring the best-quality medical care for British Columbians.

L. Reid: I want the minister to clearly understand what I'm asking. I am not asking this ministry to fund a private care provider on an ongoing basis. This minister has heard me say that three times now: this is about funding individual British Columbians today and asking the minister to do that on an interim basis until the guidelines that this minister spoke of earlier are in place.

I respect what the minister said in terms of the pilot project -- and I have asked for that, as have many British Columbians -- and this ministry believing that it needs more information about private eating-disorder clinics in this province. Our discussion has always centred around funding two or three individuals and then collecting that documentation, doing some kind of evaluation and actually funding a pilot project. I'm asking for that today, as an interim measure for British Columbia parents and their children.

Let me be perfectly clear that I'm not asking for some commitment regarding a facility; this is about whether or not the ministry will stand in today, on an interim basis. Today some British Columbia families are in jeopardy of losing their homes and families because there is some time lag built into what this ministry intends to do. I support the direction in which this ministry wants to go and where it wants to get to, but I think there needs to be a solution now. The next three or four months is critical in the lives of these British Columbians, who are typically young women.

I would ask the minister to respond as to whether or not his ministry can provide an interim solution to an immediate and urgent problem.

Hon. P. Ramsey: I think we've canvassed this issue fairly thoroughly. Let me give an example outside the field of eating disorders that I think is exactly parallel to what this member is asking about. It strikes me that something that would be exactly equivalent is if I were asked to provide funds to somebody who wished to purchase home support services from an unlicensed provider.

My answer would be exactly the same: "No, we only provide funds when they are going to providers who have met the standards set by the ministry." We are asking no more and no less of clinics that wish to specialize in the treatment of eating disorders. I believe that is an appropriate response and that it will ensure that the care provided in this province is of the highest standard.

L. Reid: I have a number of questions relating to the evaluation done on the Montreux Clinic. There certainly seems to be substantial evidence to suggest that the first draft of the report was dramatically different from the second. I would ask the minister to make available to this House, and certainly to the Health critics, the draft report and the final report, and perhaps give some comments as to why those variations exist.

Hon. P. Ramsey: What the member refers to as a first draft of the report was an initial impression, which I believe was largely based on a little field examination of the Montreux clinic. It comprised only part of the work that was done to evaluate the Montreux clinic. Much more work was done. The final report took into account the initial -- I don't know what to call them -- notes, as well as other evaluations. The final report was obviously boiled down and condensed to make sure that the overall impression of those authoring it fit the facts they had found.

L. Reid: Hon. minister, is it your practice to have an evaluation report written after a single site visit?

Hon. P. Ramsey: A number of elements go into such a report, and obviously a site visit is one. A variety of other objective evidence should be gathered and assessed on a clinic's operations, or on any treatment centre's operations. A site visit is surely only one component of what needs to go into a report on the provision of care provided by a particular clinic.

As the member knows, a variety of documents were asked for to make sure that we had the best possible information. I'll just mention one. The Montreux clinic was asked to give us follow-up data so the ministry could very carefully examine the claims of success and efficacy of treatment provided by the clinic. To date, Montreux has not been able to give us the objective

follow-up evidence that would help to establish the efficacy of the care provided. That's but one example. I hope that sort of data could be

[ Page 12419 ]

forthcoming. Other data, of course, has to do with the certification and qualifications of care providers and links between the clinic and other care providers in the area, such as acute care facilities. As evidence was gathered on a variety of things, those assessing Montreux found, regrettably, that at present they could not determine whether it met appropriate standards for the residential care of those with eating disorders.

L. Reid: I will certainly concur that accreditation is a complex task, as is evaluation. My question to the minister: is it this ministry's practice to write a report after a single visit?

[3:15]

Hon. P. Ramsey: It is this ministry's practice to write reports after adequate data is gathered; whether that's one site visit or ten depends on what information is sought. Much other evidence can be gathered, either without or in addition to site visits, that bear equal or greater weight.

L. Reid: Hon. Chair, allow me to say that this is one issue where the minister and I will disagree. Any accreditation or evaluation team worth their salt goes back more than once. That's simply the state of the art; that's public administration at its finest. I have some serious concerns, and I trust we can resolve this in the next number of days.

My next questions look to the issue of continuing care. A week ago this minister promised a special briefing a week from now -- the first week of July. With the briefing not being provided in a timely fashion, I have questions today, and this is the opportunity afforded to me. I would simply bring the questions to the minister's attention and trust that if all the information is not available today, perhaps this can be covered on, I believe, July 5 or 6.

I speak specifically of community services for the handicapped in our communities, or services for community living. I'm talking specifically about individuals with multiple handicaps who require a range of services. We have some issues, and a number of issues have been brought to me. I have taken the opportunity to share these issues directly with the Minister of Health. Individuals have suggested that there has been no true consultative process regarding the transfer of service between the Ministries of Health and Social Services.

If the minister has some information on how that process came to pass and whether or not there were consultations, I would be very interested in his opening remarks. He may indeed be able to answer some of the questions I have.

Hon. P. Ramsey: I thank the member for sharing and bringing to my attention some of the concerns that have been brought to her office by the families of people with severe disabilities. I think she and I shared some common concerns about taking steps to ensure that these people and their families feel comfortable that the high quality of care that they've come to expect will continue.

I would say only this at this time. After a very long, and sometimes heated public consultation in '91, a recommendation was made by senior staff in the Ministries of Health and Social Services to realign some services to adults with multiple disabilities from the handicap branch -- it's called Services for Community Living -- to the Ministry of Social Services. Both ministries are now examining options to relocate some or all of the people supported through that program to the Ministry of Social Services. No decision has been made; no services have yet been transferred.

I continue, as does the Minister of Social Services, to consult with families and agencies so that we understand thoroughly the concerns of those families. We are basing decisions on transfer in a way that will reflect and address any concerns that we're hearing.

L. Reid: Can the minister perhaps comment on why the decision was taken to move the program from the Ministry of Health to the Ministry of Social Services? There seems to be some confusion around that. The clients who have brought this issue to me suggest that they are being compromised for some kind of administrative ease. Would the minister please comment.

Hon. P. Ramsey: Nobody's health and no services are going to be compromised if a transfer occurs. That's the clear pledge that both the Minister of Social Services and I have made to the families whose family members may be involved in this transfer. The recommendation that transfer be made was on the grounds that many of these individuals are dealing with conditions that are non-medical in nature. Indeed, the supports required are

non-medical in nature. Those services are very similar to what those who are not adults are currently receiving through the Ministry of Social Services. The two ministries recommended that we look at combining our programs and expertise in the delivery of services for those individuals, whether they be adult or youth.

L. Reid: I have also been made aware that the associate family program may be transferred from the Ministry of Health to the Ministry of Social Services. The program provides training for families to work in partnership to provide home care for severely disabled children. Is that a decision that's in progress? Could the minister kindly comment on the intention when the proposal to move the programs was considered? What was it that the minister hoped to achieve by that change?

Hon. P. Ramsey: This ministry and other ministries of government are, I think you could say, constantly in discussion on how best to rationalize services and make sure that government services are delivered in both the highest-quality and most

cost-effective manner. There has been no decision made on transferring the associate family program to the Ministry of Social Services. That is one set of services that I know was looked at, but no decision has been made.

L. Reid: From the letters I have, these families believe the decision has been made. I will happily indicate your previous comment that no decision has been reached. I'd be happy to share with the minister this correspondence, which outlines in tremendous detail their concerns, because obviously they arrived at these concerns for some particular reason. If indeed their concerns are unfounded, I know they will be pleased to receive that information.

The head injury program, I understand, has recently been questioned in the press in terms of what kinds of resources are available. The ombudsman's office has clearly indicated that resources and programs are sadly lacking in this province. What kinds of supports can this province's head-injury clientele, if you will, expect from this ministry? Their concerns revolve around the Closer to Home initiative. Will those services be diluted as a result? Will they be emphasized as a result? Will there be any change in the delivery of that program at the present time?

[ Page 12420 ]

Hon. P. Ramsey: There is no change contemplated in the nature of care received by those suffering from severe head injuries. The issues around that care are very similar to the issue of associate families and services to those with severe handicaps. In this, as in other areas, there are opportunities for looking at rationalization of services. But no, the short answer that I can provide at this time is that we do not contemplate any change in the services that those people are receiving.

L. Reid: The minister is suggesting that no changes are contemplated, however the ombudsman's office has said that the current services available are lacking. That is in your ministry documentation. I would hope some changes are being contemplated. If the offices and agencies cannot provide services today, surely there will be some infusion of support and resources to look at what is indeed a very critical issue. Frankly, it's a very urgent issue for families in this province who are often trying to provide that care in-house.

Hon. P. Ramsey: The ombudsman's report, to which the member refers, did indeed result in this and other ministries engaging in a pretty thorough examination of what services were available to those suffering from head injuries and a close look at what recommendations they would like to bring forward about improving that service. Most of the detailed work on this report has been completed. I expect that myself, the Minister of Social Services and others will be receiving this report in the near future. After we receive it, we will then look at acting on the recommendations brought forward.

In conclusion, just very briefly, as with some of the other issues the member has raised this afternoon, it is a matter we take seriously. I'll be looking very seriously at the recommendations of this report.

L. Reid: We can spend a few minutes this afternoon on services to very young children in the areas of speech and language service. There are a number of questions regarding the similarity of, for example, Delta as compared to Maple Ridge. Maple Ridge has approximately 60,000 people, and they have a minimum of three occupational therapists and three physiotherapists. Delta, with a population of 90,000, has only one OT/PT in the district. These questions come directly from the Delta Child Health Society, and I know they have been shared directly with your ministry. The answers have not been received.

It's worthwhile to discuss putting resources into children when they are very young. Indeed, if you're going to make a difference in terms of providing some kind of specialized support service, you want to do it when children are in the zero-to-five range, particularly as it relates to speech therapy, growth and fine motor function. Those issues are best addressed when children are in that age range.

I know families in Delta have brought those issues to you, and they've certainly brought them to my office. They have some serious questions as to why these youngsters would have to wait based on where they live in the province. This plays very keenly into the discussion we've had on bringing some of those services closer to home.

I can assure this minister that in 1993, 129 children needed that service. More than half of them had to leave Delta while they were under five years of age, which causes great strain on their families, typically financial hardship. There's no transportation available. These are tremendous issues not just for the lower mainland but for other regions of the province. It has been this minister's and this government's contention that similar levels of service are available in all parts of the province. This particular group suggests that is not the case, and I would ask the minister to comment.

Hon. P. Ramsey: This is an area where the member and I share a common objective. We may not share a common perspective on the funds available to actually carry out the goal that we share.

We are attempting to move forward in providing better speech-language pathologists to preschoolers in the province of British Columbia. In some areas of the province, wait-lists are excessive and staffing is less than ideal. That's a reality. I think we've made some progress in the last little while. We are working hard to increase coordination of existing services within communities. As the member knows, other agencies that provide speech-language therapy are employed through school districts and other agencies.

We're also working to expand the educational programs for parents and child care workers who deal with children -- those requiring a language therapy to assist them in dealing with the condition of their children or the children they care for -- and to enhance an early speech and language environment for those children. We're also working with providers of speech-language therapy services to monitor and assist with recruitment and retention. In this area, as in other areas, very often that is an issue.

Particularly for some of the more remote areas of the province, attracting and retaining therapists has not always been easy.

We share a similar perception that this need must be addressed. My question is: how fast can we move to address it with the funds we have available? We are taking the steps we can. I wish we could do more and faster, hon. member. We are doing as much as we can with the resources we have.

L. Reid: I do appreciate the minister's comment. My concern -- and what I would like to be in a position to relay to parents in this province -- is whether the decision formula or framework will change once regionalized health and the Closer to Home initiative are in place. Is there any value, hon. minister, for these parents to expect a change in the near future? Will they have any ability to influence this process? This government has continually raised the issue of local decision-making and bringing those decisions closer to home. Is it something that consistently will be on the back burner for Delta?

Or are there indeed opportunities for them to bring the service level in their municipality -- in Delta -- in line with what they know to be the fact in Maple Ridge and other lower mainland communities?

[3:30]

Is there a formula today that drives the number of physiotherapists, occupational therapists, speech and language therapists? That certainly seems to be where the grey area exists in this discussion. I'm not asking the minister to spend more money today. I'm simply asking what the formula is that has driven the current service delivery model.

Hon. P. Ramsey: The current pattern of services has been driven by a large number of variables: the decisions of individual boards of health, the establishment or

non-establishment of child development centres and other care providers in communities and whether school districts in a region are coordinating their activities with those of health units. Finally, I suggest that the pattern of services also has been driven by the ability to recruit and retain therapists. So a large number of factors have gone into it.

[ Page 12421 ]

The first question the member asked, though, was whether regional health boards and community health councils would have the ability to receive funding based on a formula that recognizes the health needs of their community and to make allocations within that region to address those needs, if they consider them higher priorities in funding than they are presently given by health units or union boards of health. The answer is emphatically yes.

L. Reid: My thanks to the minister. If we can spend a few moments this afternoon on child and youth mental health services, I have a number of specific questions. The ministry's annual report stated that additional funding has been allocated to the sexual abuse intervention program. The program is described as targeted for the development of services to children under 12 whose behaviour is sexually precocious or intrusive.

I've had a number of calls to my office regarding whether that language is appropriate to describe someone who's under 12. In some cases we are talking about very young children -- two or three years old -- who somehow have been described as sexually precocious or intrusive. I ask the minister to comment, because it probably has potential to be a very valuable service. It just seems somewhat contrary to use language that is somewhat inflammatory, which probably takes away from the intent of the program.

Hon. P. Ramsey: I regret if the member finds the language inflammatory in some way. It was surely not intended to be. My understanding is that it is technical language used within the field when dealing with sexual abuse and intervention. It is a term used by psychiatrists and others to describe a particular set of behaviours. I understand further, although I don't know the Latin, that this is a direct translation from Latin to describe a particular set of activities or behaviours.

L. Reid: The parents who raised this issue have some concern about the language. If your contention is that the language is appropriate, I'm happy to relay that.

I understand pilot programs are underway in Vancouver, Port Coquitlam and Campbell River. I would be interested to know what types of programs those three pilot projects are delivering around sexual abuse interventions and perhaps what the client base is for those programs.

Hon. P. Ramsey: I'm not sure how much detail I can get into at this time. We are looking at working to develop a coordinated service delivery model. An office providing those sorts of services was established recently in Prince George. It should be an interministry effort. We're providing training for workers who deal with sexual abuse victims and looking at establishing intervention materials and program standards for those who are intervening in such cases. Counselling services form a core of what's going on, and we're also developing services for sexually abused children and youth with disabilities.

The funding provided has been enhanced recently. Actually, I think a couple of years ago it nearly doubled. We take the issue seriously. In '92-93, around 3,500 victims were counselled and treated. That compared just two years prior to some 1,300. We have nearly tripled the number of victims we're able to deal with through enhancement to the program.

As for the particular pilot projects in particular locations, quite frankly that is a level of detail I don't have at my fingertips. If it would be useful for the member to have the information for each pilot project, I can make sure she gets it. I don't have it with me today.

L. Reid: I thank the minister for his comments.

I have a number of questions regarding the availability of services in communities. We talked earlier today about issues that are emotionally complex. The next questions are in that range in terms of individuals in need of psychiatric intervention who are presenting themselves at an emergency room of a hospital but are not admitted for a myriad of different reasons -- as outlined both in the correspondence and in the coverage -- and are then involved in murders and stabbings. The three that I have before me are incredible tragedies for all concerned. There's no question about that.

What is the solution, and what are some of the useful steps along the way? Just to give you some examples, each of these individuals was turned away from emergency rooms for a different set of reasons -- i.e., there wasn't a secure site; there wasn't a protective room where they could be secured. There was a whole range of reasons, but the bottom line is that all three cases have been documented as presenting at an emergency room for some kind of evaluation or medication, and were turned away and then committed some horrific crimes.

The parents who brought these issues to me believed that two crimes happened: their children did not receive medical care when it could have assisted them, and the people who were abused in this process -- the public -- were also compromised. I would be interested in whether there have been any studies and whether this ministry has some direction in how best to receive the adult psychiatric patients when they voluntarily present at emergency rooms in this province and emergency rooms do not have the resources available to receive them. What is the next step for patients and for parents in this province?

Hon. P. Ramsey: I sought a fair bit of advice from staff, because I find this a very complex issue, one I didn't want to respond to without having some advice.

I share the member's concern. Indeed, I could give her similar examples from my own correspondence or my own experience of people with psychiatric disorders who have used one of those two classic self-referrals of last resort, almost, which results in people suffering from severe psychiatric disorders ending up in emergency rooms or in police cells, neither of which is probably the appropriate venue for them to be dealt with. As government, this ministry has done what we can to ensure that the traditional neglect of funding for mental health services has been reversed.

Over the three budgets that we presented, funding for mental health services has gone up at a greater rate than any other period in funding for mental health services in this province's history. I think the total goes up to an increase of about 60 percent.

What is lacking is the coordination of those services at a local level. If I look at some of the recent reports that have been done on the Riverview replacement, coordination at the local level is very often seen to be what we as a ministry and as individual care providers need to be concerned about. In a way, it is almost classic of the fragmented nature of the health system that we have now. There are close to 100 agencies in the Vancouver area that provide one service or another to mental health consumers. Sometimes I can't find my way through the chart of which services are provided where.

How can we expect those who are suffering from a psychiatric disorder to find their way? Quite frankly, I don't think that can ever be done operating out of this building or this city. We need to make sure that the coordination is occurring within the communities where those suffering from psychiatric disorders needing mental health care live.

[ Page 12422 ]

Not to dwell on it, that's another reason I am so committed to the idea of making sure that we establish those coordinating bodies and administrations for health care delivery for mental health consumers and for other British Columbians needing health care.

L. Reid: As the minister heard, I did not refer to specific hospitals or specific patients; I am happy to share that information. The dilemma still is: what happens to a patient who presents at an emergency room and is turned away? I appreciate all the coordination and how valuable that will be.

[3:45]

The families that have written -- and I know that they have written to both of us -- talk about the suicides because of inappropriate jail placement, and about the assaults that have occurred. Is there any answer today? Is there any consistent protocol in place across this province for adult individuals who present with immediate psychiatric needs and who can't be turned away. In two of these instances, the individuals were asked to come back the next day, and horrific things occurred in the intervening time period.

Is there a protocol that parents in this province can rely on if they have a psychiatric patient who is now finding their way into the community and who will place some stress and strain on the system unless there is a protocol in place?

Hon. P. Ramsey: I do not want to leave the impression that the ministry has been standing still or simply saying that we have to wait until the establishment of the community health councils before we can start to address that problem. That's simply not the case. In the last fiscal year, for example, we established 116 new support groups for mental health consumers and drew up over 7,000 contracts through the partnership education program, which is designed to provide information and education on mental illness.

So we are doing the work, as we can, to ensure that there is the coordination of mental health services at community and local levels for mental health consumers. This has been part of the overall and very substantial increase in funding for mental health services over the last few years. And those initiatives go on. For example, Vancouver General Hospital is currently partnering with St. Paul's and the Greater Vancouver Mental Health Service Society in developing a proposal for the Closer to Home fund in that city for a bridging team -- a short-stay, transitional facility -- in the community.

So a lot of work is going on in communities around the province to address this serious issue.

There are standard procedures for addressing the needs of mental health consumers who present at emergency rooms. Do they always work? I won't pretend that they do. You've seen the letters, as have I, about some of the tragedies that occur when things go wrong. Is this being addressed as best it can right now through the fragmented system we have? I see many care providers doing their best to coordinate with each other.

I continue to stress, though, that I think the ultimate way of dealing with this is to make sure that we have the coordination and the responsibility for the delivery of mental health services in place at community and regional levels, not at the variety of levels to which they now report.

L. Reid: My thanks to the minister. If I may spend a moment this afternoon on alcohol and drug programs, I also have a number of pieces of correspondence that, frankly, suggest extreme hardship, based on the increased daily costs for those programs. Apparently -- and the minister will know far better than I -- there are agencies, such as fire departments and police departments, that have resources in place to pay for those kinds of programs, but their ceiling is no longer commensurate with what the ministry is now charging for those services, so it leaves a tremendous shortfall for the patient.

It seems to me that it would be the goal of the ministry to have anyone who's interested in a drug and alcohol rehabilitative program benefit from it, because the costs to society are significant if those issues are left unchecked, particularly when the patient has expressed some desire to participate in a program such as that.

I also understand that the program-analysis system is now in place to monitor patients in this province. I'm not familiar with that monitoring system, and I would appreciate the minister's comment on the program-analysis system regarding the delivery of drug and alcohol programs. I'm asking the second question to emphasize the need for some kind of cost-benefit analysis. Will the monitoring program suggest any other avenues of funding for individuals who are currently being asked to contribute a tremendous personal outlay for participating in those programs?

I think this government would very much want them to take advantage of those kinds of programs in order to reduce the other social costs, which the tax base would continue to pick up.

Hon. P. Ramsey: I thank the member for raising some important issues regarding alcohol and drug programs provided through this ministry. Just for the record, I want to indicate the scope of the alcohol and drug programs being delivered in the clinical service area. That's what we're focusing on here.

We have over 200 service providers who provide clinical programs throughout the province. They do policy development, program innovation, improvement in strategies and implementation of changes. Last year some 14,300 adults were admitted to detoxification services, another 18,000 were admitted to

out-patient services and 3,200 benefited from treatment in residential settings. That's a large number, and I think it reflects the seriousness of the problem of alcohol and drug abuse in our society.

One of the things happening in alcohol and drug treatment is that the emphasis on residential programs as the answer is fading. Studies seem to show fairly consistently that there is no real difference in outcomes of people who've gone through a residential program compared to those who have gone through a day program or short-term program. That's the reality of treatment outcomes right now in the alcohol and drug field. Given that that is so, the choice for residential is almost an individual choice of where the patient wishes to receive care. Therefore we took that into account when we addressed the issue of fees for residential settings and increased them this year.

The rate that has been established reflects the actual cost of room and board, not of the treatment program. We recognize that some individuals will need financial assistance; therefore those fees are based on a sliding scale in order to provide assistance from the limited support funds we have available through alcohol and drug programs.

L. Reid: I appreciate the minister's comments. That's one of those very complex issues that hopefully will be resolved very soon.

I have some questions this afternoon on funding for AIDS issues in the province. There are some pressing contradictions in what has gone forward from this government and what is considered to be fact by the AIDS

[ Page 12423 ]

organizations. I would simply put forward both these items into the debate and ask the minister to comment.

Today the government is claiming that community groups received a 10 percent increase in AIDS Secretariat funding for AIDS projects -- more than any other area of health care this year. However, the AIDS organizations in this province suggest that the overall funding for community-based AIDS organizations decreased by 3.5 percent in 1994-95, which represents an actual decrease of $98,000. It's not just the AIDS Vancouver issue I want the minister to address, because I have a number of pieces of correspondence that look at AIDS funding for the needle exchange program throughout this province. Could the minister perhaps comment on the first contradiction?

Hon. P. Ramsey: I'm pleased that the member has seen fit to raise the issue of the treatment this ministry provides to those living with HIV/AIDS. There are approximately 5,000 to 8,000 British Columbians currently infected with the AIDS virus. As of December of last year, close to 1,700 cases of AIDS had been reported since the first case was reported back in 1983. In the last decade, our experience and ability to assist those living with HIV/AIDS have grown considerably. Over that period, we have increasingly dealt with measures to educate the broad community about the dangers of this disease and the prevention measures that should be taken.

In '92-93, the last year for which end-of-year figures are available, the Ministry of Health spent approximately $22 million on targeted AIDS and HIV programs: about $12.5 million that went into hospital programs; another $1.5 million for continuing care services; close to $2 million for medical and diagnostic services; $4 million for prevention and education; and $2 million for drugs through Pharmacare. I suspect that there are other health programs that were used by people living with HIV/AIDS.

In 1993, the previous Minister of Health established the AIDS Secretariat and charged it with allocating funding for community-based groups who provide prevention and education projects. This is one segment of funding that this ministry provides for HIV. I also want to note for members in the House that this portion, this $2.75 million that was provided for community-based AIDS prevention and education projects this year, is part of what this ministry and government does on HIV prevention and education initiatives. The total cost of those initiatives for government this year will be closer to $4.5 million.

Considering that when we took office, the amount spent on all AIDS prevention education programs was less than $1.5 million, I think our commitment to prevention and education projects dealing with the AIDS epidemic is clear. Last year, for '93-94, the secretariat allocated some $2.5 million; this year the budget provided to the secretariat amounted to $2.75 million, a 10 percent increase. I think I'll end there. I'm sure the member has further questions.

L. Reid: The minister has confirmed that the government's claim of a 10 percent increase.... That's the story, and that's where he's going with it. The AIDS organizations suggest that there has been a 3.5 percent decrease. I am left wondering which indeed is the correct figure, hon. minister.

The government's second claim is that the secretariat decided to provide most major Vancouver AIDS groups with the same money as last year or more, and devoted new money from the 10 percent increase to ensuring equitable distribution throughout B.C. The AIDS groups are suggesting that the major AIDS groups in B.C. received over a quarter of a million dollars less than last year, representing a 12.7 percent decrease. That is their contention. Would the minister please comment.

Hon. P. Ramsey: I would say that I have had some interesting times myself in the last couple of months trying to ascertain what the accurate figures are on this issue. One thing I do know with all certainty is that the cheques we're writing and the funds we're providing to the AIDS Secretariat for distribution to community groups working on prevention and education projects have indeed increased 10 percent. What is also clear from those figures I read earlier is that this ministry and other areas of government provide additional funding for these groups, for other AIDS education and prevention projects and for the treatment of those living with HIV/AIDS.

As the member is aware, I have asked my deputy minister to review the funding received by all those community groups involved in AIDS prevention and education with a view to ascertaining the facts of this matter. I can tell the member that I expect to be making an announcement later this week on the results of that review. I'm not prepared to share them at this time, because there is some work being done to contact individual groups.

I will say one other thing as long as we're dealing with the AIDS Secretariat. One thing that I have announced already is that I share the secretariat's view -- indeed, I share the Coalition of AIDS Groups' view -- that what we need is a comprehensive provincial strategy to deal with AIDS. We've had a strategy to date that has been a bit of this and a bit of that. It's been largely the responsibility of the Ministry of Health. It has not acknowledged the contribution that other ministries of government need to make both in preventing the spread of HIV/AIDS and in assisting those who are living with the disease.

[4:00]

That is why I announced, earlier this month, the expansion of community membership on the AIDS Secretariat. The number of community representatives now represent over half of the members of the secretariat. The ministries of government that are represented on the secretariat have also been expanded to include not just the Ministry of Health but also the Ministries of Social Services, Housing and Attorney General. This will ensure that we're getting a cross-ministry view of both the issues affecting those living with HIV/AIDS and the measures that should be taken through prevention and education projects to prevent the spread of the disease.

L. Reid: I certainly won't comment on the minister's upcoming announcement. I can only trust that it will make these groups happier than your previous announcement. I will simply make my comments known today, and if the answers to these questions can be contained within the announcement that is yet to come, I would certainly appreciate that. The contention today, which seems to be documented appropriately, is that no additional dollars were received by AIDS Vancouver, AIDS Vancouver Island or British Columbia Persons With AIDS. In fact, membership has increased by 35 percent, to over 2,000 members.

That's their contention. I am not in receipt of information that allows me to believe that they are in error.

[A. Warnke in the chair.]

I would ask the minister to comment, if he might, on the fact that the AIDS Secretariat believes they are being asked to divide the AIDS-funding pie, if you will, into smaller and smaller slices. They received 65 applications for funding in

[ Page 12424 ]

1994-95, and they ended up allocating dollars to 47 of those agencies. That is the government claim. The fact of the matter is that this represents a total increase of 142 percent in the actual number of groups receiving money, but they are having to divide a diminishing resource. I hope that claim can be addressed in your pending announcement. Their other contention is that only two dozen groups receive secretariat support, many of which are based in the lower mainland. Their contention is that the 19 groups that received support this year were cut back 22 percent.

I appreciate the minister's comments that he too is having difficulty coming to grips with what the facts are surrounding what appears to be very contradictory information. I can only trust that the announcement that is expected this week will respond to a number of these concerns. The issue is one of prevention in a number of respects, particularly around the delivery of services in the needle exchange program. It's not just the Vancouver-based agencies that have difficulty -- certainly the Surrey Interagency Network....

"This letter is written on behalf of the Surrey Interagency Network to express our concerns regarding the recent funding cuts to needle exchange programs throughout the province and particularly to the Surrey Family Services Society needle exchange program." So it's not just the Vancouver program.

I will not read the entire document into the record, but it seems to me that there is tremendous confusion around the issue. I for one look forward to your upcoming announcement, which will hopefully shed some light on where all these inconsistencies appear to lie. If the minister wishes to shed some light on them today, I would welcome that.

Hon. P. Ramsey: Let's deal with a couple of the general realities that I think are affecting this whole case. The first is that there are any number of worthwhile projects out there. The AIDS Secretariat received requests for funding of prevention and promotion projects. It was a total request for in excess of $7 million, and I do not doubt that many of those projects are very worthwhile. What we are faced with, as the member and the Chair know, in these difficult financial times is limited resources to meet that range of growth. I authorized the provision of a 10 percent increase in funding to the secretariat. The member has alluded to some concerns about how that funding was distributed.

Let's make it very clear. Funding for the AIDS Secretariat did not diminish this year. Funding for AIDS prevention and education projects did not diminish this year; it increased. The AIDS Secretariat took it upon itself to look at the applications it received and allocate the funding that was made available to it. In the cases that the member referred to, the AIDS Secretariat made a decision that less funding or the same amount as the previous year would be provided.

In some cases they said very explicitly that they felt that the services being provided by a specific agency did not justify the extent of funding that had been received in the previous year or had been requested for this year. I suggest that that is an appropriate decision for the secretariat to make. This is a group of highly involved individuals who are very committed to AIDS prevention and to caring for people living with AIDS in their communities.

When they tell me that they think a particular agency has not made good use of funding provided and that they are therefore recommending a decrease in funding, I think it's incumbent upon me to take their advice, and in many cases I have.

As I indicated earlier, I have asked my ministry to review the funding for all agencies that have received funds through the secretariat and to advise me of any decrease in services that has occurred in the broad AIDS prevention initiative through the community agencies. As I said, later this week I hope to announce the results of that review and any action on recommendations in it.

L. Reid: Rather than ask the minister to pre-empt his announcement, I hope, just for the record, that the announcement contains some assurance about long-term funding. It seems that a number of these agencies spend a great deal of time and energy on the bureaucratic process in terms of trying to assure their funding and to commit to some kind of long-range plan for the delivery of services. I don't know if that will figure prominently in the announcement that is to come.

But if there is any way to allow these agencies to focus on the direct delivery of the service as opposed to constantly grappling with the funding issues, that would go a long way to providing some kind of ease or sense of purpose for these agencies.

I concur with the minister that they do some very fine work. The secretariat has done some very fine work, but if we allow all its energies to focus on where the funding is coming from and what the amount might be, that detracts from the direct services it was created to provide and, I think, would very much like to provide. I would hope that some sense of that is contained in the announcement on Friday, because it's an issue for every British Columbian, in terms of health care costs. We have talked many times about the cost of prevention, and the needle exchange program is about the cost of prevention.

When we talk about one-time grants and one-time funding for something that is a continuum of service, it lacks justification. It lacks what it is to be rational about whether or not you fund a needle exchange program or some of the other resources that are designed to provide direct service on the street. I hope that will figure prominently in the minister's announcement, and I thank him most sincerely for his comments.

Hon. P. Ramsey: I thank the member for raising these important issues in the chamber today.

I don't want to pre-empt some of the work that's going on by people in the ministry in dealing with community groups concerned with HIV/AIDS. Let me just say that I think the member has identified one of the root problems here, and that is that this network of community groups providing services -- sometimes for prevention and health promotion, sometimes for service delivery

-- has really grown like Topsy. What is occurring in one part of the province is not necessarily the same as what is happening in another part. The funding for needle exchange programs, for example, is not consistent in the source of that funding around the province.

In developing a provincial AIDS strategy and focusing on prevention initiatives, we have asked the secretariat to help us address how those programs should be funded. I share the member's concern that we don't want groups spending half their time and two-thirds of their resources preparing their next grant rather than delivering the services that they wish to get on with delivering; that is a serious concern.

The question of ongoing funding and how those services are actually delivered through community groups or through other agencies is something that the AIDS Secretariat is going to be looking at, as well as the issue of what ministries and what sources of funding should be available for AIDS prevention and education projects.

L. Reid: I will ask just two more questions. I want to refer to a February press release from the Vancouver Hospital and

[ Page 12425 ]

Health Sciences Centre entitled "Vancouver Hospital Planning To Restrict Access." My office has received a number of calls about whether it is the intention of this hospital or this government to dictate from which physician and at which hospital a British Columbian can receive services. For the record, it seems to suggest that the Vancouver Hospital and Health Sciences Centre has initiated planning to redirect patients from outside the city of Vancouver who require secondary-level services.

These patients will be encouraged to seek medical care from a local community hospital instead of coming to Vancouver Hospital for treatment. Examples of secondary services include gall bladder surgery, hernia repair, general gastrointestinal medicine, hysterectomies, and general ear, nose and throat surgery.

A number of questions that I would pose to the minister regard British Columbians whose doctors have admitting privileges at hospitals in Vancouver but the patients do not happen to reside in Vancouver. They read this announcement as somehow directing them to select another physician, because if they needed any of these surgeries or interventions I indicated, they would have to seek another surgeon, if you will. Was that the ministry's intention? Was the ministry aware of this directive from Vancouver Hospital?

Hon. P. Ramsey: I surely was aware of it after I received it in my office. Let me just say this very briefly, since the member indicates she has more questions to ask on this issue. As a result of the Shaughnessy closure, a substantial number of resources and beds were distributed to other hospitals in the greater Vancouver area. In some cases, while the funding for services went to those hospitals, the physicians and specialists who delivered those services chose not to. This has created some sort of an imbalance. I read the announcement of Vancouver Hospital -- and I should emphasize that it's their announcement

-- as their method of dealing with what they perceive as being put upon to deliver services for the funding that has gone out to some of the suburban areas around Vancouver.

This letter, and the responses to it, is one of the reasons why, in the funding letters sent to hospitals this spring, we required that they consult with one another before any of them took measures to reduce services provided within their facilities.

We did not want the situation where one hospital said, "We're not going to do that," and another hospital said: "We're not going to do it, either." If the services are going to shift -- and in some cases they should shift, because it rationalizes health care delivery and helps avoid unnecessary wait-lists, which is something that the member was talking about a great deal earlier today -- then it needs to be done in a coordinated fashion between hospitals.

In conclusion, hon. member, I have no difficulty saying that those services should in some cases be shifted out of central Vancouver, out of VH, to community hospitals. The responsibility of those hospitals and this ministry is to make sure that the services are, indeed, shifting and are still available to residents of the greater Vancouver area.

L. Reid: I would like to spend just a moment on the doctor-patient relationship, which I perceive as very significant. Even though the service may indeed be available, what this notice is suggesting -- and from your comments, I suggest that you're concurring with this announcement -- is that the direction for patients in this province is that they will need to select a different physician if the services are not available to them.

There would be little value in having a physician who could see you for a common cold and a surgeon who could see you for minor things, if when you really needed them, you were forced to find another physician. I'm not sure we've done anything in terms of improving service delivery. What patients in this province have said to me is that they value that relationship. What this has done is to open the door in terms of directing people to select another physician. Is that a discussion you have had with your ministry?

Hon. P. Ramsey: On the contrary, I would say that this sort of rationalization of health care delivery asks physicians to move to where their patients are. There is nothing that prevents a physician from having privileges in a variety of hospitals and going where his or her patients are. As we make regionalization of resources more of a reality and move some services "closer to home," I think we will have better distribution of physicians and resources around the province.

[4:15]

I might point out to the chamber that yesterday in Prince George I had the pleasure of announcing a task force to look at a rural and remote health care delivery strategy for this province. One of the prime components of that is looking at the whole issue of whether we should be asking people from rural and remote regions to come to major urban centres to receive specialized services, or whether it is more appropriate and cost-efficient to look at moving those services closer to those patients. Also, we need to quantify exactly where people receive specialized services now, and do a good analysis of whether or not those services could be moved closer to where people actually live.

I want to make it very clear that as we move forward in regionalization, the boundaries between regions are not made of barbed wire. It is not the intent of regionalization to say: "You must receive services within this region." The intent is to make a wider range of services available within regions that have been traditionally underserviced, so patients have the choice of receiving services closer to home.

L. Reid: I disagree with the minister. There is something today that prevents physicians from having admitting privileges at a number of hospitals: the physician resource plan. Most hospitals do not wantonly open their doors to a myriad of physicians. The minister probably would concur in hindsight, because this minister has often said there needs to be a plan around physician supply. So I perhaps we're looking at some interim discussion on how we don't move immediately to a plan that in fact will dictate to patients in this province where they can receive the service.

My question to the minister is about this directive from Vancouver Hospital. Is it the ministry's contention that this is binding? Or will we be in some kind of evolutionary phase that allows this to be brought in through a measured, controlled approach to changing a fundamental service option, which is the ability to select your physician?

To add to the discussion, we currently have a lot of British Columbians who work in Vancouver but reside in all parts of the lower mainland, and a lot of medical services are received during the day. They take time off from work during lunch or whatever to receive that service. Are we oftentimes in fact simply shifting the cost somewhere else? We're going to say: "Come in to work if you need X service. Take the day off; go back to Surrey, Langley or Abbotsford; get that medical care and then come back again." Are we in fact looking to save some dollars in health care, simply to shift them over to spend them in some other place? I'm not

[ Page 12426 ]

clear what this ministry does with this announcement. To condense my question: is this binding today?

Hon. P. Ramsey: I'm not sure what I'm being asked is binding today. Nothing is binding today, nor have I said something is binding tomorrow. "Thou must receive thy health services at the hospital that's closest to thee" -- I have made no such pronouncement.

Let me say this very clearly, though. Those services that are received on a day basis traditionally have been funded in some of the major urban hospitals. That funding base is there, and I don't think we plan to change that. But a number of specialty services requiring hospitalization are more appropriately delivered closer to where people live. To simply say we're going to restrict choice, when the only choice for people in Kamloops has been to come down to St.

Paul's, or the only other choice for somebody in Terrace has been to come down to a Vancouver hospital, is to ignore the reality of people's lives, I submit. That was not a choice. That was forced, because the services were not available closer to where they wished to receive them. Our goal through regionalization and physician supply measures is to match the need for delivery of services with funding and the physician resources required to deliver them.

L. Reid: I was asking if indeed this directive was binding. I heard the minister say no, British Columbians will still have a choice. They will be very pleased to hear that.

In the broader issue of physician resource supply, certainly there are a number of medical students today who have some questions regarding where they would take their medical training, postgraduate training, fellowships and advanced educational opportunities, and whether the choices they make today will hinder their ability to return to British Columbia to practise. I know that's certainly been an ongoing discussion with the profession and ministry officials.

I'm wondering if there is some further discussion or update on where that sits, and perhaps some advice for new physicians in this province, folks who have recently graduated or will graduate next year, as to where they can head under that physician resource plan.

Hon. P. Ramsey: When we announced the interim physician supply measures back in February, we made it very clear that we did not want to impact on those studying and currently preparing to practise medicine in this province. Those measures were designed not to curtail their options, and that remains a very serious issue for us.

I now have received the report of the task force on physician supply. As the member knows, the representatives of residents, interns and UBC medical students were involved in consultation and preparation of that review. I plan to be announcing some next steps in physician supply measures -- this is going to be a busy week -- in a couple of days.

I assure the member that the issues raised by medical students, residents and interns are being taken very seriously as we design some next steps in developing a comprehensive physician supply model and measures to ensure the right number of physicians, the right mix of physicians and the right distribution of physicians for the health care system in British Columbia.

L. Reid: I look forward to the announcement in the next number of days. I would simply question whether or not some discussion has gone on between other ministers of health in the other provinces in terms of a national strategy for physician resource supply. Could the minister kindly comment?

Hon. P. Ramsey: There's both a yes and a no to the questions here. The Barer-Stoddart report, which was agreed to by all ministers of health, said that one of our difficulties is that we were simply training too many physicians in the country and that measures had to be taken to reduce the number of medical school placements by some 10 percent. That initiative was taken on a countrywide basis.

The other task that provincial ministers of health are undertaking is to coordinate the physician resource plans that are being developed by various provinces. Ideally, those will be worked out across the country in such a way that one province isn't doing something that impacts on another. That's the theory; the reality, unfortunately, has been somewhat different.

Some provinces, particularly Ontario early last year, took measures to restrict the practices of new entrants to the medical profession, and other provinces responded to prevent an influx of physicians from Ontario who were seeking but unable to obtain practices in that province. I would hope, when I meet with my colleagues from across the country in the fall, that we'll take steps to coordinate our activities in physician supply management a little better than we have done in the last 12 months.

L. Reid: I would hope that the discussions around physician supply that occur in the fall are indeed fruitful, because I tend to think it's somewhat simplistic to suggest that a 10 percent cut is going to solve the problem. I'm hoping that the discussion will focus on encouraging students to enter specialty and subspecialty fields that are in demand in British Columbia. The reports I have before me suggest that we need psychiatrists, obstetricians and general surgeons in this province.

A 10 percent reduction in who enters medical school does nothing in terms of measuring whether we graduate people with the skills we need in the province. I'm not convinced that our needs are dramatically different. If they are, I welcome that, because I'm hoping it is a unique plan for British Columbia. What I consider to be a gross measure -- to restrict by 10 percent -- will not answer the needs.

We started this debate by talking about Williams Lake needing a surgeon and another area in this province needing an obstetrician and the fact that psychiatric services are difficult to find in various parts of the province. Perhaps the minister can comment on whether the plan will recognize those three specific needs -- obstetrics, psychiatry and general surgery -- and whether the discussion he will be having in the autumn with other health ministers will recognize that for different parts of this province it cannot be just the crass measurement of decreasing entrance by 10 percent.

There has to be some ability to measure who actually finishes medical school and what kinds of skills they bring to bear on a very pressing problem. I would ask the minister to comment.

Hon. P. Ramsey: First, I hope I didn't create the impression that we were reducing enrolment in UBC medical school by 10 percent; we have not. The recommendation of Barer-Stoddart was that nationally we need to look at that sort of reduction. Other provinces were indeed overtraining for the population they had available.

There are a number of very serious issues here. The member is absolutely right that you can't do physician supply planning simply by looking at the gross number of physicians. It is far more complex than that. The member

[ Page 12427 ]

identifies three specialties that are obviously of great concern. I might mention in passing that psychiatry is an example. I think the member and I both read the recent auditor general's report on psychiatrist supply in the province and saw the great disparity of supply which was all out of proportion to the need for those services in different parts of the province.

We have a system that depends almost entirely on an individual practitioner's choice about where to practise or on how many practise. That's the sort of disparity we're going to get. That is precisely why we need a physician supply plan that addresses those inequities both in broad terms -- number of physicians -- and in the number of individual practitioners.

More than that, though, there are other aspects of this issue, and I will talk about a couple of them. One is to make sure that the training that physicians receive fits the needs of the health system they are going to practise in. I'll give one example. Particularly in some rural and more remote areas of the province, there is a need for surgeons with a broad range of expertise that may not be inculcated by current medical school training, which tends to focus more narrowly on one particular specialty.

We need to make sure that we are training and planning for the future population of physicians in a way that fits the needs of the health system we're devising and building in this province. Those discussions are ongoing with the medical school in this province and, I suspect, between ministers of health and medical schools in other provinces as well.

[4:30]

The other issue is the more difficult one of how to get better distribution of physicians around the province. The interim measures that I announced back in February attempted to do that by offering 100 percent fees in areas of the province that are underserviced and 50 percent of normal fees in areas that are overserviced. That seems to have had some effect. I won't pretend that it's been perfect, but it has had some of the desired effect.

Measures like that, worked out through negotiation and cooperation with the BCMA and the College of Physicians and Surgeons, will lead us to a physician supply plan that can meet the needs of the province for the number, for the training and specialties of physicians, and for their geographical distribution.

L. Reid: When the minister talks of areas of the province that are perhaps overdoctored, or underdoctored, is that formula available? Indeed, is it always appropriate to look at that breakdown in terms of the number of GPs, specialists and subspecialists? I can appreciate that there may be regions of this province that are overdoctored in terms of general practitioners, and that relates to my comment in terms of just a 10 percent reduction. When it appears that we need specialists and subspecialists in greater numbers, I'm not convinced that a 10 percent reduction across the board is the answer.

So I ask the minister to perhaps clarify whether the 10 percent reduction that is not in place -- but that is anticipated and being discussed -- refers to general practitioners or to medical admissions across the board.

Hon. P. Ramsey: The 10 percent reduction I referred to is in medical school admissions across Canada. There have been no reductions in medical school admissions in this province. Traditionally, this province has actually admitted more physicians from other provinces to practise; it has met some of its need from that, rather than from training within the province. That has been a traditional part of medical training at UBC. So we're not reducing the numbers.

The issue of how you make sure that the needs meet the training -- or that the training meets the needs -- is as complex for medicine as it is for any other profession. Those discussions are ongoing both at the provincial level, to which I referred, and at the national level to make sure that we have the right mixture of specialists, subspecialists and GPs practising in this country and in this province.

I thought there was one other item I wished to comment on, but it slips my mind now. I'm sure the member will remind me of it.

L. Reid: I was hoping that the minister would respond in terms of whether or not there will be a breakdown.

Hon. P. Ramsey: I knew there was another part to that question. The Medical Services Commission has drawn on a variety of models for ratios of specialists to general population, and it has developed a table of what those ratios should be, broadly, for a particular population. These are seen as guidelines that can be used to assist in the development of regional or provincial physician supply plans. They are not cast in stone for particular regions or for the province as a whole. They indicate a general consensus framework, rather than any rigid requirements.

L. Reid: I have just one other question pertaining to physician supply, and it's regarding the J-7 visa scenario. I have been in touch with this ministry on a number of occasions on behalf of medical students who are British Columbia graduates but wish to take additional training outside the province. It now seems that stumbling blocks, other obstacles, have been placed in their path in terms of them getting that training, which is very much in demand in this province.

Unless these students can provide to the ministry -- to the body -- some verification or authorization from a British Columbia hospital that they are guaranteed of being a physician at that hospital when they return, they are indeed not able to go. It seems to me that that was an add-on bylaw -- an add-on regulation, if you will -- in terms of restricting physicians trained in British Columbia from receiving what I think should be available to them and to the patient base in the province.

It would certainly seem that we would wish to have the finest trained physicians in this province, and to bring to bear the finest level of expertise, the finest calibre of medicine. If we suggest that a British Columbia physician who wishes to receive some of the fellowships or residencies that are available....

The issues that I brought to your ministry were around oncology training. There were two individuals. Both had been offered fellowships at centres in Texas, but were not able to satisfy the J-7 visa requirement, which seemed to be somewhat of an arbitrary item. Could the minister kindly comment?

Hon. P. Ramsey: I don't think the issues for out-of-country training are greatly different than those for in-country training. We need to make sure that the physicians being trained fit the needs of the population of the province or the country in which they are going to practise. Therefore, when Canadian residents apply for postgraduate medical training in the U.S.A. they are asked to acquire a letter of support. The letter must state that there is a need for the candidate's services in Canada on completion of training.

When they wish to train in disciplines recognized as having pending or present shortages in this province, we

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provide those letters -- no question at all. If a shortage is recognized, those letters are there, whether it's for somebody simply doing initial training and completing the two-year prelicensure training abroad or for a practitioner going on to further training. Those letters are provided to physicians who wish to go to the States or elsewhere to obtain further training.

This is a requirement, I must say, of the admitting country as well as the country sending the physicians abroad for training. They wish to know they are training people who are going to be returning to the country or province they're coming from and practising the skills they are acquiring in the States or elsewhere.

I don't think the member would suggest that we should be providing letters saying that that opportunity to practise is available when our analysis says it is not.

L. Reid: Perhaps where the confusion lies is that it did not seem to be a simple requirement -- i.e., is the service needed in this province today? It was asking hospitals and future employers in this province to guarantee that person a position four or six years down the road. A lot of these residencies and fellowships were of many years' duration. That was where the confusion existed.

The minister indicated in his earlier remarks that trying to indicate specifically what the need will be four or five years from now is not a pure, predictive science. We agree on that point.

It was explained to me and these practitioners at the time that they must have a guaranteed job to return to, whether they were out of the country for five years or ten years. That made that educational opportunity non-existent for them: no one could provide that kind of guarantee. It was a greater expectation than a simple suggestion that their services may be needed. I ask the minister to comment.

Hon. P. Ramsey: Let me just say I can provide the assurance that I think the member is seeking. I am not aware of the ministry requiring a specific position to be identified before writing a letter of support for a physician seeking U.S. training. If the member has an example, then I'd be interested in knowing about it. I'm sure the ministry indeed does canvass hospitals, as they should, to ascertain the need for physicians with a particular specialty or subspecialty training.

Just to restate it, I'm not aware of the ministry requiring a specific position at a specific hospital be identified and guaranteed before a letter of support is issued. We want to ensure that training is obtained. We have a high-quality physician resource for use in the health system and for the use of the people of the province. Whether that training is obtained in-province, in Canada or in other countries, I think all are valuable.

L. Reid: There were two physicians whose names I shared directly with your office; the name of one individual was Dr. Ralph Wong, and I can certainly provide the other name to you. But in ministry correspondence, both were asked to provide a job guarantee, and it seems to me that that is incredibly restrictive. If it was not the intention, I trust this situation can be rectified. But in dealing with your ministry officials, it was abundantly clear that that was the requirement and the expectation. That seems very contrary to what you're suggesting today, and I would simply ask for clarification.

Hon. P. Ramsey: Without knowing the details of the cases here, I guess we're dealing in the re