Manitoba Hansard — Sitting 52B (31st Legislature, 4th Session)

31-4-52b

Manitoba — Debates (Hansard)

LEGISLATIVE ASSEMBLY OF MANITOBA Tuesday,6May, 1980 SUPPLY - HEAL TH Time - 8:00 p.m. MR. CHAIRMAN, Abe Kovnats (Radisson): The committee will come to order. I would direct the honourable members' attention to Page 61 of the Main Estimates, Department of Health, Resolution No. 79 , Claus e 5, Ma ni toba Health Services Commission, Item (

d) Medical Program. The Honourable Minister. HON. L.R. (Bud) SHERMAN (Fort Garry): Mr. Chairman, just before we broke at the dinner hour, the Honourable Member for The Pas had made a couple of accusations, or allegations, with respect to the numbers of persons and complaints called in the Owen Schwartz investigation by the College of Physicians and Surgeons, and the manner in which the complaints were forwarded, and I want to deal with that.

I also want to respond to the questions that were put by the Honourable Member for Fort Rouge and the Honourable Member for Elmwood , that I hadn't had a chance to reply to, and I will deal with the questions raised by the Honourable Member for Elmwood first, with the indu lgence of the Member for Fort Rouge, because I know he has another meeting that he has to attend to. First, let me just reassure the Member for The Pas that I wanted to check on the questions that he raised just prior to four thirty.

I was not able to be present for his participation during second read ing on the bill introduced by the Honourable Member for ln kster, and I under stand he raised th13 issue again in that debate, but I have not been able to familiarize myself with what he said in that de bate and I will deal simply with the questions he put to me at about 29 minutes past four. Of the eight complaints that were reviewed by the College of Physicians and Surgeons in the hearing into the methods of practice followed by Dr. Owen Schwartz, I am advised by the President of the College that seven came direct from patients.

The eighth came from a doctor but had been referred to him by a patient; that is to say, a patient had complained to his or her particular doctor about it and had asked that the complaint be forwarded to the College. I might also say, Mr. Chairman, that those ware the eight complaints that were reviewed by the College but in no way represent the number of complaints that the College received. They received a lot of complaints. They dealt with eight of them and did not deal with many others of a similar nature.

Had they done, the hearings would have gone on some considerable time longer with doubtless no different conclusion. Mr. Chairman, the Honour able Mem ber for Elmwood expressed concern about the situation with respect to ch iropractors and some of the possible hazards that result as a consequence of the cleavage that seems to exist between various health fields and health professions in our province and inde ed in our coun try, and I want to assure him that I have concern for the questions that he raised, particularly with respect to the duplication of X-rays.

There is no question that all of us are much more alert today to the possible hazards of excessive radiation than was the case some years ago and it is a valid concern, a valid worry. The Ontario government has recently concluded an exhaus tive study on the su bject of excessive radiation, which they have made available to us or to me, to my office, and I'm in the process of reviewing it or having it reviewed for me at the present time.

It is a major and a lengthy document but it looks at the whole health hazard that has arisen through the excessive amounts of radiation that are available and are utilized in our lifestyles and life patterns today in the health field and other fields, just as a consequence of developing habits and practises. One area in which they express substantial interest and have .undertaken considerable study is the area of duplication of X-rays and overuse ofX-rays.

The Member for Elmwood quite rightly points out that is a hazard that naturally results from an inability or an unwilling ness between various health fields and health professions to acknowlege each other' s disciplines and to co-operate fully. There is certainly a real possi bili ty that we can reaso nably and responsibly move to an arrangment whereby hospital X-rays could be made available to chir opractors.

I must say to the Honourable Memb er for Elmwood that I wouldn't hold my breath on his request that x-rays taken in doctors offices and maintained as part of the doctor's confidential patient records are likely to be interchangeable very soon with chiropractors or vice versa, but I think a strong case can certainly be made for making hospital x-rays available to chir opractors and we are certainly looking at that. I don' t want to minimize the pitfalls of even that type of negotiation but it is a possible partial step in reducing this hazard that he has identified.

I think though that there should not be an incorrect impression left on the record insofar as the professional capability and capacity of using x-rays, taking x-rays and reading and interpreting x-rays is concerned. There is a wide difference, a vast difference between an x-ray technologist and a radiologist and I know that the Honourable Member for Elmwood is aware of that.

One of the reasons for the unacceptability on the part of some health professionals for that kind of exchange with others in the health field lies precisely in this difference in qualifications and dif ference in requirements insofar as professional stan da rds are conc er ned . Radiologists, after all, is a highly specialized medical practitioner, Mr.

Chairman, who has spent a number of years studying radiology after graduating from medical college, and he or she brings an enormous amount of expertise into the inte rpretation and reading of x-rays - that I think I can say without insult to the x-ray technologist - an enormous 3329

Tuesday, 6 May, 1980 amount of expertise that the x-ray technologist simply does not have. One of the reasons why the medical profession is reluctant to engage in that kind of exchange is because the bottom line in their area of respon sibility is the protection of patient and the patient's health.

Quite frankly, they raise the question as to whether x-rays taken and read and interp reted by other than radiologists are, in the case we're talking of serious health problems, whether x-rays read and taken by x-ray technologists meet the qualification standards and the profess ional standards they feel they must abide by. However, we are looking at the problem, and certainly the Ontario conclusions with respect to duplication of x-rays are important and valuable.

I think that essentially covers the questions asked me by the Honourable Member for Elmwood except, if I may say, he did ask me, in refe rence to the fact that medical doctors refused to permit this free exchange of x-rays, he did ask me why isn't this permitted. I have to say to him it isn't permitted for the same reason that it wasn't permitted during the eight years he was a member of the government of the day. Th ere has been no change in the relati onship between those two fraternities, Mr . Chairman; I think that's about the most diplomatic way I can put it. Mr.

Chairman, I just ask for a few more minutes to deal with the other questions I hadn't answered at four thir ty. Essentially th ey came from the Honourable Member for Fort Rouge, who asked me if there is any overhaul of the Health Sciences Centre Act contemplated. The answer is yes, there has been conside rable work done during the winter on amendments to the Health Sciences Centre Act and in fact I have a number of pieces of legislation in the health field which I will be . . . Well, I wont be, I must correct that, Mr.

Chairman, private members of the government will be introducing very soon in the session now, and one of them I expect will deal with the Health Sciences Centre and the need for reform of its legislation and its structure, particularly its board structure. The Honourable Member for Fort Rouge asked me about the number of obstetrical facilities, birthing centres and units in Manitoba and I infer from her questions she was asking me whether I thought there were too many and whether some rationalization was not desirable. My answer is yes, on both questions, Mr.

Chair man, there are too ma ny and some rationalization is desirable. That's the easy part. We're now down to the point of trying torationalize them, which means taking something away from some centre and some commu nity or some neig hb ourh ood that's become used to it and consolidating thos e obstetrical units in major maternity units in major hospitals.

That has been reco mmended by the Task Force on Government Reor gan ization in the Economy; it's been recommended by a number of medical bodies; it's been recommended by a number of commen tators in the health field who have passed through Winnipeg and offered their ob'lervations. I think the Member for Fort Rouge has a very good point; I hope she will work with me, stand with me and fight with me - I mean, fight alongside me - when I try to close down some obstetrical beds and consolidate them in the Health Sciences Centre, St.

Boniface, Grace, Misericordia, probably Seven Oaks, four or five major centres like that. Medical research, which is one of my pet projects, and I presume is a pet project of almost everybody in this House and is one of my identified and expressed priorities. We have moved; I think we've taken a major initiative in writing into the Health Services Commission budget this year, for the first time, - the Member for St. Boniface says, no. Well, Mr.

Chairman, it's certainly the first time for some considerable time, a specific designation, a specific appropriation, earmarked for medical research and medical research alone. That particular appropriation will be approximately 300,000.00. That 300,000 will be utilized in a way to attrack matching funds from the private sector and founda tions who have research funding available and it is only a start, acknowledgedly, Mr. Chairman. But it is a start, because it does recognize that there must be a specific appropriation de veloped in the MHSC budget now and throughout the future for specific research projects.

But here I have to take exception to a position that the Mem ber for Fort Rouge expressed. She said that there's a fear that we're falling behind, under this govern ment, in medical research. She said 1 percent or 2 percent of the Health budget should go towards research; there's a fear that we're falling behind under this government. I want to remind her, Mr. Chairman, that we're falling behind, and so are a number of other provinces in Canada, but not under this government.

We're falling behind because in December and Jan uary, 1978-79, the previous Libe ral govern ment, not the present one but the previous one, introduced a -(lnterject ion) well, the same one, the Member for Lac du Bon net says, but the 31st government rather than the 33rd , I believe that's the proper numerology. I agree with the Member for Lac du Bonnet, the same in every way, it's und istinguishable from tha t one, but nonetheless, it had a hiatus for a few months and so I'm referring to the government that was in office prior to May, 1979. In December-January, 19 78-79, that govern ment, Mr.

Chairman, emba rked on an election campaign oriented, an election campaign designed restraint program that sharply reduced research funding right across Canada. The federal government and the National Research Council cut back very sh arply on research funding to the provinces and during that period of time we had all kinds of research workers and representatives of research fields in our offices begging and imploring us to try to do something to make up this shortfall that had suddenly been thrust upon them by that federal liberal government of the day.

I don't intend to labour the point but I just want to correct the Member for Fort Rouge on that contention. We're falling behind all right and it lies squarely on the doorstep of the Trudeau government of December, January, 19 78-79. We are trying to -(l nterject ion) Well, the Member for St. Bon iface says, even before that.

He was affected by some of their withdrawals in the research field but all I can attest to is the sudden impact that we felt of that decision, and all provincial governments and jurisdictions have been scrambling to try to fill that void ever since or to try to compens ate to some degree for it. Obviously, some wealthier provinces are able to fill it more quickly than we are but we are intending to fill it as best we 3330

Tuesday, 6M ay, 1980 can and that's the reason for this initiative in the research field. Fina ll y, Mr. Chairman, on the subject of psychiatrists, lest anybody suggest to me a few months from now that we're suddenly facing an incip ient shor tage or an impending shortage of psychiatrists and I should have known about it and I should have told the House about it, I will tell the House tonight tha t we are facing in Manitoba, in Canada, in North America, and l'mtold, in the world, but our main concern of course is Manitoba, an impending serious shortage of psychiatrists.

The Member for Fort Rouge says there are only about 50 trained psychiatrists in Manitoba today. That figure is somewhat low. There are actually 83 but I'm not going to split hairs on the point. We need more psychiatrists. Many of our psychiatrists are in their fifties, which isn't old in my terms but may be old in your terms, Mr. Chairman. It's certainly not old in terms of the Member for Fort Rouge, I know that. But nonetheless, they're at the point where my friend, the Member for St. Boniface is, Mr. Chairman, they're at that age when they're starting to think about going out to pasture.

We have to develop a new supply. We are in short numbers in terms of yo ung new pote ntial psychia trists, graduates in psychiatry, coming up. If it's any consolation, so is the continent generally, but that's not very much consolation. I just give the House that forewarn ing that where we stand one day debating the possible shortage of nurses or the shortage of med ical practitioners in rural communities or in the north, we will stand one day not long from now debating the shortage of psychiatrists.

I hope that together, co operatively, we can develop some initiatives that help to forestall that shortage and to elimina te the threat and, at the very least, to minimize the impact of it when it comes. But we have to get more young people training in the field of psychiatry, and the clinical psychologist is not the answer because the clinical psychologist cannot deal with medication. Tha t's entirely therapeutic psyc hology and what we're talking about are psychiatrists who deal with medication in the treatment of psychosis, mental disorders.

Just one final point, the Member for Fort Rouge said that clinic psychologists are not covered under the Med icare program; they are, Mr. Chairman, provided their services are del ivered in hospitals. They are not covered under Med icare in their offices but they are covered for services in hospitals. We are studying with them a proposal that office visits be covered but the Mem ber for Fort Rouge inadvertently puts her finger on it when she says that it is sugge sted that initial start-up costs would be low. She's probably right.

But the truism of this business is that initial start-up costs ain't what count; it's what the cost is the next year and the year and the year after that, and we have not yet been able to ap prove tha t proposal but it's under serious consideration, Mr. Chairman. MR. CHAIRMAN: The Honourable Member for Fort Rouge. MRS. JUNE WESTBURY: Thank you , Mr . Chairperson, and I thank the Minister for his answers to my comments of this afternoon. I have a few more comme nt s I would just like to add before we conclude this

section of the estimates. Would the Minister advise whether it's true that the College of Physicians and Surgeons has a veto as to what appears in the Manitoba Health Services Commission Annual Report. This is something that's been reported to me. I'd like to know whether it's true, whether in fact they have a censoring provision as to what appears in that report. Is there any intention or provision for including air ambulance or air cost fares for bringing people back to Manitoba under Med icare?

There's a famous story about a welfare recipient in California who recently couldn't be sent back to Winnip eg to become rehabil itated at about a third of the cost of California hospitals so the government left her in California for a cost of 49,000 in excess of what it would have cost to bring this person home. Now I want to go back for a minute to the child mortality rate, some of the considerations under the task force of the maternal and child health, to which I have made reference and of course the Minister was one of those responsible for setting up the task force.

But I would like to point out some of the things that have come to us in our deli berations, I, as a member· of the task force. The whole matter of preve ntative care for expectant mothers and for ne wborn babies is something to which gove rnme nt has to pay increas ing atten tion , I suggest, Mr. Chairperson. Manitoba has the ninth worst infant mortality rate of 15 .6 per thousand. Nova Scotia has 11 per thousand. Seventy-five babies, I am told , per year, die in Mani toba, who would live if they were born in NovaScotia.

For everyo ne who dies, two live with severe health problems mainl y retardati on; that comes to 15 0 a year. Childr en who die as infants don't die quickly and, over and above the anguish to the little childr en and to their relatives, there is the economic factor. The Ontario gov ernment has estimated that the lifetime cost for treatment of a severely retarded child is between 750,000 and 1 milli on. So obviously for ec onomic as well as compassionate reasons we must look for more ways to prevent infant retardation and these lifetime figures of up to 15 0 million.

The task force, I don't know if the Minister knows this, I have been expecting that he might make the statement that the federal government has approved 13 summer students at a cost of 35,000 to work with the task force, in addition, of course, to the other funde rs who are the Winnip eg Foundation; the provincial gove rnment for 20,000 for executive secretary; Manitoba Medical Research Foundation for a high risk anal yst and social planning counsel for a half time staff person. And I hope that it won't be too long before the task force comes forward with its recommendations.

Some of the findings, some of the reports that have come to the task force already have been very dramatic and very disturbing and, of course, I'm pleased that the Minister is continuing to support this task force on Maternal and Child Health. I don't know if the community at large is aware of the important work that the task force is doing and the important rec ommendations that they will be bringing forward. Thank you. 3331

Tuesday, 6 May, 1980 MR. CHAIRMAN: The Honourable Memb er for Seven Oaks. MR. SAUL A. MILLER: Mr. Chairman, I want to touch on something the Mi n ister mentio ned in response to the Member for Elmwood, and I think this was in regard to the doctors who will not, apparently, give information or turn over x-rays, I should say, or other da ta, hard da ta, to chiro practors. I think he said that the Member for Elmwood shou ldn't hold his breath waiting for doctors to release x-rays to chiro practors. I am somewhat surprised that the Minister takes it so lightly.

Surely the x-rays - I'm talking about the actual picture or the results of a blood test - those surely belong to the patient. If I go to the doctor and I have x-rays taken, I should have the right sur ely to say to the doctor, would you please send these x rays on to Dr. X or somebody else, or to a chiropractor or to someone of my choosing.

I don't think it's the right of the doctor - maybe it isn't law, I'm not sure, the Minister can tell me - if so maybe that law needs examination; I'm not talking about the doct or's notes on it; I'm not talking about the doctor's evaluation of an x-ray or blood test; I'm not talking about the doctor's views and op inions because those are per sonal views and subjective always. So I can see the doctor would not want to release those.

But when you talk in terms of hard data, objective data, machine data, that's what they are, the method today in analyzing blood tests, it's all done on these comp uters, very highly technical machines. They simply spew out information. How you read them is up to the doctor and I don't question that he has a right to say, I have made my own analysis and my views I will not share with somebody else. But the actual hard data, the picture that was taken, on what grounds can a doctor say to me, sorry, I am not releasing it. Surely they are mine.

He has been paid for his work and has been paid for the x-ray, but surely they are mine to the extent that I have a right to say, I would like them back, I'd like to get them from you, I may even want to tear them up; or I want to refer them to somebody else without having the doctors stonewall me by sayi ng, I'm not going to do it. You haven't got access to them; you have no right to have them and you tell me who you want to refer them to and I'll consider it; I may send them on to somebody else and I may no t.

So what I am questioning is, on what basis, what are the grounds for any doctor re fusing to give me access or transferance of my x-rays to whomever I choose to transfer it to? It could be a chiropractor; it could be an astrologer; it could be a herbalist, I don't care. I'm curious about the right of that doctor to say no to me, of an x-ray taken of me.

So as I say I was tempted to rise on my feet because of the very cavalier way in which the Minister seemed to accept, perhap s a long long traditionamon gst the medical staffs, medical profession that they can determine what happens to an x-ray and only they have the right to determine what they are going to do with it. You see I make a distinction between that and any opinions and evaluation that the doctor may have had. An evaluation is a doctor's own evaluation of an x-ray or of any other test that he may have made and he, I can understand, may be reluctant to hand it out.

But the evaluation is something else, that's a very subjective opinion on the part of the doctor; that's where he is pra ctising his profess ion, evaluating something and making a decision on it, making recommendations on it. But the actual hard data, the objective data, the machine data, on what grounds can a doctor refuse a patient if that patient asks that the x-ray be sent to somebody else, or that the x-ray simply be relased to the patient himself so the patient can do with it what he will? I ask the Minister if he could respond to that. MR. CHAIRMAN: The Honourable Member for St. Boniface. MR. LAURENT L.

DESJARDINS: Mr. Chairman, the Minister is wrong again. He's trying hard to find something new that this government is doing in this department but so far he hasn't been too successful. The research was done. There actually was an amount of 100,000 in there which was very little, but it was a start. The Minister is half right when he said the fe deral gov ernment had cut do wn on the research grant in 1978; that was done roughly '75- 76. They stated some time in '77 that they were going to reinstate these grants; I don't know if they did. The start for the research was done and 50,000 was given to the St.

Boniface Research Foundation when, not Dr. Bernard, the one that was here before, when Dr. Spock was here - Dr. Salk, excuse me - we're mixed up with the T.V. program there, that's the fellow with the funny ears I think, Mr. Chairman. So it was a start and I'm glad to see that this government is continuing and is increasing the amount. Another thing, I'd asked Dr. Naimark to head a committee that would make a reco mmendation, how to deal with whatever amount of money that the provincial government had in there for research grants, and that was going to be a continuing thing.

I think in fact that it was frozen a year, there was an amount of money that wasn't paid, the year the government changed. And the committee, headed by Dr. Naimark at my request, was just starting its work and hadn't done too much then. The Min ister must be very happy with the way things were being done. He's stated that now he will not only follow what we were doing but follow what we weren 't doing. He said that there was no change in the x-ray and the rela tionship between the doctors and chiropractors that we'd had in the previous four years. Well, Mr.

Chairman, it is a damned shame that there's no t more co-opertion between the two groups. You know, if we recognize somebody, and the chiropractors were recognized by a Conservative gove rnment, the Roblin admin istra tion, when Medic are came in. They were covered under the plan. in some areas they wer en't, and the Minister talks about confrontation with certain groups, well he has no confrontation because he refused to see these people. They haven 't had an in crease. When you look at increases, what are these people, what kind of increase? Isn't there a cost of living increase for them also?

Isn't inflation affecting them at all, if they are good enough to be covered under the plan? Now the excuse is they are making more mone y, not individually but there's more money because more 3332

Tuesday, 6 May, 1980 patients are seeing them. The report I saw, the commission was saying that in 19 76-77 there were 80,000 patients that visited the chiropractors, in 1978 there were 100, and in 1979 there were 101. Just when the people are accep ting the chirop ractors more and in certain areas and individually there are still some doctors who, on the q.t. because it is frowned on by their association and the College of Physicians, there is some kind of a co-operation between the chiropractors.

As long as the chiro practors do not try to treat something they are not qualified for, they certainly have a role to play; there's no doubt about that. As long as they don't go out in the field with something they are not trained on, that they are not qualifified to treat, I think there is a rolefor the chiropractors to play. If you compare them to other provinces you will see how low they are, how low their visits are and also the limit. Why the limit? You know, the Minister is always talking about us not trusting anybody, are they a group you can't trust? Are they a group that are going to abuse the service?

Why is there a limit on that? There's no limit on doctors. It is high time that you look at the limit and either increase the fees per visit and start trying to use your good office to see there is more co-operation between the different groups looking after the health of Manitobans. There is no reason for that at all. I can unde rstand if they don't want to co-o perate as far as read ing and interpreting x-rays, that is something, but it is a darned shame to see two groups like that who can't co-operate at all. What is the Commission doing because they ask a raise?

The Commission has a committee that will study the profess ion. Ma ybe they should be suspended in the meantime. If there is something wrong, if it is dangerous, they should be suspended. The commission has had that study, apparently, for over a year and I'm quoting from a: Free Press of Ma rch 7, 19 80. -(In terjec tion)- Wel l' I stand corrected but I'm quoting here from the - (Interject ion)- They've asked to meet with the Comm ission : they've asked to meet with the Minister and that was refused.

It is the understanding that I've had and knowing them, having worked with them in the past, they are not ones to wait forever to give the proper information, Mr. Chairman. Now I was pleased to see the Minister before the dinner hour certainly went on record very straight that he doesn't favour extra billing and he doesn't favour billing assignment. This is something that there was a period where the Minister was wavering, was considering that, and we were quite em phatic on that, that it would destroy the plan and I'm glad to see that the Minister now is accepting that.

He'd better be careful though because he might be charged with a confrontation because these are the things that we were saying that there would not be any extra billing allo wed in Medic are except if the doctor was opting out and also that there wouldn't be any billin g assignment, not to fight with the doctors but because it wouldn't be good for the plan and would destroy the plan. With those two things, the Minister stated the same thing; I haven't seen the Minister saying that there will not be any contracting out, that you will have to have perm ission of the MMA before you can go ahead and hire a doctor.

So the Minister is on dangerous ground now. It will probably be said that he wants a confrontation, Mr. Chairman. I think there's something else that we've been saying all along that the majority of the doctors are very dedic ated people who are not necessarily just interested in money. Of course they want fair pay and they should get it, but this is not the only concern.

When the Minister says, well I raised their salary, I couldn't do anything else, I went to the limit that was allo wed under the ceiling that was allo wed in those days, so there is nothing else that can be done, but the way they practice, and they are interested in their fellowman and I have a few examp les I would like to cite. I have received a copy from Dr. L. C. Bartlett and this is what he is saying and I'm quite concerned and I will quote this, or I will even table it if you want, or I will read it so that it will be in Hansard: Notice re opting out. I have finally decided to opt out of Medicare, MHSC.

This is not because of dissatisfaction with the HMSC fees, it is because MHS C has formally charged with me with over servicing my patients and they charge me with providing what they call 'Cadilla c-care'. MHSC has made repeated attempts to force me to provide only average care to my patients. However, MHSC will not take any resp onsibility for the consequenc es of low ering my standards.

There are only thr ee options: One, to remain in Med icare and lower my standards; two, to leave Canada for the free enterprise system of another country; three, to exercise my legal right to opt out of Medicare and set my own standards. How opting out works: Payment for my services now becomes a business matter between you and me. At the time of your visit, we will submit a claim card, on your behalf, to the MHSC for the standard amount allowed by MHSC for that particular service. In about two months, MHSC should mail you a cheque for the amount billed to them.

This is to reimburse you for having paid your physician. He's not asking for immediate pay either. He says, If you wish you can pay your account at the time of your visit; if not, we will send you a bill. Well, I've always kno wn Dr. Bartlett as a very resp onsible member of the community and somebody ded icated to his work. So who is deciding; is it a group of his peers deciding that he's giving too much care, 'Cadillac' service, or what is the score? Another item, Mr. Chairman, that certa inl y impressed me and I saw that in The Tribune of March 29, 1980 and the heading is U.S.

Not Cure-All For These MDs, and I think it is a vindication of our program that people seem to complain about so much, comp ared to the Unit ed States, which is supposed to be doing ever yth ing better tha n anybody else. There one of the four Winnip eg physicians who have returned were deploring the fact that wallet-size often determines quality of care. I had patients, he said, that I'd be more than happy to admit them to a hospital and look after them as my contribution, but I couldn't get them into a hospital that req uired a 600 deposit in cash or cashier's cheque.

They want to see the colour of your money before they take care of you. He said Those who couldn't afford to pay were sent to a charity hospital. They might wait for three or four hours to be seen and perhaps sent home with an aspirin or something 3333

Tuesday, 6 May, 1980 because they could not afford first-rate care. In fact the doctors themselves thought it was ridiculous that some doctors were making up to 600.000; it was getting ridiculous in the States. These people are coming back without any commitments, without any promises. Nobody tried to buy them, and they say so the mselves. One of them is not too sure they will have enough work because he's a highl y-trained specialist and this is the way they look at it. Mr.

Chairman, I think I can't go by without making a reference to the proprietary nursing home and proprietary hospital because this is one of concern here. We've always said if you want proprietary nursing homes, well the n why not proprietary hospitals because there are private hospitals in the United States. And I suppose that if the Minister was in the States he'd say, we ll, you know, you 're criticizing these people that have these hospitals and they are just as dedic ated as everybody else.

You know, there's a lot of danger when mone y is the concern, when money is the primary objective, and these hospitals in the States are ther e to make money, number one. And don't kid yourselves, it is number one. They are there for a profit and so are the personal care homes. Without criticizing the people who are running the personal care homes, we express the danger to the Minister, the danger of having these proprietary, these private enterprisers, especially dealing with the health of the people of Manitoba and we've always said that they shouldn't be an element of profit.

Now some members on the opposite side have made some ridiculous statements and said, well then, you shouldn't pay the doctors. Well, salary and fees are not what we're talking about, profit where you have a busin ess, a corporation or something that is out there for profit. There is certainly nothing wrong in being paid for the service that you're doing. It's not just an investment to triple or more your profit, and that is the danger; some doctors have felt that there was a darn good program here in Manitoba and in Canada.

They want to get paid; they don't want to come here and work for nothing, but they are not the greedy type that are worried about receiving pay, whic h they could probably, some of them in the 600,000 bracket. The important thing is looking after the people of Manitoba. So I think that this proves that there is a good program. One of them is saying - well, I'm not going to waste the time of the committee trying to find this - but one of them is saying that he is going in an area where he knows they'll have to fight for proper fees and the governments will pay as low a fee as they can.

Well, that's the name of the game in a lot of areas. That's what they do with civil servants, that's what they, I'm told, by many of us here, with ML As and other groups. So, Mr. Chairman, that doesn't mean that you can't be fair but you've got to look at the population that you have in this province; you'll have to look at the service and you want people to make a good living but you can't be extravagant and practically obscene in talking about the 600,000 bracket for a year. You can just imagine how busy a doctor is making that kind of money and what kind of service he's giving to the patient. So, Mr.

Chairman, we certainly don't have to take a back seat to any country including, and especially the United States, when it comes to our system of health care here in Canada. It is the envy of many people in the United States and it's going to change in the United States. So I think that there's certa inly a lot of credit coming to our people and we have, by and large, a group of physicians who are dedic ated and there's a difference, they separate the question of business and fees and so on with their care patients.

There's never been any, oh, the odd one, it's human to err, and then, as I say, you see someone desirable in any profession. Nobody has a monop oly on tha t or on goodne ss. But, Mr. Chairman, we have dedica ted people who are providing a good service for Manitoba and I think that this is the important thing.

When we talk about the cl imate, the climate, and many of these who are leaving now, even with the change of gove rnment, more so than before, but some of them are coming back because they see what kind of service there is and they realize then they could get in the rat race and make a lot of money, but you know, there's so much money that you can't spend it anyway. What does it mean, in the rat race and the way of life that they must have out there. So they are coming back. They'r e dedicated, they have taken care of our people. And I think that the incentive should not be to always look for money.

If you can provide the facilities, the same as the nurses, they have to be able to enjoy themselves in working and seeing the progress and seeing the result of what they are doing, and I think they have the satisfaction here in Manitoba, Mr. Chairman. I wanted to cite these two examples. I'm quite concerned that somebody like Dr. Bartlett, who was saying that it's not that he's not satisfied with the fees paid but he's told that I guess he sees his patients too often, and he's told that he's giving cadillac service and it might be the only way that he knows how to practice medicine.

It might be that wants to give his services. Now if there's a reason, maybe we should know about it because this letter was not a private document that he sent me, a personal letter. It was something that was given to his patient and he was good enough, or somebody was good enough to send me a copy of this. Mr. Chairman, there might be a reason. I'd like to hear the reason if there is such a thing, and I'd like to see a little more co-operation.

That's when I'm talking about leader ship where the Min ister at times might call it confrontation but when you know you're doing something right and when you know you're working for the Manitobans and so on, you have to be able to make decisions. And these decisions have to be made in an area that I urge the gove rnment, and it hasn't been easy. The Minister is right, maybe there wasn't that much progess done in our time, but you know, time goes on and there's a lot of things that are softening up today. A lot of prej udice, I'm happy to say that they are not as pronounced as they were before.

You can't change the world in a da y, definitely, but you can work on it. This govern ment, which is a friendly government to the medical profession, and the medical profession are friendly to them, they have an opportunity to be able to try to get the people who are working for the health, to take care of the health of the people of Manitoba, to try to get them to work together. It might be tha t the medical profess ion will not recognize the chiropractors, and clutch them to their 3334

Tuesday, 6 May, 1980 bosom and fall in love with them, but at least ther e should be some kind of co-operation and that co operation also should be shown if you're going to treat people the same. I didn't say pay the same, but if you're going to treat people the same, you should have the same courtesy, the same good working conditions, with all gr oups in the health field.

I've been saying that and the Min ister has nodded his head saying that he ag rees with that in different instances when we were talking about the people, even the people cleaning the hospitals, the nurses, the nurses aides, the maids, the kitchen staff, and so on, the orderlies. They' re all people and they are all as dedica ted as anybody else. You don't just take a class in society and say, how dare you talk about them, and then don't worry about the other s at all.

They are important, every single pe rson is important in this field and in the hospitals and in this treatment of disease her e in Manitoba or anywher e in the world. Mr . Chairman, it seems to me for instance that the Minister has erred. Ther e is certainly a confrontation with the chi ropractors. Ther e might not be too many of them and ther e might be less because some of them are talking about leaving and I think it would be too bad, because it's very difficult at this time to get an appointment with a chi ropractor. I'm not ashamed to say that I go to one.

I could hardly walk over the weekend with a sore back and I went on Monday and I feel somewhat better. I'm only asking them to treat what they are qualified to do. It's only natural. They studied, it's not a fly-by-night course that they used to take maybe a few weeks at one time, and you had some quacks at one time but now these people are ded icated and they' r e doing good work and they work for the change, the change in lifestyles that the Min ister was talking about, the former Minister, the federal Minister of Health was talking about. You go to any of these offices, they won't let you smoke.

I don't kno w of any chi ropractors that has any . . . That finished my colleague to the right; I'll guess he'll never visit a chiropractor. But, Mr . Chairman, I think that these people are dedica ted also and I think that why, all of a sudden, that you are going to investigate the profession; why? Were ther e any complaints; were ther e any complaints? Is ther e anybody that wants to come up and say, here, this is what they've done against the profession, not against an individual, but against the profession. They've had to wait over a year. You know, inflation is not catching up with them at all.

And what is the answer, what is the reason given? Well, they are getting more money because ther e are more people seeing them. Ther e might be more people seeing them and less seeing other member s of the different professions or para medical people. We have always said that ther e is a place for these people and cert ainly their fee should be reviewed once in awhile and should be compared like we do. We hear that so many times, what is done in other provinces, when we talk about special gr oups but not when we hear about them.

The Min ister stated in one of the questions that I have asked that they were one of the top provinces and that's not the case at all in the fees that they get and the al lowance that they get, and the maximum that they get. They are far from being the top province. So I would hope that the Min ister will have a look at that. We'll call them in and give them a chance to talk to him. His door is supposed to be always open to other gr oups, why not to this gr oup? Mr. Chairman, I think, in summarizing this, that I'm quite ha ppy with Medi car e, the way we see it Canada, and it's not perfect.

Ther e might be some abuse. Any program like that, that covers ever ybody, there's going to be abuse. But we would sooner see the abuse than in the other side that we see in the Un ited States wher e you are not going to get treatment if you haven't got money, if you can't give them a certified cheque or the cash right then and ther e. You have to pay even for a outpatient visit in the United States in the hospital; for a five -minute thing, you have to pay 55 or more, like the case that I mentioned awhile back, Mr . Chairman. No, I have no hesitation in saying that we have good people working in her e.

It's not pe rfect and I'm certainly not blaming the present Minister, not more than I would have accepted the blame because of this lack of confidence or lack of co-operation between two professional gr oups. I want that made quite clear that I'm cer tainly not blaming the . MR. CHAIRMAN: Five minutes. MR. DESJAR DINS : Thank you . That I'm no t blaming the Minister for that but I'm only urging the Min ister in a friendly way to try to get the groups together. I know it's been very difficult to try to get the gr oups together and to at least have some co opera tion. That won't hurt anybody.

If the medical profession doesn't ap prove of chir op racto rs in certain areas, all right. They don't have to send patients ther e, although some individually do it. They are very secr et about it because they are not supposed to do it, but I think that ther e should be a little bit of co-operation. The Minister has to decide. Tell us, maybe ther e is something we don't know. If the profession is being investigated, maybe ther e is something that they are doingwrong.

Well, then they shoul d be suspended - we suspended elected politicians even without any reason rea lly - if that is the case, until that study is finished. If you are investigating somebody, they must be harmful; they must be doing something that is harmful or at least ther e must be some accusations. We shouldn't take a year to do it either, Mr. Chairman. Now, if I'm wrong, I stand to be corrected but the press release stated that the profession was being investigated, not their demands or anything like that.

I would hope that when you look at increasing the fees of these people in this field, well, then they are not forgotten. You know, it was that govern ment, as I mentioned earlier, that rec ognized them. Mind you, they had an advocate at the time, one of the Cabinet Min isters was a chiropractor and it was a different thing in those days, I guess. But that's wher e it was decided to cover them under the plan, and I also think that it's about time that we look at the situation wher e ther e is a maximum.

Ther e are some people that might have a sore back and the only thing that will help is visits to the chiropractor just as much as anything else. If ther e are certain things like we do in the medical field wher e ther e are certain tests and so on that only one is cover ed a year, cover the treatments but not necessarily the visit to a doctor or a chiropractor. 3335

Tuesday, 6 May, 1980 I would hope that the Min ister will give these things some thought and that we will try to see even better. All right, let's say that the climate is good, but have a better climate and a better co-operation. It would be nice to have all these groups working together; maybe that is what we need, a kind of an advisory gr oup to the Minis ter repre senting all of these different professions in this field, or different groups. Then we could get the full story and we wouldn't go ahead in pushing one and then in pulling another one back.

I think that's the time that we will have even better service here in Manitoba. MR. CHAIRMAN: (d)- pass - the Honourable Member for The Pas. MR. RONALD McBRYDE: Mr . Chairperson, I would like to make a few comments under this

section and I think that the comme nts of my col leagues, especially the colleague for St. Bon iface when he talked about chiropractors and the situation of them, point out the need within the overall medical system for a number of options. When the Min ister talked about, in his earlier comments, a choice on the part of the patient, I think, Mr. Chairperson, that is one of the key concep ts. As my colleague pointed out, ther e are some things that a chiropractor can do that a medical doctor can't do or doesn't normally do. There are probably within this syst em, Mr .

Chairper son, some things that a clinical psychologist can do better than the medical doctor. There are probably a number of approaches that a practitioner using the holistic medicine approach can do tha t a person using the traditional - what is now the traditional - orthodox approach can do or can't do. Mr. Chairperson, what we are talking about here is to find some sort of a balance between the options available, to provide, to assist people with their health care.

What seems to have happened right now and that seems to be that we 're taking a step backwards in terms of those practicers of orthodox medicine, the physicians and surgeons, and the Min ister seemed to be wanting to exclude any other approach except the very well defined and the fairly rigid approach as proposed by the Col lege of Physicians and Surgeons. I think that reflects itself in the Minister's attitude toward the chiropractors; it reflects itself in the findings of the College of Physicians and Surgeons in reg ard to the case of Dr. Schwartz. I guess, Mr.

Chairperson, what makes me angr y is sort of the elimi nation or the red uction of the options, and what also makes me angr y is when I see an effort, an unfair, an unjudicious effort in dealing with Dr. Schwartz; that a person that has been practising, that has a number of patients that rely on him and is now being sentenced, is now being punished through sentence, suspended, fined or forced to pay all the legal fees, re quired to reattend universit,; and it appears now even re quired probably to take some re-examination. So those are the kind of things, Mr . Chairp erson, that I find disconcerting.

Like the Member for St. Boniface, I've gone to a chiropractor on occasion and find that service very useful. I have on one occasion, Mr. Chairperson, had the services of an acupuncturist and fo und his assistance very useful. I have also, Mr. Chairper son, refused medic ation that was strictly a medication for painkilling because I didn't want to subject my body to that kind of medication.

I'm not sure that very many people do those kind of things or take that kind of approach that a physician or surgeon is another expert but is not a god-like figure in terms of my health care or the health care of anybody else, but he or she attemp ts to use the scientific methodology that appears to be working best at that time. But that scientific methodology also changes over time and improve ments or changes in that method often come by someone trying something new, someone willing to use a new approach and then convince their colleagues that that approach is effective.

So we have the chiro practors not being accepted at all at one time, then becoming accepted , at least by the govern ment, if not entir ely by the medical profession, and we have changes in health care coming along and progressing along. One of the problems I see is that the traditional medicine, as is practised now by the established medical institution, as reflected basically by the College of Physicians and Surgeons, is somewhat limited. They deal very well with a number of things. But they don't deal with all aspects of health care and some of them they deal less well with than other s.

If I was in an accident, Mr . Chairperson, and needed medical treatment, I would hope that I would have a traditional orthodox medicine man available to give me that particular service, a physician or a surgeon to give me that service. Or if my appendix were to rupture, I would hope that I would have an orthodox physician or surgeon to provide me with that emergency service of that type. When it comes to my long-term health care, to my long -term interest as an individual protecting myself and my health, I would like to explore other options and look at other ways of dealing with my long-term health care.

I would like to look at diet. I'd like to look at nutrition. I would like to look at exercise, lifestyle, etc., etc., etc. Mr. Chairperson, I think that all medicine is now coming to rea lize the very clear connection. We used to always try and sepa rate mind and body but now I think most people, except for a few, are aware that you can't make that kind of separation. What's going on in the mind affects the body and what's going on in the body affects the mind, and the two are one and you can't make a real distinction between the two.

In order to get the full kind of health care, then I think tha t we, as Manitobans, and we, as human beings, have to look at the broad range. Mr. Chairman, because the balance, because all the weight now is on the orthodox practice, then I think we have to question whether that's the only place, whether we should put all our marbles in the basket of the orthodox practice or not. There are a number of people both inside and outside of the medical profession that are questioning that.

Ivan Illich in his Limits to Medicine talks about the doctor caused diseases and says one of the major diseases in our times are diseases caused by the medical institutions, i.e. by the physicians and surgeons themselves, by our hospitals, etc. The case that the Member for lnkster referred to this afternoon reflected tha t in ter ms of a presentation befo re com mittee in one specific example of one kind of treatment, whether or not in 3336

Tuesday, 6 May, 1980 fact it was beneficial to most people. I think that's a question that we do have to deal with. Are all the treatments or all the methods as effective as they could be? Are all the methods, in fact, healthy? Are some of the methods that are prese ntly currently conside red accep table? And I remind the Minister that at one time it was acceptable to bleed people and that was thought to be an effective medical treatment. Mr.

Chairman, I think there are probably are instances in medical practice where similar types of treatment are still in effect, are still being tried mostly out of tradition, mostly out of habit and not seriously questioned. There was a study done in terms of birthing and the doctor doing the study first started to study just in terms of whether or not physicians of the day - and this study is a little older now - whether physicians of the day were in fact following the full procedures laid out in terms of the length of time, for example, before you cut the umbilical cord.

The doctor found that in themajority of cases - and his study was basically observation and recording his observations - that the practice recommended in the medical books wasn't being follo wed very well. He was particularly interested in infant death and in infant disability, mental disability, physical disability, abnormal development in childr en in looking at the birthing process from that point of view. After he studied what was going on in North American hospitals, he came to the conclusion tha t in fact the birthing process, as practised, was part of the problem.

So what he did, being a scientist, was apply the same techniques that were used for human beings being born and applied these techniques to chimpanzees and took them into the medical room with the bright lights and the modern clin ical practice and, as a result of his study, his conclusion was that in fact chimpanzees were worse off having modern medical techniques and practices applied to them than they were before. Mr. Chairperson, I think that we can't go along without questioning some of the assumptions. We can't have the medical institution as it sits now, Mr.

Chairp erson, being treated as sacred cows or a religious order that cannot be questioned by lay people, that cannot be questioned by other people in the profession. Mr. Chairperson, it's not the fault of the Min ister, I don't think. It's not the fault even of physicians and surgeons themselves. It's the general public attitude that has evolved to create a situation where a particular profession is put on a pedestal and it's not right to critize them, to question their decisions, to ques tion their judg ement. Mr.

Chairman, I'm not saying that there is a black and white situation; I'm not saying that there is right or wrong, but I think, Mr. Chairperson, that we have to look at all the options and not specifically exclude some of the options available to us. Mr. Chairperson, in the area of diagnosis, Illi ch again gives some exa mples just to show that diagnosis is not a pure science, that it's a matter of scientific training and then artistic guesswork as to what is the best diagnosis.

In one instance, autopsies showed that more than half the patients who died in a British university clinic with a diagnosis of specific heart failure had in fact died of something else. In other instances, the same series of chest x-rays shown to the same team of specialists on different occasions lead them to change their minds on 20 percent of all cases. Up to three times as many patients will tell Dr. Smith that they cough, produce sputum or suffer from stomach cramps as will tell Dr. Jones.

Up to one-quarter of simple hospital tests show seriously diversent results when done from the same sample in two different labs. Nor do machines seem to be any more infallible. In a competition between di agnostic machines and humam diagnosticians, in 83 cases recommended for pelvic surgery, pathology showed tha t both man and machine were correct in 22 instances, in 37 ins tances the com puter correctly rejected the doctors diagnosis and in 11 instances the doctors proved the computer wrong, and in 10 cases both were in error. Mr.

Chairperson, what I'm saying is that, one, it's not an exact and perfect science, the practice of medicine, and two, we shouldn't treat it as though it were, as if there was only one truth or one full approach. And we shouldn't, Mr. Chairperson, divest ourselves, as individuals, of responsibility. I think, Mr. Chairperson, this is the key, that what has evolved in our society because of our attitude, of the sociological situation of the practice of medicine, is that we expect always to be cured, as individuals.

In reality, what can the doctor or what can the medicine man do except help our natural healing processes to cure us? But one of the tragedies is that many people.have given up that responsibility for their own health care and given that responsibility entir ely over to the modern medicine man.

And in the past in some cases the y probably gave it over to the traditional old style medicine man, but today we have given that authority and that responsibility away and that is probably one of the greatest hazards and the greatest dangers in the institution, as such, is that once we give up that responsibility for ourselves then we are less likely to be able to get well. Of course, Mr. Chairperson, part of the process in getting well in another pretty thorough study by a psychiatrist called Persuasion in Healing is that in fact part of the mythology is helpful to the healing process.

That is, ifa person goes to a physician and bel ieves they' re going to get healed by that physician, they are more likely to get healed than if they are not sure they are going to get healed by that physician. And the same is applied historically to medicine men of past times and therefore elaborate ceremonies are built around the healing process to convince the person that in fact they will be healed and so the chances of their being healed are great. I guess, Mr. Chairper son, that leads to some of the spirit healing and other kinds of healin;, it's just the belief that in fact you will be healed. But, Mr .

Chairp erson, I'm not an advocate of having our modern medical system become a religion or a mythology because I think we have to . . . One is it then becomes very exclusive and that is one of my main concerns is the exclusivity that develops. Mr. Chairpers on, as I said, I see that exclusivity coming in terms of other health care practitioners, whether they be chiropractors or certified medicine men who practice using some unorthodox methods in terms of their particular practice. Mr. Chairper son, I don't see a versus or a fight.

I don't see the need to have a fight between the chiroprctors and the medical doctors. I don't see the 3337

Tuesday, & May, 1980 necessity of having a fight between those who practice orthodox medicine and those who practice holistic medical or health care, and I don't want to set up that kind of a situation where it has to be either/or because the most effective system, the most effective way is the combination of what is available, of what can be done in terms of assisting people. And it just came to me, Mr.

Chairperson, a recollection of, in British hoispitals, I think under their Medi care system but at least as part of their Medic are system, they even have spiritual healers and clairvoyants as part of hospital staff. This is an accepted practice in Britain, the realization being that there are so many aspects of illness, and the relationship between mind and body that I mentioned before. Mr.

Chairperson, I would like to just quote a little bit from some information that was sent out by the Consu mers Health Organ ization which make s, somewhat better than perhaps I can, the point that I've been making and that is, they say, There is really no conflict in the principle between the two forms of health care. Conventional health care is basically concerned with acute care, pro blems need ing immediate attention, at which it is pre-eminent and with a palliative care for chronic problems where the patient is made comfortable as far as possible and as far as possible the symptoms elimina ted.

Holistic care concent rates on preve nting disease, together with treating of existing disease aimed at elimina ting the causes of the di sease and in strengthening the body's defences so that the body becomes more immune to diseases. Conventional medicine mainly uses drugs, surgery, and other scientific (methods), while holis tic medicine uses natural substances such as thyroid hormo nes, vitamins, minerals, together with changes in lifestyle, food habits, food quality, stress exercise, exposue to pollutants and allergins, etc.

Conventional medicine treats specific diseases only when they are diagnos ed and identified as such, which usually occurs long after the onset of the initial deterioration of health. The gap is filled with no n-scientific palliative measures such as tranquilizers, sedatives, psychotherap y, and what is termed here, a cop-out such as blaming it on the patient's nerves, heredity, or mental state. Holistic medicine uses certain tests which detect early health problems and treat ment begins immedia tely, even if no specific disease can be identified, using the methods described above.

Conventional medicine treats isolated symptoms by attaching the symptoms in direct frontal attack, using drugs, x-rays, surgery, and other techniques. Holistic medicine never attacks a single symptom except in emergencies but strengthens the body so that it can fight off di sease and di sabil ity. Conven tiona l medicine takes charge of a person and treats them in a similar manner to a service station treating an ailing automobile. Holistic medicine encou rages people to learn about and take responsibility for their own health as far as is possible.

The conflict in medicine over holistic methods: The principles of holistic health care are so natural and straightforward that it is hard to see why there should be any conflict. In fact, holistic medicine could fill amassive void in the present health care system and drastically reduce the cost of keeping people healthy.

There is, however, a great antipathy between many physicians to the holistic approach which can only be explained as a result of the continual indoctrination in the use of drugs, surgery and so on from drug companies, medical schools, conferences, medical journals and the medica l organiza tions. This, combined with the difficulty of accepting what might be drastically different, but better ways to treat patients, seems to inhi bit change. (The holistic approach is already at least 60 years old in its present form and has shown continual success over the years.) So, Mr . Chairp erson, the other thing that this

article goes on to talk about is, in fact, that the physician who does try new methods is uniquely vulnerable. They say that he becomes highly visible and is often involved in a lot of publicity which is antagon istic to other physicians. Some of the patients of holistic doctors are not comfortable with the methods and they complain to other doctors they are seeing at the same time. Mr.

Chairman, it's the same in the medical profession as it is in any type of profession or any type of organiza tion; if you do something a little bit differently you have to be better at it and do more work at it than those who do something the same as everybody else. You better not make a mistake, because some of your colleagues are waiting for you to make a mistake. Mr. Chairman, if you follow the straight and narrow, if you do exactly what everyo ne else is doing, then some mistakes are tolerated and mistakes are made, Mr.

Chairperson, I don't think the Minister or anyone else would argue that mistakes are not quite made; but if you are not entirely convent ional, then you better not make any mistakes or you will be punished for those mistakes. Mr. Chairperson, in the one particular case, the case of Dr. Schwartz, the College says that the holistic medicine was not an issue in that case. Mr. Chairperson, I have trouble accepting that at face value.

It seems to me from the evidence that is available, because of the fact that there was not a misdiagnosis in this specific case but what the College terms a lack of full procedures or full proper procedures, and that no one was hurt, in fact, the patients that made the complaints, Mr. Chairp erson, did not follow the do ctor's recommendations. So we can see in traditional practice lots of times a diagnosis being made without lack of full information. I mean the doctor does what he can do; he's got a number of patients waiting and he gives you a pre scription and says, Try this prescription and see if it helps.

If it doesn't help, then come back. Mr. Chairperson, I think that any medic al prac tition er, if it was decided tha t practitioner should be looked at, could be found to have from time to time did an incomplete diagnosis or not being completely thorough in the diagnosis or in the case of the studies a natural mistake in a wrong di agnosis or a misdia gnosis. But if you practise medicine slightly different than the majority then you are not allowed . . . MR. CHAIRMAN: Five minutes. MR. McBRYDE: Thank you, Mr. Chairperson. You are not allowed to have those kind of mistakes.

It does concern me a great deal, as a citizen and as a person who, from time to time, likes professional 3338

Tuesday, 6 May, 1980 assistance in my own health care, that a style of practice and a doctor who has come to gain a lot of respect from his patients, in terms of his long-term care and his style of care, has been punished which I would say is very severely, very severely, by the College of Physicians and Surgeons, more severely than any evidence that I can read would indicate; being deprived of his livelihood, being heavily fined and requiring to pay costs and appears to be now being required to, in fact, be retested in some of the areas in which he obtained his licence a number of years ago. Mr.

Chairperson, I'm hopeful that some kind of a balance will be restored so that all types of health care can be made available to people and that people will take some responsibility for their health care and be able to select the kind of health care that they feel is going to benefit them the most and that we not restrict and we not put limitations and say that there is only one type of medicine man, there is only one type of institution or there is only one orthodox approach that's going to be most effective with all people. Thank you. MR. CHAIRMAN: (d)- pass. Resolution No. 79- pass.

Resolve that there be granted . . . MR. WILSON PARASIUK (Transcona): Yes, I was standing, Mr. Chairperson, when you were saying pass. MR. CHAIRMAN: It's a little confusing, I'm sorry. The Honourable Member for Transcona. MR. PARASIUK: Now, I was standing when you just finished the Medical Services Program and I was standing here waiting to be recognized. MR. CHAIRMAN: I'm sorry, to the honourable member. It's confusing when there is .more than one member standing and moving around. MR. PARASIUK: Oh, sorry. MR. CHAIRMAN: The Honourable Memb er for Transcona. MR.

PARASIUK: Yes, I wanted to just make one final point on the Medical Services regard ing medical research and that is that I think it's important for us to make this item a higher profile item within the estimates. I think we should think about establishing a Manitoba Medical Research Council and we should establish a fund that is more visible than what the Minister says exists right now in the Manitoba Hee.Ith Services Commission budget.

I think we have a very serious situation with respect to medical research, especially because of the federal cutbacks in this area, and that we have no way of providing any type of national priorization of medical research. We are caught in a situation where Al berta, with a very large surplus of government funds, is really raiding many of our high calibr e medical researchers from Manitoba and they are going to Alberta.

Now, I can appreciate Alberta's desire to want to establish a strength in this particular area, they have the funds to do so, but at the same time we have an infrastructure built up here, we have a tradition, we've got some facilities, capab ilities, support people, that exist and are in place. And when Alberta comes along with offers which are very difficult for people to refuse, they denude Manitoba of some very skilled expertise and it's very difficult for Manitoba to get the replacements.

That's happened with respect to geriatric care; that's happened with respect to cancer research; that's happened with respect to other areas. I think that it's a matter which the Minister should take up at the Health Min isters Conference; I think it's a matter that should be taken up at the Western Premiers Conferences and I think it's a matter that really should be taken up at the First Min isters Conference when they discuss Canada.

One of the things that is of grave concern to me is the extent to which Alberta will be using it's tremendous wealth to, in a sense, buy industries to move to Al berta, reduce the corporate taxes to a level that companies will go to Al berta, use their tremendous wealth in the area of medical research. We will create tremendous short-term imbalances which could extend into being long-term imbalances and, at the same time, Albe rta is growing too rapidly too quickly to inde ed accommodate these types of changes that are taking place within its provincial boundaries.

It just can 't grow quickly enough to accommodate this type of rapid growth, and it might be a feather in Alberta's hat; it might be something that they feel is going to broaden their economic base because medical research indeed spawn� the manufacture of medical equipment. But I fear for the impact on Manitoba; I think the impact has been dealt to da te and I really think that somehow the different parts of Canada have to start taking an approach of sharing some of these things.

I know that when the western Premiers were trying to develop some type of development strategy for the federal govern ment prior to the Western Economic Opportunities Conference of 19 73, the thing that amazed me for about a two-year period was the extent to which the western provinces were prepared to look at areas of comparative advantage in one province as opposed to another province. Alberta was willing to do that with resp ect to Saskatchewan, B.C. and Manitoba. That doesn't seem to be the case right now; it seems to be a case of deciding, Well, there isn't going to be any type of sharing.

We are rich and powerful now, let's make sure that we consolidate our base, let's make sure that we consolidate our diversification and we will use our short-term wealth to do so. Frankly, they are emb arrassed with so much wealth that they may, in fact, really become far too extravagant and we really can't compete with Alberta if it gets into that type of a price war. It's a danger that I think faces us.

I would hope that the Minister would take this up at the federal level because I think it's something that Health Ministers should discuss amongst themselves and I think it's some thing that really might be elevated beyond that. A way in which we might indicate our priority to this matter is by establishing a Medical Research Foundation. We are the only province west of Quebec that doesn't have one right now. I think Ontario has one, Saskatche wan has one, Albe rta has one, British Columbia has one and these are provinces around us and we are one that doesn't have one as yet.

I think we could establish an advisory council on medical research. I think that there a lot of people involved in medical research in 3339

Tuesday, 6 May, 1980 Manitoba who are really concerned about this matter and I think many of them appreciate the growth and development tha t has taken pl ace in medical research in Manitoba over the last 50 years. I think many of them are proud to be Manitobans, but at the same time they are concerned about the extent to which their colleagues, and possibly themselves in the short-term future, will be lured away by very extravagant expenditu res on the part of the Alberta government which in a way almost is looking for something to do with its money.

An indication of that is the 75 million that they have put into a pot or into a fund to use to help celebrate Al berta's 75th ann iversary and yet when people ask questions in the Alberta Legislature, as to how will this 75 million be spent, the Alberta government really couldn't come up with too many detailed plans; they just have the money there. It's that type of tremendous surplus of funds that leads to that type of situation and I'm worried about its impact in the medical research field. MR. CHAIRMAN: The Honourable Min ister. MR. SHERMAN: Mr.

Chairman, I have no argument whatsoever with the thrust of the remarks just made by the Honourable Member for Transcona, and I appreciate his sympathetic understan ding of the problem and his non-partisan appr oach to the problem. It is a problem that we face as Manitobans regardless of which side of the House we sit on or which particular political persuasion we subscribe to. There is a considerable thr eat to our great province and our great medical research tradition that is posed by the ready wealth of provinces to the west of us, in particular, and specifically the province of Alberta.

We are alert to that threat and have, in fact, placed that subject on the agendas of a number of meetings that have been held both at the official and the unofficial level between provincial health ministers and between provincial first ministers.

It has been raised by Manitoba, by me at health ministers' meetings and it has been discussed by my Leader at meet ings among western premie rs; whether it has actually been on the agenda of a western premiers' meeting, I cannot testify, but it has certainly been the su bject of discussions between the Premier of Manitoba and the premiers of the other western provinces, and I think that as a topic for consideration by the First Ministers of Canada, it is worthy.

I want to give the Hono urable Mem ber for Transcona some reassurance that we are moving to establish a Manitoba Research Council and we're winnowing down the mechanics and the identification of the relevant personnel to constitute such a body now.

That is part and parcel of the concept of a Research Ap propria tion in the Health Services Commission budget and the prelimina ry work has been done in structuring such a council or advisor y body, or supervisory group, to help identify the most desirable and reasonable research projects from the obvious spectrum of proposals and choices that would face us at any given time, and to help advise with respect to the distribution of the available funds and to participate with the private sector in raising matching doll ars so as to increase the size of the research fund by doubling it or tripling it, or whatever can be achieved.

I want to assure the honourable further that it will be my intention, as Min ister of Health, in devloping est imates for the department in the future, to continue to in crease the MHSC appropriation, which as I say this year is 300,000.00. That is only a start, Sir. That is not a great sum of money but it is a start and it does what I think the Member for Transonca would agree with me on, it at least represents a tangible acknowledgement and a tangible gesture in the direction of our researchers and our medical personnel here in Manitoba, that we are alert to the challenge.

We recognize their value to our society; we want to encourage them to stay; we want to encou rage more of our medical personnel to participate in research and we want to expand our capacity. There's no question tha t we have here the infrastructure, that we have developed the expertise and the reputation in many fields of medic al research, that we are recognized in North America in a number of areas of medical research as continental leaders and pace setters.

We want to maintain that position and we also want to develop positions of similar leadership in certain other areas of medicine that, I think, recommend thems elves as areas of particular significance to Manitoba, such as the field of multiple sclerosis, such as the field of rheumatoid arthritis, afflictions of that kind which for various reasons, many of them inexplicable, are somewhat endemic to this climate and this geography. So I just want to give the Honourable Member for Transcona that reassurance.

The thr eat is there, we are intending to do all we can and I suggest we have to do it collectively as Manitobans to meet that threat and maintain our excellence and our position in the research field. Could I just take a moment to respond to one or two questions that were asked of me in the last few components of the deba te, Mr . Chairman. The Honour able Memb er for Fort Rouge asked me whether the College of Physicians and Surgeons enjoyed veto powers over the contents of the Manitoba Health Service Commission Annual Report; the answer is no.

She raised the question of insured coverage for out-of-province tr ansporta tion, out-of-province ambula nce and transpor tation costs relative to medical services that would be insured under the Health Services Commission. Out-of-province ambula nce and trans porta tion services do not cons titute an ins ured service but there is considerable assistance available to Manitobans who undergo healt h and medical treatment and hospitalization out of Canada, if they have been referred to hospitals or medical practitioners in the United States, for example.

I think the Honourable Mem ber for Fort Rouge is familia r with the assistance that is available under our Med icare program and, in the case of those who need additional assistance for reasons of limited income and limited assets, that additional assistance is also availab le, but out-of-province ambulanc e and transportation costs are not covered. In the field of maternal and child health we face another of Manitoba's health and medical challenges. There's no question that much more needs to be 3340

Tuesday, 6M ay, 1980 done. We are making positive and I think very significant improvements in moving on our infant mortality rate and our maternal and child health problems generally, through some of the measures and policies and programs that we have introduced in the past two years and that we will be introducing in the coming year. In our current budget in front of members, in our current estimates, there is a total of some 886,000 which specifically add resses some of the problems in the field of maternal and child health cited by the Member for Fort Rouge.

We have offered assistance, both financial and personnel -wise, to the Task Force on Maternal and Child Health that was established under the aegis of the Social Planning Council of Winnip eg. We have our own Min isterial Advisory Committee on Maternal and Child Health, which is in continual action and at continual work.

We have in our new programs under the Health Services Commission this year, the new High-risk Newborn Transfer Program which we expect to provide us with signal bench marks of improvement and success in reducing our infant mortality rate and paranatal mortality rate and elevating our overall quality of maternal and child healt h. At the root of our problem, of course, are geography and demographics and cultural challenges.

One reason why our overall ranking in maternal and child health is relatively low in com parison to some other jurisdictions, is the problems that we face in that field with respect to our native population particularly in those vast, remote areas of the province which are difficult to serve effectively in this scientific area, but there we do believe we are making progress through the preparation of new careerists and others, to work as public health nurses and through the initiative which will hopefully see some five to ten native young people, men and women, given the opportunity to enter medicine, as a result of speed-up courses in high school and pre-med and to graduate and return to their commun ities in the north as med ical practitioners.

The other question had to do with the x-rays and a patient's right to x-rays. It arose out of some of the discussions relative to the chiropractic question and was raised by the Honourable Member for Seven Oaks, who raised the question of his right as a patient to obtain his own x-rays, either from his doctor or his hospital and he asked me on what grounds was I saying that he, for example, as a patient, has no right to those x-rays. Mr. Chairman, I say those on legal grounds.

The fact of the matter is that x-rays that have not been paid under the - well, no, as a matter of fact that really has no bearing on the question, that's a separate point - x-rays with respect to chiropractic services have not been paid under the insured program since the inception of Medicare, but those x-rays, whether taken in a doctor's office or taken in a hospital, are not the property of the patient. As far as the transfer of x-rays from doctors' offices to hospitals, to chir opractors or to patients, or whatever, are concerned, the prevailing situation, Mr.

Chairman, is that those records belong to the physicians or the hospital, they don't belong to the patient. Well we had our departmental sol icitors look in to the question, look into that very issue of ownership and there are several cases in law apparently, Mr. Chairman, where the courts have ruled that the medical records, including the x-rays, are owned either by the doctor, in the case of office practice, or by the hospital, in the case of hospital services, and they are not the property of the patient.

Now, the Member for Seven Oaks suggests we should have a look at the law; that's a suggestion that we can certainly take into consideration but the reason for the preva iling situation is as I have described it. On the matter of the Chi ropractic Review Committee, Mr. Chairman, that is not a review of the profession of chiropractic as such, it is a review of the patterns of practice relative to their request for review of their fee

schedule and for upgrading of their fee schedule. That review, unfortunately, was slowed significantly by the failure of the Chiropractic Association to supply the requested material for many many months, and references to the fact that it's taken us a year to carry out that review are not correct. We didn't receive the requested material, which was requested in the early months of 1979, until December 19 79 .

The comm ittee no w has compl eted its work, has submitted its report, its being examined and evaluated by the commission and then will be referred directly to my office, but it is the result of a perception on the part of the commission and my office, among others, that it is necessary to review the patterns of practice before making a final determination as to what adjustments are justified in the ch iropractic fee schedule. I'm certain that some adjustments will be forthcoming but there was concern, Mr.

Chairman, arising from the fact that costs under that portion of chiropractic which is insured under MHFC had escalated very rapidly, at the time that we determined a review should be unde rtaken, those costs has escalated approximately 26 percent over the previous year. And we have a responsibility to Manitobans in terms of a broad spectrum of health care services and that figure was out of line with and certainly inconsistent with cost increases in other areas of health care services. MR. CHAIRMAN: Resolution No. 79 - pass.

Resolved that there be granted to Her Majesty a sum not exceed ing 545,841 ,000 for Health. Manitoba Health Services Commission, 545,8 4 1, 000- pass. I would advise the honourable members that we are now on Page 59 , Department of Health, Resolution No. 75, Item (a)

(1) Min ister's Compensation. The Honourable Member for St. Johns. MR. CHERNIACK: Thank you, Mr. Chairperson. have a few comments to make on a few subjects. Dealing firstly with the matter just responded to by the Minister, that is the ownership of x-rays, lab reports, lab tests, I do not know either the legal reaso ning nor the ethical or moral rationale which says tha t these tests, these factual bits of information belong to the doctor or the hospital rather than to the patient.

It seems to me that if patients who may be moved from one hospital to another, from one doctor to another, from one doctor to another practitioner in the health field, should be able to take his lab tests and his x-rays with him so that he can firstly, make it unne cessary 3341

Tuesday, 6 May, 1980 to have repetitive tests of the same nature and about the same time. Seco ndly, to give the other practitioner an opportunity to note the history of the development that may have taken six, eight, ten months or years and therefore, since it is paid for and. on behalf of the patient it seems to me that there is no logical reason for the results of these tests and the actual x-rays to be kept by the doctor or by the hospital.

I say that it seems to me there's no logical reason because maybe there is and I don't know it and the Minister hasn't explained it, he just stated the law as he was told it exists. Mr.

Chairman, because of the availabili ty of expertise being on the government side, I would suggest to the Minister and to the Attorney-General, who fortunately is in the room with us today, that this might well be a matter of study - no urgency about it, it's taken a long time to develop the law as the Min ister expounded it - to consider with the practitioners and with lawyers what the reason is and whether or not it really ought not to be spelled out in a different way.

I would think that this would be a very sensible matter to refer to the Law Reform Commission, which could well look into it and give an objective review and recommendations to us in the Legislature and I would really ask that the Minister of Health, the Attorney-General, consider my suggestion and, of course as it was raised by the Member for lnk ster - I'm sorry, I saw him leaving the room - by the Member for Seven Oaks to consider whether or not, if it is a law, whether it's sensible or whether it ought not to be changed. Mr.

Chairman, there was some newspaper publicity and today I had an opportunity to watch on the CBC program, 24 Hours, an interview with Dr. Roulston who is, I belie ve, the head of the Gynaecology and Obstetrics Department at the Health Scienc es Centre. He is a person whom I know and who is highly respected in his field.

He made a strong case for the need for a separate and independent clinic to be set up in order to prevent illegal and dangerous abortions taking place in Manitoba, or to make it a costly and therefore inaccessible matter for people who have to go out of the province in order to obtain legal abortions. And his comment - and it's pretty obvious to me - was that the poor suffer, the rich don' t have any problem because they can go out of the province in order to obtain these surgical treatments.

As I unde rstand it, the recommendation was made by a comm ittee tha t this be done, tha t the government be approached for it. There then was an enquir y, a questionnaire sent out to the practitioners of medicine in the province, a large number of whom did respond and the majority of whom agreed with the rec ommendation. And then, from what Dr. Rolston said on T.V. toda y, the council was presented with this report and there was an immediate motion to table and I think he said tha t the vote was 18 for tablng and 12 against it, I believe those are the numbers he gave.

In any event, it appears that the council, by refusing to discuss this matter at all, just set it aside and prevented it from proceeding to the Minister. That's my understanding. I may not have gathered quite clearly just what the ramifications were. But I would like to suggest to the Minister that it is a matter that he should review and become fully familia r with, regardless of whether or not the licensing body decided to forward it or not. When I say licensing body, I don't even know if it's the college that dealt with it or the Manitoba Medical Association.

But regardless of that, it is not a matter that is the business or the concern of doctors alone, it is a matter of the public whom we all serve, and I would suggest to the Min ister that he ought to look into it and be prepared to deal with this question. Another matter, Mr. Chairman: yesterday I asked the Min ister, who spoke and made several points, whether he was prepared to table the comparison which he had prepared over the last 10 years of the percentage of the health estimates as compared with total estimates.

I did not get a reply from him and I asked the Member for Seven Oaks, who was here most of the time - but I wasn't here yesterday - and he is not aware that there was any response from the Minister. The Min ister stated he had done it, he had it, and I feel sure that he would be prepared to - I felt sure he would be prepared to table it but I gather he did not do so. I ask him once again, would he please table the information from which he quoted - he didn't give all 10 years, I think he gave the last three years - but since he mentioned all 10, I'd like to have it.

I also asked him in the same regard whether or not he had had it properly evaluated on the basis of changes in the presentation of estimates because as I mentioned, to my recollec tion, in the last 10 years there were several chan ges in the manne r of presentation where certain costs or estimates were netted out and others were left in gross form.

And the example I gave was that on some occasion property tax credits were used as a reduction of inc ome and in other cases was adde d as an expenditure, and the same I belie ve applied to certain mone ys received from the federal government for the Manitoba Health Services Commission. Some cases netted out and other cases showed as both revenue and total expenditure in gross. So that in order to have a proper appreciation of the statistics he gave us yesterday, I would like those two factors dealt with. Mr.

Chairman, one of the reasons I ask for this is that I find that it's not easy to get the Minister to respond to di rect questions such as I asked yesterday and have just repeated. I mention that because - oh, it's almost two weeks ago on April 24 in the even ing - I had to honour a longstanding commmitment to make a speech outside of this House and was not present to hear the Min ister respond to a speech I made and questions I asked in the afternoon of April 24, and only a couple of days ago did Hansard come to hand and I was able to read the response by the Min ister. Mr.

Chairman, he dealt with the points I raised. Firstly, the Member for Rhineland rose to his defence by saying, it seemed to him that the Minister had been receiving some abuse, especially from the Member for St. Johns, which was not deserved at all. And he thought he was taking a very responsible approach to the whole area of dental service. The Minister then, no doubt emboldened by this kind of support and a much lengthier statement made by the Member for Rhineland, then made a fairly substantial speech and he said, and I quote now from page 29 17: I have some disagreement of course with the 3342

Tuesday, 6 May, 1980 remarks of the Member for St. Johns this afternoon, because I take some exception to his fei gned surprise and his mock dismay at the position being taken by the present Minister of Health, myself and my colleagues in government on this question and on our preference for a dentist-run program, all things being equal. We've never made any secret of that. He goes on further on the next page: We've never made any secret of that position. I do take exception to, as I say, the artificial posturing of the Honourable Member for St. Johns.

I'm sorry he's not here but I had no way of knowing he wasn't going to be here. I will leave it at that, just to say that those remarks really are the only ones that I take exception to. Mr. Chairman, no matter how the Mi n ister interprets my remarks, I had to go back to read my speech just to see whether he had any reason for the statements he made. Mr. Chairman, I said and I quote from page 2876: It became most obvious yesterday when the Min ister of Health, reiterating his conviction that it is best to have the Manitoba Dental Association run the program , and I pause, Mr.

Chairman, to say that I stated that he reiterated his program so there was no doubt in my mind that I knew what the position of the Min ister was, so it was no t a feigned as tonis hment no r was it articial posturing because I said right in my speech I kne w what his position was.

But then I went on to say and I quote: That the Min ister went further and spoke of, and I think he used the words, a happy circumstances or in any event about the happiness he had in noting that the three school divisions had lost the use of their dental nurses and as a result he was able to turn these three school districts over to the Dental Association. Mr.

Chairman, it was not mock astonishment; it was not artificial posturing; it was indi gna tion tha t the Min ister, who had a commit tee reviewing the entire program and comparing the program run by· the MD A as compared to the government program, was happy in the midst of that study, was happy to note that he lost dental nurses for three schools so that he could throw those schools and trans fer them into the hands of the dental association, which he wanted to do all along, which we knew he wanted to do all along, which he admitted he wanted to do all along.

And for me, the astonishment was that the Minister would have the nerve to say how happy he was that he could do this even at the same time as he had a survey, a study going on which presumably would be objectively reviewed by this Min ister. That was the point I made and I stand by that. The Member for Seven Oaks mentions the Burns Report, which is a report which I think I see the few members present on the opposite side, are blushing because whenever they hear it, you see the Attorney General doesn't even recognize the Burns Report.

He'll be having the same reaction with the word Tritschler but that name is a little more unusual. But he will, for the same reason, be wanting to forget that name as well. Mr. Chairman, I go on with the speech of the Minister of Health on April 24. He's talking about the dentists. He says.They're not going to do it - that is they're not going to work strenuously at the program - They're not going to do it if they feel that the admin istration on Broadway of whatever caste, whatever hue, is not interested in them as creative professionals in this province. That is the challenge that we have had to cope with. Mr.

Chairman, it is an utter falsehood to suggest that any government of whatever caste or wha tever hue, may not be interested in them as creative professionals in this province.

The point that was made time and time again, and the Minister of Health should know it and should admit it, because I believe he does know it, is that the best use of the professional is in that field in which he is the most highly skilled and all along in the dental program that was developed by the NOP, it was a complete recog nition that the role of the dentist in his most expert field was to examine the patient, was to decide, diagnose the need, prescribe the need and in many cases to actually do it.

So it is completely false to suggest that people in this House are no t in terested in den tists as creative professionals. Now it may be that there is some doubt as to whether or not they could admin ister a program. That is not the same as being creative professionals. That is a field in which no one can second guess their capability and no one tries. So it was false for him to suggest that that might be the case. Mr.

Chairman, further on in his speech he says and I quote, on page 2919, The reason for the review, he's talking about the review of the dental program, I think that some of the remarks of the Honourable Member for St. Johns are rather unpleasant implied criticisms of the integrity of that review commitee. Mr. Chairman, I was concerned by that statement and I went back to read what I had said and it's a little boring reading your own speeches but I had a purpose now when this Minister attributed to me, unpleasant implied criticism of the integrity of that review committee, and I went back to read what I had said.

So I read the whole thing, and on page 2880 I said, and I quote - well, I'm starting in the middle of a sentence - I asked him to clarify the validity of the program, because, Mr. Chairman, I'm quoting from Hansard, because, Mr. Chairman, I am not in any way, not in any way, challenging the committee itself. I don' t know of whom it consists. I don' t for a moment question their integrity. But I do question the extent to which they did a complete and proper evaluation of the two programs, and since it is not evident, I want to know. Mr. Chairman, the Minister used the very word that I used.

He used the word integrity. He said I had an unpleasant implied criticism and when I read what I said, I said, I don' t for a moment question their integrity. Now you know this is a twisting of words for which this Minister has achieved some limited renown, but which makes it important that one check him up constantly because he has that ability in a broad way to distort, to misinterpret, and to make it sound glibly, the way he wishes to sound. Mr. Chairman, I go on with his speech and he says, One can raise all the questions they want, and the Member for St.

Johns has raised some old and some hairy and some hoary ones, about the meaning of the findings of the review committee and about whether we looked at a particular question or a particular aspect, or a particular problem or not, and I say to him the answer in all cases is yes, yes yes. It's a big help, Mr. Chairman, isn't it? He says yes, yes, yes. He goes on to say The committee is a committee of experts and a committee of committed 3343

Tuesday, 6 May, 1980 people who took their job seriously, have done it seriously, and don't need to be patronized by the Member for St. Johns by being told, well, there are certain questions, such as for example, if you get the dentist to work like the dickens for the first year just to build up high utilization and high accessi bility rates, what about the contrived and artificial effort that represents, will they be able to keep it up in the future? Now he is rewo rding a question I asked but I did indeed ask a question with that general intent. The committee considered that.

I considered that because the Member for St. Johns dragged up again that deplorable letter that he dragged up last year, that was debated a year ago. Again, Mr. Chairman, the letter last year was brought to this House, not dragged by any way, but brought to this House and presented by the Member for St. Bon iface; I had never seen it before. But the Min ister in his affluent style proceeded to make another reference. Mr.

Chairman, the Minister said the committee consi dered it and the Min ister said tha t he conside red it but there is nothing in the report that I could see - and I admitted then and I admit now, that I gave it a rather cursory review because I didn't have it for that long - but there's nothing there to show that they considered it nor to show that he conside red it, and I am not prepared to accept his statement that they conside red it because he says they cons idered it, no r his statement that he conside red it, unless he is able to develop some answers which I think are relevant.

What are the questions I asked of him to which the answers were yes, yes, yes. These are the questions I want to pose and others which I didn't get an opportunity to ask. I asked , considering the possibi lity tha t this committee had reviewed apples and oranges, that they are comparing a cost to government of carrying on this program, that that cost is known, but that the cost to the dentist of the program is not known. What they know is what they paid to the dentists but I don't think that these tables show what it cost the dentists to produce the program.

Now I asked the question, I really don't know, but you can't give an answer and say the answer is yes when I asked whether they knew, whether they were comparing the cost of the dentis ts program to the Dental Association as moneys were paid by the government or the cost to the dentists who are doing the work, and there is a difference.

I said, one way we know the cost of government but my question was do we know the costs of the dentist; his answer is yes, I therefore have to ask him, what is the cost to the dentists that were in the program, not what was the cost to the government to pay the dentists but what was the cost of the dentists, because I suggested the possibility of a subsidy by the Dental Association to the cost of the program. And the reason I did that is that the dentists are trying to prove that they can operate the program as cheaply and as effectively as the government scheme, or more cheaply, or more effectively. So, Mr.

Chairman, I asked, is it true that the program continued on the basis of a flat rated annual fee per patient as compa red with fee for service or salaries. The Minister apparently says yes. And I say to him wasn't it for patient eligible rather than patient treated. Accord ing to the Minister, the answer is yes. And I said, can the Minister tell us what comparison has he got, which I didn't see in the charts, to indic ate the number of attendances per treated child by the two forms of service.

So the Min ister says yes, yes, yes, when I asked him the number of attendances per treated child and the answer is yes, which means, Mr. Chairman, that he made no effort to consider my questions and to reply to my questions.

That's the accusation I make, that when we ask a question, we are either entitled to a refusal to answer or we are entitled to an answer; and when we ask for specifics, I think we are entitled to specifics or a refusal to give the specifics, but not an indication that there were unfair remarks made and the answer is yes, yes, yes, and you're slighting the profession and you're slighting the program and all that. That is not the way one should reply to direct questions, because it's the Min ister who filed the report, and I think we have a right in reviewing the report to find out what it really contained. Mr.

Chairman, let us remember that that letter which upset the Minister so much because it was read to him last year and again this year, was a letter which was apparently di stributed by the president, the then president of the Dental Association, not signed, but giving a warning: Build up your utilization is the key phrase in that letter. And this Min ister says about that, the deplorable letter.

Well it certainly is cause to deplore because it is an indic ation of an effort by the leader, the president of the organization to instruct, inform, advise, and plead , with the memb ersh ip of the organization on how they should make the results look good. And that I think gives us cause not to question their ability as professional dentists but to question the manner in which they reacted to the granting by this government of the substantial part of the program to the Dental Association, in order to make it look good. Now, Mr. Chairman, the questions I asked were clear. MR. CHAIRMAN: Five minutes. MR.

CHERNIACK: Mr. Chairman, I have read them out, they are clear, and I did not get a response. I asked whether the dentists were working on a fee for service basis paid by the Dental Association or did they contract out a contracted deal by the hour or by the day or the half day to the Dental Association. The only answer I got from the Minister is yes, yes. I don't know what that means. I said it was one or the other. He said, yes it was, one or the other. I guess that's his answer. I said who paid the dentists travel expenses. His answer is apparently yes, yes, yes.

That's a new firm of people who paid the expenses, I guess. I said who paid the mileage fee of the dentists. His answer was yes. What about the nature of the attendances? The answer was yes. What did the MD A, the Dental Program do to carry on instructions in care of teeth? His answer was yes. I said there were many unanswered questions in the report and there will be more. Mr. Chairman, every question I asked was unanswered. I have more questions, Mr. Chairman, I propose to ask them until you stop me and then on the next opportunity for me to speak, I'll ask them again. There aren't that many.

I had already asked for comparison of numbers of attendances per treated 3344

Tuesday, 6 May, 1980 child, the nature of the attendances, the travel expense, the office expenses, what was the true cost of running that program, not the cost to government but the true cost to anybody for the del ivery of that program. What fees were charged under the MDA program, how do they compare with a government fee schedule, how do they compare with a dental fee schedule, the Mani toba Dentist Association fee schedule? Did this Minister and the MDA expect the dentists to work for less than they would think that they are worth?

Did they, in other words, pay less than the regular fee and if so, do they expect them to continue to work for less? What experience or lack of experience of the dental nurses in their first year or so of activity, what did tha t la ck of experience contribute to their speed and effectiveness in their work? To conclude, Mr. Chairman, I asked him when I spoke, for a review of Dr. Storey's letter, the letter containing the report, and the letter speaks of briefs and reports and we haven't had them, we didn' t see them.

He spoke of a clinical survey and I would like to know what funding there has been made, what time was allo cated for that clinical survey which is such an essential part of that report as to make the report itself meaning less without a review of that. And there were meetings sugge sted in the letter and I would like to know what is happening at the meetings, and I'd like to know how does that final report differ from the interim report and what changes there were and why were the changes. I'd like to know what is happening to the dental nurse training program. I assume that's wiped out.

I'd like to know how the continuing study, now ongoing, is going to affect the ability of the children' s dental program to take over the comple te service, because it is my suggestion to the Min ister that he has killed the program to an extent where it would be an easy matter to tran sfer it comple tely ·t o the Dental Association, but a very difficult matter to take it over by the government itself as was originally planned.

And that's where I say the happy circumstances, that slip of a tongue, which I think it was the other day when he used it, is clearly an ind ication that he has no intention, no desire, to retain that program in the way it was where it was government operated, but he has every intention, and the desire was clearly expressed by him, in a happy way, to turn it over to the Dental Association.

So I' d like to kn ow ho w he proposes to be objective in view of his admitted bias, in looking at this report which is just an interim report, and in looking at the whole report if, as and when he is prepared to fund it, to finance it and then to receive it, and that's the report as to the effectiveness of the services of the two, may I say, competing programs. MR. CHAIRMAN: The Honourable Member for St. George. MR. BILLIE URUSKI: Thank you, Mr. Chairman. As the debate on the portion of the estimates dealing with the nursing home construction lasted into the late hours of the night, Mr.

Chairman, and I did come in and ask a few questions at the end of that debate, I did not want to pu rsue the question of the government' s policy with respect to nursing home construction and specifically as it pertains to the Interlake region, and specifically to the central and northern portion of the In terlake. Mr.

Chairman, the comments that I wish to raise are in the context of the government's moves in the last two years with respect to initially free zing the construction of the nursing home program that was originally agreed to between · the Health Services Commission and the Interlake District Health Board, which compris es of the rural munici paliti es of Coldwel l, Eriksdale, Siglun es and the Local Government District of Grahamdale. Mr.

Chairman, I know the Minister has heard me make this speech before, but cert ainly the events in the last six weeks have somewhat altered the course of action that the gov ernment had originally proposed, in terms of nursing home construction in the Interlake.

Initially when they froze the initial program of not proceeding with the construction of nursing homes jux taposed to hospitals at Eriksdale and Ashern and then holding back any construction for in excess of a year and then indicating to the District Health Board that the government was only prepared to proceed with one nursing home in the year of 1978 - I think that was the original plan of action - and that the local board should make up its mind as to which community should be proceeded with first, or initially.

The community, and if my memory serves me correct, this announc ement was made in February of 1978, and by March of that year the District Health Board made a de cision, virtuall y a unanimous decision - when I say virtually, one member voted against the majority decision of the board - to proceed with the original decision of the District Health Board, to do what? First, to try and pressure the government to agree to the original program of the two nursing homes in Ashern and Eriksdale, the health clinic in the community of Lundar and the clinic up in Gypsumville in the northern part of the district.

Failing that, the district board, in that resolution at that mee ting, made a decision to recommend to the government that if only one nursing home was to be built at this time, that they wished to proceed with the nursing home at the community of Eriksdale and that recommendation was sent to the government. And what happened, Mr . Chairman? Well, absolutely nothing happened.

We had assurances from the Min ister of Health to myself in this Chamber as late as the latter part of June, during the dying days of the session, when I questioned him about the timing of the announc ement of the construction of the homes and the wishes of the District Health Board , and the Minister assured me that the - if I recall his words correctly - that the decision would be imminent. Those are his words in 19 78.

Well, imminent, I guess in the mind and the words of the Minister of Health means, well, maybe a year, maybe two, maybe never, if we can get away with it and that's exactly what they attempted to do. Imminent? I'm sorry. I mispronounced the word, Mr. Chairman.

Then lo and behold, a petition was begun in the community of Ashern indicating that the decision of the District Health Board did not represent the views of the people of the municipality of Siglunes and that Eriksdale should not be considered as the first priority of the board, that Ashern should go ahead first, if there was going to be any home built at all in 3345

Tuesday, & May, 1980 the area. A very neat diversion, Mr. Chairman, to promote some discontent in the community. Rather than having the community stick together, as they have done over the years, there was, I presume, a seed planted in the minds of some members in the communities, and commitment was made that if the District Health Board's plans were scuttled, Ashern home would go ahead and of cour se the gove rnment's initial plans of the commun ity of Lundar would go ahead as well.

So that petition was started, the Min ister then pulled back every thing tha t he had originally announced and in November of 1978 he made a new announcement, a new proposal to the board saying, now, this is the gove rnment's de cision: We propose that if the board accepts this government's proposal, we want to build a nursing home and a , health clinic in the commun ity of Lun dar, a community where there is no hospital, Mr.

Chairman, a longstanding policy which the Minister at least indicated to members on this side, that he was no longer following; that it's a matter, not for his government, that they would follow a policy that would provide a service, efficiency and cost savings to the people of Manitoba; If they followed the policy of building nursing homes juxtaposed to hospitals, in any event he was prepared to deviate from that longstanding policy. So he recommended a nursing home in a community with no hospital and a nursing home in the community of Ashern. The board, Mr.

Chairman, after receiving that rec omm enda tion, ind icated tha t they were still sticking with their original proposal on which the District Health Board was formed, and there was corre spondence and statements made to the government asking the government if they were prepared to live by the democratic wishes of the District Health Board, which represented the majority of the citizens of that area. Replies came from the Minister ind icating that, yes, he was prepared to allow the democratic views of the board to carry forward but, Mr. Chairman, nothing happened.

The govern ment's position still stood, that unless they accepted the govern ment's offer, it appeared that nothing would happen. So for several months, from November of 1979 until early this year in 1980, the board stood firm on its decision and the government did not want to change its mind as to its proposal of constructing a home in Lundar and in Ashern, and Eriksdale would be left aside. Mr. Chairman, the people of that area, through their board representatives, stood firm. The government tried to dissuade them and tempt them to change their original position, by doing what?

The Minister apparently made telephone calls to board members in the early part of 1980, asking the board members and advising them that if they accepted the latest government proposal, that they would provide, not only 20 beds in the community of Eriksdale, but they would even go further, they would provide 20 more beds in the northern part of the area. So, Mr. Chairman, from a position of having originally determined through the Health Services Commission, in discussions and consultations with the district, they started out with a proposal of having 40 beds. Then all of a sudden, Mr.

Chairman, we already have a proposal of having 80 nursing home beds in that area. That's what the latest government proposal was, a proposal, Mr. Chairman, I suggest to you, of a very desperate government and a desperate Min ister. Why was that move made by the Min ister of Health, Mr. Chairman, in terms of making those phone calls, and what one can only consider being, I would say, kind to the Minister?

One could even go as far as to say that he was trying to bribe mem bers of the board in the Lakeshore district health area, by offering them those kinds of promises without any backing behind him - and I don't believe that the Minister is prepared to back up that commitment of putting 80 beds into an area that there has been no study, Mr. Chairman, to determine whether an additional 40 beds is needed. Certainly, Mr. Chairman, I'll be the last to argue, the last member on this side, that there is no need for additional beds in the province of Manitoba, and I want to leave that impression.

There is grave need for nursing home beds in the province of Manitoba. We have acute care beds in the province of Manitoba which are filled with patients who should be in nursing homes. But, Mr. Chairman, what we have seen by the Minister's health move in terms of what can only be - and I've said it before - political pork-barrelling, because the community of Lundar happens to be in the constituency of the Min ister of Government Services.

That is the only reason that the government has allo wed the decision to overrule the decision of the District Health Board and overrule the recommendation of the Health Services Commission 11.nd say, we are the masters and we are prepared to make our decisions stand. Well at least, Mr. Chairman, they should have had the intestinal fortitude to get up initially and say, we're not allowing this because of our political beliefs, because we want a home in the constituency of one of our colleagues and we are proceeding in this way.

Not on any wishy-washy ill-conceived form that Lundar is some growth centre as compared to Eriksdale when the communities, in terms of size, are virtually the same; some other wishy-washy statements that there is need for growth in that community; what a bunch of hogwash, Mr. Chairman. This Minis ter of Health has PR ed himself into oblivion with respect to the situation of nursing homes in the Interlake. This Min ister has had some credibility in the eyes of some of the people, Mr.

Chairman, but when he stooped so low as to try and bribe those people to agree to the government's proposal of last November by offering them an additional 40 beds in the area, he lost complete credibility in the eyes of the people of the Interlake, Mr. Chairman. Now, Mr. Chairman, it got to the point that the board mem bers were so frustrated and didn't know what to do, that they finally, finally, Mr.

Chairman, in a meeting this spr ing, the Health Services Commission came up with a compromise to the government's latest offer and they said, if you will allow the two nursing homes that were originally planne d for Eriksdale and Lundar and the two nursing homes in Eriksdale and Ashern juxtaposed to the existing hospitals and the health clinics in Lundar and in Gypsumville, we will accept the proposal and concur that we will go ahead with a free standing nursing home in the community of Lundar. That decision was made on behalf of the board after months and months of frustration, months and 3346

Tuesday, 6 May, 1980 months of being, what one can only call a trampling, to say the least, on the wishes of the board, a complete denial of the position taken by the duly appointed members of the District Health Board, which had consulted and worked for many years in the de velopment of this program with the government and the Health Services Commission, only to be pushed aside by the whims of the Minister of Hea

Document details

Collection	Manitoba — Debates (Hansard)
Citation	31-4-52b
Type	hansard
Volume / chapter	31st 4th hansardpdf 52b.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	e7bcb079bc73c883e8a61985f039884bbe665035

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