1991 Legislative Session: 5th Session, 34th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, JUNE 18, 1991

Afternoon Sitting

[ Page

12823 ]

CONTENTS

Routine Proceedings

Oral Questions

Provincial taxation levels. Mr. Harcourt –– 12823

Treatment of those found guilty because of insanity. Mr. Loenen –– 12823

Former executive assistant to Attorney-General. Mr. Sihota –– 12824

CLEU investigation of organized crime. Mr. Sihota –– 12824

Free trade with Mexico. Mrs. Boone –– 12824

Access to report alleging media bias against government. Mr. D'Arcy –– 12825

Ministerial Statement

Grawemeyer award in education. Hon. Mr. Dueck –– 12825

Mr. Jones

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Strachan)

On vote 38: minister's office –– 12826

Mr. Miller

Mrs. Boone

Mr. Perry

Mr. Jones

Mr. G. Janssen

Ms. A. Hagen

TUESDAY, JUNE 18, 1991

The House met at 2:03 p.m.

HON. MR. DIRKS: It is my pleasure to make three introductions

to this House. Here today are His Excellency Pedro Paulo De Moraes

Alves Machado, Ambassador of Portugal to Canada, and his wife Mrs.

Machado. Accompanying His Excellency is Mr. Miguel de Calheiros Velozo,

the consul of Portugal at Vancouver. Please join me in welcoming the

ambassador, Mrs. Machado and the consul to Victoria and this chamber.

HON. S. HAGEN: It is my pleasure to introduce two friends to

the House today: Randy Vannatter from Coquitlam and Al Goodrich from

Delta. Would the House please join me in making them welcome.

MR. CASHORE: Last week the federal Minister of the

Environment, the Hon. Jean Charest, presented an environmental

achievement award in the non-profit organization category to a British

Columbia organization, the Western Canada Wilderness Committee. He

stated that B.C.'s Western Canada Wilderness Committee is noted for its

unflagging efforts to increase the public's awareness of forest

ecosystems and encourage sustainable forestry. Mr. Speaker, while on

both sides of the House there are often points of the WCWC we don't

always agree with, I think we all do agree on the value of this

organization to the province. I would ask the House to join me in

congratulating them for receiving this award.

MR. REID: It's with a great deal of pleasure that I introduce

three constituents of mine from the great community of Surrey-White

Rock. In the Speaker's gallery are two young entrepreneur

tourism-interested students from BCIT: Nikki Leach and Dean Gagnon.

With them is Mr. John Leach, who is a strong supporter of this

government's initiatives and free enterprise. Would the House make them

all very welcome.

Oral Questions

PROVINCIAL TAXATION LEVELS

MR. HARCOURT: Mr. Speaker, on the weekend the Premier said:

"The biggest problem we have in this province is taxes." Which of the

800 tax and fee increases that her government has brought in since 1986

has the Premier decided to eliminate or cut?

HON. MRS. JOHNSTON: Mr. Speaker, might I suggest the question be put to the Minister of Finance, and I'll take it on notice.

MR. SPEAKER: Order, please. The question is out of order, but

if the Premier stood to answer the question, I'm prepared to accept the

answer.

MR. HARCOURT: It wasn't the Minister of Finance but the Premier

who said: "The biggest problem we have in this province is taxes."

The Premier clearly doesn't want to be held accountable for all those tax

and fee increases. Among the 800 tax and fee increases imposed by her government

is the property purchase tax. Has the Premier decided to give first-time homebuyers

a tax break and eliminate them from having to pay that property purchase tax

— and pay for that by eliminating the loophole allowing corporations to avoid

paying that tax?

HON. MRS. JOHNSTON: I would like to welcome the Leader of the

Opposition here this afternoon, his attendance is very much

appreciated. If he would like to put questions to a leadership

candidate during an election campaign, I would like to suggest he

attend the all-candidates' meetings. The question is more appropriately

put there.

MR. HARCOURT: Nobody else seems to care about attending those

meetings. So for those who don't want to come, I thought I'd ask the

questions of the Premier. Many British Columbians would like to know if

the Premier has decided to give families a tax break by, for example,

cutting the spending on doctors' pensions, cutting down on government

advertising and rolling back the medicare premium increases for

families in this province.

HON. MRS. JOHNSTON: We went through this type of questioning

yesterday by members of the opposition. The leader was not present, so

he's probably not aware of the type of questioning that we had

yesterday. It's strangely interesting to hear these types of questions.

I believe that members of the opposition have to be smarting because of

the help that their transition team gave to the Ontario government in

the preparation of their own budget.

Members on this side of the House are very pleased and proud with

the budget that has been tabled this session. We will continue to bring

about financial security and fiscal responsibility in this province.

Next time around, during the election campaign, I would be pleased to

debate each of these issues on the platform with the Leader of the

Opposition.

TREATMENT OF THOSE FOUND

NOT GUILTY BECAUSE OF INSANITY

MR. LOENEN: My question is to the Attorney-General. In view

of current proposals with respect to the disposition of persons found

not guilty by reason of insanity, what representations has the minister

made to the federal justice minister to ensure that provincial cabinets

retain the right to refuse to release potentially dangerous persons?

HON. MR. FRASER: This government and this minister have made

representations to the federal government with respect to people who

are detained and considered not guilty because of insanity. What we

have said simply is this: we're not certain; in fact, we disagree with

the idea that you can cap the length of time a person is incarcerated

because of insanity, because we're not convinced that the danger will be

[ Page 12824 ]

reduced by time in incarceration. What we're

suggesting is that people in this category should be treated as

patients rather than any other way and that our efforts should be

devoted to trying to make sure those patients are cured as opposed to

keeping them incarcerated.

It is in the purview of the federal government, not us. But we have

made representations to them in that respect. But beyond that, recent

decisions by the Supreme Court have indicated that the federal

government will have to come down with new laws within about six months

to handle this particular question.

DISMISSAL OF ATTORNEY-GENERAL'S

EXECUTIVE ASSISTANT

MR. SIHOTA: A question to the Attorney-General. Could the

Attorney-General confirm that he has terminated the employment of his

assistant Mr. Robert Walsh?

HON. MR. FRASER: If the members wish to know that my executive assistant is no longer employed by me, then that's correct.

MR. SIHOTA: Would the Attorney-General care to advise the House why?

HON. MR. FRASER: I'm very happy to respond to that question,

because it indicates that the opposition is prepared to talk about

personnel matters at any time regardless of who it hurts or why. As far

as I'm concerned, it's a personnel matter, and it's not open for

discussion.

CLEU INVESTIGATION OF

ORGANIZED CRIME

MR. SIHOTA: Is the Attorney-General confident that nothing he

has done has compromised the integrity of the CLEU investigation into

organized crime?

HON. MR. FRASER: The organization known as CLEU is under the office of the Solicitor-General, not the Attorney-General.

FREE TRADE WITH MEXICO

MRS. BOONE: A question to the Premier. The Premier told us

that she wants an active role in the negotiations of the Mexico free

trade deal. The negotiations have already started, Madam Premier. You

want influence, but you can't even show us on paper what you would say

if you were at the table. Can the Premier tell us if, since

negotiations began last Thursday, she has written to the Prime Minister

to tell him of her position on this issue?

HON. MR. DIRKS: Mr. Speaker, basically that is my responsibility. I

have notified the Hon. Michael Wilson that we are very concerned about where

the Mexico-United States-Canada free trade negotiations are going. We intend

to press our concerns in the negotiations we will have with the federal government

to make sure that the interests of British Columbians are looked after in the

best possible manner.

MRS. BOONE: A question to the minister, then. You say that

you have a position and that you've talked to the federal people. Will

you table that position in the Legislature today so that the people of

the province know what position this province is taking in these

negotiations, which are very important to all British Columbians and

particularly to the workers of this province?

[2:15]

HON. MR. DIRKS: Some time ago I was asked a question about

the report we received, or the findings we had when we went out to the

private sector, and about whether we would table that. I'm very pleased

to advise you that we will be tabling a report that will contain all of

the information. It will not be our viewpoint, but the viewpoint of the

people we talked to. We will be tabling that report very shortly.

Until those negotiations that are going on between the United

States, Mexico and Canada have proceeded in a certain direction, we

really can't take a decision or position, except to ensure that the

desires and concerns of British Columbians are being recognized. We

will reserve our decision on the negotiations and the agreement until

we see what the agreement is really all about.

MRS. BOONE: Supplementary to the minister. We got nothing but

platitudes from this government in the negotiations over the past deal.

You sold out British Columbians and the fishing industry of this

province. Has the minister decided to table in this Legislature all of

the correspondence he has had with the federal government on this issue?

HON. MR. DIRKS: I had a difficult time hearing some of that

question. Certainly we will table that report. I believe it will give

you information about what British Columbians believe.

Also, I should advise the House that we will be setting up an

advisory committee from the various sectors to not only keep us

informed as to what their concerns are, but also to keep them informed

as to how the negotiations are going.

MRS. BOONE: Supplementary question to the minister. The

minister is missing the point here. We want to know what you have told

the federal government with regard to the stand you are taking on this

issue. We want to know what you are saying to the federal government.

Will you table in this Legislature all correspondence that you have had

with the federal government to date on this very important issue, Mr.

Minister?

HON. MR. DIRKS: I guess what I have to do is talk more

slowly, because what we have referred to the Minister of International

Trade, the Hon. Michael Wilson, is that we have declared our interest,

our

[ Page

12825 ]

concerns and our expectations with respect to the

free trade negotiations. We have made it very clear that this

government intends to actively champion British Columbia's interest

during the federal-provincial negotiations on the issue of American

free trade.

We've also made it very clear that British Columbia will reserve any

judgment on any free trade agreement until we have had an opportunity

to determine whether such an agreement will benefit this province.

ACCESS TO REPORT ALLEGING MEDIA

BIAS AGAINST GOVERNMENT

MR. D'ARCY: Mr. Speaker, I have a question to the Premier. A

former deputy minister has quoted liberally from a confidential report

that alleges media bias against the Socred government. Why is this

analysis being withheld from the voters who have paid for its contents?

HON. MRS. JOHNSTON: I am unable to respond; I don't know the

document being referred to. Possibly, if it were tabled or provided to

us, we could have a look at it and give you an answer.

MR. D'ARCY: It would be interesting to have the Premier, who

has said on several occasions that the government has nothing to

hide.... We could go back to the former Premier. I know she's not

responsible for any of his policies. However, I think the former

Premier said on numerous occasions that he intended to make all polling

information public. Can the Premier enlighten the House and the general

public as to why former civil servants apparently have access to public

information that is denied to everyone else in British Columbia?

HON. MRS. JOHNSTON: Mr. Speaker, I would be pleased to

respond if the documents were provided to us, so that we would be able

to properly research them.

Interjections.

HON. MRS. JOHNSTON: Well, they haven't been identified by the opposition.

Interjections.

MR. SPEAKER: Order, please.

MR. D'ARCY: The fact is that a former deputy minister is quoting from

a significant amount of information, which he said is valid and had to do with

his duties when he was a deputy in the public information branch, and which

he claims he has knowledge of or access to. The point is, Mr. Speaker, that

it disturbs me greatly that someone outside the government and the Legislature

should have access to confidential information, which has been denied to everyone

else.

HON. MRS. JOHNSTON: Mr. Speaker, I didn't receive the same brown envelope that the member opposite did, so I am unable to respond.

Ministerial Statement

GRAWEMEYER AWARD IN EDUCATION

HON. MR. DUECK: Mr. Speaker and colleagues, please join me in

paying tribute to one of British Columbia's finest post-secondary

educators. Simon Fraser University's Prof. Kieran Egan recently

received education's equivalent of the Nobel Prize: the $150,000

Grawemeyer award in education from the University of Louisville in

Kentucky. Professor Egan is a leader in developing programs to

stimulate learning in young students. In his numerous books, articles

and lectures, he counsels teachers to excite children's imaginations as

the best way to engage their interest.

The distinguished judges of the Grawemeyer award said that the

professor's insights, if widely circulated, could profoundly affect the

work of curriculum developers and teacher-educators in many countries.

Only one Grawemeyer award is presented each year. Professor Egan is the

first Canadian to be honoured in this way. Last year an American was

recognized; the year before, it was a French scholar. Mr. Speaker, I'm

sure my colleagues will join me in congratulating Professor Egan and

applauding his achievements. His work will have a lasting impact on

generations of young minds for years to come.

MR. JONES: It's a pleasure for us on this side to join with

the government in paying tribute to Professor Egan for his winning of

this most prestigious award in education. I think most British

Columbians believe the statement in the throne speech that suggests

that education is the most important investment in the future of this

province. Probably there is no more important area in education than

curriculum development, the area that decides what is appropriate for

young people to learn and how it is to be determined, the area that

decides on how to excite children's imagination and stir their interest.

Mr. Speaker, we are proud to join with the government, and we are

proud to recognize not just Professor Egan but all of the scholars in

this province who work so diligently in their various areas to further

man's knowledge.

MR. MICHAEL: Mr. Speaker, I ask leave to make an introduction.

Leave granted.

MR. MICHAEL: I've just received notice that there are 45

students, their parents, as well as their teacher, Mr. Lucas, from the

Parkview Elementary School in the community of Sicamous, the houseboat

capital of Canada in my constituency. Will the House please make the

people from Sicamous welcome.

[ Page 12826 ]

Orders of the Day

The House in Committee of Supply; Mr. Pelton in the chair.

ESTIMATES: MINISTRY OF HEALTH

On vote 38: minister's office, $360,045 (continued).

HON. MR. STRACHAN: Earlier this morning we were discussing

correspondence from Mr. Lane, the chairman of the board of trustees of

Mills Memorial Hospital in Terrace. His proper title is chairman of the

board of trustees of the Terrace Regional Health Care Society. The

second member for Vancouver-Point Grey expressed a concern about our

review process. I'd just like to share with the committee part of a

letter from Mr. Kenny, executive director of the regional review team,

in response to Mr. Lane:

"It is the practice of the hospital care division to

provide a hospital which has been reviewed with a copy of the draft

report in order to provide an opportunity for correction of any factual

data. You" — that is, Mr. Lane — "have been provided the draft copies

so that we can verify with the hospital the accuracy of the information

in the report. As you can appreciate, it would be inappropriate for the

team to come to financial conclusions until there is a certainty on the

facts. I look forward to your input on these facts, either at a meeting

which I have offered, or, if you prefer, in writing."

In other words, the ministry staff were most forthcoming with Mr.

Lane. They pointed out that they would like to speak with him if he had

any concerns The whole idea of that discussion was to review any

factual data in case corrections were needed. I can't see anything

wrong with that policy. It's appropriate and above board. It certainly

allows for adequate response, and it implies that before any solid

recommendations come into play, there is going to be agreement on the

facts.

Further, we find out from the letter — and I won't read Mr. Kenny's

further comments — that Mr. Lane had shared his concern with some

elected officials, presumably including the second member for

Vancouver-Point Grey, but without them having the benefit of a letter

from the Ministry of Health. Of course, that gives them just half the

picture of what was happening at Terrace and what had gone on with the

Mills Memorial review.

Finally, although Mr. Kenny made an obligation and tried to make

arrangements to meet with Mr. Lane, I'm advised that Mr. Lane did not

attend that meeting. In defence of the staff, and in response to what

the second member for Vancouver-Point Grey has brought to the committee

today, I have to say that the staff have acted in a prudent and

responsible manner. I totally support the review process that goes into

place, and I would encourage Mr. Lane and any other board chairmen to

follow that policy, as it does give them adequate opportunity for

review of all the data that the review teams arrive at.

[2:30]

MR. MILLER: I appreciate the minister's response. I wasn't

here when my colleague put the question, although I was aware that the

board was presumably disturbed by the methodology and the report of the

review team. I believe that they simply refused to have a meeting until

they had been given further information. The point my colleague was

making was that it is disturbing that.... If it's misinformation or a

lack of communication, that may be another matter; but these things

have been operating for a couple of years now. Presumably people know

each other and can pick up the phone and talk to each other, so there

may be something more. I'm not able to add any more to this at the

present time. My colleague might have further information and might

wish to pursue it at a later date. Given that, I think my colleague

from Prince George would like to raise some questions with the minister.

HON. MR. STRACHAN: I've described the process of the review

and the discussions that follow a review. In a letter of June 10, which

your colleague the second member for Vancouver-Point Grey has, Mr. Lane

indicated that he felt that discussion of the review would be

unproductive. He says: "We have not received the complete report." The

idea is to discuss the draft report with the hospital, arrive at an

agreement on what facts are out there and then finalize the report. You

do it in concert, and you do it after some discussion.

As I said, that appears to be a perfectly acceptable process to me.

Obviously it's not to Mr. Lane; nevertheless, I can't think of a fairer

way of doing it. We have 120 hospital boards in the province that all

operate under this process, and no one else seemed to mind it. I would

presume from that observation that it is in fact an acceptable process.

MR. MILLER: The fact that not everybody writes a letter

doesn't mean that everybody's happy. I didn't really want to raise

that, but maybe there's a lack of communication here. Perhaps Mr. Lane

has not been able to talk to his MLA, who could properly explain

government policy. If he's watching now, I would highly recommend that

he contact his MLA, and I'm sure he'll get the whole matter

straightened out.

MRS. BOONE: I want to question the minister on something that

is very important and that we have long supported: travel subsidies. As

the minister knows, many people in our region and throughout the

province have had considerable problems in trying to obtain medical

treatment and services because of the costs involved with travelling to

obtain those treatments.

I just have some very quick questions that I'd like to ask the

minister about the program. How much money is scheduled for the program

in this budget?

HON. MR. STRACHAN: With the greatest respect, Mr. Chairman,

we have a cabinet.... As you know, this was mentioned in the throne

speech and in the budget speech. There is a cabinet document being

prepared now that will discuss the details of who will be eligible and

the amount of money that will be required.

[ Page

12827 ]

I think I'm prepared to talk about the necessity of the program, but

providing details to the committee would be most difficult and

premature. We are clearly discussing future policy here, and we are

discussing spending that cabinet has not yet seen. So I don't think I

can in all honesty and all sincerity provide any dollar figures to the

committee at this point.

MRS. BOONE: I find this very strange. This is the minister's

budget; it is the only time we have an opportunity to question him on

that budget. It is mentioned, as you state, in the throne speech; it is

mentioned in the budget, which is your budget. Yet you can give us no

information — not even a dollar figure as to the amount within your

budget. One would tend to think that perhaps there isn't any money

there. A lot of people out there want to know and have been phoning and

have written asking how they get into this deal. How do they apply for

this? Who is eligible for it? Where does the travel subsidy apply to?

Does it apply only within the province of British Columbia or does it

go outside the province of British Columbia? For the minister to deny

any information on this issue is very irresponsible and not living up

to his ministry.

HON. MR. STRACHAN: The member seems to be having trouble with

what I'm saying, so I'll say it again. The program was announced in the

throne speech, then the budget speech. There is a plan coming to

cabinet soon — I'm advised within at least the next couple of weeks —

for their consideration.

In terms of where the money will come from, it will come from vote

65, which is the contingencies vote, and that is what we have planned

for. But I cannot give you a dollar figure until such time as cabinet

has approved the program, nor can I tell you how to apply. Do you want

me to repeat that for you?

Interjection.

HON. MR. STRACHAN: You mentioned upcoming policy from the

throne speech. That's what it's for. You've attended enough throne

speeches to understand that, I'm sure.

MR. MILLER: I suppose I'm not the first person, but I have

some pride in authorship, if you like, because I have raised this issue

now with every Minister of Health since I was elected in 1986. I

haven't had the pleasure of raising it with the current Minister of

Health, but things change pretty quickly around this place sometimes.

When I first raised it with the minister back in 1987, I wasn't asking

that we jump right in. It's a bit irresponsible to simply say that we're

going to have a travel plan. We recognize there's a problem, so we're

going to implement a travel plan. Hopefully there's a lot more work to it

than that, and although we can accept the need simply by receiving narratives

of hardship endured by individuals and our familiarity with the situation, I

asked that the ministry start to assemble some information from the sources

that might be available. For example, I referred the minister to the information

available from various private plans that exist. Some of the trade unions and

their employers have negotiated what they call "travel riders" as

additions to their health plans. Most of them are paid as a direct pay-out,

as opposed to an insurance plan, with the employer absorbing the cost. In some

cases the plan is administered by one of the existing health agencies, and in

other cases it's administered by the employer. There's a history of

experience with regard to the use of the travel rider which could prove useful

for the ministry in coming to terms with the issue. Was that work undertaken?

HON. MR. STRACHAN: I believe it was. Of course, the staff

have been looking at this, and as you and I both know and any member

who represents an area that's outside the lower mainland.... As a

matter of fact, areas outside Prince George where I come from, because

we are a referral hospital — and there are many instances where people

will travel to Prince George.... It's not just travel to the lower

mainland for essential medical services. It's travel to the referral

hospitals as well that we're considering here.

I can't give you details on all the prep work that was done, but I

know from the briefing that's coming to cabinet that some was obviously

done, because we have extensive material on the suggestions we will be

making to cabinet as to how complex the cases will have to be and who

will qualify.

MR. MILLER: So through this kind of review that I had

suggested, the ministry was then able to obtain some statistical

information. Was it sufficient to make a projection in terms of taking

the information as it applied to the populations under the existing

plans, wherever they may be? Maybe the minister's staff can advise him.

Perhaps he might refer to some of the specific plans that they

consulted in order to assemble the information. That would be useful.

Was enough statistical evidence gathered, that could be reasonably

projected on the entire population that would be served, to draw some

conclusions about such things as costs and the nature of referrals that

would be covered?

HON. MR. STRACHAN: We have a lot of statistics available to

us, Mr. Member, as you will appreciate. I'm advised that the staff made

broad assumptions about what the program would cost and who would want

to be served. That's the information they have used to assemble the

presentation that will be coming soon to cabinet.

I don't know that I can provide you with more specific detail on

data we would have used in assembling our proposal — at least not right

now. I guess if you have specific questions about historical data in

terms of travel and other plans, pose those questions to us, and we'll

endeavour to provide an answer to you as quickly as possible.

MR. MILLER: For example, I'm not aware that either of the two

plans I'm aware of in my community was consulted. Maybe they were, and

I'm simply not aware of it. But I'm unaware that either the major

employer,

[ Page 12828 ]

the pulp company in Prince Rupert, or the city of

Prince Rupert were consulted to actually get statistical information

from them on the experience as it applies to the population base that

those plans serve.

Really, I think in trying to project.... If I can just deviate for a

moment, I recall the difficulty that we encountered — and when I say

"we," I mean this party when we were the government — in bringing in

the Pharmacare program. To some degree, as much as you try to gather

statistical information and to make the best possible guess as to what

a program might cost, it's very difficult when you're introducing a new

program, because your information base might be limited or there are

things that you don't account for. It's very difficult.

I recall my party suffering somewhat, having brought in the

Pharmacare program and experienced an overrun in the Ministry of Social

Services and Housing budget at that time, and being greatly chastised

for that. I suppose you have to accept those things if you think the

program you're bringing in is worthwhile — and certainly Pharmacare was

and continues to be. I only use that example to illustrate that even

with the best of intentions, it's very difficult to forecast budgets,

and in terms of this issue, it is of concern.

I have corresponded with people right across the north — in the

Peace River country, the central interior, my constituency and north of

my constituency — as a result of mailings I did to northern people on

this issue. I have received some letters that would break your heart in

terms of the real life experience that people have had to go through,

particularly people who have to go for referrals for a serious illness.

It is very costly, as the minister should know. What I'm trying to

put together is not a complete picture, but at least some indication of

where the government is heading on this. It was significant enough for

the government to include it in the throne speech, and I'm sure it was

well received, but we have to put some flesh on it. That's really what

I'm trying to do.

[2:45]

Going back to my question, it was: in gathering statistical

information, did you get enough that you could apply it across the

broad public base to which this program will be available, to draw some

conclusions about cost and those other issues that naturally would

follow? What, for example, will be covered? Will every referral be

covered? Will it depend to some degree on the nature of the illness? Is

there a limit on the number of referrals that individuals could have

covered under this proposal? In addition to transportation, will it

cover some minimal accommodation? Is it foreseen that it would cover

100 percent or a percentage of the costs borne by individuals?

There are many specific questions, and I think it's reasonable that

people want some idea. It seems to me that this is a good forum to try

and draw out what you're looking at. Maybe with those I could sit down

and have the minister respond.

HON. MR. STRACHAN: At the outset, I'll apologize to the

member. I missed it when he talked about two plans that are available

in Prince Rupert. Are these employee or union plans? Is that what you

were referring to on those plans? I misunderstood that part.

Nevertheless, the answer to that question is no, we didn't speak to

those people. What we have done in the preparation of our cabinet

submission is look at the work which has been done in other provinces

and also look at our own data with respect to travel patterns. We, of

course, can track by medical card number and other forms of

identification people who are travelling, say, from Prince Rupert to

Vancouver or from Burns Lake to Prince George for whatever treatment

they need. So that information is available to us. It's on that basis

that we are preparing our document.

I think the throne speech, if I'm not mistaken, used the term

"complex medical problems." We haven't fully decided on what's going to

be complex and what won't be. I have my own opinion, and the staff has

opinion, but this is an issue which will be dealt with by all of

cabinet so that we have a good regional perspective on the program as

we implement it.

I know the member for Prince Rupert thinks that my estimates may be

a good forum for this, and I think it's a good forum for general

discussion. In terms of discussing the plan, inasmuch as we don't have

it in front of us, the forum is not so good because there's really no

flesh on the bones yet to discuss. But if you want to offer suggestions

to me, I'll be more than happy to take them, because I think this is a

good idea. It's supported by the Ministry of Health and, as an MLA from

the central interior, I certainly support it. I'm sure you do too, Mr.

Member, being from an area which is even more remote and does not have

the medical services available that I, for example, would have in

Prince George. So I certainly can understand your concern, and I'll be

more than happy to discuss and listen to any philosophical or other

suggestions you may have with respect to the delivery of this program.

MR. MILLER: I don't want to get into philosophy, Mr.

Chairman, because, first of all, I'm not a philosopher, and secondly,

we could be here for — who knows — months and months.

I have some difficulty with the minister's answer. The minister has

indicated that they did get information about travel patterns or

referral patterns. What specific information do you have in house that

you can obtain on that question?

HON. MR. STRACHAN: What we have and how we're identifying

this is that we know which hospitals get referrals from where, the

numbers and the condition. That really gives us a good description of

the magnitude of the problem, or the concern, of travel patterns. From

there, we are putting together a program.

Let me also tell you that we're well aware of the concern your party

had with Pharmacare when you were governing. We are looking at one of

the options, which is phase-in, because we realize that these things

can snowball. I won't tell you that that's the way it's going to be;

I'm going to say that that could be one of

[ Page

12829 ]

the options presented to cabinet — a phase-in program.

To answer your questions, we can identify which referral hospitals

have people travelling, where those people are from, how many

treatments are being given and the complexity of treatment that those

hospitals are providing. That's the way we have a good description to

identify for ourselves what we're going to have to do to provide this

travel program plan.

MR. MILLER: So every hospital that receives a referred

patient from another location is recorded, and that information is

available in the ministry. Would you be able to account for people

referred to a specialist for a consultation?

HON. MR. STRACHAN: We did hospital in-patients and also

out-patients. I don't have all the details on the specialists at the

referral hospitals that we spoke to, but we are also, on the other

side....

Interjection.

HON. MR. STRACHAN: No, at the referral hospitals. Maybe we'd better pose that question again, because I don't want to misunderstand you.

We're also, on the other side, trying to have as many specialists as

we can travel outside the lower mainland into the less-populated areas.

Let me answer it this way. We tracked in-patient and out-patient

referrals to the large hospitals, and that's the information we're

dealing with.

MR. MILLER: Just a couple more questions on this for

information. Does that allow you to draw some kind of statistical

conclusion about the greater population base? In other words, does the

frequency — across the range of ages, sex and those other statistical

questions — allow you to draw any general conclusions about the

incidence of referral? It doesn't sound as though it has. In other

words, if you look at.... Well, to talk about the north, that's a

misleading word in itself. We have a population base north of a line

drawn through Williams Lake, if you like, which contains a certain

number of people with a certain demographic makeup in terms of age and

all the rest of it. So when you take the information you have gathered,

does it allow you to draw any statistical conclusions about frequency

as it relates to particular age classes and occupations and all those

kinds of things required to put a plan into place?

While I'm on my feet, I will add: would it not have been useful to

consult some private companies and some municipalities — maybe some

school districts; I'm not sure of that — with regard to the frequency

in their experience, in order to add to your statistical information

base?

HON. MR. STRACHAN: What you suggest is not a bad idea, and we may gather data from that area.

One thing: I was just advised by the officials with me that it would be very

hard to identify by occupation. You mentioned that as one of the criteria. We

simply wouldn't have to — nor do I think we would want to — take that computing

energy to try to identify by occupation. But all the criteria would certainly

be of interest to us, particularly age and sex, which is one of the demographics

we use in hospitals now. The demographic criteria we use in the hospitals now

for providing their budgets and other issues would come into it.

By the information we have from the large hospitals that are taking

referrals, we have arrived at a pretty good picture of what the travel

practice is.

MR. MILLER: I'm trying to tie this in with another problem,

which the minister mentioned, and that's trying to get medical

specialists of varying degrees — some not in the actual practice of

medicine; some in fields like speech pathology and audiology, and

others in the psychiatric field.... It is a significant problem, and I

think it goes beyond the borders of British Columbia. In fact, I know

it goes beyond the borders of British Columbia. There is a current

dispute in Quebec with regard to the government plan which was put in

place, in part, to gain some efficiencies in the system, as well as to

try to deal with the location of medical doctors — ordinary doctors and

specialists as well — in the more remote locations of that province.

First of all, dealing with this anticipated program, which appears

to be a ways off, is there some sense of tying these two issues

together? One of the things I discovered in investigating this issue —

in other words, going to bat for the people in my constituency — was

that like everything else, it was far more complex than it might first

appear. When we talk about it, we look for the easiest solution

sometimes: what is the easiest thing?

There has been a north-south orientation, at least in my part of

British Columbia. It's quick to get there — relatively quick, although

I don't think so on a Friday night when I'm leaving this place;

nonetheless it is. It's very expensive. Some have argued that as a

result of the plans in place, we've in fact diminished our opportunity

to attract specialists. You understand the logic of what I'm saying?

Because people have a plan, which pays for the transportation to

Vancouver — primarily it's Vancouver.... In the case I'm talking about,

which is the major pulp mill, there's no question about the ability to

collect the airfare and a minimal amount for accommodation. Therefore,

out of preference and over a period of time, you'll find this attitude

has developed where people will say that they're not going to go to a

local hospital and that they'll go down south because they have more

confidence in what they do there. It tends to feed on itself.

[Mr. Ree in the chair.]

In looking at this program, which is going to assist in travel costs

and, hopefully, accommodation costs for medical referrals, have you

looked at it in terms of the balance on this other side? I attended a

meeting in our hospital with community leaders, some doctors and a

person whom I'd highly recommend on this issue, Dr. Peter Newbery from

the United Church. He is located

[ Page 12830 ]

in Hazelton but runs the United Church hospitals in

British Columbia. Dr. Newbery has a very unique perspective on the

needs of northerners in health care. He talks about things that the

ordinary person would not even think about. For example, northerners

really aren't represented in admissions of students to the medical

faculty. We're underrepresented, and that has an impact on trying to

get people to come north or trying to get students from the north into

some of those facilities. I'm moving ahead of myself here, but I'd like

to get your response with respect to the balance between a travel plan

and the other really significant problem — trying to move medical

specialists up into some of the more remote locations.

[3:00]

I should say, too, that I refuse to believe that Prince Rupert is

remote. It is not remote in any classic sense of the word. Neither are

those communities along Highway 16. If you start taking about places

like Iskut, then you're talking remote. Any community that you can fly

to in an hour and a quarter and that has 16,000 people and all the

amenities is not what I would call remote.

HON. MR. STRACHAN: In no way did I imply that Prince Rupert is remote.

MR. MILLER: No, I think I did.

HON. MR. STRACHAN: Oh, you did. Okay.

The member makes a very good point, and I can assure the committee

that one thing we don't want to do with this travel assistance program

is undermine the services we provide to the communities now. Our

fundamental policy is to get the specialists and the services to the

people as opposed to having the people come to the services. That will

be an underlying thought as we put this program together. The staff

have been wrestling with that issue: how can you develop an effective

travel plan that serves those that it has to serve without undermining

the services in the more rural and isolated areas now?

Having said that, let me tell you what our physician services to the

rural and isolated areas are now and what funding we have provided. The

northern and isolation allowance program, which is a premium fee paid

to physicians serving isolated communities, costs us $5.12 million a

year. The northern and isolation travel assistance program, which

assists with travel costs for specialists' services provided on a

visiting basis, is $280,000 a year. The subsidized physicians program,

which is a guaranteed minimum income, is $180,000 a year. The nurse

practitioner services to rural and isolated areas are $680,000 a year.

Special contracts to meet the needs of rural communities are $3.19

million a year. So I think that really underscores our commitment as a

ministry to ensuring that we are providing services to the people.

Finally — this is something I'm particularly interested in, because

we're looking at a pilot program for Prince George — there are the

rural residency programs. If you've been following the medical manpower

issue, you know that intern residency requirements are going to be

changing from one to two years for those areas of practice which do not

already require two years of postgraduate training. A family practice

internship is being recommended by Prince George. I have made a strong

case for that to the Ministry of Advanced Education and also to the

University of British Columbia, because I think it's important that we

consider it. As you know, doctors who train in the north stay in the

north.

The member is bang on in terms of his suggestion and concern that,

although he supports the travel plan — and I certainly support it

myself, because of the constituency I represent — in no way can it

undermine the services to the area that we are providing now. I hear

what he's saying. I agree with his concern, and I can assure you that

it is a concern of the officials as well as we put this program

together. Of course, you can appreciate that when the program does come

to cabinet, which I'm advised will be in the next week or two, many of

the other members of cabinet who represent areas outside the lower

mainland will have that concern, because it is not in our best

interests to have any of the services we currently have in place

diminished by a travel program.

MR. MILLER: I should have asked at the outset, Mr. Chairman,

whether there's been a change of heart. When I quizzed the Minister of

Health last year, he was fairly adamant in saying that they wouldn't

consider this program; now it appears that you are. If it's a change of

heart, fair enough.

I've calculated roughly $9.5 million for the programs you read out.

Although I appreciate.... In fact, on behalf of my hospital in Prince

Rupert I have lobbied the northern and isolation allowance committee

for increases. They allocate money, and I think the last letter I saw

on that indicated that there's really an oversubscription. In other

words, the need is much larger than the budget will allow. That's

probably fair to say about almost any program, but clearly it is in

this case.

But this doesn't deal substantively with a fundamental issue. You

seemed to indicate that it's cheaper — I don't know if those were your

exact words — to take the specialists to the people than to take the

people to the specialists, or something like that.

Interjection.

MR. MILLER: Okay. You say it's preferable, but not

necessarily cheaper. That's an intriguing question, because that's what

I was going to ask: in terms of the cost-benefit, what do the numbers

look like? I would always assume that it would be. But that's an

intriguing question if you consider health care generally in the

province, which serves the massive geography we have. Do we have a

commitment to regional hospitals with — hopefully — as many specialists

as can be attracted? Because my sense of how that has been going is

that we've seen an erosion of those regional hospitals, perhaps for

some of the reasons I've mentioned earlier.

[ Page

12831 ]

I don't think you get too many referrals from the Queen Charlotte

Islands over to Prince Rupert, and yet it seems so logical. People go

to Vancouver. The reason for that is a lack of specialties — they're

simply not available — and maybe some level of competence. I'm not

certain of that; you may be able to enlighten me on that. I don't want

to focus too narrowly on my own community, but it's the one I know

best, so I'll continue to use it as an example. I get the sense that

its function as a truly regional hospital has been eroded with time.

Would you care to respond?

HON. MR. STRACHAN: It's a very interesting discussion. I want

to get this on the record; I want to repeat this for the record. I

didn't say that keeping specialists in the region was cheaper; I said

that it's preferable, and that will always be our policy — to ensure

that we are taking the services to the people, not the people to the

services. At least that will always be my policy and I'm sure the

policy of the government, because in the Legislative Assembly we

represent a good number of rural constituencies. The idea is to provide

services to people. I would say that that would be more expensive.

There is an economy of scale at VGH or St. Paul's — on the lower

mainland. It would be nice just to load up a 737 every week and fly

people from Prince Rupert, Sandspit, Prince George or Fort St. John and

have them attend this super-hospital that we built somewhere. There

would be an economy of scale, but it wouldn't be as good, because you'd

be taking people out of their communities and not allowing for any

infrastructure building in the rural areas. What we're doing now is

more expensive for treatment, but it's the most preferable to ensure

that the services are taken to the people as opposed to taking people

to the services.

There's one caution that I was just reminded of: you cannot expect

to send one specialist to a remote area and have that specialist

maintain his or her skills in the discipline. They have to have backup;

they have to have colleagues. So you have some medical problems when

you do that. It's not as easy as saying: "Let's put specialist A here,

and he'll fix all those problems." There are some other concerns that

you have to deal with, and it becomes a complex medical manpower

problem.

As I said earlier in my debates, we have a commission on medical

manpower, and your colleague the second member for Vancouver-Point Grey

will probably tell you that among physicians — and at UBC for sure —

the whole question of medical manpower — where it goes, who we should

be training and what disciplines are big ones and vexing for the

profession itself.... It's one that faces you and I as politicians all

the time; it faces hospital boards; it faces the medical manpower

committees at hospitals who want to look at providing and attracting

the best people for their medical staff. It's a question that we will

probably never resolve to everyone's satisfaction.

In any event, I have been able to share my policy with you — at least, the

policy of the government — and also, of course, my personal philosophy that it's

not cheaper but it is preferable to have services supplied to the people in

any way that you can.

MR. MILLER: Actually, before today I hadn't really thought

too deeply about the cost ratio of moving people or doctors the other

way, and it's quite an interesting answer. In some ways it could be

used to justify, on a financial basis, the program that you seem to be

embarking on. We'll reserve judgment. I'm not going to applaud you yet

for that program, until I actually see some flesh on the bones and

people know what you're talking about.

But you are right in that there's another problem that comes up. For

example, apparently they don't make the ordinary general surgeon

anymore — someone who can do things like taking people's appendix out

or cutting them open for some minimal reason as opposed to some complex

reason. I'm told that Great Britain may in fact be one of the last

places where you can recruit that kind of general surgeon. Yet in the

more removed areas of the north, that's precisely what you need, as

opposed to the body parts that people now specialize in. I don't know

if that issue is being considered by the medical manpower committee,

but I certainly think it ought to be. There may be some limits in terms

of how many you train. But we're having now, for example....

The other issue you raised is the fact that if you only get one

surgeon in a town like Prince Rupert, he or she is on their own, and

they are on call 24 hours a day. It's not that they're called 24 hours

a day all the time, but I suppose there may be times when they are. But

the fact is that they are simply on call 24 hours a day. They don't

have the opportunity in terms of upgrading skills and all the

professional things that go with being a surgeon, so they don't stay

very long. We're constantly in this recruiting business.

We're now trying to recruit a surgeon, and I really hope that we get

this person. We're looking at raising $100,000 in our community. We're

going to the business community, to the trade unions and all around the

community trying to raise $100,000 so that we can secure a surgeon.

In other specialties, such as gynecology, we have seen such a rapid

turnover. We've offered these enticements throughout. I used to be on

the hospital board years ago as a council appointee, so I'm familiar

with some of the stuff. We offer free rent and facilities. Somebody

comes up, they roll into town for two or three years and then they're

gone again. That feeds into that thing I talked about earlier about the

lack of confidence.

I know women who are pretty outspoken and pretty frank. If they

figured they had some problem that was beyond the norm, they say there

is simply no way that they would.... I hope that what I'm saying is not

interpreted wrongly by the medical profession in my community. I

believe I'm stating a fact that I, and perhaps others, have observed,

and I don't wish to denigrate anybody in my community. In fact, I

consciously argue with people that they should avail themselves of the

facilities that exist in the community before seeking to leave the

community for services. I

[ Page 12832 ]

take that position because we will never get

quality service unless people use them. If they feel there is some

deficiency, they should start to demand a higher quality. But you'll

never know unless you test it.

[3:15]

How does the provincial government tie in with a small community? I

don't think you're offering any additional money over and above what

the doctor can obtain through billing. Here we are with this small

community trying to raise $100,000, and that's only one position. What

role does the province play in trying to assist...? It really goes back

to the original question, too, which is: if the ministry or government

deems it preferable to maintain regional hospitals, it seems to me that

they have some responsibility for maintaining a decent staffing level

of the various medical practitioners required.

HON. MR. STRACHAN: I agree with the member's concerns, but I

want to tell the committee, Mr. Chairman, that we have many strategies

in place for the concerns he has identified. I listed the $9 million of

expenditures that we have to access physicians' services in British

Columbia. I'll point out one available to Prince Rupert doctors: the

northern and isolation allowance program. There are 70 eligible

communities, of which Prince Rupert is one.

It's a fee premium for physicians who live and work in rural and

isolated communities. The communities are assessed by way of an

objective point scale which takes into account both medical and social

isolation factors. The mechanism is that following registration with

the Medical Services Plan, physicians from eligible communities

automatically receive the appropriate fee premium on all

fee-for-service billings. Fee premiums range from 6.2 percent to 20

percent. For 1991, there are 70 eligible communities, of which I said

yours is one, and the estimated number of recipient physicians is 400.

The estimated cost, as I indicated earlier, is $5.12 million. That's

one way of encouraging physicians to go to the north and remain there.

I've lived in Prince George since 1966, so it's coming up to 25

years now, and my experience is that not too many have moved away. I

met a lot of the doctors when they came to town; they were all young

guys about my age, and they're all still there practising.

Interjection.

HON. MR. STRACHAN: They were young guys my age then; that was 25 years ago. Let's get that straight — I was a young guy once.

The majority of them have stayed there — many of the specialists and

surgeons. So I think the system works. That's not to say it's perfect

or we can't do more. I talked about the family practice residency

program that I would like to see located in the central interior. Of

course, we know that the University of Northern British Columbia is

going to have an impact, because it makes the quality of life generally

a little better.

You mentioned the United Church, and they are an excellent agency, along with the Queen Charlotte Islands

Health Care Society. They are in receipt of the $3.19 million in

special grants that we deliver throughout the province to many

agencies. They're not in receipt of the whole $3.19 million, but they

are part of the program that provides assistance for travel costs for

specialists.

So in many ways we are attempting to address the problem to ensure

that we are taking, as I said, the services to the people. Anything we

can do, particularly with this current minister, to ensure that better

access to physician services in the rural and isolated areas is

provided will certainly be a priority with me.

MR. PERRY: I've been listening with a lot of interest to the

discussion over the last hour, because this is another one of those

issues raised repetitively and very effectively before the Royal

Commission on Health Care and Costs. I wasn't able to attend many of

the northern hearings, but it was certainly raised even in Vancouver,

and the commissioners have picked up on it very strongly in their

northern travels.

I wouldn't mind putting in a favourable comment on the program the

minister just alluded to: the northern isolation allowance and the

travel program for doctors. I know, because I once was a visiting

consultant in Prince Rupert, and at that time the ministry paid not

only the usual fee, but also paid for the airfare. I believe that in

general they have continued to do that, if I'm not mistaken. I recall

having some complaints as opposition Health critic from physicians who

had trouble getting the airfare paid, but I believe that issue has been

resolved. So it's fair to say that was a good initiative.

But I have another suggestion. The minister asked earlier in these

debates for suggestions. It's one I've made to the dean of the faculty

of medicine, and I think the minister has a little bit of leverage over

him.

Prince Rupert, Quesnel, Smithers, perhaps Terrace and some other

smaller towns are not quite the same as Prince George. Prince George

has had troubles recently maintaining and recruiting an obstetrician,

but Prince Rupert is quite a different kettle of fish, if that's the

right metaphor.

The surgeon in Prince Rupert typically has been on call every second

weekend or every second week year in and year out, and sometimes, when

there was only one surgeon, all of the time. That means being on call

for the most serious emergencies literally all the time, and that's one

of the reasons it's so hard to recruit anyone when somebody retires.

None of the younger generation of doctors want to get trapped into that

situation, and the spouse usually is even less enthusiastic about it.

There is one possible remedy — not for the grinding on-call

schedule, but at least for vacation relief and guaranteed access to

continuing education. Many such surgeons or specialists have told me

that they have much more difficulty recruiting a temporary replacement

doctor than do the family doctors. Even for family doctors it's not

easy, but for specialists like a surgeon it's often very tough.

I think you have some leverage, Mr. Minister. We've often discussed here before the request by the faculty

[ Page

12833 ]

of medicine at UBC for some more generous funding

to expand health evaluation, research, salaries for young medical

scientists, etc. They're asking for 2 percent of the total health

budget, not just at UBC, but health research and evaluation.

When you're negotiating with them, I suggest you use some of your

leverage and ask what they will do for the rural communities. Will the

department of surgery, for example, undertake to provide guaranteed

replacement service on a rota to some of those smaller communities that

have trouble recruiting surgeons?

For example, will the department of surgery guarantee that it will

assign one of its members once every five years, perhaps, for a few

weeks so that Prince Rupert will have guaranteed replacement coverage

for six or eight weeks per year for certain holidays or for continuing

education for the surgeon there?

I don't think it's too much to ask. I would advise you from

experience, having seen it in the seventies as a medical student and

having read the press recently, not to follow the Quebec model; it's

unnecessarily harsh. I don't think you have to throw your weight around

that heavily. But just asking for something in return for improved

security of funding to the medical school that they're asking for would

be a fair bargain. I think the medical school is finally ready for that

and sees its expanded responsibility to the rest of the province.

HON. MR. STRACHAN: That's a good suggestion, and I will take

that to UBC and to my colleague the Minister of Advanced Education,

Training and Technology. I'm amazed I didn't look at this before when I

had that other portfolio. I will encourage in any way I can those

bodies to look at that. I'll tell the committee as well what the Quebec

plan was, Mr. Chairman, just for the edification of this august group.

The Quebec plan pays a sliding percentage of fee schedules, going

down to 70 percent of the fee

schedule in the very heavily populated

areas where there are too many doctors — presumably Montreal and la

ville de Quebec — and up to 120 percent in the more rural and isolated

areas. The problem with that system was that everybody congregated at

the border of about the 100 percent towns. It really didn't work. I can

see a member there laughing, knowing how the wheels would turn. It

didn't serve. I guess it looks good on paper. The first time I saw it

in the paper I thought that it wasn't a bad idea, but it didn't have

the effect that it was supposed to have.

In terms of the suggestion from the second member for

Vancouver-Point Grey, it's a good one and we'll encourage whoever and

all we can to look at it.

MR. MILLER: Gee, we come up with all kinds of good ideas in here. If we keep it up, we might actually solve some problems.

I referred earlier to a couple of issues I want to canvass. The minister may

be acquainted with Mr. Weller at UNBC. I was intrigued because when I talked

to Geoff a few times about the issue of training in the north or trying to attract

specialists, it turns out that he had actually co-authored a couple of papers.

I don't know if the minister has seen them, but I would recommend them to

him. In fact, I think it was Sweden where they actually built a medical training

facility in a very small community of some 25,000 people. I don't want

the doctors or potential doctors out there in B.C. to get alarmed, but according

to the paper it actually worked. It also worked to resolve some of the shortfalls

in those smaller communities.

Something I've tried to raise every year — I may have missed the odd

time — is that at one time there was a program which provided a higher

level of support for people who had some skills but might require

upgrading — for example, someone could upgrade to be a registered nurse

by taking some courses. There was a program whereby the provincial

government gave assistance over and above the normal assistance that

might be available through other programs. That was available to people

who were prepared to make a commitment, once they'd achieved that

accreditation, to spend some time in a small community. I haven't

inquired before today, so I'm not certain as to where that program

might sit. I'll leave it at that for now and let the minister answer

before I continue.

HON. MR. STRACHAN: First of all, the member mentioned

Geoffrey Weller. He is president of the University of Northern British

Columbia and a good friend of mine. I've known him for two years now. I

first met him in January 1989, and he was vice-president of academic

studies at Lakehead University When I was tripping around the country

trying to build a cabinet case for a university in the north, it was

suggested that I visit the northern Ontario universities, because they

were the best examples of communities not unlike Prince George that did

have universities. So I visited Thunder Bay, where I met Geoff Weller,

vice-president academic at Lakehead. I also visited Laurentian

University at Sudbury. They are both very good examples. My colleague

the current Minister of Education, who was Minister of Advanced

Education at the time, wanted to see northern universities as well, so

he went to Sweden, Norway and Finland,

whereas I went to Thunder Bay.

That just goes to show you that I'm the hard-working guy.

[3:30]

In any event, I did meet Professor Weller. He became quite

interested in our university plans, and as they developed, he applied

for the job and was short-listed. Now he is our president, as you know.

He was a superb choice, because he has spent 20 years at Lakehead

University and is used to the environment of the smaller university and

to the concerns of the smaller community. He's doing a first-class job

in putting the University of Northern British Columbia in place. Mr.

Member — you'll be aware of this, and I'm sure gratified — he also has

20 years' experience of outreach programs, and he knows what he has to

do in Terrace and in Prince Rupert to establish the presence of his

university. That's another skill that he brought to UNBC.

Interjection.

[ Page 12834 ]

HON. MR. STRACHAN: I was talking about Prince Rupert and

Terrace. They're both in B.C. I know you guys in Burnaby don't know

much, but I can tell you that Prince Rupert and Terrace are in British

Columbia.

Getting back to Professor Weller. Interestingly enough, he is a

political scientist by training, but his specialty in political science

is the politics of health delivery systems. He has published

extensively on the health delivery systems in Sweden, Norway and

Finland, and their provision in the northern — actually into the Arctic

Circle — medical and dental schools. Those three Scandinavian countries

really lead the way in providing that type of very expensive but

necessary training for the northern climes. So Professor Weller is a

welcome addition to our northern community, because he really does

understand the politics of health care in the north — how it can best

be delivered and what provisions you have to consider.

[Mr. De Jong in the chair.]

Currently, although this isn't directly associated with health care,

the curriculum development they're doing at UNBC is going to include

bachelors' and graduate degrees in public health administration. There

is a crying need for that. So that's what they're looking at — as well

as the provision of other medical services.

In terms of the scholarship program — and this has been in place for

some time, because the current Speaker was Minister of Health in the

Bill Bennett government when this program was brought in — there is

$5,000 a year provided to students taking a variety of health-related

studies — dental hygiene, medical lab technology, nursing — that are

important to the provision of good health care. The scholarship is

$5,000 per year. If you accept that scholarship, you have to commit to

staying in one of the identified communities for the amount of years

that you've used the scholarship for the bursary program. I can't tell

you right now what communities or what disciplines qualify, but it

apparently has been reasonably successful.

We had 37 bursary applications with 26 people qualifying for

assistance and committing $73,000 of the $80,000 budget for the

program, leaving $6,000 left over. I've got more details here. They

were nursing students, social work students, pre-med students, a family

counsellor, a dental assistant, pre-dentistry, child development and

psychology, sociology and long-term care — all fields that are related

to the better provision of either the social services or health care

services delivery.

MR. MILLER: Years ago I had a teacher, and whenever we wanted

to get off work, we would mention — I forget what the topic was — a

certain thing to this teacher, and he would start talking for about

half an hour. I know how to turn the minister on. I'll just mention

Geoff Weller, and we can talk about universities for a while.

I'm pleased to see that the program is still in place. It would

appear from a cost benefit view that for a modest investment of

$73,000, you're achieving — if indeed all of those 26 people achieved a

certain skill level that allowed them to go out into one of those

communities — a pretty fair return, at least in the delivery of those

or trying to cover off those areas that are often in short supply. I

see there was actually some money left over.

Perhaps because I don't watch these things, it's not generally

known. Not too many people know that the program exists. Some people

find out about it, and maybe there's a risk in advertising it: you'll

be terribly oversubscribed. But I would argue that if we have 26 people

who are going to go to small communities, then I would say that

probably in terms of your own analysis, you could probably jack that up

— it's a really small dollar amount — and get a pretty significant

return.

You have access to the statistics of where those shortages are, and

that all goes into the mix of determining which particular training

areas are eligible in which communities. I would certainly recommend

that you look more closely at that to increase the number of trained

people in the medical field that we can get into some of those smaller

communities.

When you talk about physician retention, there are some systems. The

one in the Queen Charlotte Islands has been successful. I had something

to do with the introduction of that concept. It was the old health and

human resources councils. There were five areas in British Columbia

that were picked as a model — a bit of a test I suppose. One of them

was here in Victoria — the James Bay area of Victoria was one of those

areas — the Houston-Granisle area, Queen Charlottes and a couple of

others.

I was quite dismayed last year when I travelled through Houston to

discover the fight that's taking place in that community with doctors,

the war that seems to be going on in that clinic and fee-for-service.

It seemed to me a rather sad state of affairs when you consider the

enthusiasm that the program had at its inception. On the Queen

Charlotte Islands there remains a dedication to the concept of people

actively involved through these councils in the delivery — I would say

even beyond the delivery — of health care; actively involved in health

care in their communities.

But we've got some problems. The physical plant has deteriorated

very badly. The clinic in Masset — the minister is aware of this; he's

received the correspondence — quite frankly is an old, worn-out

building. It is substandard by anybody's standards. It really requires

a new clinic. The proposal that's been put forward — I think it's a

good one and almost historic in terms of a breakthrough — is that a new

clinic be established and that it be a joint facility built on land

that lies halfway between the native village of Massett and the

non-native community of Masset. They both have the same name, although

the native community has an extra "t." There is Crown land available

there upon which that facility can be built.

It seems to me to make all the sense in the world for the ministry

to give its support to that proposal. There's absolutely no question

that the physical plant, the clinic itself, has deteriorated to the

point where it is completely inappropriate as a building which dis-

[ Page

12835 ]

penses medical services. There's absolutely no

question about that. The need is there for a new facility. In terms of

the cooperation that needs to exist in that area.... I go back a long

ways there, and I'm aware of some of the tensions that have existed

between the native community, the non-native community and the

Department of National Defence, which has its own little hospital and

which is sometimes seen as separate. I think everybody there tries

their best, but occasionally these tensions do flare up.

Dr. Peter Newbery, whom I mentioned earlier, had done a report for

the Queen Charlotte Islands Health Care Society on the issue of

physician retention, contrasting the southern portion of the Queen

Charlottes, the Queen Charlotte City area, with the northern portion,

the Masset area, and noting the difference between their abilities to

retain these kinds of services. It really delves into the difference in

perception, I guess, and the difference in involvement that exists

between the two communities. In fact, in my view it kind of bears out

really that program that my government started, which is the health and

human resources centres, actively involving people and hopefully

dealing with preventive medicine as well, trying to intercede before

medical services are required. Some of that is lifestyle. It's an

admirable goal which we've ignored for too long.

I know I've written to the minister about the need. I wanted to raise it in this House, because it is a desperate need.

While I'm on my feet — I have another appointment — I wanted to talk

about the physical plant generally. The Queen Charlotte City hospital

is again a facility that needs to be.... The consultants have looked at

it and essentially said that it's not worth putting money in to

upgrade; a new facility is needed.

In Stewart, I suppose it was a pretty lucky situation. A vehicle

leaking propane was parked beside the hospital. It leaked underneath

the hospital and eventually.... It didn't cause a fire, but it ignited.

That hospital was a mess to start with. It was deteriorated very badly

to start with, but when this big whoomf! went off underneath the building.... Well, of course, it can't be used.

That's a problem, because here I've identified — and I don't think

the minister would disagree — three instances where new buildings are

required. I don't think that's in dispute. How do we move to address

this need in these communities? In the case of Stewart, they are a

considerable distance from the nearest, biggest centre, which is

Terrace or Smithers. They require a hospital; they have to have one. We

need to have a new clinic in Masset and a new hospital in Queen

Charlotte City. I wouldn't be foolish enough to stand up here and say

that I want them in place tomorrow. But I think if there's a plan,

people are prepared to accept that you can't do everything overnight.

Interjection.

MR. MILLER: I don't know where you can get a propane truck with

a leak in it, either.

I have a number of other issues important to my region.

Unfortunately, I can't canvass them further with the minister at this

point, in view of an appointment I have, but I shall return and will be

happy to listen to your answers to my latest series of questions.

HON. MR. STRACHAN: I will be brief. You may recall, Mr.

Member, that when we first began the estimates some two or three weeks

ago, my critic the second member for Vancouver-Point Grey had a

personal concern. I had an appointment that day at 4 o'clock, so we

agreed I would take a bit of a break. At 4 o'clock I did meet with the

gentlemen from Masset, two friends of ours — maybe more friends of mine

than they are of yours; you know who I mean....

Interjection.

HON. MR. STRACHAN: Is he? Okay.

In any event, the situation was described to me in the Queen

Charlottes with respect to the hospital society, the health society and

the facilities at Queen Charlotte City and at Masset. I'm well aware of

that.

We want them to provide us with a master plan. We want them, as you

know, to undertake to try to get along together and to develop some

comprehensive plan we can look at that will satisfy the needs of the

community of Masset as well as of Queen Charlotte City and also some of

the concerns expressed by the native community. That's where we are.

As I understand it, unless I'm mistaken, the ball is now in their

court. We want them to provide something to us, and we will undertake

to react to their response.

In the case of Stewart, we will be building an integrated health

care facility there which will include acute care and other services

all under one roof to look after all the necessary processes that have

to happen in Stewart.

I share your concern about the Queen Charlottes, and we will

endeavour to provide whatever we can as quickly as we can as soon as we

can get everybody singing from the same song sheet and agreeing to a

comprehensive and complementary health care program and facilities in

the area.

[3:45]

MR. PERRY: Just before getting into some questions, let me

correct and apologize for one statistical error I made this morning. I

give credit to Hansard , who

picked it out on page 7 of this morning's Blues. I had asked the

minister to look at a number of figures and explain why the figures, in

general, had gone up. I made a mistake in reading from my sheet at

column 20 for hospital program management. The figure had actually gone

down from $605,000 to $271,000. So when we come to those answers, maybe

the minister would want to answer why it went down. That was an

inadvertent mistake, and I apologize.

Let me just come back to another issue that we have visited several

times in the last few weeks, which is problems with Pharmacare. I guess

we were reassured by this Minister of Health during the interim supply,

[ Page 12836 ]

and maybe the former one, that Pharmacare was

grappling as fast as it could with the problem of the turnaround time

for receipts. My constituency assistant informs me by fax from

yesterday of two more fresh problems. I'd just like to bring two

examples to the minister's attention to convince him that the problem

has not been solved.

She says both gentlemen said it was all right to use their examples

but not their names, but I imagine they could be provided through my

constituency assistant, Lynn Siddaway, if you need the names.

The first is a 54-year-old man on disability pension for 12 years

who is diabetic and has a heart disease and who submits his claim every

two weeks for reimbursement of Pharmacare costs. He says he spends $300

to $400 per month on drugs. He received a cheque from Pharmacare on

June 17 — yesterday — for $600, and that covers the period February 15

to April 15. But the period April 15 to June 15 is still outstanding.

So the usual turnaround time that I referred to earlier in these

debates, which seems to have been acceptable, clearly is not working in

that man's case if he's submitting every two weeks. This is said to

cause hardship in the family, as they are on limited income and do not

have sufficient resources to carry the debt.

My constituency assistant says to me: "At this man's request I asked

if it was possible for him to have a Pharmacare card as seniors do. The

man is certified disabled." I'm quoting my constituency assistant in

writing here: "I was told by the clerk: 'It would be abused."' That's

one rather disturbing example.

The second is another elderly man who had bypass surgery two weeks

ago and is also diabetic. For a Pharmacare claim submitted on April 29,

1991, he received the cheque on June 17. That would be just over seven

weeks. He's spending several hundred dollars each month. My

constituency assistant notes: "We have had more complaints about

Pharmacare than any other government program except for student loans.

Constituents complain they receive very rude treatment. This has also

been my experience."

I have to tell you, Mr. Chair, that my constituency assistant, Ms.

Siddaway, is remarkably diplomatic and polite, and for her to say that

that has also been her experience is disturbing. I just raise that for

the minister's attention, because I find it troubling. My previous

experience with Pharmacare had been very good, and this reflects the

number of calls that opposition members have been getting from

constituents. I would urge the minister again to review his policy that

calls to constituents must be transmitted through his office, because

it's obviously a significant problem for constituents now. Perhaps it

needs some ministerial direction.

Let me just raise two other very quick points while we're on the

subject of drugs before I yield to the member for Alberni. I want to

raise another example of the problems people have with the present

Pharmacare system where perhaps the government could be a little more

proactive. This is an example — I won't use the name — raised by the

Leader of the Opposition, who wrote to the former Minister of Health on

November 1 concerning a woman in the Fraser Valley. The Minister of

Health at the time responded on December 14, 1990. The file number is

HL37761 — so it could be found. The response from the minister, I

think, was adequate in that it did offer a means to address this

woman's problem, but she found it rather offensive. I just want to

raise it to bring it to the ministry's attention and ask the minister

to think about what could be done proactively to prevent this kind of

problem.

If we imagine ourselves in this woman's situation, it's not hard to

see why she's disturbed. She's a 31-year-old woman with three children

who has advanced lung disease from a genetic disease called alpha 1

antitrypsin deficiency. She writes on September 10, 1990: "Early last

year was when I was told all this news. Later that year I was told of

this wonder drug called Prolastin."

She then goes on to describe that she is taking this treatment in

the hope that it will prevent her death or requirement for a lung

transplant, which is the only possible treatment for her condition.

She's got children of three years, five years and 11 years. She

describes her expenses, which are $428 per month even after the

Pharmacare subsidy. The drug apparently costs in the range of $34,000

per year. It's an enormously expensive drug right now, partly because

it's new. But this woman doesn't sound like she can afford the $2,000,

20 percent share of the cost, plus the Pharmacare deductible.

To be fair, the former minister responded to her, suggesting that

she contact the Social Services department if she couldn't afford to

pay for it. The point I'm trying to make is that I think we need a more

sensitive mechanism to deal with people like this. She's in the

position of being an extremely vulnerable person with a very serious,

disabling illness and young children. She's being placed in a position

which she finds humiliating — having to go to Social Services — and she

writes to the Leader of the Opposition what she was told by her doctor:

"My husband and I are sick worrying about paying these bills.

I've been told to call the press to arms with me. My doctor tells me they'll

eat this up — human interest and all that stuff. The nurses at the hospital are

outraged. I can see asking the press for help, but I don't want to. My husband

is proud, and I also agree to not being a sideshow for the press."

I think that makes the point. We have someone here who really needs help. She

has ultimately been able to achieve it, but surely we could have a somewhat

more sensitive way of responding to that.

While we're on the pharmaceutical issue, I want to raise one last,

somewhat unrelated question while I see it here, which is about

suggestions made to the royal commission by the Canadian Society of

Hospital Pharmacists. There were a number of briefs to the royal

commission last fall. This one is dated October 1990, B.C. branch,

Canadian Society of Hospital Pharmacists. There are a number of similar

submissions making the same general points. This one I found rather

interesting — recommendation 13, page 72 of that brief:

"There is a need for improved consultation with the

ministry for both strategic hospital pharmacy planning and for

prospective and concurrent problem-solving. To accomplish this, a

pharmacy consultant position

[ Page

12837 ]

should be established within hospital

programs for a minimum trial period of three years. Part of the

consultant's mandate would be a requirement to prove the

cost-effectiveness of such a position by the end of the designated

term."

Think about that, Mr. Chair and hon. members: a suggestion for a

strategic approach to.... What they're really getting at is controlling

drug costs in hospitals, getting at that perhaps $50 million I saw to

be saved under Pharmacare. They are talking, of course, about the

hospital programs budget, a different budget.

They are also volunteering that the position should show that it can

pay for itself or be terminated. Not very many people make that request

to government — to volunteer a position which would be self-terminating

if it didn't pay for itself.

I think that's an interesting recommendation. I wonder whether the

ministry has given it any thought. That's what I think the Leader of

the Opposition had in mind when he was skeptical of the royal

commission; not that he doubted the work they would do, but that there

were some problems needing solutions earlier, and there are some things

where we've already got plenty of good ideas out there. We don't have

to wait for everything for the commission to table its report.

HON. MR. STRACHAN: As a matter of fact, I'm advised that

there is some serious discussion going on now between Pharmacare,

hospital programs and MSP with respect to that issue.

Staff will specifically investigate your other two concerns and

respond to me and hopefully to you as quickly as we can. I can tell you

that the Pharmacare claim pattern has increased by 36,000 claims over

the last year. We are hiring additional staff, but there are delays,

and I apologize for that. There is just an incredible increase in

subscription of the program.

I'd like briefly, Mr. Chairman, if I could, to respond to some

questions posed by the second member for Vancouver-Point Grey this

morning. They had to do with some differences in budget estimates from

'90-91 to '91-92. I'm going to briefly go through these. I'm really

going to rush, Mr. Member, not to take an awful lot of time. I'll

briefly describe why there are differences and hope that that will

suffice.

In terms of STOB 25, information systems operating costs, there's an

increase there of $609,000, about two-thirds and that's primarily

attributable to the reallocation of costs for communications and

information system expenses. They were formerly budgeted in

administration and support.

STOB 42. There's an increase of $26,594, attributable to the

realignment of funds within the program to match the budget with

expenditures for job postings, recruitment in the north and advertising

of specialized positions. It does not represent a change in overall

program funding. So we had some special funds we had to expend last

year, obviously.

Environmental, family and preventive health. We had an increase of $460,000.

We had internal transfers, including transferring of public health engineers

to Health from the Ministry of Environment; travel funding for additional staff

who will provide direct public health service delivery to meet population growth.

Funding here was also provided for native health and to annualize

programs such as child, youth, mental health, child development centres

and environmental health protection.

STOB 20, which was environmental and preventive health — $32,000

accounted as a result of the transfer of public health engineers from

the Ministry of Environment to the Ministry of Health.

Internal reallocations — $1,232,000 that was formerly in STOB 82 has

been more appropriately coded to STOB 20, which accounts for that

dramatic increase there.

The last item — $286,000 to meet population growth to annualize programs which commenced in '90-91 and for native health.

[4:00]

STOB 25. We had a reallocation of telecommunications and operating

system costs formerly budgeted in another area, and also $1,032,000 for

the provision of funding to meet population-driven utilization

increases and to annualize programs. A lot of population-driven

material here; as we know, our province is increasing.

STOBs 20, 25 and 68 are all relocation of costs that had been in

other areas. None of these changes represent a change in funding for

the program, but rather a change in the STOB or the category that they

go under.

STOB 07 went down because that expense is more appropriately coded

to STOB 10. STOB 10 went up for the same reason STOB 07 went down; we

had it changed there.

I have one more here, STOB 20: professional services and ambulance

services provision, a $143,000 increase, provision of funding for

inflation and to meet expenditures for contracted ambulance attendants'

training. These increases were provided for ambulance services only.

The professional services budget for emergency health services program

management has not changed.

I hope that answers your questions, and I thank you for them. Presumably this is all public material.

[Mr. Pelton in the chair.]

MR. PERRY: Maybe I could just satisfy the immense curiosity

of members and ask for clarification of one example under

environmental, family and preventive health, STOB 25, the information

systems and operating expenses. What does that $2.75 million buy us?

What are we talking about there that doubled in cost?

HON. MR. STRACHAN: These are ongoing telecommunications and

information systems: that is, telephone systems, fax systems, all the

operating costs that are involved in having our various health units —

and it's a huge ministry — communicate with each other throughout the

province.

The note says these costs were formerly budgeted in administration

and support services and do not reflect a change in funding. That's

$1,238,191, Mr. Member, a different category. There is a $32,512 lift,

which is a provision of funding to meet population-driven utilization

[ Page 12838 ]

increases and to annualize programs commenced in

1990-1991. I can't tell you what those new programs were, but

obviously, as I've indicated before on other issues, we have

population-driven utilization increases, and that would account for the

increase.

MR. PERRY: Am I correct in understanding that the apparent

doubling is largely a shift of funds from one STOB into another, and

there is a modest inflationary increase?

HON. MR. STRACHAN: Population-driven.

MR. PERRY: Population-driven.

One further example, under the ambulance services, column 10: public

servant travel expenses. What are we paying for there with our $250,000?

HON. MR. STRACHAN: First of all, it's the change of STOB that

I indicated earlier. It went from STOB 7 to STOB 10. Those are travel

expenses for staff who are responsible for the ambulance system,

travelling from area to area, I presume. We also have a smaller amount

for the transfer of staff from Government Management Services. That was

probably the air ambulance arm because that's GMS, the airplanes. And

then the item for the provision of funding to meet ambulance attendant

and other travel costs and for inflationary impact is $57,000.

It would appear that it's legitimate ministry employee travel from

one area to another, and it's nothing out of the ordinary in terms of

previous budgets. It's just that the coding has been changed from one

STOB to another.

MR. PERRY: Last year hon. members were privileged to see

something that usually gets reduced to three rather sanitized pages a

year or two later in the annual report of the Ministry of Health, and

that was the actual unexpurgated report of the provincial ambulance

service or the annual report of the Emergency Health Services

Commission. That report showed us a little over a year ago that the

Emergency Health Services Commission costs had gone up $1.2 million

because of the abuse of government jets for ministerial travel. Jets

intended for the ambulance service were not available, and the extra

charter costs incurred by the ambulance service when the government jet

was not there amounted to $1.2 million. That annual report made very

clear that there was an additional cost to the taxpayer incurred

because of the cabinet use of jets.

This year members have not been quite so fortunate as to see the

annual report of the Emergency Health Services Commission. I wonder if

the minister would tell us whether the total air transport costs were

less this year, given that last year they were inflated by that

unnecessary $1.2 million? Or at least how did they compare? Did we end

up coming out about even this year?

HON. MR. STRACHAN: First of all, I won't accept the fact that

all the charter costs are the result of cabinet ministers using

government airplanes. If the member had any knowledge of the north at

all, he would know that in many instances the Citations can't land, so

we charter other airplanes. A Citation needs 3,500 feet of

uncontaminated blacktop. If the member has spent any time in the rural

areas, he would know that there are not a lot of strips that qualify.

We use charters for many reasons — helicopters that can take off and

land on shorter strips, strips contaminated with bad weather or lots of

precipitation or strips that are not paved but in fact are gravel.

The last hard figures I have for air ambulance services are for

1989-1990 at $6,600,000, and estimated for 1990-1991 is $7,800,000.

There is an increase there, but that corresponds to the increase in

patients, which is from 5,500 to 6,300. That's why there's an increase

in air ambulance services — more patients carried.

I regret that I don't have, under the category called "in-flight

volumes," the figures for.... Of course, I couldn't have them from

1991-92, because we haven't had that year yet. The last figures

available are for 1990-91. The cost has gone up, but then so has the

column "patients transported"; 5,597 in 1989-90, and 6,355 patients in

1990-91.

MR. PERRY: The minister does not need to inform me that

charters are required sometimes; I've accompanied patients on some of

them — by helicopter and small plane — in my past life. I've not only

visited rural areas in the government jet; I've worked in some of them.

But the point was not that the ambulance service did not need to

charter some jets in the 1989-90 fiscal year. The point was that it had

to charter $1.2 million extra of private jets, specifically because the

government jets were out gallivanting around with one passenger — one

cabinet minister — at a time often on the frivolous business of racing

each other up to Kamloops, Abbotsford or wherever it was.

My question would be: can the minister tell us — or come back to us

a little bit later — how much money was saved in the 1990-91 fiscal

year, which just ended? How much money was saved by the provincial

ambulance service by virtue of government jets being reserved for the

people they're intended to serve, thanks to our having raised that

issue in the Legislature last year?

I presume that the annual report of the Emergency Health Services

Commission will make that information clear just as it made the abuse

clear in a report that was leaked and that members were privileged to

see for the first time in the history of this province. Or perhaps it

would be simpler for the minister to table the annual report

unexpurgated of the Emergency Health Services Commission for last year.

HON. MR. STRACHAN: I cannot provide that information to you.

In terms of filing that report, I don't know if that's ready at this

point. Apparently there is no such report.

MR. PERRY: Did I hear the minister accurately? There is no such report? There is no annual report for

[ Page

12839 ]

the Emergency Health Services Commission,

provincial ambulance service? If so, does that mean the ambulance

service has been disciplined and told not to report, after the events

of last year when its report reached the light of day and blew open the

Gran Air scandal?

HON. MR. STRACHAN: That report will be part of the Ministry

of Health's report. It will be a report but not singly identified or

described that way. But it will be made public in the fullness of time.

MR. PERRY: Let's be clear. I guess some of us on this side of

the Legislature did have trouble taking the throne speech seriously.

There was that ostensible commitment to open government and freedom of

information. If I remember, there was actually a line in the throne

speech committing the government to a freedom of information bill — or

policy, at least.

Last year when we saw the 71-page report of the Emergency Health

Services Commission, it became darn well obvious why in the past that

report was expurgated or edited down to a three-page, mealy-mouthed

version in the annual report of the Ministry of Health. The annual

report of the Ministry of Health usually comes out a year and a half to

two years late, when nobody would be interested in it anymore and

what's in there is irrelevant.

The whole point of the experience last year surely was that the

public received — contrary to the then government policy of smothering

and suppressing information — the annual report of the Emergency Health

Services Commission. It did see the light of day. All members had

access to it because I tabled it in the Legislature. The press had

access to it. It showed that the government's abuse of the jets had

cost the taxpayer $1.2 million in extra air charter costs. It showed a

number of other rather disturbing features, but that was probably the

worst abuse.

Surely we could learn from that and expect the ministry to now

provide us, as a matter of course, with that annual report, as it might

with reports of other agencies under the Ministry of Health, such as

the forensic services division. Surely we're entitled to expect that

and not to see — in some distant future under another government, no

doubt — a watered down version of the report in an annual report of the

ministry that will come out so late that nobody will even read it, let

alone notice it.

If you were to attempt to make a comparison of the rather shocking

and very disturbing facts and conclusions reported in the original

version of that annual report to what had been reported in the

three-page little

summary in the previous annual reports of the

ministry, there's no comparison. We don't know whether other reports

were as juicy in previous years. But I'd like to ask why the minister

won't just commit that when the Emergency Health Services Commission

finishes its report, he will table it.

[4:15]

HON. MR. STRACHAN: Everything is going to be consolidated in

the Ministry of Health report, and the information the member is

seeking will be there.

MR. JONES: My colleagues, particularly those from rural

communities, have done a superb job of representing the health care

concerns in their communities and with their hospitals. But Id like to

return to one we touched upon earlier, and that is the situation with

Burnaby Hospital in Burnaby.

MR. KEMPF: He knows more about that than he knows about the rural communities.

MR. LOVICK: Behold, the volcano erupts!

MR. JONES: Wolfman Jack strikes again.

We're speaking, Mr. Chairman, of a community of 160,000 residents.

Burnaby Hospital does not serve just Burnaby; it serves an area of east

Vancouver as well, so it has a very large catchment area. We know

cancer is a serious disease in our community, and I know the minister

cares as much as any member about the problems associated with that

dreadful disease. In a large population like that, one would expect a

fairly large number of cancer patients.

It seems to me that in a very large community like that, one would

expect there would be an out-patient cancer chemotherapy clinic in a

very large hospital like Burnaby, serving a very large catchment area.

My understanding is that Burnaby is certainly one of the largest

hospitals not to have such a unit. Such a unit really dispenses drugs

and other treatment but just happens to be in a hospital setting, and I

suppose if there's a reaction to that treatment, hospital services are

right there. My understanding is that the major cost of this operation

is the drugs — that it is not an extremely expensive proposition to

offer out-patient chemotherapy. I'm just wondering why Burnaby Hospital

does not have an out-patient chemotherapy clinic.

The minister referred earlier to other treatment agencies in the

lower mainland that I am sure do a marvellous job, but they are

certainly not in the same proximity to the catchment area of Burnaby

Hospital as Burnaby Hospital is. Why do we have a large community and a

large metropolitan hospital that is one of the few not to have this

kind of clinic?

HON. MR. STRACHAN: I'm just having the answer that I'm going

to supply for you confirmed, but hospitals are autonomous legal bodies

that decide on their own procedures. From what I'm advised, the reason

they don't have a chemotherapy unit is that they've never asked for one.

MR. JONES: I'm surprised at the answer, because my

understanding is that that was one of the priority items that the

hospital desired. I hope when the information comes to the minister he

will provide a further report or further evidence of that.

While we're waiting for that report, let me ask one further question

of the minister, with respect to the CBC "The Journal" report on

Burnaby Hospital which

[ Page 12840 ]

was repeated last night, a program that I think

pointed out very clearly the kinds of funding problems and other

problems that a large metropolitan hospital has. The program, shown

across Canada by the most respected and reputable news journal

television program, certainly in this country and perhaps in North

America, the minister described as contrived, implying that the truth

was distorted in that program, that the kinds of representations made

by the "The Journal" crew were inaccurate representations of the facts

of that hospital. I would ask the minister at this time to clarify the

facts that he is aware of that were distorted, the kinds of

representations there of the medical, health care and funding problems

which exist in that hospital and that were misrepresented by the CBC

"The Journal" program.

HON. MR. STRACHAN: I'll repeat what I said this morning. I

watched this program last night, and it was contrived to look as though

it happened within a 24-hour period. It took them two weeks to film

that, and that's what I said this morning. They had to spend a lot of

time getting every crisis right and condensing it to look like a

one-day experience, when in fact filming did take two weeks.

MR. JONES: Again the minister used the word "contrived."

Surely the minister appreciates that just showing a 20-minute clip from

20 minutes at Burnaby Hospital would not make for reasonable

television, or an accurate reflection of the typical problems that

exist at the hospital. Very clearly the minister understands that would

not be television which would be informative to the general public, and

that it was necessary for the film crew to spend some time at the

hospital to put together a television program that reflected the

problems which occur there. They could have spent a year there and had

more wide-ranging problems depicted in the program. They didn't spend a

year there. They spent a period of time there. The point I'd like to

inquire about is: as the Minister of Health, are you aware of

particular situations that were distorted by the CBC film crew?

HON. MR. STRACHAN: No, I'm not, and I didn't say that there

were. What I did say was that I offered to the committee the

information that it took two weeks to get this 20-minute — I think it

was a little longer, actually — clip. I guess the member in his own

argument admitted that 20 minutes at the hospital certainly isn't going

to be very exciting. So to really condense all their problems into one

20-minute clip, they had to spend two weeks doing it — editing out the

boring stuff and things that are mundane and working well and trying to

find for 20 minutes some serious crisis problems, which I'm sure over a

period of two weeks any hospital could provide to you. No, I make no

comment about them finding something untoward or something they

contrive in the sense of staging an emergency, a process or an unhappy

event. I'm just telling the committee that the 20-minute show took two

weeks to put together. I said that this morning, and I'll say it again,

because that's what did happen.

While we're on the subject of Burnaby Hospital, I'll describe it

briefly to the committee. It's a 386-acute-bed, 250-extended-bed

hospital, which operates as a large community hospital. There is a full

range of services, with many secondary services for Burnaby being

provided in Vancouver. Over the past few years Burnaby Hospital has

received major adjustments in its operating grant, and that goes as

follows: in fiscal 1987-88 the hospital care grant was $41 million; in

1988-89 it went to $43 million; in 1989-90 to $48 million; and in

1990-91 to $53 million. So they've had good percentage increases. They

are, respectively, over those four years, 9 percent, 6 percent, 11

percent and 10 percent.

We did an operational review by the hospital care division in

1988-89 and added a further base funding adjustment of $700,000.

Burnaby Hospital will be undergoing its second review in this process.

That review began in the middle of May 1991.

MR. JONES: Can the minister confirm that he still stands by

his statement that there has been no request for an out-patient

chemotherapy clinic?

HON. MR. STRACHAN: Let me respond to that again, before the

member tries to imply something that I didn't say. I said that those of

us sitting in the House right now are not aware of the application for

chemotherapy services. But as the member will note, one of the staff

people has returned now; maybe we can provide that information to the

member. I'd also like to point out that Burnaby does not face the same

population pressures that we are currently experiencing in the Fraser

Valley.

MR. JONES: I wasn't really clear on what the minister said in his last sentence with respect to the out-patient chemotherapy clinic.

HON. MR. STRACHAN: I said that Burnaby Hospital does not face the same population pressures as the hospitals located in the Fraser Valley.

Now here is the word on the chemotherapy unit. Within the last

couple of months we received a proposal from the B.C. Cancer Agency and

Burnaby Hospital, along with Cancer Agency proposals for Nanaimo and

Richmond, for chemotherapy units.... I can't read the writing; it's

probably handwritten by some doctor. In any event, the proposal is

under review and is likely to be approved. So we have recently, as I've

said, received those proposals from the B.C. Cancer Agency for Burnaby,

Nanaimo and Richmond.

[4:30]

MR. PERRY: Back to the Burnaby Hospital situation. I've been

searching through my files. I had it here the other day, and I can't

seem to lay my fingers on it, so I'll have to go from memory. There it

is.

I want to ask the minister about his response to the coroner's

report on the case of Stan Roberts, which was featured, among others,

on CBC's "The Journal" last night. I'm still thumbing through here. I

had it right to

[ Page

12841 ]

hand the other day, but I remember enough about the case that if I can't lay my hands on it all, I'll rely on my memory.

The case concerned, as it happened, a prominent British Columbian

who we know now from an autopsy died of a brain abscess, an infection

deep in his brain, a condition that might have been treatable had he

received timely therapy. He did not receive the timely therapy that he

ought to have received.

This man, who was in his mid-sixties, was found by his family

apparently confused and slumped over the steering-wheel of his car, not

quite sure what to do. They recognized that something was terribly

wrong, and they took him to Burnaby Hospital, the closest hospital. He

was well treated there in the emergency department. A serious problem

was immediately recognized by the physicians in that department, and he

received a timely CT scan. It was recommended that he receive a

stereotactic biopsy, a procedure which at that time could only be done

at Vancouver General Hospital. For complicated reasons, the biopsy was

never achieved. In the meantime, the coroner's report made that clear,

and since I can't unearth it right now I'll have to go from memory. If

memory serves me correctly, Mr. Roberts, in critical condition, spent

about three days in the emergency department at the Burnaby Hospital.

Although he technically might have and probably did receive adequate

medical care to the extent it could be provided in that hospital, it

was clearly a very unfortunate situation for both Mr. Roberts and his

family, and one which none of us would want to see repeated.

One of the recommendations of the coroner's report was that that

situation be reviewed, and I raise it now. What action has the ministry

taken in response to that report by Coroner Cave?

One of the recommendations, as I recall, was that the emergency room

situation at Burnaby Hospital be reviewed. The coroner stated that the

hospital was one of the hardest-pressed hospitals in the province.

Regardless of what the population statistics in the possession of the

ministry show, that hospital has an extremely high demand placed on it,

which it has had great difficulty meeting. There have been other cases

less serious brought to public attention. This was, I hope, the most

serious and the most unfortunate case in the hospital's history, and

hopefully it will not be repeated.

I'd like to remind the minister that there has been an ongoing

record of problems at Burnaby Hospital due to the chronic overload

there, and that the coroner drew that to the ministry's attention some

months ago. I'd like to ask: what was the ministry's response to that

report? While we're on it, in a broader context, what steps has the

ministry taken to respond to the other recommendations of the coroner's

report in the Stan Roberts case?

HON. MR. STRACHAN: The coroner's report is being reviewed by the

ministry now; also by Vancouver General Hospital. We also understand — we don't

have this confirmed yet, but I am going to leave it at that anyway — that this

issue may be before the courts, in which case it would make it sub judice for

me to continue further discussion. Even if it isn't, I'm not going to

continue discussion on this issue until I've had a chance to fully review

the coroner's report and the actions taken by this ministry and maybe seek

some other advice from officials in government.

MR. PERRY: Forgive me, Mr. Chair, but is the minister saying

that he has not read and reviewed the coroner's report? Again, I had it

with me for several days, and because of the adjournments of the

debates, I've probably left it in my office. It was brought to my

attention. I read it very carefully several months ago, and I read it

again carefully in preparation for these estimates last week, because

the question was crucial. It reflected not only on the government's

responsibility to provide services in a timely way but on the question

of whether doctors are doing all in their power to ensure adequate

treatment of emergencies. It reflected on the question of whether

hospital administrators — in this case particularly at Vancouver

General — had done everything in their power, and it also reflected

with major implications on the question of what steps institutions take

when a health catastrophe like this happens to ensure that it's not

repeated. After all, in our democratic system, that is the purpose of

coroners' inquests.

That's why, when the family of Mr. Roberts asked for my advice on

this case, I encouraged them not to go to the courts, but to go to the

coroner and if necessary ask for an inquest, and why I advised them,

upon receipt of the coroner's report, that an inquest by jury was not

in fact necessary, because the coroner's report made some very

important recommendations. So I would find it astounding if the

minister is telling us he has not read that report, or that his

ministry has not completed its study. I think that is shocking.

[Mr. Ree in the chair.]

HON. MR. STRACHAN: The member is entitled to his own opinion.

I can advise the committee that I have not read that report on Stan

Roberts. It happened some time before my coming into this ministry.

I've read others, but not that one. I am advised that the staff are

looking at it, and that's all I'm prepared to say about this issue at

this time.

MR. PERRY: I'm really troubled by this. Mr. Kim Roberts took

that case to the Royal Commission on Health Care in January. He

submitted himself to the very trying experience of describing his

father's case through a grilling by two of the commissioners, including

the chairman. There was no hesitation to discuss the issues that arose

out of the case by the Royal Commission on Health Care.

Last year in this House we discussed the case of Mary Sallis, which

also occurred at Vancouver General Hospital and raised similar

questions of whether the hospital — and for that matter the provincial

health system — was capable of responding in a timely and effective way

to emergency conditions. This has been a major problem in this

province, one that has preoccupied

[ Page 12842 ]

the public and frankly frightened a lot of people.

It is not some trivial issue. Maybe the public is suffering the effects

of the revolving-door syndrome — that "Fifty-four-forty or Fight, " or

42-50 or whatever it was — because the Social Credit government has

been unable to maintain a consistent Minister of Health over the last

five years.

I realize it's a difficult portfolio. It's difficult, if not

impossible, for the minister to master it in the month that he's had.

But if the minister hasn't studied that report as a priority, surely

his officials should have a comprehensive position by this point as to

how they would respond to the coroner's report, given that it

specifically recommended that initiatives be undertaken by the ministry

to ensure that hospitals do not repeat that experience. What would have

been the point of Mr. Kim Roberts, Mrs. Roberts and the other children

exposing their family to the experience of describing what happened to

their father in public if the ministry was not prepared to act on those

matters?

I would hope very sincerely — and let it be said in public — that

the hospitals have acted independently on the basis of that report, and

acted long before the report was prepared. It was disappointing to find

out they hadn't acted immediately after the death of either Mrs. Sallis

or Mr. Roberts. It was disappointing to know that Vancouver General

Hospital was not even aware that Mr. Roberts had died while he was

awaiting an urgent biopsy at their facility. Nobody even knew. That

revealed a fundamental flaw in the feedback of good medical care.

It would be unconscionable if hospitals have not responded to the

public reports of those and other cases. It would be unconscionable if

departments — for example, the department of neurosurgery or the

department of surgery or the medical staff at the Burnaby Hospital —

have not reviewed that experience to ensure that it will not be

repeated. It's equally unconscionable if the Ministry of Health does

not have a position and has not acted. With respect, Mr. Chairman, I

don't think it's good enough for the minister to tell us that he has

not seen the report. If he hasn't seen it in the month he's had — given

that he's fighting for his political life as well as that of his

government; I can understand that — surely his staff can inform him of

what steps they've taken to ensure that that tragedy won't be repeated.

HON. MR. STRACHAN: The member has indicated this is not a

trivial issue, and it makes my point. I'm not going to discuss it in

this political context. It is being reviewed by the medical

vice-president of VGH; it has been reviewed by the staff; and I'm

having a copy of it sent to me now. But I am not going to comment

further — probably at all — during this debate, because as the second

member for Vancouver-Point Grey accurately points out: "This is not a

trivial issue." I am not going to take a position on this issue and

that tragic circumstance during this debate. If the member wants to

discuss the administrative responsibilities of this ministry, I will.

If he wants to discuss the tragic situation of Mr. Roberts at VGH, it

will have to take place in another forum.

MR. PERRY: I appreciate the forbearance of my colleague from

Port Alberni who has been waiting to participate, but I want to bring

one further issue to the attention of the minister regarding Burnaby

Hospital. In a letter I received last December from an obstetrician and

gynecologist, Dr. H. Ewart Woolley, he points out that: "I feel there's

little point in communicating with the present incumbent since

operation of the Ministry of Health appears to have been taken over by

the Minister of Finance." That was under the former minister who now is

the Minister of Finance. Maybe Dr. Woolley would feel it's now more

worthwhile communicating directly. But he asked me to raise this in the

Legislature.

He raises another example of people in real life — not just on CBC's

"The Journal" program — having difficulty. He gives an example:

"I write to bring to your attention the situation

which exists at Burnaby Hospital, especially as it applies to patients

coming to hospital for either emergency or for short-stay surgery. At

present, the emergency patients — i.e., those with proven cancer

demonstrated by office biopsy — are waiting between three and four

weeks to enter the hospital and sometimes even longer."

That may or may not — depending on the case — be an inordinate wait.

If it's a slow-growing type of cancer, sometimes that may not be

unreasonable. But any member can imagine that it's traumatic for

someone who's been told they have cancer to wait three or four weeks

for surgery. Even when the medical evidence suggests it doesn't make a

difference, it's very difficult emotionally for people.

I quote again: "Patients in this category are those suffering from

post-menopausal bleeding where a biopsy demonstrates an

adenocarcinoma." That means a cancer. Definitive treatment is a

hysterectomy with radiation treatment. These same patients who require

a hysterectomy and radiation treatment are routinely waiting three to

four weeks after their diagnosis has been confirmed.

I quote again:

"A much larger category is of patients who are having

day-of-surgery procedures, such as D and C, tubal coagulation,

laparoscopy for pelvic pain, or endometriosis where the waiting-list is

now between six and seven months and increasing at about one week every

six months."

This is evidence that the waiting-list for people requiring standard

treatment is growing, in fact. That was as of December 7, 1990.

I would like to leave that with the minister to assure him that it's

not just the member for Burnaby North or CBC's "The Journal" that are

concerned about problems in Burnaby. There are real problems there. Of

course, solutions aren't easy, but to dismiss them as something that

was fabricated by telescoping two weeks into 40 minutes — is just not

realistic.

[4:45]

HON. MR. STRACHAN: I want to make one comment. I've now had

more of an update on the chemotherapy request from Burnaby Hospital. We

received the