1987 Legislative Session: 1st 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, DECEMBER 8, 1987

Afternoon Sitting

[ Page 2889 ]

CONTENTS

Routine Proceedings

Oral Questions

Free trade and fish-processing. Mr. Miller –– 2889

Emergency health services. Mr. Harcourt –– 2890

Heart surgery waiting-lists. Mr. Harcourt –– 2890

"Gag order" to senior personnel. Mr. Lovick –– 2890

Howe Sound Pulp and Paper Co. Ltd. Mr. Williams –– 2891

Ministerial Statement

Open-heart surgery. Hon. Mr. Dueck –– 2891

Mrs. Boone

Miscellaneous Statutes Amendment Act (No. 4), 1987 (Bill 59). Committee stage.

(Hon. B.R. Smith) –– 2892

Mrs. Boone

Hon. Mr. Dueck

Mr. Skelly

Ms. A. Hagen

Mr. Cashore

Ms. Marzari

Ms. Smallwood

Mr. Sihota

Mr. Blencoe

Hon. Mrs. Johnston

Mr. G. Hanson

Hon. Mr. Couvelier

The House met at 2:09 p.m.

HON. MR. VEITCH: It is very great pleasure that I introduce a

gentleman and a lady seated in the members' gallery. Mr. Karl Bertil

Eriksson is consul-general of Sweden. Mrs. Karl Bertil Eriksson is also

with him. I would ask the House to bid them welcome.

Further, Mr. Speaker, may I take this opportunity to congratulate

the B.C. Lions Society for Crippled Children who held their telethon

over the weekend. They raised $3,511,366. Fourteen hundred people

donated their time to work on the telethon. The Premier and myself were

down there, and we were very happy on behalf of the government of

British Columbia to donate $40,000, which I'm sure acted as a catalyst

in this very worthwhile endeavour.

MR. KEMPF: In the gallery this afternoon is Mr. Russell

Brown. Russell is a native of Burns Lake and will soon be partaking in

the internship program here in these precincts. I would ask the House

to make him very welcome.

HON. MR. REID: I rise to invite some of the opposition

members to be at the B.C. film industry for auditions in the coming

week, because some of them could use some help. But that's not why I

stood.

Mr. Speaker, it's with a great deal of pleasure that I introduce to

the House today Mr. Don Bell, the former mayor of North Vancouver and

the marketing manager for Canada Safeway.

MR. REE: I would like to echo my colleague's comments and

welcome Mr. Don Bell, who has been a good friend of mine and a good

supporter for quite a number of years.

Mr. Speaker, I would ask this House to welcome a group of 47

students from Handsworth Secondary School in North Vancouver. They are

under the guidance of their teacher, Mr. Jim Adams.

Mr. Speaker, of the group, there are 15 that have done a most

commendable job in putting a brief together on the free trade issue,

which they have presented to the federal government. Over lunch today

they met with myself and the hon. Minister of Economic Development

(Hon. Mrs. McCarthy) for over an hour and for lunch period, getting

information from the provincial government for the preparation of a

brief to the provincial government on free trade. I would ask the House

to welcome these students to Victoria and commend them for their

efforts.

MR. CHALMERS: Visiting in the gallery today is someone who is

a tremendous amount of help to me back in my constituency with my work

serving the constituents. She is my assistant, and she is here watching

the proceedings this afternoon and visiting with a number of people in

Victoria. I would ask you all to help me in giving a warm welcome to

Susan Aitken.

MR. SIHOTA: On a similar note, in keeping with the comments made by

the second member for Okanagan South, I must report to the House that all of

us have constituency assistants and that the best constituency assistant in

this province happens to be working in Esquimalt-Port Renfrew. She is seated

up there today in the gallery — my constituency assistant, Sheila McFarlane.

Would everybody please give her a warryi welcome.

HON. MRS. McCARTHY: I would ask the House to welcome two

people in the gallery today. Mr. Henry E. Justesen, who contributed to

our educational services earlier in his career and now is in the

business community, is in the gallery, along with Mr. H.Y. Yeh, who is

one of our international people here to assist us with the economy of

the province. Would you please welcome them.

MR. HUBERTS: In the gallery today is a great friend and a constituent of mine, Mr. Martin Oliver. Will the House make him welcome.

Oral Questions

FREE TRADE AND FISH-PROCESSING

MR. MILLER: My question is to the Premier. The east coast

Premiers, who did not give Mulroney a blank cheque on the free trade

deal, have been able to win concessions, namely that fish caught in

Atlantic Canada must be processed in Canada. Why have you failed to win

similar concessions for B.C.?

[2:15]

HON. MR. VANDER ZALM: This has not been a matter of

negotiations. The Prime Minister has kept us extremely well informed

over many long meetings over the past many months. At no time did

Premiers negotiate or did the Prime Minister negotiate with Premiers.

This is a federal initiative. It's within their power to in effect

arrive at an agreement between the United States and Canada.

British Columbia has certainly gained tremendously from the free

trade agreement. It will be one of the best things that's happened

to the economy of this province. I appreciate that it may be somewhat

against socialist philosophy that we establish between two nations the

opportunity to trade freely, but it will certainly help all people of

this economy, regardless of their philosophy.

MR. MILLER: It's a very interesting revelation by the Premier

that the Premiers had no input into the free trade discussions. That's

certainly news.

Mr. Premier, we're talking about a $750 million industry and 8,000

jobs in British Columbia. What steps are you prepared to take if the

preliminary ruling from GATT is finally approved?

HON. MR. VANDER ZALM: First of all, I should correct what

unfortunately happens so often when the member makes a statement such

as that. I did not say that we did not have input. There is a

difference between input and sitting down to negotiate. We certainly

did have every opportunity for input; and input was provided on behalf

of people everywhere, including British Columbia.

With respect to the other part of the question, there is a

difference between the free trade agreement between Canada and the

United States and GATT. We're a member of GATT. GATT makes its rulings.

I suppose we could get out of GATT, which means that all sorts of

actions could be taken against the country without our having the

opportunity to'respond to those actions. The country and the Premiers

and the Prime

[ Page 2890 ]

Minister have decided that we definitely want to participate in GATT and want to continue to participate in the GATT process.

MR. SIHOTA: What about fish-processing?

HON. MR. VANDER ZALM: The member says: "What about

fish-processing?" It does not mean that every decision that comes down

will be to our liking. I think we would have to be like a bunch of

spoiled kids if we thought we could be members and still have all

things our way.

We will have many decisions made by GATT that will be of benefit to

the country and to the province; we will have decisions made by GATT

that will require us to make adjustments. We've had good discussions

with respect to the decision made by GATT on the processing of fish in

British Columbia, and I'm happy to tell the members across the way that

it is being resolved very effectively by our federal government at the

urging of our provincial government.

MR. MILLER: Again to the Premier. That's not what I hear, but

it's interesting to say that all you could do was talk to the Prime

Minister; but clearly he didn't listen. I'll restate the question: how

come the Atlantic Premiers were successful in getting that kind of

protection for processing fish in Atlantic Canada, and you weren't?

HON. MR. VANDER ZALM: The member obviously is not clear on

the contents of the agreement. I can appreciate that, because it's a

difficult arrangement and the details may appear somewhat confusing,

especially when one goes in looking at the details with a very negative

view. I will be pleased to provide those details to the hon. member at

another time.

EMERGENCY HEALTH SERVICES

MR. HARCOURT: I have a question for the Minister of Health.

On November 25, an elderly patient in need of critical care was

shuffled around the lower mainland in an ambulance to three different

hospitals. I have a letter from the woman's physician addressed to the

minister, describing how she was bumped from the Royal Columbian

Hospital, was refused admission in Surrey and finally ended up in a

chair, at night, in the Langley emergency ward.

I want to quote the doctor, Dr. Warneboldt, who wrote: "It is only a

matter of time before somebody dies in an ambulance while being

diverted from hospital to hospital." My question is: will the minister

recognize the importance of access to vital health care services for

all British Columbians, and will he make sure that there are the

necessary funds for emergency care at hospitals such as the Royal

Columbian?

HON. MR. DUECK: All I can say is that I do recognize the need, and we're

doing everything we can to correct it. There have been times, perhaps, as you

mentioned, when an ambulance has gone from one place to another. I don't

know that particular instance; I haven't got the information in front of

me at present. But I can assure you that even with some of the faults in the

system, we're providing excellent health care. In that particular case perhaps

it was wanting, and it should be corrected. We're constantly reviewing and

correcting our plans in delivery service.

HEART SURGERY WAITING-LISTS

MR. HARCOURT: Mr. Speaker, I have another question for the

Premier. I'm sure the Premier is aware that on Friday the Health

minister told the House that his government is considering allowing

another B.C. hospital to provide heart surgery. Can the Premier tell

this House when British Columbians who are desperately waiting for this

vital health care –– 400, as a matter of fact...? When will the

government deliver on the promise given by the minister on Friday?

HON. MR. VANDER ZALM: I think the hon. Leader of the

Opposition should know that this should be addressed to the minister.

So I will defer to the minister.

HON. MR. DUECK: Mr. Speaker, I think I've gone on record as stating — and I'll say it again — that it is in my estimates for the coming year.

I have a good-news story, and I think this is the time I should

mention it. I spent most of my morning yesterday with VGH. Some time

ago — in 1986, just before I came into the ministry — we approved $2.7

million for development of their new heart surgery facility. That is

not completely finished, but they have moved into the facility. They

assure me that they will do their quota of heart surgery before the end

of the year. That's where some of our problems were. As I mentioned

before, we had allocated funds for 2,200 and some; only 1,700 were done

in a 12-month period. They now assure me that they will be able to pick

up the slack they were falling short on. The chairman of the board and

the president of the hospital also assured me that they have never

turned away from the hospital, nor will they ever turn away, someone

who is in an emergency. He said: "We make that very, very clear." But

having said that, he also said that it's very difficult to make a

judgment call, that very often people do have heart attacks or a stroke

or what have you at a later time, and because there is a waiting period

perhaps emergencies are looked at a little differently than if there

were no waiting period. But they assure me that they will catch up with

the 90-odd cases that they were behind.

"GAG ORDER" TO SENIOR PERSONNEL

MR. LOVICK: My question is directed to the Minister of Transportation and Highways; it's very short.

Not many days ago the minister formally announced that he was

rescinding a gag order that was given to public servants. There is now,

however, another gag order, a memo dated December 3 to senior personnel

in the Ministry of Transportation and Highways. In that memo the senior

personnel are instructed not to talk to the media about "privatization

and legislative matters."

My question to the minister is just this: will he assure this House

that he will also rescind this gag order, and that he will do so right

now?

HON. MR. ROGERS: As I told the member previously, the

original communication did not come from my office, nor did the

instruction to rescind it. I am not aware of what particular document

you are referring to now, but it did not come from my office. I'd be

pleased to have a look at a copy of it and find out where it

originated. I don't normally take it as my responsibility to rescind

instructions given by other people, but I am curious as to why it's

come forward. I'd like

[ Page 2891 ]

to see it. I'd like to see if it was done by someone in my ministry or by someone outside of my ministry.

MR. LOVICK: A supplementary, if I might, to the minister. The

minister should know that the memo comes over the signature of his

deputy minister. And given that we have already had assurances that

this new minister is going to take a hands-on approach to the affairs

of his department, will he inform the House whether the deputy minister

is working entirely on his own initiative, or whether he is in fact in

charge of that ministry?

HON. MR. ROGERS: I don't lean over his shoulder and look at

everything he signs. I'll certainly find a copy of this. It didn't come

with my instructions on it, so we'll see.

MR. LOVICK: Just once more, if I might, again to the

minister. Will the minister then at least tell us in this House that he

deplores this effort to gag public servants? Will he go that far at

least?

HON. MR. ROGERS: I'll look at the memo, see what originated it and make a decision in time.

HOWE SOUND PULP AND PAPER CO. LTD.

MR. WILLIAMS: To the Minister of Economic Development.

Yesterday the minister announced a billion dollars, which was short by

two-thirds. The question is: the backers of the project, Cantor and

Oji, are requesting electricity subsidies. Canfor has made an estimated

quarter of a billion in profits for the last two years and next year,

and Oji is, of course, a very successful company. Is the minister

actively considering a welfare subsidy to these extremely successful

companies?

HON. MRS. McCARTHY: First of all, may I just correct the

member. When I said that over the next three or four years it could

amount to a billion dollars I gave the specific amounts. If he checks Hansard ,

he will find that the modernization of the mill at Port Mellon would be

$280 million, and I announced that the new $355 million newsprint mill

for startup in 1991 would amount to $355 million. I said in my

statement that the total would be $635 million.

In terms of what benefits the company would need at the present

moment, I also mentioned in my statement that they have not asked for

anything that has not been asked for by anyone else. It's just a

question of.... There has been nothing given and there have been no

commitments given to either firm or to the amalgamated firm.

Ministerial Statement

OPEN-HEART SURGERY

HON. MR. DUECK: I'd like to make a ministerial statement, if I may.

Mr. Speaker, I rise today to clarify a comment I made in this House

last Thursday, December 3, regarding open-heart surgery. I regret that

the general

interpretation of my comments was that I personally feel

that open-heart surgery is a trendy status symbol. This was a quote

that I read out; it was not my feeling. The point I was trying to make

is that there is a broad school of thought from the medical profession

itself as to whether or not the practice of open-heart surgery is

always the best solution to this serious physical problem surrounding

heart ailments.

[2:30]

Certainly in the past 20 years, since the first heart transplant

operation revolutionized medical practices in this area, many, many

lives have been prolonged. But today we are beginning to reach a

crossroads of professional thought in this area concerning the

potential of exploring alternative options to the traumatic and

expensive procedure of heart surgery.

I wish to state today that I deeply regret any misunderstanding

which may have resulted from the doctor's comments I quoted in the

House last week. I feel it is important, however, to reiterate my

contention that alternative methods to open heart surgeries be

explored. Even the prestigious Journal of the American Medical Association ,

in a recent

article prepared by four medical doctors, states: "Coronary

bypass surgery could be postponed or forgone entirely in a significant

fraction of clinically stable patients previously advised to undergo

this type of procedure."

This comment was made at the conclusion of a study which was

established to look at the question of bypass surgery in relation to

other possible medical practices to treat coronary artery disease. A

concluding comment from this

article states: "This study indicates that

second opinions for coronary bypass surgery have merit, and

furthermore, that a large fraction of patients will adhere to a

contrary opinion provided that adequate psychological support,

reassurance and communication with the local physician is carried out."

Perhaps it is time we begin to listen more intently to this learned

body of second opinions. In so doing, it may help to put us one step

closer to reducing both the medical costs and the agony many British

Columbians are now facing as they await admittance for open-heart

surgery.

Enormous accomplishments in this field of surgical medicine cannot

be denied. Indeed, the very system itself may have become a victim of

its own successes. British Columbia provides one of the best health

care services in this country. If we wish to maintain, and perhaps

improve, that proud accomplishment, we must begin to look for more

alternatives which will help sustain the quality of that care. It is

for this reason that I have asked the advisory subcommittee on cardiac

care to look at the standard practices applied in the field of

open-heart surgery in this province and to consider establishing

guidelines which may help to alleviate the degree of current concern.

I would like to add in conclusion that I inadvertently referred to

the health ethics committee with respect to such a review last week. It

is the subcommittee on cardiac care, which falls under the umbrella of

the professional advisory committee of the British Columbia Medical

Association, that will ensure the continued involvement of the medical

profession in reviewing these difficult issues. The ethical committee

and the committee on cardiac care are somewhat overlapping, and this is

why, perhaps, the confusion comes in.

The ethics committee is to identify and clarify major ethical issues

in the field of health care, such as those related to unwanted

pregnancies, abortion, euthanasia, genetic engineering and the use of

human embryonic tissue for scientific purposes; secondly, to review the

range of standards and solutions extant in other health care

jurisdictions, to seek and develop areas of consensus in British

Columbia in respect to such issues and to advise the Ministry of Health

and develop

[ Page 2892 ]

practical guidelines for the handling of such issues by the health field in British Columbia.

The cardiac care committee is to look at and provide the ministry

with data on the incidence of coronary artery disease; the criteria of

coronary bypass surgery and coronary angioplasty; the number, age-group

and sex-mix of patients needing these individual services; data on the

number of angioplasty procedures required and repeat procedures and/or

eventual coronary bypass surgery and in what time frames; and the

impact of coronary angioplasty and coronary bypass surgery and the

demand.

I hope this clarifies my position with respect to this sensitive

issue. While I recognize the anguish of those who must deal with the

uncertainty of heart ailments, it is, as I have stated before, not just

a funding issue; but also, as new medical advances occur, the

waiting-lists will continue unless we can find some available

alternatives. And as I mentioned earlier, we are now catching up with

VGH being on stream.

I should mention, too, that with new methods on the market at all

times.... I was at VGH yesterday, and they brought in a new

lithotripter, which will crush gallstones and eliminate the use of

surgery which takes an individual into the hospital for many days. In

this way it will be one hour and they can be out. That's on an

experimental basis. They already have a lithotripter for kidney stones.

With new innovative ideas coming on the market and new technology, I

think we are heading in the direction of planned health care, and we

will continue to do so.

MRS. BOONE: I thank the minister for giving me advance notice of that. I appreciate having this in advance, as the other one wasn't.

The apology that the minister gives, I think, is owed to all the

heart patients out here in British Columbia. I'm sure that they really

accept this and welcome the apology you've made.

I also welcome a review of the practices in open-heart surgery with

a view to finding more alternatives. I think all of us would like to

find alternatives to expensive surgery. However — and this is a big

however right now — it is an issue of funding, Mr. Minister; it is an

issue of funding right now. We have hospital areas in Royal Columbian

Hospital that have the ability to perform open-heart surgery. They can

perform about 300 open-heart surgeries, but there isn't the money to

equip them. We do not have enough critical care nurses, and the

minister constantly quotes that. But we are doing nothing to encourage

critical care nurses to come into the field. We do not support them in

their efforts to obtain training; we do not give them any funding. We

do not even give them leave of absence with pay, Mr. Minister. We give

them leave of absence without pay, have them pay for their own

training, and then expect them to come into an area and not get any

extra money for it. Are we surprised that there are no critical care

nurses out there? I'm certainly not.

We have people waiting right now for open-heart surgery. They've

been placed there by their physicians. What are the alternatives that

you have now? You don't have the alternatives. You are asking these

people to wait and are putting them on waiting-lists for surgery in the

hope that you're going to find alternatives. You're telling us that

you're going to establish guidelines. What guidelines have you got

right now? You don't have them. What guidelines do the physicians have?

You don't have those either. Will you be using these guidelines under

Bill 59 to deny people surgery? Is that what Bill 59 is about?

Which of the many people already out there waiting for open-heart

surgery are you willing to tell that they have to wait, that they

haven't the option, that there are alternatives for them? There aren't

any alternatives. How many more people are we going to see die or wait

around while you explore out there to find the alternatives? The people

of British Columbia, Mr. Minister, want action right now. They don't

want to wait for the alternatives to come about. We can't wait while

you go exploring.

Orders of the Day

MISCELLANEOUS STATUTES

AMENDMENT ACT (NO. 4), 1987

(continued)

The House in committee on Bill 59; Mr. Pelton in the chair.

Section 6 approved.

section 7.

MRS. BOONE: I have some very strong concerns about this

section of the bill. This gives the minister some incredible powers,

powers that we on this side do not trust this government to use in the

best interests of the people of British Columbia.

I'd like to ask the minister, please, if he has any idea what types of treatment may be determined that people do not require.

HON. MR. DUECK: This particular legislation is not what the

opposition feels it is at all. It is companion legislation that goes in

tandem with what the Medical Services Commission has at this time.

The problem we're having is that certain surgery — for example, if

you want to have examples.... And we're doing that now. The Medical

Services Commission, in fact, says that one service is not going to be

paid for and another service is. They've done it all the time.

Otherwise you could have acupuncture or chelation therapy come in, and

if we didn't have some restriction, it would all be covered under MSP.

So you have to have some regulation that says: "These are the items

we're going to cover." Of course, all the ones under the federal act

are automatically covered; anything else supplementary, where the

province pays out of their own pocket, the Medical Services Commission

has that authority under the ministry. But what we didn't have under

hospital....

In other words, if somebody had a transsexual operation, which would

not be covered under MSP, they could still go to the hospital and the

hospital would in fact pay for that patient's days in the hospital. All

we're doing now is that if you have something that is not covered under

MSP, it will also not be covered under the hospital. That gives me the

authority...not me personally but our medical staff has the authority

to make that decision.

MRS. BOONE: Set me correct if I'm wrong on this, but I understand that things can be eliminated from the Medical

[ Page 2893 ]

Services Plan by order-in-council, through the regulations. Is that not correct, Mr. Minister?

HON. MR. DUECK: Yes, the same as MSP. We could eliminate any

of those supplementary services — which you are well aware of — at any

time, but not anything that's under the medical plan with the federal

government, where we have the funding relationship with the federal

government. Anything that we fund on our own in this province, yes. And

we can add also.

So you want us to say that we should not add or eliminate? We've

added all kinds of functions in the last so many years under MSP; that

was the authority we had. But we never had companion authority with the

hospitals. What we're saying now is that if we should eliminate, for

example, cosmetic surgery, other than a child in the hospital for

medical reasons and what have you, then that individual would not get

paid for the doctor's fees. But the hospital would continue to pay, and

that person would have no charges for hospital stay.

If it's not covered by MSP, it will also not be covered under the

Hospital Act, provided we decide that it shouldn't be. That is a very

common occurrence. No one has ever complained about MSP. We add

services, we delete services, and it will continue to be so.

[2:45]

MR. SKELLY: What concerns me about this

section is that it

allows the minister to make the decision after the fact. After the

surgery or the procedure has been done by the doctor, after the

services have been obtained in the hospital, the minister or the

ministry can review the medical evidence and decide whether this is a

service that's going to paid for under the Hospital Insurance Act. That

makes it extremely difficult for somebody to go to a hospital or to

take a particular surgical procedure, because he knows that the

minister or the ministry is second-guessing the doctor in the hospital

on this issue.

I bring up a case that was brought to me by a physician in Port

Alberni, and that's the case of circumcisions. MSP now decides after

the fact whether a circumcision is medically required or whether

there's some other reason for it. The doctor now doesn't know whether

the service is going to be paid for or not, or whether he has to go

after the patient or not. As a result, the doctor now goes after the

patient in every case for payment of this service.

One of the reasons we have to be concerned about this piece of

legislation is that the minister is allowed to decide on a

patient-by-patient basis. That's what the legislation says, in any

case: that he "determines, on a review of the medical evidence, the

qualified person does not require" a particular hospital service.

That's why we're concerned about this particular

section of the

legislation. We don't know what is going to go into the minister's

decision. He's not saying that a class of services or a class of

procedures.... You're saying that in the Legislature, but you're not

saying that in the legislation. How do we know whether a particular

patient requires that class of service or not? Now you're taking it

upon yourself to do this on a patient-by-patient basis.

This

section allows the government, a minister who has no medical training

whatsoever, to decide whether a particular patient is going to receive a particular

service and be covered under the Hospital Insurance Act for that service. That's

why it appears to us to be a dangerous piece of legislation, because you're

not barring a particular class of service. You're examining the medical

records of a particular patient to determine whether that service or that procedure

provided by the doctor in a hospital should be compensated for under the Hospital

Insurance Act. How do we know that it's not being done on a political basis?

How do we know it's not being done on an economic basis, after you've

reviewed that particular patient's medical evidence? I think this gives

you a dangerous amount of power. I think that if a particular service is going

to be excluded, then it should be spelled out clearly, and it should be excluded,

I suppose, for every patient, regardless of the medical evidence.

How are we going to hold the minister accountable in the Legislature

for a decision made with respect to a particular person receiving

service in the hospital? At all times you should be accountable, and

you can't be held accountable here on the medical evidence, because we

don't have the right to review it, nor should we have the right to

review it. Nor should you have the right to review it.

In my opinion, this is a very dangerous section. A patient can be

referred to a hospital by his or her doctor, can receive a service in

the hospital, and then after the fact. for reasons known only to the

minister, can be disqualified from receiving payment. That's a

dangerous situation because the patient can't hold you accountable, the

doctor can't hold you accountable and we can't hold you accountable

because you're practising medicine without a licence.

HON. MR. DUECK: To begin with, it's not me personally who is going to review the file, that's for sure, because....

Interjection.

HON. MR. DUECK: Well, it has to be the minister because he's

responsible for that ministry, which you well know. But it's companion

legislation which we have in place now, and the wording is exactly

that, and I read from

section 4.04(g): "...service that the commission

determines, upon review of the medical evidence, is not an insured

service because the service so rendered was not medically required by

the patient." So in other words, what we're saying is that it is

companion legislation to that which has been in place for a long time.

In most cases, if someone wants certain surgery — and I again refer to

the classic cases such as cosmetic surgery for someone with wrinkles,

or perhaps transsexual operations — the doctor will say: "I'm sorry,

but these are not covered. It's automatic; it's not going to be covered

in the hospital."

Now if an individual comes to the hospital and wants surgery done,

and does not know and does not check in advance, there could be cases,

as there are cases now under the Medical Services Plan, where we in

fact turn them down after they've been to the doctor. But I don't see

any other way that this can be done. The way we've got it set up I

think is very fair. We have a medical doctor in fact on staff who

reviews these cases, which happens not too often because most items

that are covered or that aren't covered are well known. So I don't see

any problem whatsoever in this area.

MRS. BOONE: There have been changes to some of the things

that are covered in Alberta, and I'm wondering if the minister can

confirm or deny whether some of these things are being looked at by his

ministry with regard to being removed or eliminated. Some of the things

that they took out

[ Page 2894 ]

of the Alberta legislation were contraceptive

counselling, vasectomies, tubal ligations and circumcision, as we

mention here. Is the minister reviewing all of those areas, and is he

considering removing these from coverage under the Medical Services

Plan?

HON. MR. DUECK: Circumcision is already not covered in our

province. With regard to the others, I'm not going to detail what may

or may not happen in the future. The items you mentioned are currently

not under consideration.

MRS. BOONE: Mr. Minister, you're asking us to put a

tremendous amount of faith in you here, because you're not telling us

what things are being considered. You're not telling us what may or may

not be part of the changes that are coming forth in the future, yet

some time down the road we may suddenly find that all of these things

that I mentioned — birth control methods, IUD insertions — are not

available to people. These things are very, very scary to the public

when they don't know. When you put such a thing in blanket legislation

like this and then don't tell us what you're considering, and you won't

even tell us what's on your agenda, how can we have faith and accept

that you are not going to eliminate these things, that it's not going

to jeopardize the health of a lot of people? Particularly the things

that I mention, of course, affect women to a great extent. How can you

expect us to accept this at its face value when you won't tell us what

you're considering?

HON. MR. DUECK: Mr. Chairman, I guess as long as governments

have been in this present form, governments have added services.

Governments have deleted certain services or procedures that they paid

for under certain plans. Since we have a universal plan that's

partially funded federally and partially provincially only, I think

it's the duty and mandate of the government to add.... Over the years I

heard no complaint when we kept adding services. Nobody said: "Oh, gee,

don't do that without telling us." There may be times when we have to

eliminate some, because we want to make sure that this health care

system is sound and financially able to carry the basic health care

services. Some procedures may be eliminated over a period of time. We

have eliminated some and we've added some. This is what I'm saying. All

we want is to have companion legislation that covers the same as what's

in place now. That's all we're doing with this legislation — making it

equal.

MS. A. HAGEN: Perhaps I could pursue the line of questioning

in the context of the companiability of these two sections,

understanding that the minister has said to us that the purpose of this

particular amendment is to bring the Hospital Act into the same

context, to use companion language to what exists in the Medical

Services Plan.

I think one of the things we are trying to understand here, Mr.

Chairman, is what may be affected by this particular program in the way

of hospital services. The minister has suggested that there may be

services that are not covered under the Medical Services Plan, but

because they haven't had this particular clause in the Hospital Act,

they may in fact be funded under the Hospital Act.

Perhaps what we might do is to work backwards, recognizing and acknowledging

the minister's comment that there may be services that are added or subtracted

from those that are covered under our medical plan, whether it's MSP or

hospital services. Perhaps the minister could give us some idea of those services

that are currently excluded under the Medical Services Plan. Then could he respond

to what I might hypothesize: that is, if these are in fact excluded under the

Medical Services Plan, and this amendment is passed by this House, we might

presume that those same services would be excluded for coverage under the Hospital

Act. That might give us some concrete examples of the current state of exclusions.

I don't think we're looking to bind the minister to the fact that there

might be further exclusions as time goes on, but for now it would at least frame

for us what is excluded under the Medical Services Plan and what would be excluded

under the hospital services delivery system. I shall try, Mr. Chairman, to keep

my eye on the minister instead of that extremely vivid tie of his seatmate,

the Minister of Tourism (Hon. Mr. Reid), who is about to leave.

HON. MR. DUECK: Mr. Chairman, the federal government at this

time doesn't have a list of medical services that are included or

excluded; they just say "medically required." We're going under that

same basis. If we feel a certain procedure is not medically required

and we no longer wish to include it for coverage by provincial dollars,

then we may eliminate that particular procedure. But anything that's

medically required is covered under the federal health plan, and that

of course won't, change. Even if we tried, we can't change it. That's

part of their scheme and agreement with the provinces. But there are

certain procedures that require a judgment call and these may.... I'm

going back again to perhaps certain experimental surgical procedures.

There are all kinds of things that may happen; and some of you come

along and say: "Well, I had it done by a doctor, therefore I'm entitled

to have this done by the physician and also entitled to have

hospitalization." We can't do that. We're saying now that the authority

is there under MSP to look at it and say: "No, we're not going to cover

this under MSP. It's a judgment call; it's not medically necessary."

We're saying we want that same authority to say under the Hospital Act,

and we can say: "It's not covered there; we're not going to cover

hospital payments either."

MS. A. HAGEN: Perhaps then I could rephrase the question to

see if I can get a more concrete answer, because I think there are some

more concrete answers. With respect, I think the minister's answer

still deals with the broad methods by which one would deal with this.

Let me ask then what procedures presently aren't covered by the Medical

Services Plan and would presumably not be covered by hospital.

[3:00]

Let me take the minister's own words. He has has given us some

indication that there are some classes, if you like, that are excluded

from coverage. You've noted that circumcision, for example, is not

covered under the Medical Services Plan. Could I presume then that that

particular procedure would not be covered with this amendment under the

hospital services act?

You've talked about cosmetic surgery, and I'm presuming that

possibly that is not covered as a class under the Medical Services

Plan. Is that one that would be excluded?

You've talked about transsexual operations. What's the status of

that particular procedure under the medical services plan? Does that

move into this area?

Are there other areas — and I want to pursue the areas, raised by my colleague for Prince George North (Mrs.

[ Page 2895 ]

Boone), having to do with fertility: procedures

having to do with tubal ligations or vasectomies or the insertion of

IUDs — that have any exclusion under the Medical Services Plan? And

would those then not be covered under the Hospital Services Plan'?

What I'm asking the minister.... I want to try to be very clear,

because I recognize that there are two possible answers to these

questions, and I'm wanting us to try to find out what those answers

are. I'm asking him if there are some classes, procedures, that might

be grouped under some headings which are excluded under the Medical

Services Plan and which would be affected by this amendment.

I think I'll stop there, because then I will follow with another

clarification about matters that might be looked at more on an

individual-case basis, rather than on a class basis as a group of

procedures.

HON. MR. DUECK: I just want to, again, elaborate and perhaps

explain a little more closely what we're looking at and why we need

that authority to make that judgment call.

For example, if we said all cosmetic surgery would be eliminated, we

would then perhaps come across a situation where a child was born with

some disfigurement where cosmetic surgery would be very necessary, and

we would not want to exclude that. So there has to be some judgment

call by a physician in our ministry who can make these decisions'

otherwise, we either eliminate or add, and where do you draw the line?

Other examples: experimental surgery unproven medically; cosmetic

surgery without medical requirements — a child would certainly fall

under the category of medical requirements, because that child would

definitely need that type of surgery. And there's chelation therapy.

I've gotten letters by the hundreds wanting us to pay for chelation

therapy. Well, until that has been proven medically, we're not going to

do it. Under this authority we can say no, not until it's proven

medically. But if we had some doctor come along and say, "Yes, I

believe in it and I'm going to do it," and we didn't have the

authority, we would pay. I think that's unfair to the rest of the

citizens.

Abused procedures like excessive or experimental psychotherapy may

be another one. There are quite a few which one can list, because we

have quite a variety of medical people too, and — I'm sure you're aware

of this — you have a difference of opinion where you have all kinds who

would say: "I believe this is the right therapy or medical procedure

for this particular patient." We say, unless we believe it's medically

necessary....

There's no problem with anything federally, because that is decided

by the federal law. So we're speaking of things that we fund

provincially. I would say that to have this authority in tandem with

the MSP is very necessary. It has been a long time coming, and we feel

it's going to work well, the way it does with MSP. We have no problems

at all with the MSP.

MS. A. HAGEN: I'd like a yes or no answer to this question.

I'm not trying to phrase this in the sense of putting the minister on

the spot, but I want to just clarify it before I decide whether to

pursue a particular line of questioning or to shift my line of

questioning.

Would it be fair to say that there are no procedures that are excluded from

medical coverage at this time, and that each procedure is, in fact, accepted

on its merits? The question I was trying to get at, Mr. Minister, was: at this

time what is the list, if it exists, of specific procedures where there is an

exclusion, by order-in-council or by whatever procedure it comes through the

regulations? I want to know if there is a list of exclusions at this particular

time that presumably would be affected by this. I'm not trying to put the

minister on the spot at all as to whether there may not be changes in this.

I'm wanting to know very clearly what the guidelines are now, what the list

is now. Surely the people out there are not taking every one of these cases,

nor are doctors trying to figure out in every one of these cases whether it's

covered or not. I'll come back to the minister's own comments about

circumcision and transsexual operations. Those are two that you've listed.

Are they excluded from coverage? Are there others? Have you got the

list? Can you give us that list? I went way too far for a yes-or-no answer,

Mr. Chairman.

HON. MR. DUECK: I haven't got a list per se. Of course, under

the fee

schedule we do have thousands of items which are automatically

there because they are medically necessary. But there are many things

that come to our attention from time to time, and I mentioned some of

them. There may be elimination of some programs such as transsexual

operations, which you mentioned. It's no secret that some time ago I

put a hold on all transsexual operations, but they has not yet been

eliminated. Should they be eliminated from MSP, then of course they

would not be covered under hospital coverage either. That's an example

of what we're getting at.

MR. CASHORE: I find that last comment of the minister very

intriguing. If I understand what the minister said, under MSP anything

to do with transsexual operations is on hold, and by inference, that

would be the same in the case of the hospital plan. Am I interpreting

correctly what the minister has said?

MR. CHAIRMAN: I believe the second member for Victoria would like to make an introduction. Shall leave be granted?

Leave granted.

MR. BLENCOE: I appreciate the House allowing me this

introduction. In the gallery this afternoon we have 12 students from

the Inter-Cultural Association of Greater Victoria who are

participating in the ICA's work search program. They are with their

instructors, Suzannah and Anne. Would the House please make these

students welcome.

MR. CASHORE: Mr. Chairman, does the minister intend to state

in response to my question that transsexual operations would not be

allowed following passage of this bill?

HON. MR. DUECK: I'm not saying that at all, but this would

give us the authority not to give hospital coverage if they were

eliminated from the MSP side. However, all of these operations, of

course, are done out of province, and they would have to have prior

approval in any event.

MR. CASHORE: I would like to ask the minister if he would

explain whether or not the reference he made recently to putting it on

hold applies in this case. Does the minister intend to place

transsexual operations on hold?

[ Page 2896 ]

HON. MR. DUECK: I have instructed my staff not to give any

approval unless it is an operation that is already in process — to

complete that particular operation because it requires, I understand, a

number of trips to the hospital, not just one. I'm not sure, but we may

have some that have gone part way, and I think it would be unfair to

not complete that particular surgical procedure. Other than that, I

have instructed them to not give approval to any new cases that come

forward at this time.

MR. CASHORE: I would like to ask the minister if he would

explain to the House, given the qualification he has just made, why he

has placed this procedure on hold.

HON. MR. DUECK: That will come out once we do a review of a number of these items, and I cannot comment on that at this time.

MR. CASHORE: I hope the minister recognizes the dilemma that

this places us in, having to vote when the response to my question

cannot be forthcoming. We need to know the context in which this act

will be acted out. If the minister is not able to answer my question,

then it compromises our ability as a Legislature to make a

knowledgeable decision with regard to what is before us. I am gravely

disappointed that that information is not forthcoming.

I would like to ask the minister, with reference to a phrase he used

a few moments ago.... I understand that the phrase was "medically

required." I would like to ask the minister how he can reconcile the

phrase "medically required," understanding that medically required is a

"dynamic present reality." If something is medically required, it is

medically required here and now. Could the minister explain how that is

compatible with the concept of placing something on hold?

HON. MR. DUECK: I understand that we can, if we characterize it as a class, eliminate it from the plan right now without any legislation.

MR. CASHORE: I would like to ask the minister if he could

explain how it is possible to place something on hold which may be

medically required.

HON. MR., DUECK: That information and further information I will get from my medical people.

MR. CASHORE: I understand that the minister, in order to be

able to make the kinds of decisions that he is given the power to make

by virtue of the enactment of this legislation, will have to consult

with medical practitioners. I would like to ask the minister if he can

quote a medical opinion that would justify having placed this procedure

on hold as something that, in all cases, is not medically required at

this time, it being on hold.

HON. MR. DUECK: Now we're getting into medical practice. I

understand that it's not "medically required," but perhaps

"psychologically required." You can be very critical on that

explanation. Perhaps some people would say it's medically required; I

can get opinions from various medical people, and they can go and

explain it both ways.

This legislation we're talking about really doesn't affect that, because

I can do it right now without an order-in-council. I can classify, categorize

and eliminate it. So the legislation that is before us.... We're talking

now about something that perhaps we don't agree on. You say it should be

covered and maybe we say it shouldn't, although that decision has not yet

been made. But this does not affect this legislation; I think we're not

talking about this legislation. We can do that as a class right now without

an order-in-council, just with the authority we have, and so could you when you

were in power.

MR. CASHORE: I would point out to the minister that a few

moments ago when he gave two examples of procedures that could be

affected by this legislation, he mentioned cosmetic surgery and

transsexual operations. It's on the basis of the minister having used

that example that we are pursuing it and trying to get some definition

around how the minister views this.

Again, I would come back to the point I made a moment ago, that in

order to vote knowledgeably on this, we need to recognize that we're

dealing with an issue here that comes down to how ethical opinion is

achieved with regard to certain types of procedures. This is an

incredibly important issue for all of us. For that reason, I think that

we are having a very significant discussion at this time in this House.

[3:15]

I would point out to the minister that when we talk about medical

opinion, we should realize that the whole range of medical opinion, as

recognized by the Ministry of Health, includes all specialties of

physicians, from neurosurgery to all aspects of surgical work to

general practice to psychiatry.

To just think of psychiatry for a moment, a psychiatrist, in

preparing a medical opinion with regard to an individual, will include

reports of psychologists, of people who have an awareness of the social

milieu of the patient, including all kinds of consultants' reports, in

order to make up a composite which forms a medical opinion. Therefore

we cannot say that we're talking about something that may be for

psychological reasons and suggest that it is somehow excluded from

having a medical opinion. It is not. It is part and parcel of a medical

opinion. It is basic to it, and I submit that it is immoral to place

such a procedure on hold when it very well might be that it is

medically required on the basis of those very physicians that the

minister should be consulting with in order to form an opinion.

I find it absolutely astounding that such a procedure could be

placed on hold when obviously there's medical opinion out there that

would overwhelmingly recognize that you cannot base the need for that

type of operation on one narrowly defined kind of evidence. I would

like the minister to comment on that.

HON. MR. DUECK: We're not talking about legislation that

would perhaps affect MSP. We're talking about hospitals. That's what

this legislation is all about. The MSP is in place. Our physician can

in fact say that this procedure is not medically required and not pay.

All I'm saying is that we want companion legislation that will also

give us authority to not pay for the hospital stay in case it is a

procedure that the Medical Plan does not pay for. So let's not get into

the medical side of it, because that legislation is there and it has

worked very well. All I'm saying is that we haven't got the companion

legislation; I don't think it was ever intended that way. But there may

be situations — very few — where the Medical Plan does not pay and yet

the hospital would have to

[ Page 2897 ]

provide space for a procedure that was decided not medically necessary by our doctor in the ministry.

MR. CASHORE: My question is this: assuming that this

section

of this bill passes, once it is enacted will, under the Hospital

Insurance Act, sex change operations be on hold? Yes or no?

HON. MR. DUECK: If you're referring to that particular procedure, transsexual operations, this requires prior approval because they're done

out of province. They currently are on hold.

MR. CASHORE: I don't think the minister is making clear what

is meant by being on hold. I understand the meaning of "prior

approval." To me that does not mean being on hold. It means requiring

prior approval. In the view of the minister, are those two terms

synonymous: to be on hold and to have prior approval?

HON. MR. DUECK: No prior approval has been granted from the time that I put them on hold.

MR. CASHORE: I think we have now got the answer that is the

answer, which is that under the present situation and certainly

continuing under the future situation if this is enacted, whether the

operations require prior approval or not or whether they're conducted

out-of-province or not, the minister has decreed that they are on hold.

MS. A. HAGEN: Perhaps the minister could give us some

indication of the means by which these decisions are taken. I think we

have to look at it both from the context of the Medical Services Plan

and of the Hospital Insurance Act, because the minister has indicated

that these are companion pieces and that the one has an effect on the

other.

The particular amendment that we're looking at speaks about the

minister or his designate making those decisions. I want to have some

knowledge about how those decisions are made. What is the basis for

those decisions? And I'd like the minister to respond in the context of

the discussion that we have just had which would perhaps suggest that

those decisions may be taken for reasons that may go beyond medical

reasons.

HON. MR. DUECK: Mr. Chairman, we do not make any of these

decisions in isolation. We never have. Neither does the Medical

Services Plan. We consult with the medical committee. We consult with

experts — doctors in our ministry — we consult with the committee of

the Medical Association, and it is on that basis that we make a

decision, MSP. All we're saying now is that when the decision is made

that something is not covered under MSP, we also do not want to cover

that under the hospital plan. That's what this legislation is about.

MRS. BOONE: I'm getting a little confused as to.... You are unable

to tell us what particular things will not be covered under this act, and yet

you are saying that this is being put in place in order to go hand in hand with

legislation that already enables you to not cover things. I think we've

been trying to understand what things will not be covered in hospitals now that

you are having difficulty with regard to them being covered under the Medical

Services Plan, and now you say you don't want them covered by the hospital

plan.

What are the services that you are currently having difficulties

with that have brought about this legislation? Where have you found

people going and having a service that's not covered by Medical

Services Plan, but then they have to pay for the hospital stay? What

are the services that you have had to pay for under those things that

has brought about this legislation?

HON. MR. DUECK: One example, I suppose I can think of

immediately, is cosmetic surgery. We're not covering it under MSP, but

we're still covering it under the Hospital Act.

MRS. BOONE: I've talked to your ministry with regard to this

and they have been unable to tell me because they say they are

reviewing some of the things. Can the minister confirm whether you are

currently reviewing many different procedures to have them removed from

the Medical Services Plan, and then it would automatically of course be

covered by this as well? Can you tell me if you are right now reviewing

other areas to be removed?

HON. MR. DUECK: Mr. Chairman, if you're asking whether we may

or may not remove some from the Medical Services Plan from time to

time, we add from time to time and we remove from time to time. This

has been ongoing. There are services that are perhaps going to be

removed that don't require hospitalization so it wouldn't affect those;

there probably are some that would be removed where hospital services

may require it. I cannot give you a list at this time, because I have

not yet taken them forward.

MR. SKELLY: I think the concern on this side of the House,

Mr. Chairman, is that with these kinds of openings in legislation,

ultimately the government can really drive a Mack truck through the

medicare program, the medicare and hospital insurance program in the

province.

I'm just trying to think of a female relative who lives in

California and is covered by medical insurance down there. In fact she

buys two or three different plans in order to try to make sure that she

keeps covered. Yet when she goes to the hospital or obtains some kind

of service from the health insurance scheme she has down there, they

let her know after the fact whether she's covered or not, or whether

the process was medically required.

Let me give you an example: this female relative had two

stillbirths, and one live birth with toxemia. The medical plan told her

after the fact that the stillbirths weren't covered, nor were the

complications of the live birth that related to the toxemia. When the

daughter was ten years old, she was still paying for the ones that

weren't born live.

That's what we're concerned about. If the minister has an

opportunity to open up the medical plan and open up the hospital

insurance service in this province, ultimately what services are going

to be covered and what services aren't going to be covered? We know

that there are certain lines of political belief that would like to see

medicare undermined or destroyed, and one way to do this is kind of

through the back door: by ultimately telling people that certain

services aren't medically required.

Who determines that? Is it ideologically determined? Is it

determined on the basis of religion or politics? That's what we are

concerned about, because there is a great deal of religious

[ Page 2898 ]

debate over some of these operations and whether

they are medically required. There's a great deal of political debate

and ideological debate over whether some of these services are required.

What we're really doing here — and I realize that the MSP has been

opened up in this way — is now opening up the hospital insurance

service on the same basis. A minister or people that the minister

chooses to consult, and generally those are people that are hired by

the minister to tell the minister whether something is medically

required or not.... It's that process that we're concerned about. And

we are concerned about creating these new openings through the back

door so that ultimately the medical care system in the province of

British Columbia becomes useless.

When I see what people go through, including relatives of mine in

California, when ostensibly they're covered by medical care which

covers their hospital services as well. and yet so little is covered,

because the plan has the right to decide almost after the fact whether

a particular service is covered or not or required or not, and the plan

can always second-guess the doctors and her personal physicians whom

she consults.... Basically she's not covered at all unless they decide

to cover her. That's why we're concerned about this section.

We didn't have an opportunity in this Legislature to talk about the

way the Medical Services Plan was structured; that was done by a

previous Legislature. We have an opportunity today to deal with this

section 6 of Bill 59, and that's why we're concerned about giving the

minister any more openings that may or may not be used by this minister

or this government. After all, Mr. Chairman, we're talking about a

government that discusses secondary virginity and whether that is a

real medical thing or not. I can recall....

[Interjection.]

MR. SKELLY: I'm treating this issue seriously and we're

concerned about it seriously. I can recall when the ladies auxiliary to

the Social Credit Party, when I was a member of the Legislature,

presented a resolution to the Social Credit convention saying that

rapists should be circumcised. It may sound silly, and I think that

that resolution was withdrawn.

[3:30]

But there is political comment on medical procedures, and there is

ideological and religious input into whether decisions are medically

required or not. If we're going to open up medical coverage and

hospital insurance coverage, just how is the process going to be

conducted? How are we going to determine whether a procedure is

medically required or not?

I have a great deal of respect for the member for

Maillardville-Coquitlam (Mr. Cashore), who was asking questions about

sex-change operations for people who require them. The ministry may

have determined already — because they've got this type of surgery on

hold; I understand it's being done out of the province — that these are

not medically required. Yet when you look at the concept of health as

determined by the World Health Organization, a more broadly determined

concept of health and what's medically required, some views would

suggest that they are medically required for the overall health and

happiness of the person involved and that person's relationship with

society.

By opening up this

section of the Hospital Insurance Act, we may give people

with very narrow and very restricted and very ideologically-dominated views

of what's medically required the right to open up hospital insurance services,

and to determine after the fact what's medically required or not. I think

it's a dangerous thing to do unless there is some process that the minister

has specified — the broadest possible consultation perhaps. If he's going

to eliminate from hospital insurance coverage some of the things that we have

on the list from Alberta — and a lot of those things relate to vasectornies,

tubal ligations and things relating to methods of birth control.... We don't

know if these things are going on the list because there's some question

as to whether they're medically required or not. It now appears, Mr. Chairman,

that a person can get an abortion virtually at any time because the federal

government requires that; but in order to obtain sterilization or some other

method to prevent, say, a series of abortions, that person may not be covered

for those kinds of operations, because the government can deny them that coverage

after the fact.

If the minister informed us how this process of consultation may

take place.... Is it done on the broadest possible basis, with the

consumers of health services consulted as well as the practitioners and

the people providing the hospital services? If we had some idea, or if

the minister had in place the process of consultation so that we could

be assured that it would be done on the broadest base possible, then I

think we could accept an opening up of the hospital insurance scheme in

this way. But in the absence of that broad consultative process, it's

pretty difficult for us.

HON. MR. DUECK: To begin with, the federal Health Act is

very clear. It certainly spells out what is medically required, and we

have no argument with that; we couldn't if we wanted to. However, when

we're talking about something that's provincial, where we pay the total

dollar, we of course take the advice of our senior medical officer, who

in turn talks to the physician involved in the particular procedure and

with the medical fraternity, and the decision whether it's medically

required or not comes from them.

Again, I have to stress that the legislation we're talking about now

is the hospital, and as you have seen in the last years it's working

very, very well. You can't compare it with California. We have a plan,

a scheme, here that is entirely different, and we don't want to use

that even as a remote example of what's happening anywhere across the

line. I'm very committed to having a very good health care system.

However, there may be some services or procedures that we should

look at very carefully, because if we don't, if we didn't have this

protection in the MSP, you could in fact, with 6,000 doctors in this

province, have some doctor come along and say: "I demand that this be

covered because I think it's medically required." You must have some

stop-gap where you can have a body of physicians ask: is this a

medically required procedure? We're doing that now with MSP and it is

working very well. From time to time we'll have somebody across the

line or in Europe have some procedure that is not accepted by us at all

as medically required, and we will in fact not pay it. But it doesn't

affect the hospital scheme, because they're out of province.

When it's something done in this province, if the MSP doesn't cover

it, we certainly don't want to cover it under the hospital scheme

either, and that's all we're asking for in this legislation.

[ Page 2899 ]

MS. MARZARI: I want to pursue this line of questioning,

because I think this is where we're going to find where the mandate is

and where the procedures actually lie. The difficulty we have,

obviously, is that you are giving yourselves the power, basically

through order-in-council, to hire or appoint a person — the minister

does this — and to designate that person, on review of the medical

evidence, to decide post facto whether or not that individual deserved

the treatment that he or she received.

You have just described for my colleague the process which is used

now. Let me reiterate or repeat: the senior health officer, in

consultation with the medical fraternity in the hospital situation,

reports back to you the cluster of services or the nature of the

medical attention that is to receive compensation or that is to be

covered, and then that comes back to you. That is the procedure which

has gone on and which seems to work fine.

What has happened that makes you think that an individual should be

appointed or designated or hired by you to do much the same thing? Let

me go further than that: as I see it, this individual designated by the

minister does not necessarily have any clear procedure to follow. There

is nothing in this to tell me who that individual consults with, as my

colleague has just pointed out, on what basis the consultation occurs,

or at what point that consultation occurs. It's obvious that the

consultation is going to occur after the fact of the medical attention

being given.

Where do you find your mandate to do this? If you're doing it after

the fact, doesn't the Canada Health Act have something to say about it?

Are you only going to be conferring with this designated individual on

issues and matters which aren't funded by the Canada Health Act? Are

there that many procedures that aren't covered by the Canada Health

Act, that aren't retrievable in terms of dollars from the federal

government?

Also to follow along with previous questioning, who is this person

going to be — this one person designated by you — and what will the job

description look like for this person? What criteria are you going to

use in the hiring or appointing of this person, and from what bodies of

medical or consumer experience are you going to accept advice in the

hiring of this person? How long does the tenure last of this particular

appointment? Does it last forever? Does it last at the discretion of

the Lieutenant-Governor? Does it last until the rninister resigns his

post? Does it last for one year, five years, ten years? What is this

person called — the superintendent of post facto decision-making

regarding operations? Is this person male, female? Does this person

have a religious bias, as my colleague discussed? Is there going to be

a particular political bias that this person should bring to the job?

These procedural questions, I think, have to be answered. I don't think

you should establish a position in legislation such as this without spelling

those things out very carefully for this House and for the province. Because

what you do is you leave in the minds of everyone in this province very strong

suspicions that you're kneecapping and undermining and leaving a strong

feeling that people should not be approaching the medical health plan in the

way they have in previous years, through our previous Canadian history. In fact,

everything that we do as parents, as citizens, in terms of our relationship

with the hospital is now suspect, is now in limbo until a person that you have

designated says whether or not our treatment is legitimate. You can see what

kind of fear that would instil in a community.

HON. MR. DUECK: No, I do not see that. These people have been

in place for a long time. They are medical people, doctors who are on

staff. Are you saying that if we hire a doctor, his opinions are worth

less than the doctor you use in your own private life? They work for us

under hospital programs and the medical commission. Right now we're

rejecting claims that our medical people say are not necessary, and

we're not paying for them. All I'm asking under this legislation is

that we also don't pay the hospitalization.

Somebody talked about ruining the health plan. Again, I'll go back

to "medically necessary." There's nothing refused or turned down that

is medically necessary, and this information comes from the medical

people.

MR. SKELLY: Under your definition.

HON. MR. DUECK: Under the doctors' definition.

MR. SKELLY: The people you hired.

HON. MR. DUECK: It doesn't matter who hires them. They

consult with the medical people. In other words, they're autonomous.

They come to a conclusion that this particular procedure is medically

not required.

I'll give you an example. Just the other day.... I've received many

letters on chelation therapy. We have taken it to our medical people

and said: "Look, apparently some people think this is a good procedure

and should be allowed and paid for under the Medical Plan." Our people

said: "No. Until it has been proven medically, we will not pay. When

it's proven medically permissible or advantageous, then it will be

added to that list, it will be medically approved, and it will be paid

for."

All we're asking for under this legislation is the hospitalization.

The other is in place and has been in place and working well for years

and years. The same people are going to do this. If a certain procedure

is not medically required and the Medical Plan won't pay for it,

hospitals won't either.

MR. SKELLY: This will be my last question on this subject. I

gave the minister the example of the doctor I spoke to in Port Alberni.

I know that the Medical Services Plan has decided that circumcision

will not be covered unless medically required. Have we got that

straight? MSP says that. The doctor I talked to said: "Look, this is

such a small operation and takes such a short time with such a short

service required by the doctor and the hospital insurance service. It

can be done when mother and baby are still in the hospital, along with

all the other services that are billed for at the same time." But now

the doctor gets a letter back from the Medical Services Plan to

determine whether this thing is medically required.

This doctor tells me that rather than go through a paper war with

MSP over whether a particular circumcision is medically necessary or

not, he automatically bills the patient. That's a minor item, but I'm

just wondering what other services.... The doctors don't want to get

involved in a paper war with the Medical Plan or the hospital insurance

service. because it's going to create more problems for them and

they're interested in the practice of medicine, not in trying to dun

MSP or the hospital insurance service for payment for a small item like

a circumcision. If they get involved in this kind of bureaucratic paper

war over the practice of medicine in other items that you may decide are

[ Page 2900 ]

questionable as to whether they are medically

necessary or not, doctors are going to simply turn around and bill the

patient and say to the patient: "You do the bureaucratic war with MSP.

We're involved in the practice of medicine. We're not going to go to

war with MSP over these types of operations."

What's going to happen is that the patient is going to be billed,

and that's why we're concerned about the situation developing along the

lines that I suggested is happening in California. A patient down there

— and I've had kids in the hospital in California myself — gets a list

of billings a mile long for everything from shining bedpans to opening

the curtains in the morning. All of these things are billed separately.

The patient, or the mother of a just-born patient in many cases, isn't

capable of making the kind of medical decisions or doing the kind of

battle with MSP and hospital insurance that are going to be required if

the doctor simply says: "Well, I can't deal with it. I'm going to bill

the patient. Let them argue with the Medical Plan and try to recover

from the Medical Plan whatever they paid to the doctor." I think it's

going to create needless confusion.

[3:45]

That's not to say that I disagree that some services shouldn't be

covered by either MSP or hospital insurance services. I think that

there has to be some power within the act that allows the people who

pay for those services to decide whether those services are required or

not. What I'm concerned about is the process. The process isn't spelled

out clearly enough here that I can be satisfied that.... Not this

minister, because I have some respect for this minister. Not every

Socred would get up and apologize as the minister did in the House

today.

[Mrs. Gran in the chair.]

But I have some concern that in the future some minister who is more

ideologically motivated, or who more rigidly applies his particular

beliefs to the practice of medicine and the health system in the

province, may say.... I'm concerned about that future minister, who is

going to be governed by this legislation as much as you and I are. So

that's what I'm concerned about: if you make a hole in this plan big

enough to drive a Mack truck through, you might not drive the Mack

truck through it, but somebody else might. That's why I'm concerned

that you haven't established a procedure here that's adequate to

satisfy our concerns about ministers who want to practise medicine,

although that concern may not apply to you.

MS. A. HAGEN: A few minutes ago we were discussing a process

by which a procedure was in fact denied. I took the minister's comment

to suggest that his decision had in part been placed on his own

personal perspective on the particular medical procedures which would

involve hospital care and operations.

I want to move into another area. I want to explore the matter of

how men and women in this province receive medical services that deal

with their fertility. That might involve counselling on family

planning, on contraception and on other methods of birth control. It

might involve decisions that could require hospital procedures for

sterilization of men and women. We know that this issue is dealt with

not just in medical terms but also in ethical terms. We know that

people have many different perspectives which may inform their own

personal decisions in this regard. But I don't think that any of us

would question the fact that the matter of our fertility and how we

exercise responsibly our own decision-making about the size of our

families — when and how many children to have, or in fact whether to

have children — is very much an ethical as well as a medical matter. I

want to ask the minister, since these procedures, whether they be

counselling or direct medical practices, either by or with physicians

in hospitals.... What would the method be that the minister might use,

dealing with this particular legislation, in coming to decisions about

the availability, the coverage, for anything to do with one's fertility

— either the exercising of it to make one more fertile, or the

controlling of it to limit one's family, including sterilization? What

would be the bases that the minister would bring to bear in this

regard? How would "medically required" be interpreted by this minister

in dealing with this particular area of service under the Medical

Services Plan and under hospital insurance coverage?

HON. MR. DUECK: Madam Chairman, currently — and that's the

way it's been for a long time — it's the medical consultant that we

have on staff, and the hospital programs and MSP would make that

decision of whether it's medically required. I would get that

information, and on that basis the decision would be made.

Currently I don't even see what the MSP does, because they're

autonomous and they make that decision. When they say that this is not

a medically required procedure, it is not paid for, and they give the

clients that information. If it's an out-of-province case, there are

certain rules that go there.

But again, we're not speaking about MSP; we're speaking about

hospital. The other legislation is in place, and if MSP say it's not

medically necessary, then hospitals will also follow the same rule.

Because if it's not medically required to have that procedure, or

operation or whatever it is, then hospital programs will in turn,

through their medical people, I'm sure make the same decision and say

it's not required for a hospital stay either.

MS. A. HAGEN: Does the minister know what kinds of

definitions or guidelines the Medical Services Plan uses in this

regard? Mr. Minister, I recognize that we are not dealing with this

plan, but by your own admission we're looking for compatibility between

the two. It is impossible to separate them. In fact, the guidelines in

place under the Medical Services Plan would surely apply also when this

amendment is in place.

We are talking, as you yourself have said repeatedly in this

discussion and this debate, about the same language and presumably some

commonality in the pursuit of what is medically required. I am asking

for a broad definition that guides the Medical Services Plan. Is it the

World Health definition, for example, that speaks about health and

medical resources related to health as dealing with the mental,

physical, emotional and social health of people? What does "medically

required" mean in the

interpretation of the act?

HON. MR. DUECK: Of course, we are speaking about MSP now, and

some of the services you just asked about do not require

hospitalization in any event. So they would have no effect under this

legislation. We're speaking of procedures that may require

hospitalization, because the other is in legislation. We now have

people who make decisions about

[ Page 2901 ]

whether or not they are medically required under the MSP. What we're speaking of here is hospitalization.

MRS. BOONE: The minister consistently states that the current

act does not allow the hospitals or the government to refuse services,

even if they have been denied under the Medical Services Plan. Yet

under the benefits

section of the Hospital Insurance Act,

section 5, it

says, "The general hospital services provided under this act are...,"

and it gives a great list of things. And then it says: "...but do not

include transportation to or from hospital or services or treatment for

an illness or condition excluded by regulation of the Lieutenant

Governor in Council." It says: "No person is entitled to receive any of

the benefits under this Act unless it has been certified in the manner

provided in the regulations that he requires the service."

It appears to me — and it goes on to do some other things — that

there is adequate regulation and legislation here to enable the

hospital to deny those services already. Why have we put in a

section

that, instead of dealing with the Lieutenant-Governor-in-Council

regulations, gives the power to the minister to determine what are

required services? The act clearly has the ability to deny medical

services already. Why are you putting more power into the hands of your

ministry and out of the hands of the Lieutenant-Governor?

HON. MR. DUECK: It is absolutely correct that we could

exclude certain classes, but again we have areas of concern.... Earlier

I mentioned cosmetic surgery. We can't really exclude it as a class

because it may be very necessary in one case but not in another. If

it's a case of a child born with deformed features, it would be very

necessary to do cosmetic surgery, but it may not be medically necessary

to have wrinkles removed or a tummy-tuck. And that's what we're

speaking of. Those are the only areas.... Yes, you're absolutely right:

we can exclude all the others. We have that power now. That's why I

cannot see why you're hung up on this, because we're talking about

these very few areas that perhaps don't cover the total and the

specific areas I mentioned as an example. Other than that we can; we

can add and we can eliminate. It's right there in the legislation now.

MRS. BOONE: I fail to understand why the minister is saying that it's

right here that you have the ability,

whereas half an hour ago you told us that

you didn't have the ability to do these things. That's why we needed

this legislation: because you had things that were denied by the Medical Services

Plan and a doctor could go in and say that they required those things, and you

would have to pay for it. You mentioned a certain type of surgery that was being

requested, and you said they may have to pay for this under the current legislation.

Yet the legislation states here quite clearly that those areas can be denied;

you can deny service for an illness or condition excluded by regulation of the

Lieutenant-Governor. I'm sure cosmetic surgery could be included in that

area. You mention, "...it has been certified in the manner provided

in the regulations that he requires the services," so surely that gives

you the ability right there to decide whether or not tummy-tucks are required,

or facelifts or what have you. That gives you the ability there. Why do you

need this legislation here that gives you or your designate the power to determine

these things? What are you trying to change, and why do you need that power

in your hands when there is already the ability here for our Medical Services

Plan to deny various things?

HON. MR. DUECK: I think we're repeating ourselves. I said

very clearly a couple of times that we're talking about specific

change. We'll deal with individual situations, not classes of services,

which are presently covered. I gave the example of cosmetic surgery.

That's about as good an example as I can give you at this time. You

certainly wouldn't want to exclude it as a class, because with many —

especially children — it would be medically required. But we do not

wish to pay it where we figure cosmetic surgery would not be a

medically required procedure.

MRS. BOONE: I am having a lot of problems figuring out how

this is going to work. Are you going to sit down in regulations and say

all cosmetic surgery is going to be denied payment under the hospital

program? Or are you going to say some services, and then is your

designate or yourself going to sit down and go through all cosmetic

surgery that comes through the Medical Services Plan and decide what

can or can't be covered? Are the people of British Columbia never going

to know, when they go in for surgery, whether it's going to be

determined by the minister or his designate that this is required?

[4:00]

How is this going to work? You have not laid out any guidelines; you

have not established any procedures. We don't know how this is going to

work. You have said that some cosmetic surgery could be deemed

necessary. At what point are you going to decide if it's necessary?

After the surgery is completed, when the bills are all in, are people

going to be asked for refunds? Are they going to be billed later on, or

are they going to be billed initially and then will have to submit

bills to you?

What are the classes? You are talking in terms of classes. What are

the classes of surgery, then, that you are looking at that could

possibly have some areas come back? Are you going to eventually look,

as I said, in open-heart surgery here...? You say: "Coronary bypass

surgery could be postponed or forgone entirely in a significant

fraction of clinically stable patients." Are you or your designate,

after bypass surgery, going to look at it and say that this person was

stabilized, and he or she could have been dealt with in a different

manner? We don't know....

MADAM CHAIRMAN: The minister rises on a point of order.

HON. MR. DUECK: Madam Chairman. I do not appreciate the

bringing in of statements again that I have made certain statements,

when I said "from medical people." I don't like to see the opposition

keep saying that I made those statements, because I didn't. That's got

nothing to do with this, and I object to it.

MADAM CHAIRMAN: Your point of order is well taken. May I

suggest that the members address their comments through the Chair and

not directly to the minister.

MRS. BOONE: It states here that four medical doctors state:

"Coronary bypass surgery could be postponed or forgone entirely.... But

that's even worse, because this is saying to me that you've got medical

people out there who

[ Page 2902 ]

could possibly say this is not medically required. We don't know, when you haven't told us what it is.

The only thing that you keep bringing up is cosmetic surgery. Tell

us, what else is on your agenda? What else is out there that we may

find? Once this is passed, what are we going to find sitting there in

an order-in-council that is suddenly removed from the Medical Services

Plan and thereby will be removed from the hospital plan as well? What's

on your agenda, Mr. Minister, with regard to this bill here? Because we

sure as heck don't know what it is.

HON. MR. DUECK: It will work exactly the way it's working

now. If you went to a doctor and your physician said that whatever you

requested was medically not required, you probably wouldn't get paid

for it. That's exactly what's happening now. The doctor makes the

decision. What will happen now in the hospital is that if you went to a

doctor, and he said that this particular service was not required, and

with consultation with our people the Medical Services Plan did not pay

for that particular service, the hospital wouldn't pay for it either.

It's working well; it's in place now. If you don't like the system

the way it's working now, then let's go back and change it. We have a

Medical Services Plan that's working very beautifully. We have very few

complaints. We have a medical team in hospital programs and in the

Medical Services Plan. They consult with the physician, and there are

very few cases where anything would come up in any event, because there

are normal procedures on the fee schedule. No one's going to argue with

anything that's on the fee schedule; it's medically accepted.

All we're saying is that if there is a procedure that is medically

not required — and that's the physician that's doing that particular

procedure in consultation with our people — and our people agree that

that is not a medically required service, then hospitals will not pay

for it either — that stay in the hospital.

MRS. BOONE: I've read some of the medical journals and

magazines that you've been quoting from lately, and one of them

recently stated that perhaps.... A professional said that perhaps

allergy testing may not be medically required; perhaps cholesterol

testing may not be medically required. There are a load of things out

there. Some of them say that they are going to be medically required.

Others are going to say that they are not medically required. There's

going to be a variety of opinions there.

If you go to a doctor, and the doctor says it is absolutely

required, then the Medical Services Plan is going to pay for this even

though your doctors may have determined that this particular item is

not medically required? Under all circumstances are you going to take

the opinion of the patient's doctor over your Medical Services Plan

doctors?

HON. MR. DUECK: Madam Chairman, if it was a procedure that

was so questionable, they may well phone the Medical Services Plan and

ask if this particular procedure is covered. They may well do. I don't

know when that happens; it may be never. But because we have such a

program.... We're talking about medically required services, and

anything medically required is covered.

But are you telling me seriously that we should not have this type of protection?

Are you telling me that anyone could go to any doctor, as long as he has a licence,

and have the doctor say: "I personally believe it's covered; therefore

we will pay"? You're surely not saying that it would be a wideopen

program and, instead of spending $1 billion a year, that we would spend $2 billion

and keep on going? We have people in place who make that decision on a medically

sound basis, because they are medical people. There must be some order. Surely

you can't disagree with that.

We are saying that it should also work on the other side as far as

hospitals are concerned. You keep going back in the Medical Services

Plan and all that. That is in place. All I'm saying is: if it's not

medically required, and the MSP does not cover it, then hospitals won't

either.

MADAM CHAIRMAN: Hon. members, could the Chair just ask again, please, that you address your comments through the Chair and not to one another.

MRS. BOONE: From my reading of the hospital program thing, I

believe that there was already that ability for the ministry to deny

services. I just do not understand why there's a need to put this

amendment in here, which puts a tremendous amount of power into the

hands of the minister and not the Lieutenant-Governor. There is the

ability within that system, and you said yourself: why hasn't the

system run rampant then? Why hasn't it increased? You seem to think

that if there's not this change today, suddenly we are going to have

this increase in hospital usage. There hasn't been. The controls have

been there; they have always been there. For some reason or other the

minister wants more control.

Madam Chair, I don't believe that we will be reaching too much

conclusion on this, because it's obvious that the minister is not going

to tell us the items on his agenda to have removed from the hospital

services. I'm sure they come through the Medical Services Plan as well.

I'm disappointed that we haven't been able to get very many straight

answers from him, aside from cosmetic surgery. We know that tummy-tucks

aren't going to be involved, and we know that sex changes will not be

covered. But other than that, we really haven't been able to find out

where the system has been abused and which procedures were paid and

which were not paid by the Medical Services Plan and consequently were

a problem when it came to the hospital services.

I haven't been able to see the problems, and I don't understand why

this amendment has come through, unless there is a desire by the

ministry to remove more things from the Medical Services Plan and the

hospital services — and this amendment was made in order to do that.

I think the member from Port Alberni expressed our concerns very

clearly and, as he pointed out, this makes such a hole in this that you

can drive a Mack truck through it. I am very concerned that we don't

know the agenda here and that we could see some severe changes that

would radically change the lives of British Columbians. We will be

watching the order paper carefully to see if anything does come through

here and if there are things being changed that will affect us.

MS. SMALLWOOD: I have two questions to the minister. Number

one, I am interested in knowing when the blue-ribbon committee, the

committee on ethics, is going to report, because I fear that this

legislation is reflecting the work that that committee is doing. If the

minister could comment on that, I have a second question.

[ Page 2903 ]

HON. MR. DUECK: Madam Chairman, I cannot answer that, because

they have had a number of meetings and have not reported back to me as

to their deadline. I did not give them a specific deadline, so I

honestly can't give you an answer as to the date that report will be

coming forward.

MS. SMALLWOOD: As a rule, when committees are struck, there

are some instructions, some mandate and reference as to the work that

is outlined for that committee and a date for completion. When the

minister says that he has not given a time-frame for that committee, is

the minister communicating with that committee? Does this legislation

reflect some work that that committee is doing?

HON. MR. DUECK: I think I read part of the mandate in my

ministerial statement. Yes, I have had some reports back from them.

This legislation has no connection with that committee whatsoever.

MS. SMALLWOOD: I think our critic for Health outlined some of

the actual items that are not being paid for by their medical or

hospital plan in Saskatchewan or Alberta. I wonder if the minister is

using that province as an example for a program that he is bringing

into this province.

HON. MR. DUECK: We are so far advanced in giving good health care, they look at us for examples.

MS. SMALLWOOD: Perhaps the minister could tell us whether he

shares the same view as the Premier as to the necessity for

contraceptive coverage by the Medical Plan and if the minister, through

this legislation, will be expressing that view in not covering those

types of services.

HON. MR. DUECK: I'm not quite sure what area you're getting

into. It's getting a bit.... I think it's going into birth control and

all kinds of areas, I don't know whether that requires hospitalization

or not. It didn't in our family. Our children are five years apart and

it didn't require any hospitalization as far as birth control methods

were concerned.

MS. SMALLWOOD: I'm sure that I don't have to point out to the

minister that there are operations, tubal ligations and vasectomies,

that do fall into day services for some hospitals. My question, again,

is whether or not the minister's legislation would cover that and would

be directed by the Premier's own views on those subjects.

HON. MR. DUECK: I am not going to say what may happen in the

future. It may be another Health minister; it may be your government

that has to make these decisions. I did say earlier that I am not

considering those specific items that you just mentioned. They have not

been under consideration at this time by myself or my ministry.

[4:15]

MS. SMALLWOOD: Can the minister state for the record that he does not support the exclusion of those items.

HON. MR. DUECK: I did not say that. I said they have not been considered

by me at this time. So don't start saying.... I don't know what the

future will hold. I'm not going to make statements here that may be next

year or the year after.... I'm also not going to make statements that I

will. That's future policy. Surely you're not going to ask me what I

will do as Health minister with a lot of things a year, two years or three years

down the road. I'm saying that at this time I have not given that consideration.

MS. SMALLWOOD: I am asking the minister at this time to state for the record that he does not support the exclusion of those services.

HON. MR. DUECK: I am not going to make that statement at this time.

Section 7 approved on the following division:

YEAS — 33

Savage

Rogers

L. Hanson

Reid

Dueck

Richmond

Parker

Michael

Pelton

Loenen

Crandall

Rabbitt

Dirks

Veitch

McCarthy

Strachan

Vander Zalm

B.R. Smith

Couvelier

Davis

Johnston

Jansen

Chalmers

Ree

Bruce

Serwa

Vant

Campbell

Peterson

Huberts

Messmer

Jacobsen

S.D. Smith

NAYS — 17

G. Hanson

Barnes

Marzari

Harcourt

Boone

D'Arcy

Gabelmann

Blencoe

Cashore

Guno

Smallwood

Lovick

Sihota

Miller

A. Hagen

Jones

Edwards

Section 8 approved.

section 9.

MR. CASHORE: I would like to ask the Minister of Health about

section 9, second line from the bottom, where it says "...the number of

days of care for which payment will be made...."

I think it behooves the minister to give us some reassurance on this

because it could cause consternation to families of persons who require

hospital treatment outside the province. Realizing that adequate

medical treatment may require, for instance, 25 days, and since the

number can be decided through this process, it may be decided that they

will only receive ten days of treatment and then be left to their own

devices in terms of how to pay the bill.

I would like the minister to explain to the House how that family

will know in advance what their situation will be, or will they be left

with a horrendous medical bill? Does this

section indicate that this

government actually intends only to cover a limited number of days on

some medically appropriate procedures outside the province?

HON. MR. DUECK: My understanding is that they are told in

advance and it's a melcal judgment as to the type of operation, how

long it will be. So there has never been a

[ Page 2904 ]

situation where someone had to have medical attention outside who did not have the full coverage for that particular procedure.

MR. CASHORE: I would like to ask the minister, then, if he

would give us his undertaking that such assurance will be provided

either by entrenching it by amendment in this legislation at this time

or by order-in-council at the earliest opportunity. I would like to ask

the minister if he would give us that assurance.

HON. MR. DUECK: That particular

section as to the time limit

is not changed. It's in place and it's continuing exactly the way it

is. There is no change to that whatsoever.

MR. CASHORE: Then I would like to ask the minister why it is

here. If I may clarify, Madam Chair, my question is: why do we have

this before us if it's not a change? I don't understand the minister's

comment, because it would indicate that there is no need for this if

it's already in place.

HON. MR. DUECK: The way I see it is that this amendment is

consequential to the change made in

section 25. We changed

section 25

and therefore this has to be changed, but there is no change in the

time limit — those days. There's no change in that particular part, and

that was the question you were asking.

Sections 9 and 10 approved.

section 11.

MR. SIHOTA: I am quite happy to debate this

section because

it deals with the repeal of the Investment Contract Act, but I notice

the Minister of Finance (Hon. Mr. Couvelier) is not here. It's my

understanding the Investment Contract Act would fall under the....

We're dealing with

section 11, Mr. Minister, so you're off the hook

now. I want you to understand that I wasn't even in the House. I was

being nice to you.

I'm dealing with the Investment Contract Act, and I have no problems

in dealing with it. But I'm certainly not prepared to make comments

with respect to this until the Minister of Finance appears in the

House. I don't know what the procedural.... If we can stand it down

until the minister returns, that would be fine with me.

Section 11 stood.

Sections 12 and 13 approved.

section 14.

MR. BLENCOE: I want to pass a few comments on this section, and then maybe the minister will do us the honour of responding.

[4:30]

The reason we have this

section 14 before us is, of course, that

it's something we should have had some time ago. The minister is aware

of that, and I'm not going to go into the details of that. It's

unfortunate that we have this retroactive legislation before us,

however. We all know that because of the oversight of the minister in

the last municipal elections, we are having to deal with this on a

retroactive basis. Of course, it could have created — and may indeed

still create — some problems; we don't know. Some months before the

municipal elections, the minister, through her staff, allowed

municipalities to use the provincial voters list, and then suddenly

discovered that such permission required legislative change.

Madam Chairman, I don't want to dwell on that particular oversight —

and I think it was a major oversight. It's happened before over

municipal elections. It happened in the byelections some months ago —

changes to who could vote a matter of days before the election. People

had voted at the advance poll, and then they changed the rules so that

British subjects couldn't vote. That created some real problems. And

that was done right in the middle of by-elections. So there seems to be

something of a history in this ministry of not dotting the i's and

crossing the t's. But I don't want to dwell on that.

Interjection.

MR. BLENCOE: I'm being serious.

What I would like to address is this whole question of what's

happening with this government. So many times they think now — and it's

symptomatic of what's happening with this government — that rather than

use the Legislature for most business on behalf of the people of

British Columbia, they can do it just by some sort of news release or

an order-in-council or cabinet decision without using the Legislature.

It's happening more and more. Here we have another example of this

government's thinking: "Well, we don't have to go to the Legislature to

change who can vote or what lists can be used at the municipal level.

We'll just make a pronouncement that you can use the provincial voters

list."

The only comment I make on that specifically is that this government

continues to get itself in trouble because it wants to do so much of

the people's business outside this chamber. For the second time in a

matter of months, without this Legislature approving the change, this

government and this minister have got us into a potentially very

embarrassing situation. In so many things in the last year we have seen

important decisions not being carried out or authorized by this chamber

— this-time over changes to the Municipal Act which clearly require

legislative change. We nearly got ourselves into — and may indeed be in

— a very embarrassing situation. It has to be, once again, a warning to

this government that when you are prepared to usurp the roles of

parliament and the Legislature, and run government by orders-in-council

and special decrees and virtually presidential announcements out of the

Premier's office, you're going to run into trouble. It's symptomatic of

a government that forgets that the business of the people of British

Columbia must be done through this chamber. Once again — this time over

a voters list, changing the list that municipalities could use — this

minister and this government thought they could do that through making

an announcement without reference to the Legislature. It's symptomatic

of what's happening to this government and of the state of affairs in

the province of British Columbia today.

More and more, we see that citizens are becoming very concerned

about the way this government is doing business, and I refer to

organizations like the Coalition for Democratic Process, an

organization that's starting in Victoria and is now establishing

chapters all across this province for people of all political

persuasions who are deeply concerned about this

[ Page 2905 ]

government's action and the lack of utilization of

the people's Legislature. This retroactive legislation that we have

before us is part and parcel of the sickness that is overwhelming this

government in terms of it not using the Legislature to do the people's

business.

I want to make some other comments about the whole process of voters

lists and the municipal election process, because I think it's time for

a total review. It's unbelievable now that in the province of British

Columbia municipalities can choose whatever voters list they want to

use. It's unbelievable that we don't have a process that's laid out —

you either do enumeration or you don't do enumeration. It's

unbelievable that we don't have a process in British Columbia that

tells people, through an enumeration or some sort of process, that

there is about to be a municipal election. Ws sort of like if we keep

it quiet and we don't tell people through enumeration or proper voters

list development.... We really don't want to tell people that there are

municipal elections happening in the province of British Columbia.

We also have some confusion in municipal voting. We have situations

we still don't work out, where some people in this province have two

votes at municipal elections. I could debate all day whether people

should have the right to vote twice. But what's happening is that I've

got people coming to see me saying that, for instance, in one

municipality they go to vote for mayor and aldermen, and they vote for

school board in their own home municipality. They then come down to the

next municipality, and because they own property, they get to vote

again for mayor and aldermen, but inadvertently they vote again for

school board for the same school district, because they are given a

ballot. And that happens all across the province: they're given a

ballot for school board again. The checks and balances of municipal

election procedures are very weak and inefficient, and I believe we

need to take a look at that process and the election procedures for

municipal elections.

I certainly think we need to take a look at who prepares voters

lists. We had a situation in this last election, an unbelievable

situation, where in Richmond.... Not only did we have in Richmond and

every other municipality the potential for a court challenge, because

it was said by this minister that the provincial lists could be used,

but we had in Richmond a situation where they privatized the

development of the voters list. Could you believe it? The fact that you

privatize the voters list is bad enough, but guess what, Madam

Chairman? Who developed the voters list in Richmond — the Premier's

home riding, I might add? Who developed it? Who was given the contract?

MR. JANSEN: Who did?

MR. BLENCOE: Well, guess who. Sid Treur, head of Datex

Services, president of the Richmond Independent Voters' Association and

Premier Vander Zalm's riding association chief.

AN. HON. MEMBER: Name names.

MR. BLENCOE: I've named names. Here we have a privatized

list, and guess who gets the contract to develop the voters list? The

president of the riding association for the Premier's own riding

association. Here we go.

Interjection.

MR. BLENCOE: Well. Is it wrong? Is it wrong that a voters

list should be developed by the private sector — a privatized voters

list — and you hand it to a consulting firm....

Interjection.

MR. BLENCOE: .... a voters list developed by the consulting

firm that happens to be connected to the Premier by the president of

the riding association. Now only in British Columbia, Madam Chairman,

could that happen. Only in British Columbia could that situation

happen, where a democratic roll of voters is not done by the public

sector but by the private sector, and done by somebody who is clearly

politically connected not only to the government but to the Premier of

this province of British Columbia.

Is nothing sacred? Is nothing sacred in the province of British Columbia? It clearly isn't, Madam Chairman.

AN HON. MEMBER: Everything's Socred.

MR. BLENCOE: Nothing is sacred in the province of British Columbia.

MR. SIHOTA: Not even voters lists.

MR. BLENCOE: Not even voters lists — the basic, fundamental ingredient of ensuring elections are run honestly.

MR. SIHOTA: Fairly.

MR. BLENCOE: Fairly, and that those that get on the list get

on the list properly. And here we have in Richmond, whereby.... And

this minister allows this to go on. I tell you, Madam Chairman, if

there was ever a time we needed a review of the election procedures for

municipal government, it's today. But of course, in British Columbia

anything goes. Why, we'll privatize all the voters lists. It's

unbelievable.

MR. SIHOTA: And they applaud that.

MR. BLENCOE: And they applaud that. Not only do they applaud

that but they applaud that in Richmond. And the people of British

Columbia, Madam Chairman, must really wonder what kind of government

they've got. They really must, when a municipal voters list, the basic

ingredient of fair, democratic elections, is developed by a private

consulting firm, with no public accountability, by the president of the

Social Credit riding which the Premier represents. Well, well, well!

That's where we're at in the province of British Columbia. Nothing is

sacred, Madam Chairman, not even the voters lists.

Now would this government believe that the provincial voters list

should be privatized? Should that be done by the private sector" Should

that be done in each riding by Socred president consulting firms? I bet

they wouldn't say that, Madam Chairman. Or would they?

Nothing is sacred, quite frankly, it would appear, on behalf of this

government. If nothing is sacred, then in my estimation nothing should

be Socred in the province of British Columbia.

[ Page 2906 ]

Madam Chairman, we need new municipal rules for voting at municipal

elections. Clearly demonstrated in Richmond; clearly demonstrated by

all sorts of enumeration problems and voters lists; and now here we're

dealing with a retroactive piece of legislation.

In my estimation a committee should review the whole question of

disclosures for municipal officials. I think the time has come in the

province of British Columbia, as we are suggesting provincial rules,

when we should take a look at spending limits, at how much is spent on

municipal elections. As my good colleague from Victoria has suggested

in a private member's bill, some recommendations regarding running

provincial elections in the province of British Columbia, and the

requirement after the election is over to submit disclosures about who

contributed over a certain amount of money, are needed. I think the

time has come in British Columbia when we need to take a look at that

sort of thing, not only provincially but municipally. We're in the

eighties. I think people want to know. They want to have better

disclosure and better conflict of interest rules. They certainly know

they won't have better conflict of interest rules at the provincial

level. So I believe there needs to be a look taken at the whole process

of disclosure for municipal officials, as we have suggested for

provincial elections as well.

[4:45]

I think the time has come — and the opportunity for a debate on this

section 14 is today — for this minister and this government to

recognize that we have some real problems at the municipal level; that

it would be a good idea that we review the municipal processes for

elections. And at least let's deal with the question of privatizing

voters lists, because I don't think that's even acceptable to a Socred

British Columbia. I would hope not.

HON. MRS. JOHNSTON: It appears some clarification is

required. The

section that we're dealing with today is a direct upshot

of the proclamation of our Charter of Rights Amendments Act, brought in

last April, which in turn was a result of federal legislation in 1985.

The comments by the member opposite certainly go to clarify the

difference between the two party philosophies. We had a choice of

requiring the municipalities to go to full enumeration, which across

this province would have cost them tens of thousands of dollars, or we

could have acted in cooperation with the municipalities, as we chose to

do, and allow them to use the provincial voters list.

It seems to me, Madam Chairman, that it's important that all levels

of government work together in order to save the taxpayers' money

whenever possible. The action taken by this ministry and this

government resulted in considerable savings to all of the local

communities, including your own community, hon. member.

I want to tell you, Madam Chairman, that the doom-and-gloom

statements and the suggestions that we would have chaos at the polls

and that there are still possible problems coming up are absolutely

false. In checking with the UBCM, the representative of all the

municipalities, we have been advised that there have been absolutely no

complaints with regard to the use of the provincial list. In fact,

several compliments were issued because of the smoothness of the

operation at the polls.

It seems to me that the member has been repeating statements regarding the

preparation of a voters list that are completely contradictory to what he suggests

is the opposition position, which is autonomy for local governments. The provincial

government doesn't prepare the voters list in the municipalities. This is

a decision made by local government. Is the member suggesting that the provincial

government go into each of the local council chambers and suggest to them how

and who should be preparing their local voters list? I would suggest not. It

was a decision made locally, as it should be, and I would hope that we would

not attempt to interfere with that type of decision.

I can give the member this assurance, Madam Chairman, as I have on a

number of occasions: the entire local election legislation is under

review. The review has been underway for some time now, with the most

major significant change being that of the three-year election term.

The member is well aware of the fact that the review is underway. It is

a priority in this ministry, and I would look forward to any suggested

improvements that the member would care to send along to us to include

in possible changes.

MR. BLENCOE: First, Madam Chairman, I could suggest that

perhaps she'd like to use the standing committee on municipal affairs

to debate this whole issue. We'll have some hearings with UBCM and key

mayors, and we'll talk about this whole thing.

HON. MRS. JOHNSTON: That might be the way to go.

MR. BLENCOE: That might be the way to. go. I think there's some room.

Let me comment, Madam Chairman, about this "I'm suggesting that we

tell municipal government what to do." You're saying that you're

allowing them to be independent and make their own decisions. But you

get to the point where you could say that for everything. Why have a

Municipal Act? That's ludicrous. Why don't you just deregulate and get

rid of every act that governs everything? Privatize the works. That's

where we're at, it would appear. Nothing's sacred. We have legislation

and guidelines in the Municipal Act. Is that the attitude: that we're

just going to get rid of all regulations and we're going to privatize

it all and nothing is sacred; the marketplace will determine everything

and the government has no role to play in being a check and balance?

The Municipal Act is there in terms of these issues. It gives

guidelines. But it was written a long time ago. Is the minister

suggesting that we throw out the Municipal Act and all the sections on

elections?

What I'm suggesting to this minister is that I've brought to your

attention a situation in Richmond where there's a potential problem,

and this minister just laughs about it. It's not a laughing matter.

I want to ask the minister a question. Does she approve of privatization of voters lists at the municipal level?

HON. MRS. JOHNSTON: I would suggest that that matter should best be left with local government.

MR. BLENCOE: Are you the Minister of Municipal Affairs? Do

you just take total direction? I asked you a question. You are the

minister. You have some guidelines. You have the Municipal Act. You

have some authority. You have some role to play. I repeat my question

to the minister. Do you approve of a Social Credit association

president and his consulting firm preparing the democratic voters list

[ Page 2907 ]

Richmond? Should that be encouraged in other parts

of the province of British Columbia? And don't try to say it's up to

local government.

MR. JANSEN: Give me a break.

MR. BLENCOE: Give me a break! The only break you're going to get, Mr. Member, is in the next election, when you get removed from office.

MR. SIHOTA: Madam Chairwoman, I want to talk a little about

this

section because the minister talked about chaos and the Charter of

Rights and why this provision was introduced when it was because of the

provisions of the Charter of Rights.

The provisions of the Charter of Rights were brought down in April

1982. The provinces were given five years to get their act together and

make sure that all statutes complied with the provisions of the Charter

of Rights. Five years ago it became evident to the government that the

provisions of the Municipal Act would have to be brought into

conformity with the Charter of Rights. The issue of Commonwealth

citizens was not one that came up between 1982 and 1987. In 1982

everyone knew that Commonwealth citizens would have to be removed from

the provisions of the act. It wasn't as if there were a court decision

that came down in 1986 that warranted the removal of the Commonwealth

inclusion, if I can put it that way.

I appreciate that the good minister wasn't responsible for all those

five years in terms of this issue, but the government had five years to

bring about the changes necessary for conformity with the Charter of

Rights. Surely in that five-year period it would have been possible for

the government to have worked out some type of scheme with

municipalities to make sure that municipal voters lists were in

conformity with the Charter of Rights. Over that time, certainly there

must have been some dialogue with municipalities to the effect that:

"Look, the Charter of Rights is coming now, and this is how it's going

to affect you." I know that there was a team within the

Attorney