1985 Legislative Session: 3rd Session, 33rd Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

WEDNESDAY, MAY 22, 1985

Afternoon Sitting

[ Page

6221 ]

CONTENTS

Oral Questions

Hazardous wastes. Mrs. Wallace –– 6221

Prince Rupert grain terminal. Ms. Sanford –– 6221

Seedlings for Japan. Mr. Howard –– 6221

Manning Park sale. Mr. Mitchell –– 6222

Sales tax on benefit recording. Ms. Sanford –– 6223

Holiday travel planner. Hon. Mr. Richmond replies –– 6223

Presenting Reports –– 6223

Medical Service Amendment Act, 1985 (Bill 41). Second reading

Hon. Mr. Nielsen –– 6224

Mrs. Dailly –– 6226

Mr. Lea –– 6229

Mr. Macdonald –– 6231

Mr. Passarell–– 6232

Hon. Mr. McGeer –– 6234

Mr. Hanson –– 6235

Mr. Reynolds –– 6237

Mrs. Wallace –– 6238

Mr. Mitchell –– 6239

Mr MacWilliam –– 6241

WEDNESDAY, MAY 22, 1985

The House met at 2:05 p.m.

Prayers.

[Mr. Strachan in the chair.]

MR. REYNOLDS: Mr. Speaker, today it was announced in Victoria

that the Victoria Open, a golf tournament taking place July 22-28 of

this year — a PGA event — will take place and be sponsored by Pay-Less

Gas. I would like the House to congratulate Mr. Allen Vandekerkhove for

this great move to support Victoria and tourism in this area.

HON. MR. BRUMMET: Mr. Speaker, I had the pleasure today to

meet with a visitor from down south, the Hon. Terry Hemmings, Minister

of Housing and Construction and Minister of Public Works in the state

of South Australia. He's visiting me and the Minister of Municipal

Affairs (Hon. Mr. Ritchie) and the B.C. Buildings Corporation staff

today. Traveling with Mr. Hemmings are Mrs. Joyce Hemmings, ministerial

adviser Mr. John Luckens, and Mr. Paul Edwards, general manager of the

South Australia Housing Trust. I would like the House to make them very

welcome today.

MR. REID: Mr. Speaker, on behalf of the first member for

Surrey (Mrs. Johnston) and myself, I'd like the House to welcome a

member of the Surrey School Board who is in the members' gallery today,

Mr. Marvin Hunt.

Oral Questions

HAZARDOUS WASTES

MRS. WALLACE: Mr. Speaker, I had intended to ask my question

of the Minister of Energy, Mines and Petroleum Resources (Hon. Mr.

Rogers). In his absence I think I will ask his parliamentary secretary.

In April 1984 the Minister of Energy was informed that Hydro was

being advised to delay their PCB waste disposal because of the cost

involved. What action did the minister take at that time?

MRS. JOHNSTON: I will take that question on notice and get an answer back as promptly as I can.

MRS. WALLACE: The present Minister of Environment's

predecessor was advised at the same time that Hydro was being advised

not to dispose of their PCB waste because of the cost. Is he aware of

any action that was taken at that time by the former minister?

HON. MR. PELTON: No, Mr. Speaker.

PRINCE RUPERT GRAIN TERMINAL

MS. SANFORD: A question to the Premier. Officials of Prince Rupert Grain

Ltd., including Dr. Hugh Homer, have proposed that the old Prince Rupert grain

terminal be saved for specialty grain products and surplus storage. This would

preserve the jobs of about 70 people, as I understand it, Mr. Speaker. Will

the Premier advise whether he discussed this proposal with the federal government

and the other parties involved when he was at Prince Rupert last week? If so,

what was the outcome of those discussions?

HON. MR. BENNETT: Mr. Speaker, in response to the member, I

was there when the question was asked of the federal minister during a

press conference at the exciting opening of those very modern and

high-tech grain unloading facilities in Prince Rupert. The impression I

got was that the federal government.... The answer he gave was that the

federal government, which has been in charge of the old terminal and

the port facilities, would look very hard at ways in which the old

facilities could be maintained. I accept that he meant what he said.

MS. SANFORD: Mr. Speaker, I am wondering if the Premier is

prepared to state what his position and the position of his government

is with respect to retention of that facility.

HON. MR. BENNETT: We certainly support any effort the federal

government makes in areas of their jurisdiction to maintain and create

jobs in the province of British Columbia.

SEEDLINGS FOR JAPAN

MR. HOWARD: Mr. Speaker, I would like to ask the Minister of

Forests if he can confirm that the expected number of seedlings

available this year for planting in our forests will be short by some

eight million seedlings.

HON. MR. WATERLAND: No, Mr. Speaker, I can't confirm that.

MR. HOWARD: I ask the minister if that is a fact. Does he know that they will be eight million seedlings short this year?

HON. MR. WATERLAND: Mr. Speaker, I've answered the member's

question. I cannot confirm that fact — if he claims it to be a fact. I

will certainly find out if we have had any difficulty in growing the

seedlings required for this year's planting, but I have not been so

advised.

MR. HOWARD: I take it that the minister doesn't read the

newspapers or listen to what officials in his department say, but

that's understandable. I wonder, in the light of that, if the minister

can explain to the House why he permitted his colleagues — one of them

— to extract from his grasp and potential some 500,000 seedlings that

would have been available for planting in British Columbia, so that

they could be transported to Japan and given to tourists over there.

HON. MR. WATERLAND: Mr. Speaker, the member for Skeena is

badly misinformed. No seedlings which would have been available for

planting in British Columbia's forests were sent to Japan.

MR. HOWARD: I want to say that the minister is misinformed.

He just doesn't know what's going on within the government, that's all.

In light of the fact that there could have been some 1,000 person-days

of employment to British Columbians available right now, immediately,

if those 500,000 seedlings had not been given away to tourists in

Japan, can the minister explain why he permitted that to happen?

[ Page 6222 ]

HON. MR. WATERLAND: Mr. Speaker, perhaps I should explain to

the member some of the facts of the subject which he's talking about. A

request was made by Mr. Henry Wakabayashi, who is consulting for the

provincial government in their involvement in the world's fair in

Tsukuba, Japan. He requested that we provide them with 500,000

seedlings. We denied that request, saying that any seedling capacity

that we have would be used for the production of seedlings for planting

in British Columbia. However, we made available to them about 500,000

seeds, which were excess to the requirements of British Columbia and

which could not have been used because of the provenance from which the

seed would have to be planted, which would not be usable in British

Columbia during the usable life of those seeds.

Those seeds were then taken and grown in three private nurseries.

These nurseries were: Arbordale Nursery, which grew 100,000 Douglas fir

seedlings; World Silviculture Nursery, which grew 275,000 ponderosa

pine and spruce seedlings; and Riverside Nursery, which grew 125,000

ponderosa pine seedlings. These private nurseries produced seedlings

out of surplus seed that we donated because it was not usable by us;

those are the seedlings which were subsequently provided by the private

nurseries to be used in Japan,

[2:15]

MR. HOWARD: Isn't it a fact that if the minister would have

been a bit more persuasive with his colleagues, the space taken up by

the growing of those 500,000 seedlings could have been used to grow

seedlings for planting in British Columbia?

HON. MR. WATERLAND: Mr. Speaker, no, that is not the case.

The member seems to think that the only thing involved in reforestation

is the growing of seedlings. The growing of seedlings is but one step,

which has to be done up to three years ahead and in some cases, in

terms of a containerized seedling, one year in advance. But growing the

seedlings is but one step. The site preparation is another step which

has to be taken, and sites were not prepared for the planting of those

seedlings, so there was no point in using that nursery capacity for

growing those seedlings.

So we have had an expanding plantation of seedlings throughout the

period of time that I've been minister, Mr. Speaker, For example, prior

to my becoming Minister of Forests there were fewer than 70 million

seedlings planted in the forests of British Columbia. Last year — the

year just ended — I believe the figure was 120 million seedlings. That

rate of growth is now accelerating.

The member for some strange reason has not asked me recently when

we're going to get approval for our forestry agreement. He asked me

that question quite regularly up until a few days ago. Now he's giving

out the....

Interjections.

HON. MR. WATERLAND: Mr. Speaker, that agreement will allow us

to within two years be producing and planting 200 million seedlings a

year in the forests of British Columbia. That is quite an

accomplishment.

MANNING PARK SALE

MR. MITCHELL: Mr. Speaker, my question is to the Minister of

Lands, Parks and Housing. I hope I don't take two years to get the

action that we've got out of the Minister of Forests. My question to

the minister is: according to the rules and practices of this House the

minister is required to table a document referred to in question

period. In view of the minister's reference to a secret agreement for

the sale of property and assets at Manning Park, will the minister now

table that document?

DEPUTY SPEAKER: There is a question there.

HON. MR. BRUMMET: I detected a question there. Thank you, Mr.

Speaker. I resent the implication of the secret documents and that sort

of thing. That document is available to people who want to drop into

the ministry. We don't produce them in great numbers on these

contracts, and so the answer to the question, basically, is no.

MR. MITCHELL: It's still a secret document to the people of

B.C. if we don't have access to it. Why is the minister hiding the

DEPUTY SPEAKER: One moment. That does impute a dishonourable motive to another hon. member, and I'll ask the member to withdraw that phrase.

MR. MITCHELL: Well, I'm not saying he's telling an untruth; I'm saying he's hiding the truth. He has the truth; he has....

DEPUTY SPEAKER: That offends the Chair, hon. member. Will the member simply withdraw that statement?

MR. MITCHELL: I'll withdraw that statement.

DEPUTY SPEAKER: Thank you. Please proceed.

DEPUTY SPEAKER: Order, please. Simply ask the question. Withdraw the phrase; it is offensive to Parliament. Thank you.

MR. MITCHELL: Hiding the facts?

DEPUTY SPEAKER: Withdraw, please. A simple withdrawal will be sufficient, thank you.

MR. MITCHELL: Okay. Can I rephrase it again? Why is the minister withholding the truth?

SOME HON. MEMBERS: The facts.

MR. MITCHELL: The facts.

DEPUTY SPEAKER: We seem to have a little problem here. No, that phrase will also have to be withdrawn. Will the member please simply withdraw.

[ Page

6223 ]

MR. MITCHELL: I'll withdraw.

DEPUTY SPEAKER: Thank you.

MR. MITCHELL: We'll rephrase it again, Mr. Speaker. I seem to have your attention, but I haven't got the minister's.

Why is the minister refusing to file a copy of the terms and

conditions of the agreement, whereby assets costing the taxpayers of

this province $20 million in investments were sold to friends of the

government for $500,000? If you realize that $500,000 is but

one-fortieth of its true value, or that the assets were sold at a fire

sale price of approximately.... The people of B.C. received

approximately 2.5 percent of the money they invested in that park. Mr.

Speaker, I'm asking why the taxpayers cannot get a copy of the

agreement that allowed that to take place.

DEPUTY SPEAKER: Before recognizing the minister, I'll point

out that our standing orders require that questions and answers shall

be brief and precise and stated without argument or opinion.

HON. MR. BRUMMET: Again, it is evident that there's no point

in giving facts to that member, because he doesn't listen. I gave him a

correction on his figures yesterday, and he is still quoting the

misinformation that he's basing his questions on. If the member wants

answers, then he should ask the particular questions. I cannot be held

responsible for his incompetence in asking questions.

MR. MITCHELL: The minister did not dispute my facts when I

said that the assets were sold for 2.5 percent of the invested value of

the taxpayers' money. He hasn't disputed that.

HON. MR. BRUMMET: I certainly don't intend to get into calculations of percentages when that member is using the wrong figures.

SALES TAX ON BENEFIT RECORDING

MS. SANFORD: I have a question for the Minister of Finance.

I'm wondering if the minister will advise us approximately how much

money has been collected for sales tax on the Canadian-Ethiopian relief

record entitled "Tears Are Not Enough."

HON. MR. CURTIS: I thank the member for her question. I'm

sorry that I don't have that precise figure available in question

period. I will attempt to get it as quickly as possible and bring it to

the member.

MR. HOWARD: I wonder if I might have leave to make an introduction, Mr. Speaker.

Leave granted.

MR. HOWARD: I'd like the House to join me in expressing a

welcome to a long-time friend of mine, Mr. Satwant Singh, who I've just

noticed in the gallery today.

HON. MR. RICHMOND: Mr. Speaker, I would ask leave to answer more fully

a question that was asked of me yesterday.

DEPUTY SPEAKER: An answer taken in question period?

HON. MR. RICHMOND: Yes.

DEPUTY SPEAKER: Leave is not required.

HOLIDAY TRAVEL PLANNER

HON. MR. RICHMOND: After being asked yesterday by the member

for North Okanagan (Mr. MacWilliam) the reason for Needles showing on

our Tourism travel planner, and realizing the urgent nature of the

question, and not wanting people to think we take these things lightly,

I have done some more research into the question of why Needles appears

on the travel planner.

I have come to the conclusion, Mr. Speaker, that Needles appears

there for the same reason that Swartz Bay and Galena Bay appear on the

maps. If you wish to take a trip on a ferry to Tsawwassen, you must

leave from somewhere. Hence we show Swartz Bay on the map, even though

there is no town of Swartz Bay. When you wish to cross the Arrow Lakes

from the west side to get to Fauquier, you have to leave from somewhere

to get to Fauquier. Conversely, and just as important to the people of

Fauquier, if you want to leave there and go to the other side of the

lake, you have to be able to go to somewhere. That somewhere shows on

the map as Needles.

Not only that, Mr. Speaker, but if the member has driven to Needles

lately, he will know that the Minister of Transportation and Highways

(Hon. A. Fraser) has spent millions of dollars upgrading a road to go

to a place called Needles, so that his ferry can leave from somewhere.

I will leave the member with the immortal words of Yogi Bear: "If

you don't know where you're going, you might end up somewhere else."

DEPUTY SPEAKER: That was an answer to a question taken on notice in question period. A reply is not in order.

Presenting Reports

MR. REE: Mr. Speaker, I have the honour to present a report

from the Special Committee of Selection. I move that the report be read

and received.

Motion approved.

MR. REE: Mr. Speaker, pursuant to an order of the House made

on May 16, 1985, your special committee appointed on March 4, 1985 to

prepare and report lists of members to compose the select standing

committees of the House for the present session begs to report that the

following is the list of members to compose the select standing

committee to recommend a person to be appointed ombudsman pursuant to

section 2(2) of the Ombudsman Act, being

chapter 306 of the Revised Statutes of British Columbia, 1979 :

Messrs. J.M. Parks, convener, R.G. Fraser, J.J. Kempf, C.C. Michael,

W.B. Strachan, Hon. J.A. Nielsen, Hon. W.S. Ritchie, Mrs. E.E. Dailly,

Messrs. D.G. Cocke, D.F. Lockstead and G.R. Lea.

Mr. Speaker, by leave, I move that the rules be suspended and the report adopted.

Leave granted.

[ Page 6224 ]

MR. MacWILLIAM: On a point of order, the minister was expanding on an answer....

DEPUTY SPEAKER: Just a moment, please. One more procedure apparently has been.... The question on the motion.

Motion approved.

MR. MacWILLIAM: On the point of order, Mr. Speaker, the

minister was expanding at some length on an answer given previously in

question period yesterday, so I do believe that under the rules of

order, that does allow me a reply.

Interjections.

DEPUTY SPEAKER: Hon. members, the minister took a question or part of a question on notice...

SOME HON. MEMBERS: No, no!

DEPUTY SPEAKER: ...and replied today. That was the statement

given to the House. It was not a ministerial statement, and therefore a

ministerial reply is not allowed.

MR. HOWARD: I think it should be pointed out that the

minister yesterday, in answering questions posed by the member for

Okanagan North, replied to them fully, did not take any of them on

notice. So in fact when he rose today at the conclusion of question

period, he was making a ministerial statement, and as such I think the

member — for Okanagan North in this instance — should be afforded the

opportunity of a reply.

[2:30]

MRS. WALLACE: Further to the point of order, Mr. Speaker, I

would like to point out, in line with what my colleague from Skeena has

said, that that did in fact occur yesterday. Also occurring yesterday,

the Minister of Environment got up and asked leave to answer a question

that I had asked, which turned into a ministerial statement, and which

you allowed me to respond to without raising a point of order, which I

certainly would have done had you not.

HON. MR. NIELSEN: Mr. Speaker, the Minister of Environment

yesterday asked leave to answer a question which he did not answer

during estimates, rather than in question period. The member for North

Okanagan has asked that he be allowed to reply to an expanded answer to

a question answered in question period. Those were his words.

Mr. Speaker, the standing orders do not recognize that situation.

The member for North Okanagan asked if he could respond to the

minister's expanded answer to a question, and the standing orders

simply don't recognize that.

MR. LEA: Mr. Speaker, regardless of the decision you make, I

hope you realize the gravity and the importance of this whole topic. Do

you realize that many of the unemployed out there today are just

sitting at the edge of their chairs waiting for this decision, to see

whether it's going to be Needles or Fauquier, or whether it leaves from

one side.... It's really important.

DEPUTY SPEAKER: Yes, I appreciate the gravity of your statement.

MR. ROSE: I won't extend the satire that has already been

accorded you, Mr. Speaker, but I would like to say that yesterday I was

very proud of the Chair for recognizing that this was not really a

question taken as notice but in fact a ministerial statement. It seems

to me today that what we got here, in the guise of an explanation or an

expansion, was an opportunity for a minister, who was accorded a

question yesterday, to expand and explain and justify his stand, albeit

humorously — and it was very enjoyable. I think that's fine, except

that when this goes on, when ministers are permitted, without rebuttal,

to get up after question period and say, "Well, I didn't mean that

yesterday, but I subsequently found out about this.... Doesn't that

amount to a statement by ministers, not just an expansion on a

question? I think that, under those conditions, if it is not a question

taken as notice, then a rebuttal should be allowed by the person who

posed the question.

DEPUTY SPEAKER: Hon. members, the records will show that we

had an interesting procedure yesterday: a question arising out of a

question taken as notice, if you will, in estimates;

whereas today

we're discussing a question taken as notice in question period.

Interjections.

DEPUTY SPEAKER: Let me finish, please. I will undertake to

review the Journals. I will now put the question to the House: shall

leave be granted to the member for Okanagan North?

Leave not granted.

Orders of the Day

HON. MR. NIELSEN: Mr. Speaker, second reading of Bill 41.

MEDICAL SERVICE AMENDMENT ACT, 1985

HON. MR. NIELSEN: Mr. Speaker, I move second reading of Bill

41, Medical Service Amendment Act, 1985. Perhaps a few introductory

remarks with respect to the purpose of this bill.

As members would know, Bill 41 resulted in part from the withdrawal

of the previous Bill 50. The bill now before the House will reinforce

one of the most significant social programs in our province, our

medicare plan.

Mr. Speaker, universal medicare has been a reality in our province

since 1968, and most citizens take it for granted as something they

expect to enjoy. During this period of time, as medicare has become an

entrenched social program, some significant patterns have emerged in

providing universal medical services. In particular, there has been a

spectacular growth in costs and, in British Columbia especially, a

rapid growth in the number of physicians, coupled with an oversupply of

doctors in the lower mainland, in the Victoria area, and in the

Okanagan Valley and other areas. While that oversupply exists in the

metropolitan areas of the province, there continues to be a shortage of

physicians in rural and isolated communities.

[ Page

6225 ]

The bill directly addresses the question of physician supply by

explicitly granting the Medical Services Commission the authority to

issue or not to issue what are now called practitioner numbers, which

entitle physicians and other health professionals to receive payment

from the Medical Services Plan for rendering insured services.

As members are likely aware, Mr. Speaker, the Medical Services

Commission has been issuing practitioner numbers since September 1983,

according to a control process developed in conjunction with the

official organizations representing the medical professions. However,

about one year ago several of these organizations withdrew from the

committee — withdrew their cooperation. I am told they were told by the

CMA not to sit on the committee. Last month the process was called into

question by the Chief Justice of the Supreme Court, who ruled the

commission did not have the statutory authority to control the issuing

of billing numbers. In this bill such authority would be made explicit.

Mr. Speaker, the idea that there could be too many doctors may not

be readily appreciated by those who are not directly involved with the

economics of our health care system. Frequently it is suggested that

the more doctors the better our health care — not necessarily the same,

Mr. Speaker. Certainly the costs would be almost out of control if

there was no control. Surprising as it may be to some, B.C. has more

doctors per capita than any other province. We are way above the

national average. Greater Victoria and Vancouver particularly are

overendowed with specific types of physicians.

It's quite different when society is paying the entire bill. In a

free enterprise health system, where doctors were responsible for

collecting their own fees and patients were responsible for paying

them, it could be argued that there really was little need for

controlling the number of practitioners. The marketplace presumably

would play a role. Not so with a nationalized medicare system. Each

doctor who joins the system adds several hundred thousand dollars a

year to the cost of running the system. As an example, Mr. Speaker,

each physician receives an average of $144,000 in gross payments from

the plan. In addition each physician generates further costs through

his or her ordering of lab tests and through admissions of patients to

hospitals.

By the most conservative yardstick, our province has at least 300

more physicians than we actually need. The cost with those 300 is about

$50 million. We probably now have 400 to 500 more physicians than we

require. In fact, even if B. C. had 300 or 400 or 500 fewer doctors, we

still would have the most doctors per capita in Canada. The oversupply

of physicians in our metropolitan areas is not a figment of

imagination. The fact has been acknowledged by various studies —

studies in which the B. C. Medical Association and the College of

Physicians and Surgeons were full participants along with government.

One study was the Black report — 1979 — which recommended restrictions

on practitioner numbers. A similar recommendation emerged from the 1982

study by the Joint Committee on Medical Manpower, which had been

established as an outcome of fee negotiations between the government

and the BCMA.

Just some interesting figures for a moment, Mr. Speaker: the 1982 study showed

that the number of B.C. physicians had grown by more than 30 percent from 1975

to 1982, from 4,016 to 5,380. The major source of this increase was the movement

of physicians from other parts of Canada, particularly the other western provinces

and Ontario. The study also found that in the ten years from '72 to '82

the number of services provided by physicians rose by 88 percent. The population

increased by 26 percent. Services grew more than three times as fast as the

population. The committee said: "This strongly suggests that other factors

— including the number of physicians in the area — apart from population, 'need'

for medical services, determine the level of physician services provided."

Mr. Speaker, we in British Columbia have one physician for each 508

people. The national average is one physician for every 604 people. In

New Brunswick it is in excess of 900 per physician. I might add that

much has been written and said over the past few years to suggest that

Canada in total has an oversupply of physicians. So even then the

national average itself is not necessarily an ideal level. It is

estimated that if we do not control the production of physicians in

Canada, by the year 2000 we'll probably have a surplus of 6,000.

Mr. Speaker, the ratio of physicians to population in greater

Vancouver is one physician for every 391 people; in greater Victoria

one for every 376. There is no mystery as to why physicians find

Vancouver and Victoria attractive areas, not only for the natural

attractions, but because there they also have the benefits of

first-rate medical facility, a medical school and an active health

research community. But whatever the reasons, the fact is that greater

Vancouver and Victoria and certain other areas of the province have an

overabundance of physicians.

A little bit of history, Mr. Speaker, if I may, because we're

engaged right now in quite a battle — well, not much of a battle

actually, but an argument, I guess — with the BCMA and PARI. PARI, I

explain, is the Professional Association of Residents and Interns. For

a while someone thought I was speaking about a Dr. Parry, but it's an

association. BCMA and PARI.... In fact, I gather that yesterday we were

already advised that they're going to take it to court, which is

interesting because the bill isn't law yet, but apparently they're

going to take it to court anyway.

Mr. Speaker, I introduced a bill in 1983 known as Bill 24. It

contained similar legislation to control the issuance of billing

numbers. In consultation with the BCMA it was suggested, as has been

suggested for the last decade, that there were better ways to control

billing numbers and better ways to control physician supply, manpower.

After considerable discussion with the BCMA, we allowed Bill 24 to die

on the order paper. During our discussions the BCMA asked if they could

take

part in a committee which would review applications for billing

numbers. We agreed. The BCMA, PARI, the College of Physicians and

Surgeons, the B.C. Health Association and the University of British

Columbia Medical School were all party to the committee.

[2:45]

Very briefly, the process required an applicant for a practitioner

number to be licensed by the College of Physicians and Surgeons, to be

granted admitting privileges by the local hospital, and to be

recommended by a local medical manpower committee. The latter

committee's role was to advise on the need for another position or for

certain specialties in the local area. All three of the stages involved

full participation by members of the medical profession. In addition,

the process included a provincial medical manpower committee to review

applications on which the Medical Services Commission requested further

advice.

It worked quite well — until they got their walking orders and

abandoned the committee. In 1984, 258 practitioner numbers were issued.

Of those, 128 were permanent and 130

[ Page 6226 ]

were locums. In 1983 we issued 393 numbers. Last

year 135 fewer numbers were issued. It was working well without any

adverse effects on health services.

There's a lot being said about the right of doctors to practise

wherever they choose to practise. Well, a doctor is licensed by the

college. We do not license doctors. We become involved when a doctor

seeks to receive compensation from the Medical Plan. We believe that as

managers of the plan the commission have a responsibility to manage the

plan, not simply to rubber-stamp applications.

It's most interesting that doctors take

part in local manpower

committees at the hospital level. If a doctor is seeking hospital

privileges to practise his profession at a hospital, the medical

manpower committee reviews the credentials of the doctor. Finding them

to be correct, they then review the need for that physician at that

hospital. If they find that they do not require that physician's

specialty, or if he's a GP and they do not require another GP on staff,

they deny privileges in the same way we wish to review the need for

that doctor or his specialty in a region of the province. The medical

people take part at the hospital level. They refuse, so far, to take

part at the provincial level. We believe it is basically the same

principle.

An important part of this bill is the establishing of an advisory

committee to review this manpower question. I've been advised by

spokesmen for the health professionals that there are better ways of

controlling manpower. I've been hearing that for five years; the

ministry's been hearing that for ten years at least. I asked the BCMA

to prepare their alternatives for me in written form. I have not

received those as yet. I asked my deputy ministers a week or ten days

ago, when they were meeting with BCMA officials, if they would have the

BCMA officials put down in writing what their alternatives to manpower

control were. They refused to put them in writing. I told my officials

to advise them that it is not serving any useful purpose to continue

discussion when we don't really know what it is we're considering. We

put our proposals in writing, in the form of Bill 50 and now Bill 41.

We asked them to do the same, under their letterhead.

So I don't carry the can when another professional organization

accuses us of going after them. The advisory committee will provide the

opportunity for the BCMA, PARI, the college, BCHA, for university and

other people who may be appointed, to work on the alternatives. But

until they come up with the alternatives, we will have some control

over the number of practitioner numbers issued in the province.

I told the BCMA last Saturday in Whitehorse that we simply could not

stand around and spin our wheels, waiting for these alternative

proposals to materialize. We've been waiting ten years now, and I hear

the same story: there are better ways. But what are the better ways?

There were some suggestions made which I made notes of, but still they

haven't been written — and I would suggest that they could be

challenged in court without terrible difficulty.

I will ask the advisory committee, if it's established and if these people

wish to take part, to prepare their alternatives. We will then review the alternatives,

we will test the alternatives from a legal point of view, and we will determine

if there would be any difficulties in making use of those alternatives as law.

But until that time, we will have some control when this act becomes law. If

they can develop a better mousetrap, we'll use it. If they can produce,

through the advisory committee, better methods of controlling manpower, we can

substitute those methods by regulation.

MR. ROSE: You're not long for this world; I think you're going to need a doctor.

HON. MR. NIELSEN: A chiropractor can fix it for me.

MRS. WALLACE: Maybe you should stop smoking.

HON. MR. NIELSEN: That's what I need.

Mr. Speaker, we are not in basic disagreement with the

professionals. The BCMA admit there are too many doctors in B.C. What

they do disagree with is the method of controlling medical manpower.

Unfortunately, they have yet to come up with a proposal that I can

actually see. I've heard some comments. Others have dropped hints and

suggestions. But I need it in writing. I think the committee will

probably provide that for us.

I'm going to be asking the BCMA and the others listed in the bill to

sit on the committee. Should they not wish to, fine. If they don't want

to take

part in the resolution of the problem, then they're going to

have to accept our resolution of the problem.

Mr. Speaker, I believe Bill 41 is essential to allow the Medical

Services Commission to control the number of practitioner numbers which

will be issued in our province; to attempt, at least, to eliminate some

of the surplus medical manpower in certain areas of the province; to

try to keep costs down a little at least; and perhaps to encourage

practitioners to practise elsewhere, where they are desperately needed.

I agree that simply controlling the issuance of numbers is not going

to solve the manpower problem. Neither, I would suggest, is ten years

of wheel-spinning going to solve the manpower problem. In speaking with

the Ministers of Health in Winnipeg last week, every one agreed we have

a manpower problem. I'll tell you, the Ministers of Health of all

provinces, and the federal minister, are consistent if nothing else. At

every meeting everyone agrees we have a problem with manpower. But to

this point in time, no one seems to have come up with a resolution. A

report is expected to be released soon which will offer certain

recommendations on a long-term basis, and we'll probably support it.

But we have a problem now. We intend to move in this matter this way

until such time as a better method is developed — we hope through

cooperation with the professional associations. If they choose not to

take part, then we'll have to do it alone.

Mr. Speaker, I move second reading.

MRS. DAILLY: The official opposition will not be supporting

this legislation. We have the same concerns that the minister has over

the matter of manpower and costs. But our party, the NDP, does not

believe in trying to solve a problem with the heavy hand of a

centralized government. That is the issue: the heavy hand of a statist

government. That's what we have.

Mr. Speaker, the NDP believes in negotiation. The minister has said

that he has tried to come up with solutions. As far as we're concerned,

he has been the minister and the Social Credit have been the government

for many years in this province now, and the very fact that after all

these years they throw up their hands and say they can't find a

solution and bring in something that is absolutely repugnant to most

people in British Columbia says something about the inability of that

government to govern.

[ Page

6227 ]

The minister is quite aware that this went before the B.C. Supreme

Court. Just to remind the minister of what the Chief Justice said about

this attempt...

Interjection.

MRS. DAILLY: I'm talking about the past attempt; I will make

that clear. The past attempt of the minister to try to regulate the

free mobility of physicians in this province has already been tested.

Right?

Interjection.

MRS. DAILLY: I will then talk to the minister very

specifically about the case of Dr. Mia, who graduated from the

University of British Columbia. He knows what I'm referring to. This

case went before Chief Justice McEachem. This physician was denied a

billing number by the commission. That is exactly what we're discussing

in this bill — the unilateral denial of a billing number by the Medical

Services Commission. So when the minister shakes his head and says it's

nothing to do with the bill, that's nonsense. That is the basic crux of

this bill. It's a denial of the right....

Interjection.

MRS. DAILLY: Yes, you've set up a committee, we agree. And

the doctors have said they will sit on that committee. But we're still

down to the basic issue of government deciding, if they wish, that they

can curtail the free movement of someone in this province.

Interjection.

MRS. DAILLY: Well, I would hope that the minister will explain that a lot more clearly to us, because that is not the way the bill reads.

Interjections.

MRS. DAILLY: You still have a right in this bill, as we read

it — and as the physicians and interns of this province and other

concerned citizens read it — to curtail the issuance of billing numbers

on a geographic basis through the Medical Services Commission. Is that

correct? Yes. Well, Mr. Speaker, if you can curtail the issuance of

billing numbers on a geographic basis, you as government are taking

over the right to curtail the mobility of certain doctors in this

province.

Any government which attempts to curtail this mobility is infringing on the

Charter of Rights. As the chief justice said: "Until now it has never been

suggested, in modem times, that options of location within a province could

be restricted." He went on: "After all, this is Canada, where freedom

of movement for any lawful purpose has always been one of the handmaidens of

liberty."

Interjection.

MRS. DAILLY: The minister says: "Nice words." You know, we on

this side happen to feel that to uphold civil liberties is more than

nice words. It's what we're all about, and as legislators what we

should be concerned about.

Interjection.

MRS. DAILLY: Mr. Speaker, I will just continue. I find the

comments of the minister across the floor somewhat helpful, but on the

other hand, it seems to me that we are still faced here — I want to get

back to the bill — with a basic problem of a centralized government

that has thrown up its hands. They're incompetent. They've been ruling

this province for years, and they still can't find any solution to this

problem except to use a heavy hand and restrict mobility of physicians.

[3:00]

On top of that we have the ironic situation of this Minister of

Health.... He has thrown up his hands and says: "Well, nobody's come up

with any answers and solutions to me, so I'm going to use a heavy

hand." But at the same time, one of his own cabinet ministers keeps

boasting about the fact that ever since he became minister of

post-secondary universities, communications, whatever, he has been able

to increase the number of doctors going through the medical school.

I'm for B.C. students having an opportunity to become whatever they

wish. Right? The problem is that today you have not shown any concern

about the teachers of this province, who can't go into the faculty of

education any more with any hope of getting work because of the

recession. On the other hand, Mr. Speaker, we have a problem here where

the minister throws up his hands and says: "I can't handle this. We've

got too many doctors out there. I think there are too many doctors. The

doctors think there are too many." Yet his own cabinet colleague says:

"Let's keep producing more and more." You can still put a control on

the number going in without denying everyone the opportunity to

practise eventually. I'm saying that it all has to go together. But

you've taken one approach only, and it's a very heavy-handed approach.

The minister is going to get up and say: "The NDP don't want to see

the students becoming doctors in British Columbia." Let us get it

clear. We're proud of having a medical faculty; the NDP supported it.

But you have to be reasonable today. You can't have one minister

complaining that there are too many doctors coming out to practise, and

the other one insisting that more go into the school. There has to be a

meeting of the minds. That does not mean that young people today cannot

attend the B.C. medical faculty. Let's just try to have a meeting of

minds on this between you and your colleague.

[Mr. Ree in the chair.]

Mr. Speaker, the other areas that this minister keeps talking about....

He keeps saying over and over again: "There are no alternatives, therefore

we've taken this move." He himself referred to the number of studies

that have taken place. His government has set up quite a number of studies.

He mentioned himself, I believe, the one that took place in 1979, was it — the

Black one? I believe that there were some recommendations out of the Black report.

Were there none there that the minister could have used?

Interjection.

MRS. DAILLY: If he used some of them, why has it not had an effect then? I hope the minister, when he closes

[ Page 6228 ]

debate, will tell us specifically which ones he

actually endorsed, and why it had no effect. Perhaps you just picked

the ones that.... Mr. Speaker, perhaps he's really not interested in

moving on this in a logical, compassionate, humanistic way. Maybe this

minister has a feeling that to take a heavy-handed approach will be

populist. Maybe out there the public will think: "Isn't he a great,

strong minister? He's taking action." You know, out there the public is

also concerned about their access to a doctor. They're not happy with

this move to infringe on the free movement of their doctors. I don't

think that the minister has, in talking to the public, met with too

much approval for this either.

I notice that his committee meetings all seem to be just made up of

the doctors and the minister. I haven't noticed too many of the

consumers — the people who eventually may have to make use of their

doctor — involved in any of these discussions with you. I think it

might be interesting for the minister to find out their comments.

I think that the minister has had an opportunity. I know in the

Black report there were a number of items suggested, and maybe this

will refresh the minister's mind. It did actually suggest that UBC not

expand its enrolment to any great degree — the minister obviously

rejected that — and "that a joint committee determine the number of

residency positions for each specialty." Here are ways of going about

this. Was anything done about that? It also suggested "that medical

training be nationally coordinated."

The minister has been going back and forth across Canada meeting

with the other ministers for years now. What's come out of that? He

says we all agree we've got a real problem. Okay, all you Ministers of

Health have been getting together and meeting. If you all have the same

problem, why is it that only B.C. has moved on this draconian — to

quote someone else, not me — measure? I would say it is a draconian

method that he is using. What I want to know is: why are we the only

place in Canada? Why are we the only province in Canada that has felt

it necessary to take this heavy-handed status approach? That's what I

want to know, Mr. Speaker. We have other provinces in Canada, as he

admits, facing the same problem. They haven't moved in this way with

this kind of legislation.

They've also suggested in this report, the Black report, "that a

comprehensive incentive program, including bursary loans, community

grants, housing and educational grants, be instituted to encourage

physicians to go to underserviced areas." Let's remember that this

minister has also stated that there are too many in the urban areas,

and he thinks being able to move them around at his will will solve

this problem. I want to ask the minister why he hasn't embarked on some

of these policies. I understand the province of Quebec, for example,

has embarked on one of these.

So I ask the minister in closing, and, of course, we'll have an

opportunity in committee...? What about a comprehensive incentive

program, including bursary loans, community grants, housing and

educational grants? What about them? Why has this minister or his

government not done anything in this area? I don't think a thing has

been done. Maybe he can tell us, but obviously they haven't or he

wouldn't be faced with the problem he has today.

They also recommended "that training in rural medicine be expanded,

including a special program for psychiatry in Prince George." Now

that's just one specific thing. I'm not suggesting that would solve the

whole problem, by any means. The suggestion "that a national physician

data bank be established" — has that been moved on? All right, there

are a number of suggestions there for the minister, yet he throws up

his hands and says: "Nothing is coming through." Then there was another

committee founded. This was another committee set up in 1982, the joint

committee on medical manpower, once again made up of the Medical

Services Commission and the BCMA, and no one else.

"Its purpose" — and I know the minister, I'm sure, remembers

— "was to evaluate existing physician manpower and to recommend ways of

improving distribution and controlling the supply of physicians, and report

back to the negotiating committees. As a basis for comparison, the committee

accepted the doctor-population ratios of the national committee on physician

manpower (1975) and modified these ratios.... Essentially, therefore, the

doctor-population ratios in this report did reflect the application of unmodified

dubious data from the late sixties and early seventies" — which I would

consider would be a basic problem.

Now that minister has some very up-to-date computer equipment which

we give him full credit for, and I would hope the data that is being

used by these committees.... I would hope that access to these

committees would be made by some of the minister's technological feats

in his ministry so they can be up to date.

"From the data available at the time, the committee agreed that there

was a suggested oversupply of general practitioners in the Vancouver and Victoria

areas. The committee suggested nine measures to control physician supply."

Now in reading these, I'm not going to say that we endorse all of them.

I'd just like the minister, however, not to continually throw up his hands

and say: "They never tell us anything. They never come up with anything."

Here were some of the suggestions out of this committee: "....to rely

on market forces, to provide information (the college's placement list),

to limit hospital privileges, to reduce immigration, to apply more stringent

licence requirements (Alberta and Hawaii models), to link licensure with hospital

privileges, to use financial disincentives (Quebec model), to restrict billing

numbers and to control medical school enrolment." That committee made up

at that time in 1982 did suggest some restriction. I would like to ask the minister,

when he closes debate, to tell us on what basis they suggested that. They also

suggested that you should look at the Quebec model, and I wonder why the minister

has not been interested in looking at that model. It is an incentive model.

I would like to remind the minister again about the other arguments

that we on this side of the House basically have against the bill. I

started off by stating to him that the denial of basic freedoms — a

government should not be able to tell citizens where they can or cannot

work — is one of the fundamental reasons for our opposition. The

patients are denied a choice. Here again you have a problem once you

start doing this. You could say that you are restricting some of the

medicare.

The minister always goes "Ha!" whenever we talk about medicare and

the principles, because that minister — and I've listened to him; I've

heard him growl when I've mentioned medicare in this House — is really

not committed to medicare. As a matter of fact, when that minister

speaks of medicare in this House — he's glaring at me, but I will not

disappear, Mr. Minister — there is a sardonic tone.

[ Page 6229 ]

MR. ROSE: Yes. Draconian, too.

MRS. DAILLY: Yes, and.... Well, sardonic primarily. For

example, today when he talked about medicare, do you know what the

minister said when he was introducing his bill? I noted this; he said

about medicare:"...all the benefits of medicare which the people of

B.C. expect to enjoy." He always throws in this "the people expect," as

if somehow or other the people of British Columbia don't really have a

right to medicare. I don't think that minister believes they have a

right. He really does not believe they have a right to medicare.

Whenever we talk about medicare, he refers to the Canada Health Act. He

wishes it would disappear.

Interjection.

MRS. DAILLY: Well, the Canada Health Act.... He just said

that, yes, it would be a good idea if it disappeared. What is the

Canada Health Act all about? It's founded on medicare. The whole

those things are ingrained in the Canada Health Act. And that minister

keeps telling this House he wishes that Health Act would disappear.

Obviously that minister does not believe in medicare.

That's why any minister who is not philosophically committed to

medicare would find it quite simple and easy to bring in this kind of a

bill, which absolutely goes against some of the basic principles of

medicare. And this is why the people of British Columbia are very

nervous about the moves made by the Minister of Health when it comes to

what's going to come next? If this minister admits he's tired and

doesn't have any more ideas.... If this doesn't work, what's going to

come next? What will be the next statist move by the Social Credit

government?

I mentioned earlier that this denial or handing out of billing

numbers on a geographical basis can discriminate against young

graduates. I don't think there's any question about that. I'd like the

minister to let us know how he feels about more and more young people

being encouraged to go into our medical faculty, when at the other end

he's brought in a bill which is going to deny them access to practice.

What kind of sense is there in that? The young graduates are being

encouraged by that minister, obviously, and his colleague, the Minister

of Universities (Hon. Mr. McGeer), to keep going into medical school,

and yet he brings into the House today a bill which will deny them

access to practice.

[3:15]

Also what about women? Fortunately there are more and more women

going into medical school. We know that in the last few years there's

been a dramatic increase in the number of women entering medical

school. Now they'll be denied practice, even though there is becoming a

greater demand in the public for women physicians. All these young

people who are coming out now — how are they going to get a job?

Interjection.

MRS. DAILLY: We don't believe in any discrimination. I would go to a male or female doctor. I imagine you would, too.

Interjection.

MRS. DAILLY: Neither of us would.

But, Mr. Speaker, I think the problem we have here is that it's the

young people who are coming out who are going to primarily be

discriminated against. I think that's most unfair. How is the minister

going to handle that situation? Is the minister perhaps not...? Should

he not be devoting some attention maybe to some kind of incentives at

the other end, so that some of the doctors at the other end of the

scale might consider — those who are tired now and perhaps would like

to get out of practice...? Perhaps there should be some consideration

given at the other end of the scale, not just to the heavy-handed

measures on the young ones who are coming in.

So, Mr. Speaker, we have a number of concerns, primarily from the

point of view of this heavy-handed statism approach, this move to limit

the civil liberties of one sector of our society, the physicians of

this province. It's a fact that if this bill goes through, those basic

things are going to take place in the province of British Columbia.

That is why, Mr. Speaker, I have started off this debate today with

some of those basic concerns. A number of others on the floor in the

official opposition who also have concerns dealing with these aspects

and with others want to follow me. So I would hope that the minister

will pay due attention to our concerns and realize that here is a bill

which is not really going to solve his basic problem. That is the

issue. We ask him to withdraw that bill and maybe set up a committee

involving even.... He may make a face at this: why not involve some of

the MLAs?

MR. MACDONALD: Even the public.

MRS. DAILLY: Even the public might be interested, and the

MLAs who are supposed to represent the public. Why have you never

invited us to assist in this? If you're not getting any help otherwise,

we're here. We would much prefer to be sitting down working positively

on this with you, Mr. Minister, than having to stand up here and have

thrown at us a bill which to our minds is a simplistic, heavy-handed

approach that will not work.

MR. LEA: Like the official opposition, I will not be voting

for this bill, but possibly not for the same reasons. I don't believe

that the minister is trying to destroy medicare. I don't think that's

his intention at all. I don't think he is the harbinger of the forces

of fascist evil, trying to make the doctors run on time. I'm not going

to vote for the bill because I don't think it'll work. I think probably

the minister has some doubts in that direction.

The official opposition pointed out that the government has been in

power for a lot of years and they don't seem to have an answer to this

problem. I found it amusing in a way that the official opposition has

been in opposition longer than the government's been in power and they

don't seem to have a position either, except to read out some possible

positions written by someone else. But let's not commit ourselves to a

position on this issue, because it may not turn out to be where all the

votes are.

Mr. Speaker, I don't know whether we have a problem of too many

doctors, but I agree that we have a problem in where doctors live and

practise in the province — obviously in the urban areas, the more

desirable areas to live, in some people's minds; not in all, but in

some. They'd like to live in Victoria. The minister read out some

statistics in terms of doctor-population ratio that make you wonder

who's going to

[ Page 6230 ]

the doctor and how often if a doctor can make the

kind of money they seem to make out of 300 patients each — or even less

if it's per patient to doctor to population.

Probably one of the problems we have is that we don't have a

ministry of health in this province, or in any other. We have

ministries of sickness as opposed to ministries of health. We don't pay

nearly enough attention to preventive health care. We don't pay nearly

enough attention to those areas where we could reduce the need for the

kind of medical services that we supply now. But the incentive system

is one that I think could possibly work.

Why is it not possible to negotiate remote and urban areas of the

province with the doctors, and to pay the doctors a higher fee for

service in the remote areas? Would we not be getting the same desired

effect? Wouldn't we then be using an incentive system to have doctors

move out of the urban area into the rural area, the incentive being

that they can make more money if they go to the rural area? That seems

to be an incentive that works for the rest of us. Why isn't it good

enough for the doctors? I suspect that it is. I suspect that if you sat

down with the medical profession and negotiated that kind of package,

it would be possible to have fruitful negotiations and reach a

conclusion that would leave everybody maybe not completely happy, but a

consensus that could be worked into the future.

Another area where we could consider an incentive program is the

student going to medical school. If a student wanted, sign a contract

that after completion of studies and internship they would serve a

certain period of time in a remote area of the province, the trade-off

being that the government or the people of the province would help that

student in terms of money getting the medical degree; but for that help

they would owe the people of the province a certain term of years in a

remote area. I suspect that many of them, after they had practised

there for a while, wouldn't even want to come back to the urban area.

It would be a system of getting them out there to see what they think

of more rural living.

So there are two incentive programs, Mr. Speaker. One is the

incentive program in the training itself: that there would be more help

from the taxpayer for those medical students who would sign a contract

to spend a certain amount of years in the rural or remote areas of the

province. A double-fee system; possibly even a triple-fee system. You

could have remote, rural and urban fee systems. But it would be an

incentive system.

A number of times the minister used the words "manpower control, "

and I think that's the problem. We're trying to control the

dispersement of the manpower instead of using an incentive system and

allowing doctors to practise where they want. I thought the minister

used a very bad example to make his point, and I think he'd probably

agree with me.

If you're a doctor in the system now and you move, say, to a place

like Terrace, what if you're fully licensed and you have a medical

number, but you can't get hospital privileges? When you start looking

behind the scenes at why some of those doctors don't get hospital

privileges, it's not based so much on manpower as who has the heavy

investment in what medical clinic in town. It's sort of like the island

mentality. You live on the island and the population is always one

short until you arrive, then it's just right and you don't want any

more.

That happens in a number of small communities. A few doctors have

operated in the community for some time. They feel that the ratio is

just right and they want to keep it that way. Instead of examining

whether someone should have hospital privileges just based on their

qualifications, they base it oftentimes on their own economic problems

they may have. They want to keep their income up to pay off debts.

That's happened, and I know of that.

What will work? Can you, in a centralized way, pass a piece of

legislation that does not meet the general will of the people that are

going to be governed by that legislation? Can you have a cooperative,

harmonious society if you do it that way? I don't feel qualified to

speak on the legal niceties of whether it meets the terms of the

Charter. But I do know that the only way things will work is if there

is a negotiated consensus around which people can work. You can't lay a

heavy on them and expect people to work productively and happily and

harmoniously in society. It doesn't work that way.

The incentive system is the only system that we can use. We don't

apply this same standard to lawyers. We don't apply this same standard

to any other profession that I know of, but we're singling out the

doctors. Admittedly, it's a problem. The question that we're debating

in the Legislature today is how to resolve the problem. Do we do it by

a centralized government saying: "You are going to get a billing

number, and you aren't because of where you live"?

The minister's absolutely right in terms of mobility. The doctor can

live anywhere he wants. The problem is, can the doctor make a living,

or does he have an opportunity to compete to make a living? That's what

this act will remove — the opportunity for a fully qualified doctor, a

resident of B.C., possibly born and educated in B.C., who will not be

able to get a billing number to practise medicine. In that way, you do

take away choice from patients, from citizens, because you may want to

go to a doctor who doesn't have a billing number but is practising, and

you can't afford to pay the fee if he doesn't have a billing number. So

freedom of mobility may not be the question. The freedom to make a

living and the freedom of choice of patients is affected, though.

I have a feeling that if you went to the incentive method, both in

the training field and the requirement that you owe the people of

British Columbia a certain amount of time in a rural or remote area....

The incentive program of a double- or triple-fee system for doctors

could mean that urban doctors may get less than they get now because

you don't want to raise the aggregate in terms of the medical system.

That may be a fact. It might mean urban doctors would get less and

rural doctors would get more.

But at least it would be a consensus; at least it would be workable;

at least it's something that could meet the general will; at least it

would fit into the democratic model. It would not leave a society

behind it strewn with hard feelings and a lack of proper attitude. It

would leave a happy society. I think we could go that way, and when the

minister closes I'd like to ask him to express his opinion. He's

probably been working with this more closely than the rest of us.

Have these kinds of approaches been taken with the British Columbia

Medical Association — the incentive system both at the school level or

university level and the number of fee systems between rural, remote

and urban? Has that been a discussion between government and the

medical profession? Have they turned it down? Have they said they won't

discuss it? It seems that all of those avenues should be taken before

we come in with a bill that's going to take away the

[ Page 6231 ]

opportunity for some people to practise medicine in this province.

I think that the marketplace would sort it out. It wouldn't be very

long before there would be people saying: "Well, I'm not going to

medical school, because you can't make a living at it." It would sort

itself out. People aren't going to continue to go to medical school

when they know that there's a glut on the market and they can't make a

living. The marketplace would sort it out. The patient preference would

sort it out, as opposed to government sorting it out for the citizens

and for the medical profession.

So I'll be voting against the bill. I'd actually like to see the

minister withdraw the bill, go back to the bargaining table and sort it

out that way. In the end it's the only way that it's going to work for

the doctors and for the patients and for all of the citizens of this

province. You cannot legislate this; it has to be negotiated.

[3:30]

MR. MACDONALD: Mr. Speaker, I support what the member for

Burnaby North (Mrs. Dailly) has said: that it is very unjust that young

people should go through medical school for five years and then have

the province of British Columbia tell them that, even though they're

qualified, they may not practise their trade — and do that by

legislation. The minister says: "Well, it won't work out that way." But

I think that everyone who qualifies has a right to practise their

trade. It's a denial of civil liberties.

HON. MR. NIELSEN: They can all practise in Vancouver?

MR. MACDONALD: No, no.

What the minister is doing in this bill is presenting a smokescreen,

under the pretence that he is controlling manpower, when the real

problem is that the costs of the Medical Plan have spiralled out of

control under his administration in the last seven years. The answer

that he comes up with in this legislation is not going to solve the

basic problem, which is medical costs. We should ask the real Jim

Nielsen to please stand up. He comes on before the people of British

Columbia as a stem fighter for restraint against the demands of the

medical profession for more money. In fact, Mr. Speaker, that minister

has been shovelling money in the hundreds of millions out of the back

of the truck to doctors.His real face is Mr. Giveaway; his make-believe face is Mr.

Restraint. You might wonder why anyone with two faces would use the one

we're looking at.

MR. WILLIAMS: Unkind!

MR. MACDONALD: I want to give the figures. The figures don't

lie. The legislation is not addressing this problem, and it should be.

Fee-for-service payments to the roughly — and I'll come back to the

exact figures....The Medical Plan are very cooperative in this respect,

as they should be. I commend their work and their dedication — all of

them. Fee-for-service payments to the roughly 5,000 doctors in British

Columbia have risen exponentially every year in the last seven, and

they are still rising. In 1978-79, from tax and premium dollars of the

people of British Columbia, the Medical Plan paid $321,524,000 in fees

for service. By 1984-85 — the figures have just come in — these

fee-for-service payments had risen to $752,463,000, which is

considerably more than double. In one recession year, when speeches

were ringing in this Legislature about how teachers, wage-earners and

all the other people in the province of British Columbia should be

pulling in their belts, Medical Plan pay-outs to our doctors increased

by $142 million, which on average per doctor in gross sums was $28,000

for each of them in that one year. So it's very obvious, Mr. Speaker,

that some have been under more restraint than others.

"Well," you say, looking at those figures, "does it matter,

when there has been no increase whatsoever in social assistance rates and people

are suffering in terms of basic things like good food?" It does matter.

The same dollar can't go everywhere. Does it matter, when in the case of

transit, as my colleague from Vancouver East (Mr. Williams) pointed out, the

transit subsidy has been reduced since 1982-83 from $91 million to $72 million,

a reduction affecting thousands of people — poor people to be sure? I don't

blame the doctors for asking for more, like Oliver Twist. I don't know any

group in the province of British Columbia that doesn't ask for more. I blame

the minister for fiscal mismanagement. However, some groups are more influential

than others. I guess the old working-class tune from Great Britain is unfortunately

still true today: "It's the rich what gets the gravy, it's the

poor what gets the blame."

Many doctors, including my own, work very hard and well for a very

reasonable income. Yet there are far too many who are making $200,000,

$300,000, $400,000 and $500,000 in gross payments — and I'll come to

the matter of overheads in a moment — and that's far too much public

money that has flown out under this particular minister. Can you

imagine a doctor who is worth four times as much as the Premier of

British Columbia?

AN HON. MEMBER: Yes.

MR. MACDONALD: Oh, you can? I guess several people can.

The number of doctors could perhaps be given a little more exactly

with the figures I've got. The last precise count was 2,335 general

practitioners and 1,661 specialists. Then there are part-time doctors,

who are classified as those who work part-time and gross less than

$30,000 a year, bringing the present total of doctors up to 5,351.

The minister is quite right in saying that there are more qualified

doctors who want to be able to work in medicine in British Columbia and

build a plan. And why not? Under that minister the

schedule of medical

fees is 32 percent above the Canadian average. The doctors I have

mentioned, who are perfectly good citizens of the province of British

Columbia — and hard-working and capable — have nevertheless received an

average extra payment from the Medical Plan of $86,000 a year in the

last seven years. So of course you're going to have a surplus of

medical manpower. But, Mr. Speaker, the problem is costs, and the

government is not addressing that.

The member for Burnaby North is quite right: you can't let young

people go through school, with areas of the province desperately

needing doctors and not getting proper medical service, and then deny

them the right to practise their profession.

Interjection.

[ Page 6232 ]

MR. MACDONALD: Well, yes. But under this bill, Mr. Minister,

if the problem is manpower and not costs — which it isn't, and the

minister should know that — you and your appointees will have the power

to grant or withhold billing numbers. You shouldn't have that. You

shouldn't be able to deny the carpenter the use of his last; the state

shouldn't be here to deny anybody the right to practise a profession

such as medicine — or law — when they're qualified and have spent money

going through medical school. As the member for Burnaby North says,

it's a denial of a basic civil right, and the wrong solution to the

problem that I have enunciated. In this respect, Chief Justice

McEachern was quite right: under the Charter of Rights you can't deny a

qualified person the right to move or practise his or her profession.

There is a crying need in many parts of the province for medical assistance, for medical doctors who have....

Interjection.

MR. MACDONALD: Yes, let the member for Atlin (Mr. Passarell) get to his feet and tell us about areas where those doctors are needed.

Interjection.

MR. MACDONALD: Under your control. You say that, eh? Legislation gives you the power to cut it off.

The real cost drain remains, notwithstanding this panacea that has

been offered by the minister. Cutting back on the number of new doctors

won't solve it. There are better, more cost-effective ways to deliver

medical care, and the minister hasn't taken them seriously at all.

There should be, beginning in areas which have that need for medical

care which is not being met, community clinics with salaried doctors

and paramedical help under the Medical Plan. The fee for service must

begin to give way to a fair annual payment to doctors for the care of a

patient.

AN HON. MEMBER: A salary.

MR. MACDONALD: I'm not talking about a salary there, Mr.

Minister. You misunderstand me. My own good doctor, for looking after

me, would receive so much a year. And if he kept me healthy and on my

feet, he would make as much or more money, and he would have more time

to spend with his family. Because today my doctor — who is Dr. Henry

Chong, and is a very good doctor — works very hard, and his family life

is almost nonexistent, with a holiday of ten days. That's not right;

even from the standpoint of the people working in the profession it's

not right.

Mr. Speaker, there are better ways in which we can service those

areas that need medical care. In the estimates the minister and I

talked about a Dr. M. Fisher, who's on Main Street. He made, gross....

You know, the overhead costs are carefully hidden. We don't see them.

The doctors talk about a Price, Waterhouse report, but they won't show

it to the public. They say it's 40 percent — that overhead is 40

percent of what they take in. Well, I think there could be some offices

where it is 40 percent, but in most cases it must be much less,

particularly as you go.... Well, take a surgeon who's making $300,000

from the plan, and he has a reception office and works out of the

hospital. Is his overhead 40 percent? Of course it's nothing like it.

So take our friend Dr. Fisher, who received from the plan, with a

very small office, $496,000 last year for dispensing mostly Valium. My

friend from Prince Rupert says: give him an incentive plan, and he'll

go north and dispense Valium to the people in the northern areas of the

province of British Columbia. So what would we do — instead of

$496,000, we double that, in his case, to try and persuade him to

leave? I doubt if he would.

That's not the way to go. You've got to provide the alternative

ways, along with the fee-for-service for the time being at least, of

delivering effective medical care — the best available — at a proper

cost to the public, and stop this spiralling out of control of medical

costs. If you did adopt an alternative such as I've been suggesting,

there would be an incentive to keep people well and a disincentive to

treatment.

MR. PASSARELL: Mr. Speaker, I'd like to discuss my own

constituency a little, and why I will be supporting this bill today. In

the community of Atlin we have no doctor. There are 350 people there in

the winter, maybe a little less. In the summer it can get up to 600. We

have a doctor who comes down from Whitehorse in the Yukon Territory. He

has recreational property in Atlin. That's one of the reasons why he

comes down. But when he comes down he puts a flag up — runs up a blue

flag — that there is a doctor in town. This doctor, who has come to his

recreational property in Atlin, informs the community that there is a

doctor in the vicinity. He could be out on the lake fishing ten miles

from Atlin. He could be hiking in the mountains 40 miles from Atlin. He

puts a flag up.

I wonder how many people in this Legislature would want their

constituents — and I talk about the mainland MLAs — to have health care

provided in their communities by putting a flag up to inform people

that there is a doctor in the vicinity. That's a shame, Mr. Speaker,

because we're talking about 1985; we're not talking about Canada in the

1700s.

[3:45]

Hundreds of years ago the Hudson's Bay Company used to raise a flag.

They raised a flag when there was rum, when the rum shipment came into

town, In Atlin we have a flag raised when there's a doctor in town.

Parents, when their children are hurt, or a grandfather or someone in

their immediate family.... When they're hurt and they have to go see a

doctor, sometimes they have to drive hundreds of miles — sometimes even

outside the province — to see a doctor. Cassiar, which is the biggest

community in the constituency of Atlin, has a doctor there. He is

supported by the company of Cassiar Brinco, which encourages having a

doctor in the facility. At one time, not too long ago, it used to be

called a private hospital.

But I have 12 communities out of the 17 communities that I represent

— 25 percent of this province — that do not have doctors: Atlin, Lower

Post, Good Hope Lake, Telegraph Creek, Iskut, Eddontenajon, Bob Quinn

Lake, Meziadin, Nass Camp, Greenville, Canyon City and Kincolith. The

people have to rely on RNs, nurses, who provide excellent service to

those residents in the far north. I'll never fault an RN for the

services that they've performed in lieu of a doctor in the far north.

AN HON. MEMBER: Do they deliver babies?

MR. PASSARELL: Nurses are the major health care functionary in the far north. They provide more service than

[ Page 6233 ]

doctors ever will in the far north. I've received

numerous letters from constituents, people that I know personally,

about complaints regarding the lack of GPs in the far north. The

responsibility falls upon the RNs, or LPNs in some cases. Mr. Speaker,

it's not the same to have to go to a RN if your son or daughter is in a

life-or-death struggle. I'm not faulting the RNs, as I said previously.

When you're talking about a member of your own family in a

life-or-death struggle, it's just not the same not to be able to see a

doctor.

I get a kick out of these doctors. They're the highest-paid

employees in the country, with salaries coming close to $100,000, and

the taxpayers of British Columbia and Canada pay for these salaries.

I graduated as a teacher. Let's say that when I got my degree, I got

a billing number. It was called a certificate at the time, and it was

signed by the Hon. Eileen Dailly. I'm very proud of that. She was the

Minister of Education. But let's say I received a number. I cannot go

to a school board in Vancouver or Victoria and say: "Hey, I got my

certificate. Give me a job." It's not the same. There are other

professions similar to that. Why should doctors have the exclusive

privilege, once they have their number, of saying they can practise in

Vancouver? It's like a God-given right to them.

I also get upset with doctors who believe that they are a privileged

class. I know that we would never bring politics onto the floor of this

Legislature and talk about class distinctions, but the doctors look

upon themselves as a certain class in society, dictating to the rest of

us how much they should make, where they should practise and how long

they should work. I'm tired of that. My taxes pay for these people.

Those 12 communities that I represent have the right to see a doctor

once in a while. They should not have to wait until a flag is raised in

the community of Atlin to be able to see a doctor, who is coming down

from Whitehorse to his recreational property.

The B.C. Medical Association opposes Bill 41 because of the Charter

of Rights. If there had been a Charter of Rights in the 1940s, when the

first CCF government brought in socialized medicine in the province of

Saskatchewan — and the CCF stood their ground on this — we probably

never would have had socialized medicine in this country. We would have

a situation similar to that in the United States, where the rich can

afford medical assistance and the poor become second-class citizens and

have to go to special hospitals. Of course the CCF government at that

time faced hostilities from doctors. There were statements made then

that were very similar to those made by Dr. Karr in this morning's

paper. It's been a principle of the NDP to stand for the basic rights

of human beings to have health care in this country.

As I mentioned, Dr. Karr is president of the doctors. He stated that

they acknowledge that B.C. has more doctors than any other province.

That's fine. I think many speakers today have mentioned that. But where

are they? They stay in Vancouver, Victoria and the lower mainland. Dr.

Karr said that doctors would avoid practising in remote areas of

British Columbia for fear of being locked in. Locked in? When I was a

teacher, did I feel that I was being locked in because I went up to

Good Hope Lake to provide education to children? What are these doctors

talking about?

Isn't it their job to provide health care to any individual in this

province regardless of what their colour is, what their race is or

where they live? How can they say they're going to be locked in? That's

bunk. I think any doctor who would make a statement like that should

scrutinize his thoughts again. Locked in. They might have to go up and

work three months or six months in the north, where residents have not

been able to see a doctor.

He goes on further, and this is the point that really gets my goat.

He threatens northerners when he says that they will fight what they

see as being a direct threat to the health of the people in British

Columbia. It is a threat, saying that he's going to oppose this bill

because it's a threat to the health of the people of B.C.

These words were used before in different situations, in different

historical contexts. They used it against the CCF — the NDP — in

Saskatchewan. They've used it at times when other provinces started to

bring in socialized medicine.

We in the north aren't expecting anything special. We're not

expecting the government to come out and say: "We're going to bring all

these new doctors up into the Atlin constituency." We just want the

health care that people on the mainland take for granted. We pay the

same medical fees and the same taxes. Why can't we have the same

services? We're not asking for a big hospital to be built in these 12

communities that I mentioned, but why not allow some doctors to come up

there? If they don't like it, they're not going to be locked in. A

teacher is not locked in because he comes up north to teach for a few

years. They might gain some experience that they'd never gain by

sitting in a city. They might enjoy some lifestyle that northerners

have, that we take by choice and not because we live in the cozy

confines of Vancouver.

I don't think, Mr. Speaker, that anybody's naive enough to think

that this bill is automatically going to make a change overnight, and

that once the government and the opposition vote on this, doctors are

going to rush up north; but it's a start, I believe. I'm talking not

because of party policies or because I'm an NDPer, but because I

believe, in my conscience, that I have to support this bill. I'm not

selling out my party principles, and I'm not selling out philosophical

beliefs that I have grown up with and that my parents have taught me. I

seriously believe that we have to start stepping on these doctors when

they start taking the north for granted and making statements in the

paper threatening people by saying: "If you pass this bill, we won't go

up north; it'll force us to stay in the cities."

I propose a number of resolutions or issues that doctors should be

addressing. The first one: these employees of the government... They

receive their salaries because of our taxes, so more or less they are

employees of the government. They're the highest paid employees of the

government service across Canada. I propose that 3 percent of their

gross salaries a year go to help finance a flying doctor service that's

similar to the one in Australia. If you're making $100,000 a year when

there are more and more people standing in food banks, I think you can

donate 3 percent of your salary out of $100,000 to go up north and

provide some medical assistance. They might learn something, because

they're going to see people who really appreciate their services.

Secondly, I'd like to see — to go along with number one that doctors

donate five days a year for service in the north to provide medical

assistance. Five days a year; they can take it on a holiday, and write

it off on income tax if they want to. Most of them are private

corporations anyway; they probably can find out some way to write it

off. Lawyers provide services in legal aid aspects; why can't doctors

get out of the mainland, and come up and provide some kind of health

care?

[ Page 6234 ]

When I was talking about the wealth from the taxpayers — how they

gain their large increases in salaries — let's talk about Dr. Jory. He

used to be president of the B.C. Medical Association. He got his hands

and wrists slapped a few years ago. He lives, Mr. Speaker, half the

year in England, in a castle or in some....

HON. MEMBER: Magic pumpkin.

MR. PASSARELL: Yes. His children go to a private school in

England. But where does he make his money — by working six months in

the province of British Columbia. The way I look at it, Mr. Speaker, if

our money is good enough to pay his salary, our province is good enough

for him to live in, too.

I'd also like to see doctors hold province-wide hearings — and not

by just going up to Prince George and then getting on the first

available commercial aircraft and flying back to Vancouver the next

morning. They should come up in the fall and winter of this year and

drive around in a vehicle. I know they won't be able to use my

motorcycle, but I think we could find them some accommodation to get

around in the far north, hold some kind of province-wide hearings there

and listen to the concerns that rural residents have and the problems

that they have faced year after year by not having doctors in the far

north. They would see exactly what the people feel about the profession

of the doctors, because, in essence, we all pay their salaries. They

have to come and talk to us and find out exactly what our concerns are.

Another idea that I'd like to see is that the pay difference that

B.C. taxpayers pay to doctors — between a specialist and a GP — be

restricted. There is a big gap between what GPs get and what

specialists get, and I would like to see that restricted.

Mr. Speaker, I'm proud to belong to a political party that allows me

to stand on the floor of the Legislature and say what I believe in, and

not to be held back because of a doctrine, as I've seen in the six

years that I've been an MLA. The doctrine of some political parties

will not allow an individual to stand and say what they feel they

should be saying. I'm proud that the New Democratic Party and my caucus

members have allowed me the opportunity to stand and do this. I don't

follow the beat of the same drum of a lot of individuals. People can

label me as they wish, but I have the concerns, I think........ I'm not

anything special. I'm just a person who has been elected, and I try to

listen to what other people tell me. I listen to the voices and the

concerns and the wishes and the dreams and the aspirations of people up

north, who desire to be treated equally, not specially — not a special

class, not a special privilege, as the doctors look upon themselves,

but to be treated equally. I think any of us who live in the far north

want to be treated equally. We want medical assistance by doctors. Let

them come up north. If this bill doesn't work, I'm going to be the

first one up on this floor attacking the hon. minister. But I will be

putting my name behind the government today, or tomorrow, supporting

this bill, because my conscience cannot allow me to support what

doctors have done to make us second-class citizens in the far north.

[4:00]

HON. MR. McGEER: Mr. Speaker, I rise to support the bill, but

particularly the remarks made by the member for Atlin (Mr. Passarell).

He makes clear, of course, that he is not supported by the New

Democratic Party in that respect. We have a rather different philosophy

from the party's, which I conclude would become their policy were they

to become government.

[Mr. Strachan in the chair.]

The point which the member for Atlin makes, and the one which he

himself has demonstrated by example, is individual rights — i.e.

patients' rights — over professional rights. When we support programs

like medicare, we support those for the benefit of the patient, not for

the benefit of the doctor. When human rights have to be considered, the

human rights of the patient must be those that come first. But in the

official position of the New Democratic Party that principle has not

emerged. That, I take it, is the dilemma of a party which claims to

represent the common man, but repeatedly in this House turns up

defending the vested interest.

The first member for Vancouver East (Mr. Macdonald), who just left

this chamber, drew attention to the Charter of Rights, but he also drew

attention to the cost of medicare, pointing out that this has to be an

issue involving every citizen of British Columbia; they pay the taxes.

Do they get value for the taxes that they pay in Atlin, where there are

no doctors? What use is an insurance scheme, supported by taxes, to the

people of Atlin? "Well, " says the member for Burnaby North (Mrs.

Dailly), "you offer an incentive." But, Mr. Speaker, that is precisely

what was done in British Columbia, by giving an average fee for service

— demanded by the doctors and defended by the NDP — of 32 percent above

the national average. That incentive worked: the doctors did come to

British Columbia.

I'll tell you where a large group came from: they came from the

United Kingdom, in some years 100 physicians a year, a number of

physicians that we have yet to graduate from our medical school in

British Columbia. Why? Because in Great Britain they had the very

per-capita system that the first member for Vancouver East advocates

that we introduce into British Columbia. I suppose that were the NDP in

power and to bring what I take it is the official position of the NDP

and therefore the policy of the programs they would introduce, that

would solve the physician supply. A per-capita program here, even if it

could be introduced with federal legislation, would soon cause the

physicians to leave, perhaps many of them to go back to Great Britain.

But that system has not only worked out poorly for the physicians so

that they want to emigrate and naturally come to the place that offers

the highest fees schedule; it's not worked out terribly well for the

patient either.

I'll tell you what a lot of the physicians do in the United Kingdom.

I've talked to them after they've come to British Columbia, and what

they do is this. They're paid so much per capita to keep you well. It

might be the Minister of Health. He's got a problem with his back now,

so you scratch him off your list. You just go through the list every

six months, and anybody who's sick a lot gets scratched off the list,

and then there is lots of time to play golf. But that's the system

proven to work in this fashion; that's the system the New Democratic

Party wants to introduce into British Columbia. That's how they intend

to get medical services to the ill in this province. That's not going

to solve the problem of the member for Atlin.

The member for Burnaby North, who led off criticizing the government in this debate and for this bill and decried the

[ Page 6235 ]

fact that British Columbia graduates were not

receiving billing numbers from the Medical Services Commission,

neglected to tell the chamber one thing: every single person who

applied was offered a billing number if only they would go to the areas

that needed physicians. But they didn't go to Atlin; they didn't go to

Smithers; they didn't go to Stewart. They went to court. They went to

court for their right to 32 percent higher average fees than anywhere

else in Canada and the amenities of urban living. You're defending that

when you vote against the bill, and you're saying you approve of that.

You want the physicians to go to court instead of going to Atlin. Only

one of your members will stand up and say: "People should go to Atlin

and not go to court."

MR. VEITCH: He's a good member.

HON. MR. McGEER: He's a good member, because he's been where

there are no physicians. He pays his taxes. He belongs to the insurance

scheme, as do the constituents up there who support your party. Have

you got a policy that will bring them medical services? No, sir, you

haven't. All you have a policy of doing is attacking the government and

supporting the vested interests. You say it's the human right of the

doctor to go to court and demand the right to be the one more physician

in the city of Victoria; if anybody comes up with a policy that will

send that physician or encourage him to go to Atlin, that has to be

attacked as unfair. That's what your members have said — all of you.

Read what you said in Hansard and then you'll know that the New

Democratic Party is bankrupt of policy, even when you have a member who

describes to you the problem and says: "Solve it in my area." Not one

of you can do that. You should be ashamed of yourselves. You've only

got one person in your caucus who speaks for the average citizen, and

he has to come almost and apologize to you in this House for letting

him speak out on behalf of citizens in Atlin. What kind of a party is

that? What kind of a party is it, Mr. Speaker, that would harbour this

sort of thing?

While we're on the subject of human rights, which you've been

championing over there, I want to say that the physician who isn't

obligated to serve an underserviced area, who wants to bring health

services to the most overdoctored area in Canada at premium cost to the

taxpayers of this province.... We've got another problem with human

rights if that's going to be the cornerstone. Why should that extra

physician, if he's entitled to a billing number, not be entitled to go

onto the medical staff of the hospital of his choice? Why shouldn't he

be a member of the medical staff at the Royal Jubilee Hospital or the

Vancouver General Hospital if he wants and he has patients who need

medical service? That extra billing number might get the Minister of

Health with his bad back, and the physician might say: "You need an

operation." Can he get a hospital bed, which is supported by the

taxpayers — same medicare system that you people here are saying

entitles that physician to the number? It doesn't entitle him to a

hospital bed, and if you're his patient it doesn't entitle you to get

that tax-supported hospital bed. No, sir. That goes to the physician

who wants to protect the system of unrestricted billing numbers and

also wants to protect the system of privileges in individual hospitals.

I want to tell you that what the minister is doing, Mr. Speaker, is bringing

patient rights to British Columbia, and you people over there in the official

opposition — the member for Burnaby North and the first member for Vancouver

East — and, I'm sorry to say, the member for Prince Rupert are not supporting

patient rights. You're supporting vested interests, as you always do in

that party. I don't care whether it's the labour unions or the doctors'

unions or the teachers' union. Yes, sir, if it's a union and a special

interest you can count on the NDP support. They're always for special privileges

for some. They're never, despite all the verbiage in this House, for equal

rights for all.

No, the New Democratic Party shouldn't be listening to the bill or

to the minister or to me. The New Democratic Party should be listening

to their conscience, represented by the member for Atlin. We're going

to vote on this bill, and I think this will be a day of infamy for the

New Democratic Party.

MR. HANSON: Mr. Speaker, I happen to think that it's ironic

that that Universities minister would take his place in this debate on

this bill when British Columbia is at the absolute bottom in all of

Canada in terms of training university people. We happen to rank tenth

in the production of university graduates in all of Canada.

DEPUTY SPEAKER: Hon. member....

MR. HANSON: Mr. Speaker, I'm getting to my point. The point

is that that minister took his place and made a spurious speech when

the Black report of 1979 suggested that the remedy to this pressing

problem — and there's no doubt on this side of the House that it is a

problem — was that a comprehensive incentive program, including bursary

loans, community grants, housing and educational grants, be instituted

to encourage physicians to underserviced areas. Yet that minister in

charge of bursaries and loans has stripped British Columbia to the

lowest level in all of Canada for university training. For him to stand

up in this House and take the spurious line we just heard is an

absolute disgrace. Mr. Speaker, please dismiss his speech entirely.

It is not the first time that this government has addressed a health

or social problem by stripping away liberties. That course of action

has been taken on a number of occasions. It has always failed; it has

always been costly; and it has always been pointed out by this side of

the House that it was a foolish course.

Mr. Speaker, do you recall the heroin treatment program championed by the member

for Langley (Hon. Mr. McClelland)? It cost the taxpayers of this province millions

of dollars: millions of dollars of lost money on a program that stripped away

liberties, was struck down by the courts and cost the taxpayers a fortune. It

didn't work, and we pointed it out at the beginning. This is the same thing.

The chief justice of the supreme court said a number of things in

his judgment on the Bill 50 question, and I believe that those remarks

should be outlined again.

[4:15]

Interjection.

MR. HANSON: It was on the practitioners' case; thank you.

I think it's important that all members of the House know the major points that he stressed in his conclusions. He said:

"It is inconceivable that the Charter of Rights and

Freedoms could assure the right to pursue the lawful gaining of a

livelihood in any province, only to have

[ Page 6236 ]

that right limited within a province. I have

considered, but rejected, the suggestion that the Charter only

guarantees mobility between provinces but does not guarantee free

movement within a province."

What we have before us is a make-work project for lawyers. It's a

political bill; it has nothing to do with addressing the so-called — in

their terms — manpower question. We don't dispute the fact that there's

a maldistribution of physicians in the province, and that there's a

serious problem pointed out by the member for Atlin (Mr. Passarell) and

other members in this House from outside of metropolitan Vancouver and

greater Victoria. There is no question that there's a maldistribution

in the quality of health care delivery in British Columbia. We don't

dispute that fact.

But this is the wrong way to deal with it. It's the wrong way to

deal with it because it will not work; it cuts away at fundamental

liberties which will be struck down in the courts, which will cost a

fortune in tax dollars, rather than address the fundamental questions

that could be addressed as follows.

Mr. Speaker, I have heard Dr. David Suzuki on a number of occasions,

and he is very concerned about this question of the mutual

responsibilities in taxpayers or citizens of a province financing the

education of needed professionals, and having those professionals

perhaps leave the country or not provide services that should be

required. His argument is this. For every physician trained in a

medical school there are five equally qualified citizens that for one

reason or another are not admitted or cannot afford, or whatever, to go

to medical school. There should be a program whereby students that have

the ability, that have the qualifications to undertake medical

training, should get full support from the province.

In exchange — I'm talking about students that would participate in

the following program for financial reasons, where they are not able to

pursue a medical education — they would undertake in a contractual way

with the province to guarantee service for a certain time period, for a

term certain, in an underserviced area of the province in exchange for

full funding, full bursaries, etc. In other words, the educational

payments in tuition and books would be provided in exchange for an

undertaking of service after graduation, after becoming fully

qualified. That would be one prong. Secondly, there should be a full

incentive program as pointed out by Mr. Black in 1979 — the

comprehensive incentive program including bursary loans, community

grants, housing, educational grants and so on — to meet the kinds of

legitimate concerns and needs that do exist.

But what we have is a government that is willing to strip away

fundamental liberties to try and address a social or administrative

problem. It does not work. It is going to cost us more money in the

long run. There is no doubt about that. Just as the heroin treatment

program was a failure, this bill and its contents will also be a

failure. It will be a make-work project for lawyers and will cost the

taxpayers of this province an incredible amount of money.

Let's just look, for example, at the tradition where the young,

talented, innovative doctors who are just graduating now from the

universities.... They are being told that their liberties are gone, and

they will not be entitled to billing numbers. Rather than taking a

positive approach whereby the ministry could sit down with the medical

schools, with the different agencies involved, and work out an

incentive program that would mobilize doctors and talents into the

regions as required, we get the traditional Socred punitive response,

which is doomed to failure.

So who will suffer? We maintain, Mr. Speaker, that many of the young

and talented physicians that are presently graduating and coming up for

application of billing numbers will leave the province, after the

people of this province have financed their education, because the

government is not willing to pursue a positive, negotiated settlement

to a serious social and health administration problem. This is just

coercion and a punitive approach that doesn't work. They constantly

have to prove that they are the toughest — not that they are the most

skilled negotiators, not that they are willing to sit down and meet

individuals and respect their fundamental liberties and come to a

negotiated settlement on any matter. No, it's a matter of they know

best, and they'll do it by legislation.

The people of the north and the people in remote areas are going to

suffer, because this will not encourage doctors into those areas. We're

going to be facing legal fights and so on. Let me read a little bit

more from Mr. McEachern's conclusions in his Supreme Court decision. He

said:

"Our history shows that restrictions on movement for

purposes of employment were, short of imprisonment, the most severe

deprivation of freedom and liberty. This is demonstrated by a brief

glance at history."

He goes through the development of law in this area:

"I have no doubt that freedom of movement within the

province for the purpose of lawful employment or enterprise or for the

practice of a profession, trade or calling by qualified persons in any

community is indeed a right, properly embraced within the rubric of

liberty."

He's saying that in our tradition over the hundreds of years of

common law, that the right to practise one's employment and freedom of

movement is a fundamental tenet of the rubric of liberty. So we know

that this bill is going to be struck down by the courts, because

restricting movement within a province is no different than restricting

movement within the country, and that is contrary to the Charter of

Rights and Freedoms. So why are we going through this exercise? We're

going through this exercise because Social Credit is now in a

pre-election mode and this is a political bill to tackle the doctors.

They're taking on the college instructors, the university instructors

and the teachers; the public sector workers have had their day in the

barrel; and now it's the doctors' turn, for political purposes.

Interjection.

MR. HANSON: Construction workers have had their turn. I'm

sorry if I've left........ The list is so extensive that I couldn't

possibly list them all.

Mr. McEachern goes on:

"A limitation on the free right to practise a

profession and a further limitation on the right of mobility within a

province are vastly more serious than other suspensions...that take

place under other legislation and have been struck down, such as

temporary suspension of a driver's licence.... Then unquestionably the

right of a member of the College of Physicians to practise medicine and

to move throughout the realm for that purpose must also be a liberty."

[ Page

6237 ]

There are more ways to deal with the problem. Mr. Speaker, it's a

sorry day when the only solution to problems in the province is the

restriction of liberties. We see it all the time: the firing of duly

elected school boards, constantly appointing your own trustees. That's

a practice that you've developed over some period of time. A hospital

board has different points of view — wipe them out and put in a

trustee; take it over.

On this side of the House we happen to think the Charter of Rights

and Freedoms is a valuable and important codifying of our rights and

freedoms, and it's very important that we be vigilant in protecting

them.

Mr. Speaker, Justice McEachern says:

"We cannot abrogate fundamental liberties that I am considering

in this case. This practice, particularly the geographical restriction on where

physicians may practise, cannot withstand any careful analysis. It offends too

seriously against fundamental rights in a free country."

So if we have this as the backdrop and the overall context of the

problem, that the courts will uphold the rights of individuals,

professionals or other occupations to move freely intraprovincially as

well as interprovincially, then we have a serious problem, because

we're going to be just spending money on court cases. The A-G's

ministry is going to be up to their eyeballs in researching and

spending the taxpayers' money on fighting on behalf of the province on

a bill that is basically wrong and a bill that basically will not work

and is ineffective.

In the meantime, what are we saying to the international medical

community? We're not saying, come and provide the best quality of

service, bring your skills and so on. We're not saying to our new young

talented doctors, come and let us sit down and discuss various

possibilities where you could provide service and the province would

deal fairly with you. We have the situation where the province and the

taxpayers have paid for their medical training and now they're going to

be attracted to other jurisdictions, go abroad or to the States or to

other parts of Canada where the freedoms are upheld, until this is

settled.

It's a denial of basic freedoms. I've made those points, Mr.

Speaker. Also, as our lead-off speaker, the member for Burnaby North

(Mrs. Dailly), indicated, it's only in the last few years where women

have entered into the medical profession in significant numbers. That

particular increase in the number of graduates just started a few years

ago, and a larger percentage of women practitioners are now coming onto

the scene. This particular group within our society is going to be

unjustly discriminated against, in addition to the restriction of their

mobility within the province, because just when they had an opportunity

to begin to practise and consider the kinds of discussions and

negotiations which could take place, their career path will be

truncated and they will start looking at other areas as well.

Mr. Speaker, it's a very sorry day when the only response of the

government to social problems, to health problems and to administration

problems is to undermine fundamental rights and liberties. Surely

that's not the way to do business. It's going to fail. It's going to

lose.

[4:30]

The Minister of Universities (Hon. Mr. McGeer) falsely accused this side of

the House of not having a program. We certainly do have a program. We would

encourage, in a positive way, through the incentive programs of Mr. Black, a

settlement in the underserviced areas of the province. We would sit down in

a consultative way, not constantly combative and looking to pick fights that

only end up with a lot of cost.

One final comment, Mr. Speaker. In Mr. McEachern's judgment he said

that categories of ins and outs — in other words, those professionals

that can be in and those that are out — are created within the

commission and the college.

"The practice works against youth and talent by

lifting the drawbridge to protect established members already within

the plan against competition, and it purports to give the commission

power to dictate where within a free country and a free province

physicians may practise and therefore where they will live. In many of

its aspects this practice is the antithesis of fundamental justice."

MR. REYNOLDS: I won't be very long, but I have to make some

comments on Bill 41, after listening in my office to the member for

Atlin (Mr. Passarell), who is going to vote for this bill. I'm amazed

that members of his own party, after listening to his explanation as to

why he would be voting for the bill, can get up and make speeches like

the one we just heard from the first member for Victoria. He talks

about how doctors are going to go to other provinces where freedoms are

upheld. He also talked in other areas of "liberty."

[Mr. Ree in the chair.]

I wonder if the first member for Victoria and other members of the

NDP caucus listen to what's happening in their party in other provinces

in Canada. I was reading a Winnipeg Free Press

article where Mr. Desjardins, who is the Minister of Health in that

province, as an NDP member, was quoted as saying: "Manitoba should have

some way of regulating where physicians practise, to ensure everyone

has access to medical care." Mr. Speaker, that's what Bill 41 is all

about. The Health minister in Manitoba agrees with Bill 41; yet we've

got NDP members in this House who are saying that it's not a good bill.

Let me give you some further quotes. The Minister of Health in Manitoba says:

"'I find it difficult that governments can't come

up with something, ' he said, adding some form of regulation must be adopted.

During debate on his department's estimates in the Legislature, Desjardins

said he was disappointed the courts ruled unconstitutional British Columbia's

policy of regulating where doctors practise by controlling their billing numbers.

He said he agreed with the policy...."

There's the Minister of Health in Manitoba, an NDP province, who

agrees with the NDP member for Atlin that Bill 41 is a good bill for

Canada, and he agrees with our Minister of Health; yet we've got NDP

members in this House getting up and giving all the reasons why they

support the doctors. It's very easy to sit there and agree with

everything and knock the government. But certainly in this bill the NDP

members should at least have some solutions to the problem, not just

knock the bill. One of their own party members, a Minister of Health in

this country, agrees with the Social Credit government in British

Columbia that Bill 41 is not only a good thing for British Columbia but

would be good for the province of Manitoba and good for all of Canada.

[ Page 6238 ]

Interjection.

MR. REYNOLDS: The Minister of Health says, "Watch and weep."

I'll bet he is weeping, because he would like to bring in the same

legislation in his province.

Another quote; I think it was the first member for Vancouver East

(Mr. Macdonald), and I'll get to some of his comments in a minute. He

talked about freedom. The Health minister in Manitoba says: "It's okay

to talk about freedom of the individual...but what about the population

in general?" Mr. Speaker, I think that's something these NDP members

here should take a look at when they're talking about Bill 41. They

should all go home tonight and read the speech from the member for

Atlin. It made a lot of sense. He talked about being a teacher. He

can't just walk in from Atlin to the city of Vancouver, and walk into

the school board. He's got a certificate, just like a doctor has his

degree. Can he walk into the school board in Vancouver and say, "Here's

my certificate; give me a job"?

There are rules and regulations. There are responsibilities that go

with certificates and with degrees. That's what this bill is all about.

The doctors have not lived up to that responsibility. It's not an easy

decision. Nobody likes to put controls on people, but in certain

segments of society, and within our society, there must be controls. In

a lot of cases we agree upon those controls. But where there can be no

agreement, you then require legislation.

I mentioned the member, with his certificate. I'm sure, because he's

got that feeling.... He's got the feeling of his constituents in the

north, who are saying to him: "How could you vote against this bill?

You know that this bill is going to help us get some medical service up

in this northern area" — as it will help get medical service in many,

many other areas.

The first member for Vancouver East talked about the freedom to

practise their profession. He related lawyers to doctors. There's a

great difference there. Certainly the lawyers have a degree, I guess,

equivalent to that of a doctor to practise their profession, and we

don't tell them where to go, but, Mr. Speaker, there's a big difference

there. The lawyers get fees for services paid for by the general public

as they need them. The taxpayer pays the doctors. There's a great

difference there. When your fees are paid by the taxpayer, the taxpayer

has to have some input as to how those fees are paid. It gets right

down....

I haven't heard any of the members of the NDP getting up complaining

about the fact that to just drive a taxicab, whether it's in the city

of Victoria or the city of Vancouver, you must have a licence and you

must have a licence to drive in a certain area. You can't just go and

buy or rent a car and decide that you're going to be a taxi. We have

regulations that say where you can and cannot drive a taxicab. I

haven't heard the NDP getting up and saying we should abolish that law

in the province of British Columbia so that a lot of people can get

jobs driving cabs. Heaven knows, with the messy, dirty cabs we've got

in the city of Vancouver, I'd love to see that law abolished so we

could get some people driving clean taxicabs there. But, Mr. Speaker,

this party of the people isn't talking about those taxi drivers, and

there are regulations there. You can't go out and buy an airplane and

start flying an airplane; the government has regulations there, and

those regulations, in most cases, are agreed upon through negotiation.

I would finish up just by saying that the College of Physicians and

Surgeons has to come to grips with this problem. This bill is going to

solve it for them, but why haven't they come to the government and

said: "We know we've got a problem in Atlin; we know we've got a

problem in rural areas; we know you only have so many dollars to spend

on health care. All of those doctors who are practising in Victoria and

Vancouver and the urban areas will take a 10 percent cut in their fees

so we can put a 10 percent increase on the fees of those doctors in the

rural areas." Why hasn't the college come with a commonsense plan like

that? They haven't done that because, I think, the college is no

different. And when you speak of the college, you're not speaking of

all the doctors, because not all the doctors necessarily agree with

that political group called the College of Physicians and Surgeons. Why

hasn't that college come? They sit with the minister. They negotiate.

They talk, but they won't put anything in writing. The simplest of

things: negotiate a different fee schedule. But, Mr. Speaker, they

won't sign up for that because it affects the pocketbooks of all of

them.

I would suggest, as I did earlier, that the members of the NDP would

do well to support this legislation. It's fair legislation. When

negotiations break down.... The member for Atlin has made it very, very

plain, and I know, and his colleagues must know, that it's never easy

to vote against your party in any parliament. It's a gut-wrenching

thing to do, but he has obviously studied the issue. He comes from an

area where he knows there's a problem and he knows this is the solution

to his problem. I would suggest, Mr. Speaker, that his colleagues

should read his speech very well and not only applaud what he's doing,

but join him when we vote on this bill and vote with the government.

MRS. WALLACE: Mr. Speaker, if I shared my colleague from

Atlin's belief that this bill would in fact bring doctors to Atlin, I

might be persuaded to support it, but I can't see that happening. What

this bill is doing is saying to new entrants into the medical

profession: "We're going to give you a life sentence. You will get a

billing number to practise in a certain place. It's only good for that.

It's not exchangeable. You can't do anything about it except stay and

practise in that place for as long as you practise medicine." That's

why it isn't working, Mr. Speaker. That's one of the main reasons why

it isn't working. And it won't work. That's what's so bad about it.

We're creating a situation here that is protecting those people who

have billing numbers, regardless of age or ability or capability, and

to all the new people we're saying: "No — unless you accept a life

sentence to go to Atlin." You may have never been in the north. You may

have no understanding of the people there.

My colleague from Victoria talked about the idea of some bursaries —

some training facilities — and that's something that's been talked

about for a long time: the need to take people from these outlying

areas, people who understand the situation and who know the people, and

give them the opportunity to become professionals in the field of

medicine so they can go back and work with the people they know and

provide the kind of service that those people have every right to

expect. It won't happen through simply setting and limiting billing

numbers.

I'm particularly concerned about the women who have been studying

medicine. In 1982 only 15 percent of the practising physicians in

Canada were women, and there was a real move to try to improve that. It

was projected that it would increase within 30 years to 40 percent as

opposed to 15

[ Page

6239 ]

percent. In fact 50 percent of medical students are now women.

Women are the historic care-givers: the midwives, the wise women of

ancient times. They have lost their role in medicine. Now they are

trying to regain it, and what's going to happen? They're not going to

get the opportunity to practise here in British Columbia, in spite of

the fact that 50 percent of those new students are now women. We're not

going to change that imbalance one little bit, because if I were a

young woman graduating in medicine I would not be prepared to accept a

life sentence to some outlying area.

What we should be doing is the bursary system, with a guarantee that

people from those areas are prepared to go back for a period of however

many years to practise medicine in that area. That's the long-term

solution. The short-term solution is community clinics. We started that

to a degree when we were in government, and it worked very well. If

this government had brought in that sort of an arrangement for the

outlying areas of the province like Atlin, and had put in community

clinics where young doctors could go for a year or two and provide the

kind of medical service that is needed, with a support staff around

them, with a clinical setup to facilitate their practices, we would

have proper medical care in those outlying areas. But without that kind

of an approach it's not happening.

[4:45]

I submit that the government is simply evading its responsibility by bringing

in this simplistic and autocratic solution to a problem that is solvable through

reason and negotiation. It's been mentioned that they've talked about

negotiating on the fee schedule, and they couldn't get anything in writing

from the doctors. That suggests to me, Mr. Speaker, that the minister has not

been ne