Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, MAY 20, 1997

Afternoon

Volume 5, Number 3

[ Page 3457 ]

The House met at 2:05 p.m.

Prayers.

I. Waddell: Mr. Speaker, the Young Ambassadors program was launched in 1994 by the Chinese Canadian Association of Public Affairs -- that's a non-profit organization -- to promote mutual respect and understanding amongst Canadians of all ethnic origins and to increase the political awareness of the Chinese Canadian community. I'm very pleased to have the House welcome 18 young ambassadors, who normally would go to Ottawa, but we're fortunate that they came here this year. Would the House please welcome Catherine Yeung, 18 students and two adults from the Young Ambassadors program.

G. Campbell: I am pleased that in the legislative precincts today is a councillor from Terrace, Linda Hawes. She is here to meet with us on the Northwest Communities Coalition. I'd ask the Legislature to make her welcome.

Hon. J. Cashore: In the gallery today is Margaret Makawaza. She's a guest of the United Church of Canada and Pilgrim United Church. She's here from Harare, Zimbabwe. Together, Margaret and the congregation are exploring what it means to be global partners. Margaret works with the Zimbabwe ecumenical church loan fund, which funds projects that give opportunities to the economically disadvantaged. Accompanying her is Gaye Sharpe, formerly the special assistant in my office. Would the House please make them both welcome.

R. Masi: It's my pleasure today to introduce two visitors from North Delta: Leslie and Brent Schaeffer. Would the House please make them welcome.

Hon. A. Petter: In the gallery today are a number of volunteers from the Royal Museum Shop at the Royal British Columbia Museum. They include June Yelland, Susan Cumar, Margaret Bragg, Eileen Goossen and, along with them, my mother, who's also a volunteer, Lisl Petter. I'd ask the House to make them all very, very welcome.

F. Gingell: It's my honour today to introduce another visitor who's very close to our caucus. I ask you all to welcome Mr. Sindi Hawkins, otherwise known as Ralph.

H. Giesbrecht: Visiting us today from my riding are six members of the Northwest Communities Coalition. One of them has already been introduced, but also here are Mario Feldhoff; Trafford Hall, who's the municipal manager of the district of Kitimat; Linda Gammel; and also Linda Hawes, a councillor for the city of Terrace. Unfortunately, I didn't get two names this morning when I made the call to determine who was going to be here, but there are six of them. Would the House please join me in making them welcome.

I. Chong: I notice in the precincts today one of my constituents and a B.C. Young Liberal. Would the House please welcome Mr. Bryan Matthews.

G. Bowbrick: I'm very pleased today to be able to introduce to the House my father John Bowbrick, as well as my wife Anna Santos and my 18-month-old son Colin. I know all of us in this House appreciate how important it is to have the support of family in this business, and I am indeed very fortunate. Would all members of the House please join me in making them welcome.

G. Abbott: I have two special guests in the gallery today from the Shuswap: my wife Lesley and my son Wade. I would ask the House to make them welcome.

E. Gillespie: Hon. Speaker, I have the honour today to make two sets of introductions. I'm pleased to welcome Molly Bain and Yvonne Bain, visiting here from Powell River-Sunshine Coast. I ask the House to please join me in making them welcome here today.

I would like to also make welcome a constituent of mine, Orville Reimer, who was here visiting over lunch today with the Minister of Forests and who is an advocate, in particular, of small-scale forestry on the north Island.

J. Dalton: One of the people accompanying the young ambassadors that the member for Vancouver-Fraserview introduced earlier is a friend and a constituent, Mr. Chris Lee. I first met Chris when he was the Premier of the North Shore Youth Parliament a few years ago. Would everyone please make him welcome.

Hon. S. Hammell: There are 45 great grade 11 students and their teachers, Mr. Murdoch and Mr. Shiu, from L.A. Matheson Junior Secondary in Surrey -- one of the many schools in all of Surrey that was built during this government's period of time. Would the House please make them welcome.

S. Hawkins: In the gallery, sitting here today, is the person who first got me involved in politics 15 years ago and who signed me up with the Liberal Party, which I've been working for in the last 15 years. And to set the record right, his name is Ralph Hawkins, not Mr. Sindi Hawkins. Would the House please help me make him welcome.

I. Waddell: I rise again. Normally we're reluctant to welcome people who live east of the Rockies, especially journalists, but I do see an old friend of mine whose brother I used to represent in Parliament. He's the national affairs reporter for the Globe and Mail , Jeffrey Simpson. I noticed him here. I think . . .

An Hon. Member: He's hiding.

I. Waddell: . . . he's hiding. So just for maximum embarrassment, I'd like the House to welcome him to the premises.

Introduction of Bills

CHILD, FAMILY AND COMMUNITY

SERVICE AMENDMENT ACT, 1997

Hon. P. Priddy presented a message from His Honour the Administrator: a bill intituled Child, Family and Community Service Amendment Act, 1997.

[ Page 3458 ]

Hon. P. Priddy: I move the bill be introduced and read a first time now.

This amendment act will result in four more recommendations made by Judge Gove about existing children's legislation being addressed. This raises the total to 18 legislative changes.

Additionally, we are introducing four important amendments recommended by the Children's Commission. The amendments largely revolve around the recommendation which advocates the ability of the director of child protection to apply to court by summons for an order supervising a parent's care of a child, without first removing the child from the family. On a policy, legal and practice basis, a child protection worker should be removing a child if that child should be in the custody of the director, not applying for the lesser option of a supervision order.

[2:15]

The amendments are many because the new supervision order has necessitated different types of initial hearings before the court, of notice provisions for the new summons, of grounds for obtaining a supervision order without removing the child, of enforcement mechanisms for the new supervision order, and of removal provisions attendant upon a supervision order being breached -- as well as some cementing of existing supervision order provisions to ensure that the new summons procedure will be effective.

Therefore a significant part of this bill is extremely technical. However, to put it in words that I and others who are not lawyers will understand, the summons procedure will allow the director of child protection to apply to court for an order supervising a child's care in the home, instead of removing the child from the family. This would only be done in cases where removal is not necessary and would be too extreme an action. This change will add to the spectrum of tools available to help families care for their children.

The other amendments are: a discretionary offer of a family conference instead of a mandatory one, when mediation might be inappropriate; requiring the director of child protection to make reasonable efforts to inform community members of the results of child protection investigations when this is necessary for the child's safety; the ability to apply for continuing custody up to 60 days before the expiry of a temporary custody order, instead of 30 days; changes to the service delivery principles to enforce the principles of integration and prevention; and, the last one, whistle-blowing protection for people who ask the director to review a decision made in the course of providing services.

Bill 24 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

CHILDREN'S COMMISSION ACT

Hon. U. Dosanjh presented a message from His Honour the Administrator: a bill intituled Children's Commission Act.

Hon. U. Dosanjh: This bill demonstrates government's commitment to creating a new system solely focused on the needs of children for a nurturing and safe environment. This legislation gives the Children's Commission many powers:

1. To monitor the development and implementation of internal review processes across ministries and agencies of government to ensure they are respectful, timely, effective and child-centred. We will start with the Ministry for Children and Families.

3. To ensure all children in care have a plan that meets their needs.

4. To investigate critical injuries that occur when children are receiving designated services.

5. To review all child fatalities and investigate any that are suspicious and unusual, through an investigation and multidisciplinary process.

The Children's Commission has the most comprehensive fatality review process in Canada, ensuring that we learn from mistakes to prevent further child deaths. This legislation also provides the Children's Commission the power to report on the progress made by the child-serving system in implementing change as recommended in any or all parts of the Children's Commission's mandate to better protect children. Public reporting, of course, will ensure ongoing accountability and government responsiveness. I move that the bill be placed on orders of the day for second reading at the next sitting of the House after today.

Bill 23 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral Questions

B.C.'S CREDIT RATING

AND FINANCIAL MANAGEMENT

G. Campbell: Last week another agency cut B.C.'s credit rating because of this inept and incompetent NDP government. Since 1992, real per capita GDP has gone down in this province. Put another way, in the last five years under the NDP, the standard of living for British Columbians has gone one way: down. In 1995 we were the only province where real per capita GDP fell. To quote the government's own statistics released last week, British Columbia ranked tenth amongst the provinces and territories in terms of economic growth last year. A province that once proudly shouted, "We're number one," is now reduced to whispering: "We're number ten."

The people of B.C. deserve some hope for a reversal in the decline in their standard of living. My question to the Minister of Finance is: will the minister take the first step toward establishing that hope, and resign?

Hon. A. Petter: I'm constantly amazed at the ability of the opposition to quote selectively from whatever reports suit their purpose. The fact is that British Columbia, as the rating agencies have all noted, continues to enjoy one of the lowest debt-to-GDP ratios not only in this country but throughout the world. We pay less than any other province in terms of taxpayer dollars going to service debt. We remain strong economically, and that's why all the rating agencies have continued a rating in British Columbia that is second to none in this country and is tied, in some cases, with Alberta.

G. Campbell: You know, the problem with this minister is that his economic policies are having a huge negative

[ Page 3459 ]

impact on people's lives in this province. There is no question that the standard of living in this province for the people who live here, for the families who live here, has been going down for the last five years. The minister's own discredited budget says: " . . . economic growth . . . must be a component of any complete fiscal plan." But, in the last year, we have watched a decline in agriculture, a decline in logging, a decline in fishing, a decline in manufacturing and a decline in construction. There was a 13.2 percent decline in business investment in non-residential construction.

Can the minister tell us how he expects economic growth to improve while private sector investment in British Columbia is going down and he is driving the jobs of British Columbians out of this province?

Hon. A. Petter: There is no doubt that due to a decline in pulp and newsprint prices, principally, there has been a slowdown in economic growth in this province in the last two years. That's certainly the bad news.

The good news is that this province is enjoying considerable strength in other sectors, and because it's a more diversified economy, the overall effect on the economy is not nearly as great as it was, say, ten or 20 years ago. The member declines to refer to the fact that we've seen considerable growth in the high-tech sector and considerable growth in service sectors, and that consumer spending has continued to be strong. In terms of employment, employment is a major success story.

Notwithstanding the slowdown in economic growth in the last year and in some measure, I would say, because of the commitment of this government to employment, employment last year went up by some 39,000 employees over the previous year -- an incredible success record in this province, notwithstanding some economic problems this government is working hard to overcome.

F. Gingell: Within the space of a week, B.C.'s credit rating has been downgraded by two bond-rating agencies. The agency stated: " . . . the provincial debt burden will continue to climb in the current fiscal year. This is contrary to Standard and Poor's prior expectations." While every other province is getting their act together, B.C. is going in the opposite direction with more debt. Will the Finance minister admit that the budget fiasco and this government's litany of broken promises are making life tougher for British Columbians?

Hon. A. Petter: I don't know . . . . I can't fathom that the members opposite think the people of British Columbia can't see through the duplicity of their position on this and all other matters. This is the same opposition that on Mondays, Wednesdays and Fridays cries that more should be spent on schools and hospitals, and on Tuesdays -- I guess today is a Tuesday -- complains about the level of debt.

Yes, we said to the finance agencies that we were going to continue to invest in schools and hospitals, that we were going to continue to invest in education. We recognize that by doing that, we might not please them and their bottom line. But we are determined as a government to maintain fiscal prudence -- which has been recognized by all these agencies -- with a commitment to continue to invest in those things that matter to British Columbians. It's the priorities of British Columbians that are important to this government, not the priorities of a few bond-rating agencies . . .

The Speaker: Thank you, minister.

Hon. A. Petter: . . . and not the schizophrenic position of the members opposite.

F. Gingell: The one thing that we complain about on Monday, Tuesday, Wednesday, Thursday and Friday, as all British Columbians do, is the incompetence of this government. When the cost of borrowing money goes up and the government insists on adding more to the province's debt burden, there is less to spend on health and education. We now spend more money on servicing taxpayer-supported debt than the total of all provincial government expenditures in 1973. Will the Finance minister tell us how many more credit downgrades it will take before this government puts a stop to the growth in British Columbia's debt?

Hon. A. Petter: Again, the member quotes selectively. The fact is that in this year's budget the debt burden is going down by about $100 million, not up year over year.

Interjections.

The Speaker: Members . . . .

Hon. A. Petter: As much as they try to cry out of one side of their face and scream out of the other, the members cannot have it both ways. If you invest in schools and hospitals, yes, that will increase debt. If you invest in programs for kids, if you invest in programs for health care, that will affect the bottom line. The members don't seem to care about that or understand that; we in this government do. The good news that's come out of these recent reviews is that this economy is performing relatively well compared to other economies -- notwithstanding some serious slowdown in the pulp and newsprint sectors.

We are able to maintain our commitments to health care and education not just because we have the political will but . . . . Woe betide this province if that group ever comes to office . . .

The Speaker: Thank you, minister.

Hon. A. Petter: . . . because they don't have the political will.

BRE-X STOCK LOSS

BY TEACHERS' PENSION FUND

J. Weisgerber: My question, too, is for the Minister of Finance. The B.C. Teachers Federation pension fund reportedly lost $80 million due to the Bre-X debacle. Given that the teachers' $1.8 billion unfunded liability is now on the province's books and effectively underwritten by the province . . . . Can the minister tell us the effect of that $80 million loss -- the liability to the province of British Columbia -- from the teachers' pension plan? In other words, are taxpayers ultimately on the hook for the $80 million gamble by the BCTF on those high-risk funds, those Bre-X funds?

Hon. A. Petter: The member's facts seem a little askew. As part of a general investment portfolio undertaken on behalf of pension funds, there is a general policy of investing a small component of the overall investment strategy in the top 100 and top 300 companies that list on the Toronto Stock Exchange. That was undertaken in this case, and Bre-X was one of those companies. As a result, a very small component of the overall investment portfolio was allocated to Bre-X -- so small that it will have virtually no impact whatsoever on the overall investments.

I can get the member the numbers, and I can give them to him in percentage terms if he wishes, but it is such a small component that it really doesn't show up as a blip in the overall investment scheme.

[ Page 3460 ]

[2:30]

J. Weisgerber: A supplemental. Perhaps the minister was talking about the investment fund of the province of British Columbia. Perhaps he's saying that the amount lost on Bre-X by the province in its investment portfolio is insignificant. I will accept that, if that's the statement by the minister.

If he's saying that an $80 million loss by the teachers' pension fund is insignificant, I would say to him: why then, if he's prepared to accept those kinds of losses, doesn't the province take responsibility for the investment policies of the teachers' fund and other liabilities that are accepted by the province? In other words, if we're on the hook, why don't we make the investments ourselves rather than leaving them to the people who would risk pension money on $80 million worth of Bre-X stocks?

Hon. A. Petter: Well, I'd be happy to provide the member with a detailed briefing on this matter, but again, I believe his assumptions are in error. In fact, I think the number he's quoting, the $80 million, is the number that reflects the total loss across all investments of all pension plans, not the prorated amount that affects the teachers' plan.

My information is that the impact overall and within individual plans is small indeed -- large in the individual numbers but small relative to the total exposure and amount of capital in those plans. But I'd be more than happy to provide him with the detailed information.

B.C. TRANSIT CHAIR COMPENSATION

D. Symons: On Friday afternoon Derek Corrigan left his position as B.C. Transit chair. However, it isn't clear whether he jumped or was pushed from his position; either he quit or the minister fired him with cause. Neither should result in any severance being paid. Can the minister tell us why she felt the need to give the Premier's hand-picked B.C. Transit chair a $66,000 golden parachute?

Hon. J. MacPhail: Before agreeing to any settlement when the chair and I mutually agreed he would not carry on, I needed to receive assurance in two areas: (1) that there was a case for severance to be paid out; and (2) that when that severance was paid out, it was paid out within the context of the legislation introduced by this government the week before last. I received those assurances, and it was on the basis of those two assurances that severance was paid in the amount of $56,000 to Mr. Corrigan. The hon. member's research is wrong.

D. Symons: There are thousands of unemployed and poor people in this province who will see this payment to yet another NDP patronage appointee as a betrayal. Corrigan was appointed by an order-in-council which stated that he would be paid $4,000 per year and $500 per day spent working on transit. Yet the minister has seen fit to line Derek Corrigan's pockets with -- she corrects the figure to be -- $56,000 of taxpayers' money for a job supposedly worth $4,000 per year. Considering Mr. Corrigan's been paid this $4,000 per year, how can the minister justify giving him a severance payment worth 16 times his contract?

Interjections.

The Speaker: Order, members, please.

Hon. J. MacPhail: Hon. member, when the chair was appointed in 1994, our government took a very aggressive approach in the subsequent years to the implementation of public transit. In fact, I have not heard this member, who has been the critic for transit during that whole period of time, actually ask any question about public transit whatsoever. Clearly the opposition has no plans for public transit in this province.

We undertook a ten-year plan for implementation of a transit plan in the context of the lower mainland. We put in place "Going Places," which was to bring about better transit in the lower mainland. We brought about commuter rail, and we announced light rapid transit. We also managed to do something which has not been done by a government previously, and that's enter into negotiations with the greater Vancouver regional district on matters of funding and governance. I announced those negotiations last month. That brought to a conclusion the full-time tasks of the chair of the Crown corporation. The job is now part-time, and hence the change in duties.

The Speaker: The bell terminates question period.

Petitions

R. Neufeld: I rise to present a petition. It will be the short version today.

"We the undersigned, being citizens concerned about the condition of the Alaska Highway from Mile 30 to Mile 54 -- and in particular the stretch of highway known locally as the south Taylor hill -- hereby petition the Ministry of Transportation and Highways for an upgrade and reconstruction of approximately 24 miles of highway from two lanes to four lanes as per standard ministry specifications."

Orders of the Day

Hon. J. MacPhail: In Committee A, I call Committee of Supply. For the information of members, we will be debating the estimates of the Ministry of Aboriginal Affairs and the Ministry of Municipal Affairs and Housing. In this chamber, I call Committee of Supply. For the information of members, we will be debating the estimates of the Ministry of Health.

The House in Committee of Supply B; G. Brewin in the chair.

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 40: minister's office, $462,000 (continued).

D. Symons: Just before I get into Health, I would like to remind the minister that if she goes back into Hansard , she will find that many times I have raised issues to do with transit. She seemed to have missed some of them, I gather, by her answer in question period.

To deal with a Health issue, we have a group in Richmond called RADAT, the Richmond Alcohol and Drug Action Team, and they've expressed some concerns to me over regionalization. One of those concerns involves a move for Vancouver, which now -- the minister may remember -- is part of the Vancouver-Richmond regional health district. There was a lot of concern, I must say, on the part of the health care givers in Richmond about that amalgamation -- or should I say absorption? -- into Vancouver, sort of the mouse-and-elephant attitude, I think, on the part of people in

Rich-

[ Page 3461 ]

mond. We do thank the minister for increasing the membership of Richmond's representation on that board. I would remind the minister: at the rate that Richmond is growing, we will no doubt be needing further representation to be proportional to the populations of the two centres.

My first question, I guess, will be: as Richmond's population grows relative to Vancouver's, will you be increasing the proportion for Richmond? And will that be by adding another member, or will we replace one of the Vancouver members when that time comes? In other words, is 18 going to remain fixed, or as the growth comes, will the total number on the board increase?

Hon. J. MacPhail: Actually, I've been very pleased with the way that the Vancouver-Richmond health board is getting up and running and with the model of consensus they've reached, not only amongst the board members but amongst the communities. I met with the mayor of Richmond to resolve some of the differences, and certainly the representations I've had from the community are that they too are pleased with the amalgamation -- not an absorption but an amalgamation.

As we have discussed many times here, the representation on boards is a combination of a group of skills to be able to plan across the board for health care delivery, not on a community-by-community basis. There is a taking into account of the size of the community and the representation that community should have on a board. It's one factor to be considered. So certainly as population shifts in our province generally and as population demographics shift, we will watch carefully that the makeup of our boards represents those shifts. But that is a general comment and not specific to Vancouver-Richmond.

D. Symons: I thank the minister for that answer.

I did mention RADAT earlier. The concern that they expressed to me . . . . Before Richmond and Vancouver amalgamated, Richmond had worked out a pretty good program, a model for delivery among all the health care givers within Richmond -- and RADAT was one of those groups. But they find now in Vancouver that there's a move toward what I think they call neighbourhood health centres. There are to be six of them in Vancouver, I believe.

RADAT, among a few other caregivers -- and mental health would be one of them also; it's coming up in a moment, so I might be covering that topic as well . . . . They have some concerns that if that is the model that's going to be used for some health care delivery -- where all the doctors, dentists, mental health and so forth are all in one centre so you can have a one-stop shop, shall we say, for health care delivery -- there could be some problems there. Because people, particularly those recovering from alcohol and drug abuse problems and those with mental health problems, might care to be a little bit more discreet than being in a public location.

RADAT works out of a quiet, back alley sort of location where the people who come there for help aren't sort of stigmatized in the community by the problems that they are dealing with. This concern has been expressed by RADAT. Can the minister give some assurances that there will be opportunities in the various health care facilities that are going to be developed so that people with those concerns won't be put in an area where they may not access the facility, simply because of the fact that it's going to be too public for the problems that they're dealing with?

Hon. J. MacPhail: Yes, and we had a very good discussion on this last week, as well. Certainly all of those factors have to be taken into account to meet the needs of the patient first, as we move toward establishing some pilot projects for community health centres.

G. Abbott: I have just a few questions for the minister to kind of sum up the various questions that I asked a few days ago with respect to regional health boards and regionalization. I guess the principal questions I have are with respect to the role that local committees might have in relation to regional health boards as a means or as a mechanism for communities to have a way, a voice or an opportunity to meet with regional health boards and so on.

[2:45]

But before I go on to that, I have a question -- and this is a question that I'm really relaying on behalf of the Chase and District Health Services Foundation. For several years now this group -- or the Chase and District Health Society, as it was formerly known -- has been pursuing a proposal for an intermediate and long term care facility for Chase -- in my riding, obviously. I'd like to ask the minister first -- and I asked the minister about this last year, and she indicated, I believe, that this facility was still on the five-year list -- whether that facility remains on the five-year list.

Has it moved up a little closer to the day of planning and construction, and has the timetable for the facility been affected in any way by regionalization?

Hon. J. MacPhail: The issue of a multilevel-care facility for Chase is unaffected by regionalization. It is part of the capital review, of course, though it is . . . . I mean, it's part of a capital plan. But certainly there is a recognition that in Kamloops and the surrounding area, which includes Chase, there is a growing need for long term care beds and that there is already a demand there. They have a lower number of beds than their population demands, even currently.

G. Abbott: I believe I also asked this question last year. It is sort of a curious-sounding question but I think one that has to be asked -- that is, does the existence of this proposed facility on the five-year plan indicate that it will be constructed within five years? And given that a year has passed since the last time it was confirmed as being on that list, is it now anticipated that it that might be built within four years? Or is the horizon for this particular facility rather closer than that?

Hon. J. MacPhail: Actually, I haven't made the capital announcements for health care yet. Those announcements will be coming very shortly.

G. Abbott: So the minister is saying that at some point in the foreseeable future we can expect some confirmation or some announcement with respect to where facilities such as the proposed intermediate and long term care facility for Chase might be provided with that planning or construction designation?

Hon. J. MacPhail: What I'll be announcing in the near future is the rollout of the capital plan for '97-98.

G. Abbott: I'll leave that one for now. I do hope that, as the minister has suggested, this facility will be given full consideration by the ministry. Certainly the Shuswap is a rapidly growing area. Seniors, in particular, find it an attractive place to retire. I suspect as a consequence of that that there is more than average pressure on our existing facilities in that

[ Page 3462 ]

region of the province. I do hope the minster will give full consideration to the requests that have been made with respect to that facility.

I'll turn now to the issue of local committees and how they might be a part of health care governance in the future in British Columbia. I'll preface my question by saying that the very widespread interest that exists within communities about their health care systems frequently surprises me. Certainly when the first phase -- if we can call it that -- of New Directions was moving forward, there was a lot of interest in all the communities in the Shuswap in the new form of health care governance. A lot of people wanted to be involved, in some measure, in the decision-making in that area.

With the more recent change -- the appointed boards and so on -- I think there is considerable concern within communities about whether they will have a voice in the future and in what way their input, if we can call it that, into health care governance might be realized.

The question here is . . . . In Revelstoke -- which is not in my riding; it's in Columbia River, obviously -- I understand they have created a health advisory committee which they hope will provide an opportunity for that community to meet with the regional health board and express concerns, ideas, etc., with respect to that community. Would the minister consider that to be possibly a prototype of community involvement with the regional health board?

Hon. J. MacPhail: Yes, that would be good if that occurred.

The Chair: I might just take a minute to remind all members that we are dealing with the estimates for this year. So questions should be related to and within the parameters of the budget for this year. Your question wasn't out of order because of the way you raised it, hon. member, but your introduction to it might have suggested a different kind of question than you actually asked. You may carry on now.

G. Abbott: Thank you for that clarification. I frequently do go off in tangential directions, and I appreciate your guidance with respect to these kinds of issues.

One area in my constituency of Shuswap where . . . . Again, this question has been put to me directly from . . . . I believe they call themselves the Sorrento Wellness Council. Essentially, it's a group in Sorrento that's very concerned about health care delivery -- all the various aspects of health care delivery in their unincorporated area.

Sorrento is an area of somewhere around 4,000 to 5,000 people. They don't have a representative on the North Okanagan regional health board, at least at this point. They would like very much to have an opportunity to have a voice or to have an opportunity, at least, to meet at some point with the regional health board, as well. Does that seem a reasonable kind of format, for a community to organize itself in that way and have a voice at the board that way?

Hon. J. MacPhail: The same general principles that we discussed all last week apply -- that is, the regional health boards are to get community input in the way that best meets the needs of the communities that they're responsible for. Regional health boards have been asked to do that and are beginning to do that.

It sounds like there's a great deal of interest in your area in ensuring that the community gets together with the regional health board. I look forward to them doing that in a fashion that makes the most sense for the community.

G. Abbott: I appreciate the minister's response.

To conclude, I just have a few relatively straightforward questions. These are questions arising from the news release from the Ministry of Health on March 28, 1997. The first line of the news release reads: "At the request of three regional health boards, [the Health minister] took action yesterday to ensure a full transfer of authority for health care decision-making into their hands on April 1, 1997." Could the minister advise what three regional health boards requested that intervention?

Hon. J. MacPhail: Sorry -- what was the date of the release?

G. Abbott: March 28, 1997.

Hon. J. MacPhail: I hate to engage in an exercise here, but are the hospitals not specified in the news release -- the hospitals that are affected?

G. Abbott: Not that I see.

Hon. J. MacPhail: Okay. If the member wants to send across the news release, we'll get that information on the three health boards.

G. Abbott: The news release also notes that the changes surrounding regionalization were preceded by extensive planning and consultation. Could the minister advise whether there was any consultation engaged in beyond that provided by the RAT team?

Hon. J. MacPhail: Yes, throughout the whole period of New Directions there was consultation. I consulted with some people and the regional assessment team consulted with some people. There was an election fought in between, as well.

G. Abbott: The concern about the lack of consultation has been forcibly put forward, particularly by the community of Revelstoke. Revelstoke has been included as one of the members of the North Okanagan regional health board. They were very much concerned with the amalgamation and very much concerned with the lack of prior consultation. Could the minister advise what there was in the way of consultation for the community of Revelstoke?

Hon. J. MacPhail: The consultation from the regional assessment team did cover Revelstoke through their visits in the Kootenays. There is an indication that one area was caught with a flat tire and didn't make it to the meetings. Consultation did occur afterward, but not in the formal meetings. I'm not sure whether that was Revelstoke or not, but I want give that . . . . There was consultation through that factor and then through the other methods I just previously mentioned.

G. Abbott: Just one last observation. One of the last points made in the news release of March 28 suggests that amalgamation will not diminish public input in health care. I hope that in fact that is going to be the case.

I'm pleased that the minister appears to be very receptive to community involvement in regional health board decisions. I think that will have to happen for the process to work effectively. I presume we'll see some evolution of community participation in regional health board discussions over time, but I'm pleased that the minister is at least initially open to that and hope that amalgamation will not in the end diminish public health input in health care.

[ Page 3463 ]

A. Sanders: I'd like to canvass a couple of areas that I had originally asked about on Vernon, and then I'd like to talk about mental health -- if that's appropriate -- in terms of staffing, just to let the minister know that.

The first area that I'd like to revisit from last week, hon. Chair, is that of renal dialysis. I'd like to let the House know that the minister and her staff have in fact sorted out the dialysis problem for the patient in my riding, for which I am appreciative.

The second question, which I did not ask and would like to at this point, is: would the minister be able to provide me with a breakdown of the members of CHCs and RHBs in terms of occupation or, if retired, in terms of previous occupation, as well as political affiliation?

[3:00]

Hon. J. MacPhail: We don't have political affiliation, but I can certainly provide it for occupation. And, in some cases . . . . I just know personally that some retired people have identified their occupation before retirement, but others haven't, so . . . .

A. Sanders: I would appreciate any information that we can have so that I can look at this in terms of the analysis of groupings -- which groups are represented in bulk and which are perhaps not.

The third issue having to do with Vernon that I wanted to recanvass was what seems to be a confusing circumstance between MSC -- Medical Services Commission or Medical Services Plan -- and a private laboratory in Vernon. I want to read the minister a letter from a constituent in Vernon, a Mr. Kevin Kienlein. This is a gentleman who has something called tricuspid atresia, which means that the valve on the right side of the heart is poorly formed. In addition, he has a hole in his heart; he suffers considerably from failure of the heart and requires bloodletting in order to prevent congestive failure. These individuals are often very, very unwell. Often they are on disability pension.

Mr. Kienlein writes to the attention of Lorne Verhulst, senior medical consultant at Medical Services Plan:

"Dear Sir:

"On Tuesday, May 13, I went to the Valley Medical lab located at the medical clinic here in Vernon for my biweekly blood test which I have had done there for the past 30-plus years. When I arrived, I was told they would not be able to do my bloodwork, as the doctor who looks after my case has had his eligibility status cancelled, so that his patients cannot be served by the lab. I was then told that I had to go to the outpatient lab down the street, which is run by the same company, to have my bloodwork done. I then had to go back to the doctor's office for the rest of my checkup.

I then had to wait three days to find out the results of my test, which usually are done the same day within 10 to 20 minutes while I'm waiting for my appointment.

"Today I received a call from the doctor's office and was told that I required a phlebotomy."

This is a process where an amount of blood is actually removed from the patient and decreases the workload of the heart.

"I proceeded to the lab at the clinic, where I was told that they could not provide this service either, which I have had done there for the last 20 years. I was told I had to go to the hospital across town to have this procedure done. I arrived at the hospital, where I had to fill out forms, wasting some more of my day. I finally had the phlebotomy done two and a half hours after I had originally arrived at the Valley Medical lab for a procedure that would have been done in 20 minutes.

"My time is just as valuable as yours, sir, and if you feel you are making our medical system more efficient and cost-effective, you are very wrong. Whatever bureaucratic wrangling you are having with this lab is not serving British Columbians at all. If my case would have been a serious one, I would be holding you personally responsible for any serious problems that might have arisen from the instatement of this" -- he uses an expletive that can be abbreviated to b.s. -- "[b.s.] politics that seems to be going on. I hope next time you go to the doctor you are made to wait and waste your time as I was.

"Sincerely,

"Kevin Kienlein"

I had explained to the minister in a brief way that there was a problem with the medical lab and that this was basically a lab where, in 1985, eight or ten doctors used to work. The lab expanded; there are now 19 physicians there, and Medical Services Plan has decided that only the original eight can have their patients go there. So we have a two-tiered circumstance within the clinic, where one doctor's patients can go to the lab and the other patients' doctors cannot send their patients to the lab. As a result, a list was passed out of physicians approved to use the lab directly in the building, and a list of the people who could not use the lab was passed out.

There has been some back and forth conversation between the physicians and the Ministry of Health. The ministry has specifically said that no new laboratories or any significant expansion of present laboratories will be approved until there is reasonable utilization of existing approved labs. In other words, they would like the patients to go to the hospital rather than use the lab that's right in the building.

I think that Mr. Kienlein's letter is a very good demonstration of what the problem is in this case. I would like to provide the minister with the information, in terms of correspondence, so that she can look at this and perhaps suggest a more equitable solution to what wasn't a problem but what has been created through one aspect of the regionalization process. I would just like some feedback from the minister on that.

Hon. J. MacPhail: I too was interested when you brought forward this issue last week, so I actually looked into it. I'm sure the member is well aware of how complex these matters are in terms of bleeding stations and licenses, etc. This is particularly representative of a complex situation where the policy around funding of labs and who could refer, and what used to be called the vested-interest lab . . . . The policy changes around that -- which, the member is quite right, took place throughout the mid-eighties and into the early nineties -- are complex.

So I am interested in your bringing this particular example to my attention, because I certainly have been approached by many people who say we need lab reform. We need to reform the way that we carry on our business in laboratories. Of course, the previous decisions around laboratories -- and this one, too -- is a Medical Services Commission decision. Because labs exist on fees for service, the method by which labs are funded or receive their funding is a Medical Services Commission decision. But there is no question that lab reform is needed.

We're not issuing any bleeding station licences until the matter of utilization is addressed. It's a very important issue for physicians in this province, and it certainly is an important issue for the Medical Services Commission as well, since the fee-for-service budget for laboratories really is expanding quite substantially.

I know that in the situation you refer to -- I have information, but it's only written information; I've never been there -- the hospital had set up a collection station within about two

[ Page 3464 ]

blocks of the Okanagan Pathology Group's office, so the referral didn't have to be to the hospital. There was a collection station only two blocks away, and I guess that information wasn't available to the patient.

But let me just say that I hope to work over the course of the next year with our physicians and laboratories, as well -- both the publicly owned and the privately owned laboratories -- on a new way of delivering our laboratory services. And there has been reform that has taken place in other parts of the country, which . . . . There are some successes to be learned from and there are some failures or a lack of success in other areas of the country, too.

I think this is an area that can only get better through the use of regionalization, in that the use of laboratory services would probably be better determined on a regional basis and by what the community truly needs rather than by edicts from Victoria.

The Chair: Hon. members, I have an introduction to make. In the gallery there's a group of 35 grade 7 students, parents and their teacher, Mr. Struckmeyer. They are from the Annie Wright School in Tacoma, Washington. Would the House please make them all welcome. We caught them just in time, just as they were leaving.

A. Sanders: The importance of this issue is severalfold. Number one, it isn't creating a new laboratory; it's creating a use that was already established. In other words, this lab has been there as long as the clinic, although the ownership has changed. The ownership originally changed -- I'll find the letter -- because of the 1985 ruling in the medical-clinical partnership document from the College of Physicians and Surgeons. Basically, the clinic got out of the business of running a lab because it was felt to be a conflict of interest for physicians to do that.

I have the documentation of that in a letter to Dr. David Bolton from Dr. John Mann, March 19, 1986, which I'd be happy to share with the minister. Specifically -- although I feel, too, that laboratory services need to be critically analyzed -- we are talking about a lab that used to exist, so we're not increasing utilization by having patients go there. So number one is the point of no increase in utilization.

Number two is that in this particular area, with which I'm familiar, two blocks can be quite a considerable way, because a number of the individuals who go to this clinic are elderly. Many of the older physicians were originally located there, and these elderly people are probably skewed more towards the medical clinic. Incidentally, I don't work there and have no vested interest in whether these people have a lab or not.

But I do know that this two blocks, if you're in wheelchair in Vernon in the winter, when we do not clean our sidewalks, has brought me a few patients in emergency with fractures that they didn't leave with. So it's not as easy as one may think, even though two blocks does not sound like a long way.

Thirdly, the purpose of rules in any system is to make the system work, to streamline it and to have people obey the law. I think this can create an underground laboratory experience for patients. In other words, if I am a patient of Dr. Stacey Butters and need a laboratory test done, and she is not on the list of physicians who can utilize the clinic literally next door to where the patient has been examined, but Dr. Arnold is on the list, then I can become a patient of Dr. Arnold's -- or use Dr. Arnold's laboratory forms -- in order to still go to the lab instead of going two blocks away.

What we're doing here is that we're creating a circumstance of inequity for the patient. The doctors can probably still get around this if they want to put their nose to the ground and really keep their back up above it. But I don't think that's the purpose. I think that if we're going to create rules, we want to be creating them so that people follow them and not look for ways to get around them.

So this problem needs to be looked at and to be solved for these individuals. I think we need to figure out an equitable way, within the parameters of how the ministry is working, to allow patients to go to the lab they've been going to for 25 years and to allow the increase in physicians who are at that lab and have been using the lab since day one to continue doing on Tuesday what they were doing on Monday, basically the day before.

What I would do at this point is just leave this documentation with the minister and, hopefully, have some further discussion once there's an opportunity for her to go through this, because I truly feel she can solve this problem with no blood loss and no additional phlebotomy.

Hon. J. MacPhail: When I receive the documentation, I'd be happy to refer it to the Medical Services Commission for further advice to both of us.

A. Sanders: I'd like to shift gears a little and move from the regional aspects of health care in Vernon -- which, of course, is of interest to me, and I'm charged with the responsibility of seeing that my constituency is well addressed -- and turn to an area that is of larger concern for me and certainly of significant importance for a number of people in British Columbia. That is the area of schizophrenia. There are a couple of points that the minister has made over the period of time in the House that were documented in, I believe, her opening remarks on Health.

I'd like to read those into the record, because I feel they are important. I do feel they are what the minister feels is the template for what we should be working on in mental health.

[3:15]

Specifically, the minister said:

" . . . our commitment for the most vulnerable in society is to care for them through the provision of high-quality health care services. This is our measure of our humanity and a testament to all of those who have paved the way for a system that would never turn its back on a person in need, regardless of their ability to pay."

A second quote that I thought was appropriate and important was that "working hard to keep prescription drugs affordable for all British Columbians" is a mandate of this government. These are two quotes from Hansard that the minister has made in the past.

Specifically for the benefit of those who may not be familiar with schizophrenia, it's not an uncommon condition in B.C. About one in 100 individuals will suffer from schizophrenia. The suffering of schizophrenia is not something that we understand totally. It's a biochemical problem. We have more information that there is in fact a genetic relationship, but there are many other factors beyond the genetics in terms of why the biochemical change occurs.

The profound problem of schizophrenia is that young children who are in a family and not in their teen years are normal children with no obvious sequelae going to happen to them in terms of their family life or their schooling. The usual clinical presentation is that you'll have a normal, happy individual who at 17 -- somewhere between 17 and 29 -- will start to develop some very strong and often very bizarre symptomatology. Specifically, they'll come to their physician, their counsellor at school, their friends, their minister, often

[ Page 3465 ]

with hallucinations. These hallucinations are in the form of voices they hear. Sometimes these voices will be command hallucinations, and these commands will tell the individual to do certain things. They will come with ideas that are called delusions, meaning that they will interpret a set of circumstances as being something totally different. Often, again, these are delusions of paranoia, where people are plotting against them. They often have signs that are similar to depressive symptomatology. They may be very flat, unable to exhibit any behaviour. When they have behaviours, they may be very bizarre.

For example, they may have posturing and go into positions that they will maintain for very long periods of time.

The things that families see once they've . . . . Often families confuse these first symptoms with drug abuse, which, especially between the ages 17 to 29, can become quite a problem. But the other things that are so profound and worrisome for families are the decrease in personal hygiene -- this is a global benchmark for deterioration in terms of schizophrenia -- and also, even more important, the decrease in premorbid functioning.

So you will have people who were gainfully employed, who were doing well at school, who were participating with groups -- maybe in a drama club -- who have absolutely no ability to function socially -- tremendous social withdrawal in addition to the very marked symptomatology.

When these people present themselves, wherever they come into the system, they have the opportunity for treatment. When you have a son or a daughter who's been completely fine and then has marked deterioration so that they are no longer able to do any of the things they were able to do formerly, you find parents and families and communities in severe distress. When you look at individuals who have a clear diagnosis of schizophrenia, the most important thing for those individuals is treatment.

One thing that often people don't know, if they have not been in contact with or had family members who are schizophrenic, is that the first interaction with that individual as a patient may be the only chance that individual gets. So, very commonly, if an individual comes in with a first break, a first psychosis, and you treat them appropriately with something that doesn't make them worse, you may find that you can actually help them. The help is something that goes on forever, because this is not a curable condition.

So if we're looking at treating someone with schizophrenia and treating them well, that first contact and what we do to that patient may be everything; there may not be anything more. If they have a good result -- a good interaction with whoever is looking after them -- that may indicate whether they come back in a year or two or three down the road.

These are the most vulnerable members of our society. I feel more than anyone that these people cannot be here to stand up for themselves, because of the correlations of the disease with poverty, with the lack of ability to support oneself, with the lack of job opportunities and the lack of relationship opportunities. We therefore must stand up for them.

One of the things that government needs to understand when looking at the medications we use to treat schizophrenia is that if you look at the population that's being treated, about 50 percent of people who are treated will discontinue their medications because of side effects. It's one of the highest percentages for any medications we use for any condition. If 50 percent stop the medications, we are going to be in a position where we have not done our job.

So we have people who can't stand up for themselves, who are the most vulnerable, who get into problems with incarceration -- police involvement, forensic psychiatry -- and who have terrible side effects from their medication. We see them once, and maybe that's our only chance to treat them. We're looking at a circumstance where this is a highly volatile and vulnerable group.

Why is this important now? The reason is that we're looking at a situation in British Columbia where we have the opportunity to do something right by looking at the medications we treat schizophrenia with and providing the best solution for that problem. What we have right now are two new medications which we've been using in British Columbia for about five years. One is called risperidone, and the other is called olanzapine. These are drugs for schizophrenia. What we haven't done in B.C. is put those drugs on the front line for use by people with schizophrenia.

Because of cost-containment measures, if an individual comes in with a first break or with schizophrenia, that means they must first be treated in British Columbia with medications that belong to a family of which one representative drug is something called Haldol. There is a good reason why Haldol is used, and that's because it's cheap. But in this case, we have to decide whether cheap is best.

If we look at Haldol and compare the difference in the results, what will happen if you have people who are treated with Haldol is that 23 percent of them will not take the medication and another 30 percent will have to stop the drug in the first five weeks due to side effects. So here we have almost 60 percent of individuals who go on Haldol -- albeit it's cheap -- who cannot take the medication because of side effects.

With the other medications, which are more expensive, we find that they do not deteriorate cognitively, meaning that their thinking is not impaired as much on the medication. It's also the best tolerated of the medications, along with olanzapine. A very prominent psychiatrist and researcher into schizophrenia in British Columbia has written the following:

"It is essential that these factors of better tolerance and less cognitive decline be considered when prescribing decisions are being made for patients with first-episode schizophrenia. If this is not done, they will be denied the opportunity for the best possible outcome."

What I need the minister to address . . . . And I really do feel that probably the most important thing I will do as an MLA is to bring this issue forward. We are in a situation where we have put in reference-based pricing. We allow physicians to use a special-authority form to put a patient on one of these expensive drugs, and the comparison is: Haldol, 15 cents a day; risperidone, $6 a day; olanzapine, $15 a day. So we've basically said: "You can't use them for first-line unless you have a good reason. But if you get special authority, you can."

The most important group, as I hope I've demonstrated to some degree, that this totally knocks out of the ballpark is the group with first psychotic break. These are the people we need the risperidone for; these are the people we need the olanzapine for. And we must use those medications first.

If they work for the individual -- and sometimes they don't -- we have to use those medications first, and then if the patient is stable and has some feeling of success about their treatment and has some rapport with the individual looking after them, perhaps we can be in a situation where we could change them to the cheaper drug. But to do it the other way, where we do not allow individuals who are this vulnerable a medication that could potentially cause them to be well for extended periods of time, is completely unconscionable for us as government.

[ Page 3466 ]

I want to read the minister some of the side effects of the traditional medications we use. If you see a patient who comes in with first psychotic break into emergency, you put them on medication. They will often manifest a number of disorders. First of all, the more common ones are that they'll have dry mouth and . . . .

Interjection.

A. Sanders: Basically, hon. Chair, what I want to do at this point is ask the minister if this issue has been brought to her attention previously.

Hon. J. MacPhail: I would just like to say to the member for Okanagan-Vernon that I very much appreciate her presentation and the compassion with which she articulates the issue, as well.

Yes, I am well aware of this issue, and I appreciate the fact that we can have a discussion across the floor about it and work toward a resolution on this very important matter. I don't share the experience from a family point of view but certainly from a neighbour's point of view. Many of the people who are affected by schizophrenia end up living in my community by virtue of the untreated symptoms that the member so compassionately describes. So it is an issue for me on behalf of my neighbours, as well.

Just a couple of points. I would like to tell the member what we are doing in this area to address the concerns that she has raised. But I hope we can discuss this in a context that is truly about the facts. This has nothing to do with reference-based pricing; this is not a drug controlled by reference-based pricing at all. It is about the practice of special authorities. That's true -- the hon. member does describe that accurately -- but special authorities have been part of our Pharmacare program almost since its inception. The member is correct in saying that olanzapine and risperidone are on special authority.

A couple of things. I've met with many people to discuss this issue, and I think it is time -- even after we've got our pharmaco-economics initiative, our therapeutics initiative and even our BCMA

chapter of psychiatrists to address this issue -- that we also have to talk to the community about it. We have to talk to the Schizophrenia Society, the parents and the patients themselves.

The good news -- and it is good news -- is that olanzapine and risperidone are covered by our Pharmacare program. But the member is quite right that they're not used as a first-line therapy but as a second-line therapy. We did investigate thoroughly the effects, the advantages, of olanzapine and risperidone in the context of our pharmaco-economics initiative. The member is correct that other first-line drugs are cheaper, but really, we know that we have to look at the investment in our treatment plan in the context of the overall cost and not just of the cheap cost of the drug.

If there is a more cost-effective way of treating a patient that requires a higher input into a drug upfront, we'll certainly do that.

[3:30]

We have been gathering the evidence. We, of course, do practice evidence-based medicine in this province. We have been gathering the evidence, and the evidence led us to the conclusion, initially, to grandfather people who are on risperidone now. The approximately 4,000 patients who are on risperidone now continue to receive that drug. Then we have put olanzapine and new patients for risperidone treatment on special authority.

It is controversial. There's no question about that. It is controversial among those who are most vulnerable in our society, and I very much appreciate the comments that the member made about us having . . . . It's almost the one illness where you have one chance to get it right, and then you have to work really hard to get a second chance. I know that from talking to family members of people with schizophrenia.

[E. Walsh in the chair.]

So it is under review. Let me reassure the member that our policy of special authority for risperidone and olanzapine is currently under review. We're working hard right now with the BCMA psychiatry

section and with the PI and TI initiatives but also with the Canadian Mental Health Association and the Schizophrenia Society in the review of our Pharmacare policy around this matter.

A. Sanders: The minister said one thing that's very important in this whole discussion -- that there is a large group of people who have been grandfathered -- but new patients are the ones who require this special authority. Those are the most important of the entire group. If they have already been on the medication and are grandfathered, that's great, but it's with those first-break psychotic individuals, who are young people coming into whatever facility they are first seen in, that special authority . . . . Waiting two or three days to get the paperwork done in order that they can actually have medication cannot be the way that these individuals are treated.

From a humanitarian point of view, if this government wanted to make political hay in terms of doing the right thing, they would huck out their review of whether or not this is an economically viable solution. What you're not comparing in that economic viability, when you look at the cost of Haldol at 15 cents a day versus risperidone at $6 a day, is that you are not looking at those people who cannot take the medication. That is up to 50 percent of the individuals, from the studies I can cite for you, and those individuals are unable to take the medication because of the horrible side effects.

Some of these side effects are permanent. You have permanent movement disorder. You cannot get away from a jerking or a flinching, and abnormal, bizarre behaviour that is with you forever because of medications like Haldol.

What we need to remember is that if schizophrenics are not treated and are in the community, we are not paying for the medication but we're paying for the mental health worker, the nursing people who are in the emergency department, the physicians, the crisis line and the support team. We're paying for the Attorney General ministry's costs of policing and incarceration, and for forensic psychiatry. If they are on Haldol, we're now paying not just the 15 cents for the Haldol, but most people who are on this kind of medication also require one or two additional drugs to stop side effects.

When you're looking at the cost of the drug and comparing the two, you actually have to look at that. If the person is on Haldol, they're also on an anti-Parkinson's drug to stop all the jittering and jumping movement that the Haldol causes. You have to take the two drugs almost in conjunction with each other. There's a cocktail for all these people who are on anti-psychotics such as Haldol, the ones that we pay for as government. They're not just on one drug, and if we're looking at cost versus cost, we have to look at what the combined cost of all of the medications is in terms of treating these individuals.

Hon. Chair, I'd just like to ask the minister a question, and I am very interested in hearing the answer, because I can tell

[ Page 3467 ]

her that there are very many people in British Columbia who also will be awaiting the answer. If we are having a pharmacy review, what is the time line for some information or direction coming from that pharmacy review with respect to the newer anti-psychotics?

Hon. J. MacPhail: I just want to reassure the member that while the review is underway, the drugs are, of course, available on special authority. But the first-break aspect of this is under review now and will probably be completed within the next few weeks. The people most affected by it are, of course, involved in the review, so they'll be well aware of the time lines of the review.

I hope the member heard my comments when I did agree with her that one has to look at the overall health care costs to the system and examine what's the most cost-effective way of . . . . When one puts a cost-benefit analysis in place, I totally agree with her that you have to look at the overall costs and benefits. But I also know that in my discussions with members of the mental health community, there is also a recognition that there are many thousands of people who are functioning in society on drugs such as Haldol and many of the other typical anti-psychotic drugs.

It's important for us to make sure that their confidence is not undermined at the same time. In the context of the atypical drugs such as risperidone and olanzapine, the review will be completed within the next few weeks.

A. Sanders: I'm pleased to hear that it will be that short a time line. In terms of the minister's concern about those who are already on Haldol and who may feel discriminated against, what the drug review should in fact do is say that, instead of special authority, patients will be placed on whatever medication works and then moved to cheaper drugs if possible. That way, you would catch all those individuals with a first psychotic break.

If other drugs such as Haldol were helpful or useful, these could be used in the future. Then you're not barring the way for those medications to be used at a future time for the patient who has that first episode of psychosis, but you're still treating that first break with the most user-friendly medication that can give people quality of life and not render them susceptible to side effects.

Those range from being purple . . . . Those of you who have visited Riverview will know that is in fact the case. Often the patients are blue, purple or grey-coloured because of the medication, which also inflicts them with permanent movement disorders that would isolate them from society forevermore should they venture out into the real world with controlled schizophrenia. When we're talking about one in 100 individuals and the potential to treat them properly, when they are not able to stand in the House and fend for themselves, these are things that we must do.

I appreciate that it will be two or three weeks, and I will be looking forward to the minister making the right choice on this particular issue.

The second issue I wanted to canvass, other than the use of these two medications . . . . I offer the minister a letter from Dr. Liddle, who is our made-in-B.C. expert on schizophrenia. If she does not have that letter, I offer that. He is a very well-known psychiatrist and also a good researcher, and he has written a very effective letter as to why government should be in the business of providing this as a first-line drug without special authority, so I will provide that for the minister.

I'd like to look at the mental health initiatives. The auditor general indicated in his report that the Legislative Assembly needs to be better informed about our mental health services. He recommended an annual status report on implementation of the mental health initiative and how this initiative will show the community what facilities will be available in British Columbia as Riverview is downsized and mental health services are improved.

The auditor general made a number of recommendations; I would like to focus specifically on three. The first is that the ministry apply principles and practices of program management to replace Riverview. My question to the minister is: have we in fact followed the auditor general's recommendation? Are project management practices and principles being formulated for the replacement of the Riverview facility?

Hon. J. MacPhail: This report may have been published prior to the member becoming a member, so I can make it available to you. The ministry published a 1995 report in response to the auditor general's report; it's called "See Mental Health in a New Light." The short answer to your question is yes, those principles are being followed, but perhaps the member would like a copy of the entire report, as well.

A. Sanders: I have seen the report. Is this a report that will be done annually now, as a response to the auditor general's recommendation?

Hon. J. MacPhail: I made some very brief comments last week when we started to talk about mental health. I indicated that the original mental health plan for the province was done ten years ago, and we are now reviewing the plan again in the context of what has been achieved in that ten-year period. There have been several reports: the ombuds report, the auditor general's report. There has been, I think, a large amount of public debate around the direction that mental health should go in this province: should Riverview Hospital play a bigger role than had been planned in terms of deinstitutionalization, or is there another approach to take in that area?

So the whole mental health plan is under review now. Again, I reported that we're working with the stakeholders in the industry. That plan will be completed probably by the end of September, at which time we will then publish another annual report.

A. Sanders: So I should anticipate seeing the '95-96 report at the end of September.

Hon. J. MacPhail: No, it will probably be published in 1998, because the changes, if any -- I suspect there will be changes; I certainly hope there will be -- will be put in place over the course of later this year and into the spring. Then a report will be published.

A. Sanders: One of the acute strategies with replacement of Riverview was the shift from what are called tertiary beds, meaning the third level up -- in other words, you're not in your town or in your district, but in a centrally organized place, which is Riverview -- to secondary beds. Theoretically, these secondary beds would be at the regional level. As part of the replacement of Riverview, 170 acute psychiatric beds in general hospitals were to be created. My question to the minister is: has this been done as of May 1997?

[3:45]

Hon. J. MacPhail: The figure in my briefing of 170 acute care beds comes from back in the mid-eighties; I assume that's

[ Page 3468 ]

where the member is getting that from, as well. Since that time there has been a great deal of consultation, up to and including the '87 mental health plan. The community standards by which we develop mental health plans shift. Since that time the community has said to us: "Don't institutionalize. Set up community beds, as opposed to acute care beds." So the beds have been in place, but they're community beds, not acute care, institutional beds.

A. Sanders: In terms of the demographic changes in British Columbia, I'm wondering whether it is the ministry's understanding that we are in fact holding our own with the establishment of in-the-community placements of any kind for our mentally impaired patients.

Hon. J. MacPhail: Generally, in terms of where we stand in relation to other provinces, we take the lead in most areas of supported living, whether that be beds in a hospital or independent living. That's mainly because we've been developing our solutions through the provision of housing. Other provinces have gotten out of the business of providing social housing, so I think that's where the difference comes.

Let me provide you with some numbers, and you can check the interprovincial comparisons. First of all, in terms of the acute side of psychiatric and crisis residential beds, there are 705 psychiatric beds in acute care hospitals and 83 crisis residential beds. In the area of supported housing, there are 1,780 residential care beds in the community; there are 190 family care home beds. In supported independent living, there are 731 beds. Under BCHMC, which has a policy for priority to people with mental illness, there are 255 beds.

We've just expanded that policy with BCHMC to give priority now in terms of placement for people with mental illness. There's a rent subsidy for people with mental illness: another 817 beds. And there are other miscellaneous supported housing initiatives with another 354 beds. So in community residential care there are now 4,127 beds.

A. Sanders: I hope the minister will be able to provide me with a copy of that information sheet.

I would like to canvass a little bit about what many emergency room nurses and emergency room physicians, especially, call "mainland gridlock," for want of any better name. Specifically, this is acute care space in the emergency room that is occupied by sometimes five or six individuals who have mental illness. Often with the emergency care for psychotic patients in hospitals outside the very lower mainland -- Vancouver General, for example -- there are no restraining areas for patients.

Quite commonly, because there aren't any beds in the hospital, the patients have to be restrained in the holding tanks of the emergency room, the outpatient department. The restraint is either physical, meaning that they have to be bound down, or chemical, meaning that they're given a cocktail that will knock them flat, so they aren't walking about disturbing everyone. This comes down to an issue of humanity and justice and whether this is the right thing for us to be doing in a health care system. I'm interested if the minister has ever been alerted to this situation.

Hon. J. MacPhail: Yes, I have, partly from my own constituents and also from the emergency room review that we did earlier this year. The hospital of use for my constituents who suffer from mental illness is St. Paul's Hospital. The community support groups inform me -- this is all anecdotal, but clearly it supports what the hon. member is saying -- that the emergency room at certain periods of time becomes the social centre . . . . I don't mean that in a pejorative way.

It becomes the referral centre for people with mental illness who may need just some other support in the community but the services aren't there late in the night or on weekends. Statistically, in January, the emergency room review team came to the same conclusion that the member states, which is that often the backup in emergency rooms is as a result of people with mental illness being both improperly held and improperly referred.

Just a couple of solutions that we're putting in place now . . . . One, of course, is to put services into the community that meet the needs of people with mental illness on a much more regular basis, so that the services are there when the patients need them and not at the convenience of the hours of operation of the service. So we are looking at putting more support services in the community.

We also know that supported housing is the way to go in many cases, so when a person gets in crisis and needs some support, that can be given in the context of her living situation and she need not go, or be forced to go, to an emergency room. We're now, this year, building 200 supported-housing units in the lower mainland, and more are planned throughout the province.

The final issue, of course, is that we have found that the occupancy rate of Riverview is below what it should be, in that hospital emergency rooms have not been able to refer patients to Riverview. We investigated that because, of course, Riverview is funded at a level where the beds are available, and the occupancy should be maximized for patients who need institutionalization at Riverview. So we have given direction that Riverview must make 50 additional beds available for admission immediately -- we did that last month, actually.

There's no sense of keeping an occupancy rate at 90 percent if you're funded for 100 percent and the beds are needed. So that direction has been given to Riverview.

Also, we're now planning to permit the regions to admit directly to specific Riverview beds, so that their critical needs are met. I don't want to use the term "designated beds," but they don't have to go through a circuitous route . . . .

A. Sanders: I'm pleased to hear there will be more beds available at Riverview. The minister did mention that to me last week. I can tell you, it has been very difficult to get individuals into Riverview. As recently as the Christmas holidays there were two patients that I specifically am aware of who were not committed under the Mental Health Act, despite the fact they should have been, because there was nowhere to hospitalize them. So they were not committed.

I've also been aware of one patient in my own facility who was denied hospital care until they committed a crime and was therefore sent to the forensic psychiatry location. I've also been aware through letters of parents who have resorted to laying charges against their own psychotic children in order to get that particular individual into the hospital, into the facility and eventually into Riverview. That does result in a criminal record for the individual. And we've come to a sorry state when we're creating criminal records for people in order to get them health care.

I'm interested in the Riverview expansion of 50 beds, because I understand there is some differential in how these beds are named. I wonder if the minister could explain to me the differences between the beds: for example, designated bed, occupied bed and this other terminology -- just so I can understand that there aren't beds being counted twice and, in fact, that there are 50 more beds.

[ Page 3469 ]

Hon. J. MacPhail: Regardless of what designation the beds have, there will be up to 50 more people in Riverview than there are now, assuming that there is the demand for up to 50 more people. But if there's a demand for commitment of 50 more people, there will be the beds available -- extra beds, new beds.

A. Sanders: What will be the final bed count with the addition of 50 new beds?

Hon. J. MacPhail: Seven hundred and twenty-five -- that includes the new 50.

A. Sanders: Could I have the dollar figure from the minister for funding a Riverview bed, please?

Hon. J. MacPhail: The funding for Riverview Hospital is $92 million.

A. Sanders: I'd just be interested if the minister has any figures that can break that down into . . . . For example, in our hospital we have a per-bed figure. If we open a new bed, we know the dollar figure. Is there such a figure for Riverview?

Hon. J. MacPhail: Riverview is funded on a global budget; there's not a per-bed breakdown such as there is in the acute care institutions.

[4:00]

A. Sanders: I'm interested in one more aspect of emergency care. We've dealt with acute psychosis or those individuals with chronic untreated psychosis in the emergency departments, and the reality that they are often restrained. They are in less than ideal circumstances, either physically or in a chemical way.

Again with emergency services -- which seem to always be the tip of the iceberg for communities -- my concern now turns to the broader spectrum of suicidal patients. My question to the minister is: is the minister aware, or does she feel the communities have presented to her, that there is a paucity of acute beds for suicidal patients?

Hon. J. MacPhail: I haven't had anyone make that specific point to me.

A. Sanders: This is an area that I would be interested in the ministry staff looking into. In a way, we are forming protocols for just about everything, from how to administer medications to how to brush your teeth. This an area where I think there's a lot of work to be done.

One such example where there is an inquest . . . . And it's not the only reason. I receive many letters from the community about individuals who have taken their suicidal children to hospital, and found that they've been discharged from emergency. The family is not understanding whether that is the appropriate way for their individual family member to be treated. This is common.

[G. Brewin in the chair.]

This young woman, Brenda Barrass from Castlegar, exemplifies the problem. Specifically, this is a woman who . . . . The actions of Vancouver Hospital officials were questioned because she slit her throat -- committed suicide. She had tried to kill herself four times in three weeks prior to her death on December 9. She was treated at three Vancouver hospitals, forcibly held once for involuntary treatment, and each time discharged. She was admitted on December 7 to Vancouver Hospital -- fourth suicidal attempt -- and released within three hours.

There is an inquest into this, and I do understand that it is before the courts. My interest is not specifically related only to Brenda Barrass, but more to the fact that I get -- and many MLAs do -- very, very many letters where family members do not understand why they took their suicidal family member to the hospital, and they were discharged an hour later.

I think that the ministry needs to do some education, that we are moving towards more of an out-patient-oriented service, and that those services such as crisis-line therapy counselling that we can bring into the hospital through our mental health quick-response teams are the answer, and not that the system is failing. I would appreciate the minister looking into that particular circumstance, and doing some more educative stuff for the public so they are not viewing the system as failing them in terms of their families.

Hon. J. MacPhail: Some excellent points were made there. Just a couple of responses. I talked at length with Mr. Barrass, Brenda's father, shortly after her death, and it truly is tragic. We hope that the coroner's inquest that's going on now will make some strong . . . . We do anticipate them making some strong recommendations. Of course, all of the health care facilities are cooperating fully with the coroner's inquest.

A couple of points on education. You are absolutely right. We are working right now, as the member suggests, to strengthen the link between those who learn and those who educate us -- for instance, the chief coroner's office, the UBC suicide prevention program and the adult mental health division -- so that we can have a coordinated approach and then make the community aware of the coordinated approach that is available.

We are now printing the guide to the Mental Health Act, which is a plain-language, family-friendly, consumer-friendly guide to the act and what your rights are as a patient, what your rights are as a family member and what responsibilities there are for health care institutions. That should be on the shelves very shortly. It's being printed as we speak.

A. Sanders: I turn in a little bit of a different direction to specifically focus on psychogeriatrics. For those who may not be aware, psychogeriatrics is the psychiatric care of the elderly. Again, from a demographic point of view, that's involving more of us than it maybe used to, and from the bulge in population, will involve a very large number of British Columbians.

Looking at psychogeriatrics, you have to look not only at acute medical conditions but also at continuing medical conditions and the mental aspects. You are looking at quite a few different areas in geriatric medicine, and psychogeriatrics is a part of that spectrum.

The individuals we're talking about specifically are those . . . . Commonly people understand Alzheimer's being in that category, but there are many other individuals with organic brain dysfunction from incomplete suicides, chemical exposures, etc., who fall into this category, as well as a large percentage of the elderly population who experience delirium, either acutely or on an ongoing basis. As we have an increase in the percentage of the population that's elderly, we are most definitely going to need more of a focus on psychogeriatrics.

[ Page 3470 ]

My question to the minister is: in the four planning regions, is there specific psychogeriatric care that will be incorporated into those areas?

Hon. J. MacPhail: The review that we're doing now specifically addresses psychogeriatric needs in the population. Addressing that concern will be part of the new plan. And yes, it's based on a provincewide solution.

A. Sanders: I'd like to focus specifically on the psychogeriatric unit at St. Paul's. This was a 20-bed ward -- 15 geriatric medicine beds and five geriatric psychiatry beds. This has been cut down to 11 geriatric medicine beds and four geri-psych beds. I'm wondering what the longstanding vision for this service was, and having it truncated within a couple of years of its creation.

Hon. J. MacPhail: This was a decision that St. Paul's Hospital took last year. The hospital has reassured me that it was based on the utilization of the beds, in which they changed and amalgamated their services. But, since that time, I've also followed up with St. Paul's Hospital, and the changed nature of the provision of services is meeting the demands of the population.

A. Sanders: I think we have to look at this issue critically, and again, it would be helpful to talk to those who work in the facility as well as to management, because there is some definite misunderstanding between those levels of bureaucracy. There is also concern, specifically with hospital amalgamations, that these beds will be cut further at St. Paul's and perhaps distributed to other areas -- a turf war kind of circumstance.

In terms of expertise and in terms of functioning, so that we can learn from these facilities, I think there does need to be a critical size, below which you don't learn much. If you only have four geri-psych beds, you need to maintain that funding and have the hospitals work together. So I would encourage the minister to follow that and to make sure that she is getting all the information and not just what comes from the managerial level.

I'd like to ask a brief question on another area in the mental health realm that has become topical, it seems -- at least, to the media. This is on the ethics of mental health, specifically when we're looking at the ethics of what we do either in the large spectrum of health care or in the smaller spectrum of mental health. I'm interested in knowing what kind of ethics committees we have set up to deal with the issues in health care.

Hon. J. MacPhail: There is a minister's advisory committee on ethical issues that reports directly to me. They examine and investigate and then publish opinions and advice to the minister on matters of ethical concern. I've met with them a couple of times -- three times, I guess. It's a very interesting group. I can certainly make those reports available to the member, including the makeup of the committee as well.

A. Sanders: I would be specifically interested in several things. Number one, who is on the committee? Number two, how are they picked? In other words, how do they get to that position? And, number three, what is the committee's position on ethics? Specifically, we're looking at one issue right now that I think is very important, both for mental health and for other health conditions. What is the position of the committee on the ethics of when it is ethically defensible to assist patient suicide? So, specifically looking at whether they have a stand on that, and especially with the media . . . .

In another province a physician was recently arrested for the assisted suicide of a terminal patient. Where are we in that circumstance?

Hon. J. MacPhail: The advisory committee on ethical issues has been in place since 1987. The 12 members are selected for their background and expertise, and they don't represent a particular organization. The current committee have backgrounds in philosophy, medical ethics, religion, human rights, law, education, medicine and nursing. I will provide the names of the members to the member opposite, as well. They have published a report on euthanasia and physician-assisted suicides. I will make that report available.

A. Sanders: That will be interesting bedtime reading, I'm sure.

Another area I would like to canvass is that of eating disorders. This is a very, very common problem in British Columbia, within the care of many physicians. In some family practices the condition may be as common as two of every five patients. Specifically, I'd like the minister to describe for me the provincial strategy that we have for eating disorders in British Columbia at this time.

Hon. J. MacPhail: Let me just go through a couple of points here. But I also want to offer the member this: many of the services for eating disorders have been transferred to the Ministry for Children and Families, and particularly those that affect children and young adults.

Overall, our comprehensive program is that we spend more than $6.5 million on direct eating disorder programs: $2.7 million of that is in acute care and mental health services; $330,000 is for a high-level out-patient program at St. Paul's; then there is the day program for children and youth at Children's Hospital. That figure doesn't take into account the billings that are made to MSP services -- that's separate and apart from that -- or the costs of the acute care beds.

[4:15]

There is a provincial eating disorders steering committee that was established two years ago, and its job is to improve communication, support and referrals across the province amongst health care providers.

There are three initiatives being developed as we speak. One is the provincial database, which is a database of what services are offered where, to whom and with what outcomes. There is a prevention framework that really involves school prevention initiatives. The Ministry of Education is heavily involved with that, but the coordination is now done through the Ministry for Children and Families.

My understanding, although I don't have personal experience -- actually, I do, sort of -- is that there is a lot of prevention work already being done in the schools. But the committee will be setting the standard for schools in terms of the prevention work.

Then there's a needs assessment, where the committee looks at where the greatest needs are, both for patients and their families. The committee also has the responsibility for developing therapeutic standards for the residential programs that wish to be considered for public funding. There are private programs that have no public funding, but the committee sets the therapeutic standards for the publicly funded programs.

[ Page 3471 ]

A. Sanders: There was a term that I would like the minister to clarify, because I'm not sure it's the same group that she has just described. Is the Provincial Advisory Committee on Eating Disorders the group that the minister was talking about?

Hon. J. MacPhail: I'm talking about the provincial eating disorders steering committee, which is the group that's giving the direction and advice on all of this. That's what we call it.

A. Sanders: One thing I have some concern about with respect to this issue being transferred to the Ministry for Children and Families is that I would probably say that in practice, although a very large percentage of anorexia patients are children under 20, a very large percentage of obese or bulimic patients are over 20. In fact, often those disorders actually become masked in secondary disorders.

In other words, the crossover for drug addiction, alcohol abuse and other such issues is so large that we -- the Ministry of Health -- need to be careful that we are not decreasing services that have been available to individuals who are over 20 by transferring the money to a ministry that will, hopefully, focus on children.

I saw an

article in the paper in Vernon this weekend that I was interested in, and I would appreciate the minister's comments. This was also concomitant with information I have about a private eating disorders clinic in Victoria, I believe, although I have not had any information about or interaction with that individual place. A 100-bed holistic treatment facility is planned for Westside Road in Vernon. It will be the first of its kind in the world. Dr. Bryan Lask of Great Ormond Street Hospital in London, England, who is a world expert on eating disorders, came to Vernon to tour the site.

He is specifically interested in setting up such a private facility for eating disorders. Because there is an interest in my community, there is a group of parents, many of whom have experience with this condition, that is spearheading the development of a state-of-the-art treatment facility.

Could the minister please explain to me how, within the legislation we have in British Columbia, we can have private facilities for this type of circumstance, when we have actually done away with private facilities that had to do with ophthalmological surgery and orthopedic surgery, etc?

Hon. J. MacPhail: It's an interesting question. There are no private clinics that receive public funds in British Columbia. There is a private clinic in existence in British Columbia -- in fact, in this vicinity -- but they haven't asked for, nor do they receive, any public funds from government. The provincial eating disorders steering committee is responsible for setting standards for establishing the program requirements of eating disorder services. That's who we work with and provide public funds to, but not to private clinics.

There is a method which anyone wishing to establish a publicly funded clinic in this province would have to go through, meeting the standards and developing the same user-payer relationship that other health services have with us as well. So there may be private clinics, but they're not in any way funded out of public dollars.

A. Sanders: I'm interested, in terms of the individuals who are planning this . . . . And I think it's an admirable thing on their part to move forward with something they had as a problem in their family and develop a service for all of us to use. Would it be my understanding, then, that the staff, including physicians, etc., who are working with this population would not procure any tax dollars from British Columbians?

Hon. J. MacPhail: I would prefer to provide an answer that's not in the context of this particular situation, because I can't address the specifics of this situation. But if anyone wishes to open up a health service that provides physicians' services or hospital services, they have to meet the test of our legislation. We'd be more than willing to talk to anyone who wishes to offer a medical service about how they can do that, but publicly funded health care institutions have to meet the test of the legislation.

A. Sanders: I understand that. I understand it in the context, for example, of private orthopedic services in Vancouver, where British Columbians cannot access those services because parallel services are offered within medicare. What I don't understand here is: would this then be a clinic that could only treat individuals from outside British Columbia? Using that model suggests to me that if you have an orthopedic problem in B.C., you have to go to a publicly funded B.C. hospital and not a private facility. If you have an eating disorder, you would have to go to Vernon Jubilee Hospital; you could not go to Dr. Bryan Lask's service. So I'm just interested in a clarification of that parallel.

Hon. J. MacPhail: Again, let me offer this: the group expressing an interest in setting up a clinic should contact our ministry. There is a very complex set of criteria to be applied. That's what should happen here. We'd be more than willing to engage in those discussions.

A. Sanders: I will offer this to the minister for her to view, and I will try and contact someone so they don't go and build a 100-bed facility that they cannot treat British Columbians in.

A question along the line of eating disorders, under the context of mental health estimates, which I wish to turn to now, is that of steroid abuse. Although it may not appear obvious why I've moved from eating disorders to steroid abuse, I will offer exactly why that is the case from a women's magazine that I read at the hairdresser's on the weekend. This particular magazine is talking about disorders and how the disorders of anorexia and bulimia, which occur most commonly in women, are paralleled and mirrored by steroid abuse in men.

The psychometric equivalent -- if you're looking at a personality profile of those individuals who have eating disorders and are, in general, female -- will often be similar to that of males who are on steroids.

This is an area that I know is not dealt with at all by the ministry, and it's an area that is definitely growing within the context of young people. This magazine reads:

"The AIDS crisis -- which made thinness synonymous with illness -- helped popularize Hercules chic, but the look can be traced back at least as far as Michelangelo's David. Many of my gay friends take the dangerous but quick route to the de rigueur physique: steroids. In fact, steroid addiction -- the self-confidence provided by instant bulk is absolutely addictive -- is the gay equivalent of eating disorders in women. And gay men who do not fit the rigidly defined physical parameters don't just feel alienated; they are spurned, derided and essentially invisible."

This is the opinion of James Patrick Herman in a well-known women's magazine.

[ Page 3472 ]

[4:30]

More importantly, the Canadian Association of Sports Medicine and the British Columbia Medical Association have tried to make us aware of the large numbers of young men, especially, on steroids. Because of the sequelae of hardening of the arteries, heart disease, stroke and liver failure, I think it behooves us, as government, to spend some time looking at the parallels between eating disorders and steroid abuse. Although we have put quite a significant amount of money into eating disorders, as the minister has outlined, in my opinion we have put very little money into this equivalent.

My question to the minister is: is this something that the minister has ever heard of or been apprised of?

Hon. J. MacPhail: Not as Health minister, but I thank the member for bringing it to my attention, and I will look into it.

A. Sanders: I'd like to see the ministry look into this issue. The statistics are there, and there are many individuals within the Council on Health Promotion who can give you an idea of this -- and, most definitely, those of us who deal with a lot of sports athletes and the gay population.

My next question to the minister revolves around an issue that is familiar to many of us through the work of Dr. Christine Loock at Children's Hospital. I have received a letter from Templeton Secondary School -- May 8:

"Dear Mrs. Saunders:" -- I think it's supposed to be me and that's Sanders, but anyway -- "We are a group of family management students at Templeton Secondary School in Vancouver, and we are writing with regard to children with fetal alcohol syndrome.

"After hearing a guest speaker discuss FAS in our class, we became more aware of the serious consequences of drinking during pregnancy and realized that teenagers, as well as adults, lack knowledge of FAS. We strongly believe that there is a need for more education for expectant parents, communities, schools and multicultural groups.

"We are particularly concerned about funding cutbacks to educational facilities for children with FAS. These resources are too important to lose, because many students with FAS need specialized learning environments. Without special attention children with FAS are at risk of being neglected in the educational system. We believe that there is a need for government support for public awareness campaigns and involvement, media coverage, billboards, television commercials, volunteers in schools, speakers and tutors.

"As new voters in the next election, we would like you to know that your consideration of our concerns with regard to FAS may influence our voting decisions. We would appreciate a response to our concerns and your position, including that of your party, on the matter. We look forward to your reply."

This is from the family management students -- grades 11 and 12 -- of Templeton Secondary School, and there are 15 signatures on this letter. For the benefit of those young people who did take the time to actually write to a member of government, I would like the minister to say in the House what we are doing, in Health, in terms of fetal alcohol effect and fetal alcohol syndrome.

Hon. J. MacPhail: Is that Templeton Secondary School in Vancouver?

Interjection.

Hon. J. MacPhail: Oh, that's in my riding.

I'm most familiar with our government's response to the community in working with the community around fetal alcohol syndrome from my time as Minister of Social Services. There are two aspects that the member has noted. One is prevention, in terms of us notifying the public and making them aware of how this 100 percent preventable syndrome can disappear. The second is how we work with our children who have fetal alcohol effect or fetal alcohol syndrome.

For the detailed response, what I will do is to let the Minister for Children and Families know to expect this in her estimates, because she is responsible for the programs, even those that were previously delivered by the Ministry of Health. There is a wealth of services offered now, and Dr. Loock is truly a world-renowned leader, I think, in the area of the treatment of FAS and the proposal for community support.

I do know that the Minister for Children and Families has a coordination of programs that involve Sunny Hill Hospital for diagnosis of FAS children, coordination through children's mental health, the education system . . . . The member is quite correct; these are special needs children as they go through our day care and educational systems. Of course, youth corrections is also involved, because so many of the children end up in a criminal atmosphere simply because of the lack of proper treatment of their syndrome.

I could go on at length with this because it was so important when I was Minister of Social Services, but I would really be answering for the Minister for Children and Families. I will let her know to expect this and to have a good discussion about the range of services in the community.

A. Sanders: I'd like to pass that letter with these signatures on to the minister, and if she would be so kind as to give those individuals the appropriate answer from the appropriate minister . . . .

My next area of canvassing is that of accountability within mental health. Accountability within mental health is a very complex circumstance. The reason it's complex is because we are talking . . . . What are we talking about when we talk about accountability here? Are we talking about dollars spent? Are we talking about hospitalization decreases? Are we talking about the quality of life of the individual? Because there are so many different ways of looking at accountability, looking at it in terms of mental well-being is a very, very difficult circumstance.

There is a technical paper, which the minister probably has, from the Canadian Mental Health Association describing and discussing the elements of accountability within mental health. For my first question . . . . I would be interested if the minister has previously seen this paper.

Hon. J. MacPhail: My staff have seen it.

A. Sanders: We know how good the staff are and that they will pass on all of the information to the minister. Hopefully, we can all use this as somewhat of a learning experience.

Specifically, when we're talking about mental health accountability, what I would like to know is: in terms of mental health, how will accountability be established in B.C.?

Hon. J. MacPhail: In the area of mental health care services, we're now focusing on, in terms of accountability . . . . For the fiscal year '97-98, the regional health boards and the community health service societies will be provided with a separate funding envelope for mental health programs from the adult mental health division. The funding envelope will be provided to health authorities along with the funding envelopes for acute and public health programs. The

[ Page 3473 ]

funding letters to the health authorities outline explicitly the terms of reallocation of program funding and the expectations regarding maintenance or improvement of existing levels and quality of mental health services. The funding letters note that changes to the range or volume of mental health regional and/or tertiary services must be identified in the budget and approved by the Ministry of Health prior to implementation.

It further states that the quality of mental health service delivery will be maintained and existing mental health clinical programs and services will be preserved with no reductions in the levels of service except as related to the positive changes in utilization patterns. And that's a nice way of saying that we're going to protect the funding for mental health even though we expect health authorities to integrate their services and get efficiencies from that integration. We also expect them to allocate no less than the money that we currently spend -- along with the increase that we gave this year -- on mental health.

We did that this year to reassure the mental health community, and also the patients, advocates and families, that we are committed not only to the preservation of our mental health services, even as we move towards regionalization, but also to the enhancement of those services. There's external monitoring of provincial and regional services. There's a Provincial Mental Health Advisory Council; they monitor the performance of B.C.'s mental health services system, and they provide recommendations to me on system requirements.

Then there are regional mental health advisory committees that have been developed to monitor regional systems issues and to provide advice to the health authorities where it's requested.

Then, of course, there's the detailed status report to the Legislature and to the public around Riverview Hospital. We've already discussed that and when to expect the next report in that area. I've also indicated that the PMHAC -- which is not what you think of as PMAC, but is the Provincial Mental Health Advisory Council -- and other stakeholders are working with us now as we develop the updated mental health plan for consideration this fall.

Also, at my direction, ministry officials are now working closely with Riverview Hospital management to improve the utilization of its current funded capacity -- we've already talked about that -- and to minimize the time required for admissions from referring general hospitals. Adjustments to the membership of the B.C. Mental Health Society board are also being explored to further improve the linkage between the new regional health authorities and the Mental Health Society board.

A. Sanders: Accountability is one of the things that the auditor general and the public are demanding of us more, as budgets get tighter and tighter. And one method, in addition to those that the minister has outlined as appropriate ways to establish accountability, is the potential for accreditation. I'm interested if the idea of accreditation within the mental health framework has been floated within the ministry staff as a possibility.

Hon. J. MacPhail: Yes indeed, we have piloted accreditation in mental health services. We initiated the pilot project last June, 11 months ago, and that was to test the applicability of standards and survey processes of the two major accreditation organizations: the Canadian Council on Health Facilities Accreditation, out of Ottawa, and the Commission for Accreditation of Rehabilitation Facilities, out of Tucson, Arizona.

Twelve sites volunteered to participate, and ten have been surveyed. The above ten sites have been accredited for periods ranging from six months to three years. The results were uniformly very positive, with all sites reporting that there was increased teamwork among the staff, greater accountability, and a stronger focus on quality management and performance indicators. We have determined that this pilot project has been very successful and that we're going to continue the strong encouragement of accreditation in the area of mental health programs as a result of this pilot project.

A. Sanders: I'm interested in the concept of a mental health advocate, and would like to have the minister discuss that with me now.

Hon. J. MacPhail: That was a recommendation made by the ombuds about a year and a half ago. Certainly, the establishment of a mental health advocate is part of the review that we're doing now because, of course, certain changes have taken place, not only in the area of mental health but also in the area of advocacy, with some of the mental health services now moving over to Children and Families and there being the child and youth advocate. So certainly, how we bring about the recommended mental health advocate is part of the review and will be part of the mental health plan.

I certainly see myself, and have said to the community that I see myself, as an advocate for mental health. They think that's fine, but they say: "Yeah, yeah, but we want someone who can do it on a full-time basis and can get in there and advocate within the system, as well."

[4:45]

A. Sanders: Just to bring one blanket statement to this area of accountability within mental health, I'd like to look at the CMHA report and their conclusion in terms of accountability and the individual. The reason I feel this is so important is that it comes back again to the issue of risperidone and olanzapine, as we've been talking about earlier. So I'm going to get the mileage out of that as much as possible because it's such an important issue.

Their conclusion reads as follows:

"This fact sheet has looked at the issue of accountability at the system level and discussed measures of quality, such as balance, as well as ways of achieving quality. It has looked at accountability at the program level and talked about ways of ensuring that interventions achieve the goals or outcomes set for themselves. It discussed the technique of program evaluation as a way of measuring this type of success. It also looked at a specific kind of evaluation: cost-effectiveness studies. Research shows that there are existing program models . . . which are effective in meeting outcome goals, and have potential to reduce costs, at the program and wider system levels.

"Implicit throughout this paper and throughout the entirety of the fact sheet series is the understanding" -- and this is the important part -- "that for the concept of accountability to have meaning it must begin and end with the consumer."

It doesn't begin and end with government; it doesn't begin and end with the psychiatrist; it doesn't begin and end with the mental health worker or the social worker; it begins and ends with the patient, the consumer.

"Planning and evaluation at the system level must include the consumer and his or her support network. At the program level, outcome goals should reflect the consumer's wishes about how treatment and support should be arranged. The most fundamental issue, though, is that system, program or individual supports should improve the consumer's quality of life, as defined by him or her. This is the touchstone of any real notion of accountability.

"Once again, the importance of removing medications from special formulary or special authority that are so

impor-

[ Page 3474 ]

tant to preventing side effects for those individuals who have diseases that result in marked social, personal and relationship deterioration such as schizophrenia . . . . "

While I catch my breath here, I want to provide some of the information that I want the minister to have, specifically the letter from the eating disorders group in Vernon, the correspondence from Dr. Peter Liddle, professor emeritus for the schizophrenia division at UBC, and the Templeton Secondary School letter from the grade 11 and 12 family life class.

I'd like to ask a bit of a potpourri here -- some short questions. Short question No. 1: I'm interested in the concept of the short-stay unit. I'm interested to know if the minister has been apprised of this concept by the ministry staff.

Hon. J. MacPhail: We're consulting here. Is it also known as the crisis stabilization unit? Yes, we are aware, and we are providing beds in that area.

A. Sanders: This is a concept that is working very well. I think we need to have ministry staff concentrate in this area in terms of looking at this as a bridging unit between acute care and the community. There are beds being planned in my own riding. I would be very interested to show the minister the use of those beds in the future, why they are much better than hospital beds, and why, for acutely sick patients, they are better than putting them in the community when that is not the appropriate place. That is something I would like her to take some interest in over the next couple of years as we move towards that concept more.

Another question that I was asked and have been asked to relay to the minister concerned the lands at Riverview Hospital. Specifically, I was asked if the communities were having input into the use of those lands as Riverview is being downsized.

Hon. J. MacPhail: Yes, there is a community consultation process that has been ongoing for awhile.

It's interesting. The whole premise of future use of Riverview lands is based on a change in the use of Riverview Hospital. So what we have done is say: "Whoa, just a minute on planning for change there until we figure out, with our renewed mental health plan, what exactly is the future of Riverview Hospital." So the community actually has agreed -- along with the MLA of the area, my seat colleague, the Minister of Aboriginal Affairs -- to put the community process on hold while two things occur: we determine under the renewed provincial mental health plan the future of Riverview Hospital itself; and the community works on costing various models of future use, as well.

A. Sanders: My understanding is that in that community -- where your colleague is in fact MLA -- the community had hoped to use that land for a future hospital site. I wonder if the minister has any comments on that.

Hon. J. MacPhail: Actually, there is a range of proposals. This land is known for its unbelievable number of unique species trees that were planted by Riverview Hospital over the course of the last decades. It's a unique arboretum, I'm told.

There's also a request from the community, strongly held by family members of people with schizophrenia, that there be a future use, a residential use, on the site for people who suffer from schizophrenia. There's also a request that there be some continuation of psychiatric hospital services as well as out-patient services. Then there's the ever-present demand for commercial development as well. These are the interests that are being explored in the community model.

A. Sanders: Thank you for the information.

One final area that I'd like to canvass at this point, before turning it over to my colleague, has to do with what's called the review panel. Specifically, the review panel, in my estimation, is not working.

The review panel is what we have under the Mental Health Act that allows individuals who are unable to be protected from harm to be placed, against their will, within psychiatric facilities, be they at the hospital level or at the Riverview level. Specifically, with the review panel, if a patient is committed against their will with the signature of two attending physicians, and the individual then decides that they feel this is an unjust treatment, they can call in a review panel. The review panel comes in, composed of a number of individuals.

Those individuals review the case independent of the treating individuals and come to a decision as to whether the committal was appropriate. If you look at the statistics for the review panel, 30 percent of the cases of individuals committed are reversed by the review panel. I guess my first question to the minister is: is the minister aware of that fact?

Hon. J. MacPhail: Yes.

A. Sanders: Because the minister is aware of the fact, I would be interested in whether there will be any motion afoot to