1980 Legislative Session: 2nd Session, 32nd 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)

FRIDAY, JULY 18, 1980

Morning Sitting

[ Page

3381 ]

CONTENTS

Ministerial Statement

Health services in Alert Bay.

Hon. Mr. Mair –– 3381

Routine Proceedings

Committee of Supply; Ministry of Health estimates. (Hon. Mr. Mair).

On vote 114: minister's office –– 3381

Mr. Cocke

Mr. Gabelmann

Mr. Hall

Ms. Brown

Ms. Sanford

Mr. Levi

Appendix –– 3401

FRIDAY, JULY 18, 1980

The House met at 10 a.m.

[Mr. Davidson in the chair.]

Prayers.

MR. D'ARCY: In the gallery today we have two young adults, occasionally

from Castlegar. I'd like the House to join me in welcoming Michael and Rebecca

D'Arcy.

HON. MR. CHABOT:

Mr. Speaker, in the gallery today we have an old friend of mine, Mr.

Gaston Lapalme from Granby, Quebec. We worked together on the railroad,

the CPR, in the province of Quebec so many years ago that I wouldn't

want to say how many years that was. I want the House to welcome him to

Victoria.

HON. MRS. McCARTHY: We have two friends in

the House today that I would like you to give a special welcome to. The

first one I would like to introduce is Dr. Shrum's executive secretary.

As you know, Dr. Gordon Shrum is one of our great British Columbians

associated with the building of the tremendous trade convention complex

in the city of Vancouver. I would like the House to welcome Maureen

Grant. Accompanying Maureen is John Gorham from Toronto.

HEALTH SERVICES IN ALERT BAY

HON. MR. MAIR: If this is the appropriate time, I would like to make a ministerial statement.

The

members opposite, and indeed my own colleagues, have from time to time

raised the question of the Alert Bay situation, which continues to be a

problem for all of us in British Columbia. I thought this would be an

appropriate time to bring the House up to date as to where matters

stand.

As I have already told the House, I have personally

been to Ottawa to meet with the Minister of National Health and

Welfare, the Hon. Monique Bégin. I would like to emphasize that this

was a special trip, particularly for the situation at Alert Bay and the

provision of health services to native Indians. In addition, the staff

of my ministry have contacted the Assistant Deputy Minister of Medical

Services, Health and Welfare Canada, in an attempt to clarify the

present activity of the federal government at Alert Bay. The latest

discussion was on Wednesday morning, July 16. The report I can give the

House now is as follows.

First of all, there is now a second

physician at Alert Bay. This physician is on contract with the federal

government, and for a short time only. Secondly, the federal government

has now funded for a four-month period the hiring of a hospital

administrator and three health board members. I emphasize this is not a

hospital board but they have just hired these three members. The sum of

the four-month contract is apparently $57,000 to cover salaries and

expenses, and it is expected that the administrator and the board

members, who will be full-time salaried board members, will review the

present health services available to natives and make recommendations

as to just what the health service requirements in that area are.

Thirdly, Health and Welfare Canada are preparing a proposal for funding

of a review on a much longer basis.

They have not, however, received approval from their Treasury Board for these additional funds at this time.

order to further clarify this matter, I have requested a meeting with

Dr. Lyal Black, the Assistant Deputy Minister of Medical Services,

Health and Welfare Canada, and can confirm that if he receives approval

from his ministry Dr. Black will be in Victoria to meet me next

Wednesday morning, July 23.

It's difficult, as you can see

from what I've just said, Mr. Speaker, to determine just what the

future plans of the federal government are in relation to the provision

of health services at Alert Bay. I realize that everyone is aware that

health is a provincial matter, however the federal government are

involved in the provision of health services to natives in this

province, which, of course, complicates the matter.

I might

say that in order to meet our responsibilities as the government of

British Columbia, I have just approved the planning to proceed for a

new hospital at Alert Bay. It should be understood that what I have

approved is the planning of this hospital subject to the approval and

participation of the regional district, as well as the approval and

participation of the federal government on behalf of the native

population.

This new facility, if approved by the other two

government bodies, would consist of ten acute-care beds, two

extended-care beds and three intermediate-care beds.

The

requirements for detoxification would still have to be worked out and

could be accommodated within the above hospital as planned.

summary, Mr. Speaker, I thought that this would be an appropriate time

to bring the House up to date as to the provision of health care

services in this particularly sensitive area of the province.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 114: minister's office, $165,162.

HON. MR. MAIR:

At the risk, once again, of filibustering my own estimates, I will try

to answer two questions raised by the hon. member for New Westminster

(Mr. Cocke) late yesterday afternoon.

The first question

concerned Mrs. Lily Emma Hicks. This was a death which occurred at

Langley. I think that I can indicate to the member opposite just by

showing him the size of the file that it has indeed been investigated

by the ministry. I'd like to give the results of that investigation.

think a couple of facts are in order, Mr. Chairman. Mrs. Hicks, at the

time of her unfortunate death, was 94 years of age. She was admitted to

Langley Memorial Hospital on September 10, 1979, and was confused and

agitated when admitted. She died, unfortunately, on November 9, 1979.

Apparently

she had been placed in a chair and — I don't know what the proper

terminology is — made secure in that chair for the purpose of feeding.

Ten minutes elapsed between the time she was placed there and when she

was found dead. The autopsy report indicates that there was no evidence

of trauma or violence, and I think it's important to note that.

[ Page 3382 ]

was investigated completely; I have the autopsy report here. The

apparent cause of death was heart stoppage or seizure, and I must

repeat that there was no evidence of trauma or violence. I might just

read the pathologist's final anatomical diagnosis:

"

(1) Arteriosclerosis generalized severe with (a) 50 percent narrowing of

right and left coronary arteries and focal myocardial fibrosis; (

b) arteriosclerosis of cerebral arteries with cortical cerebral atrophy,

especially in the frontal regions; (2) nephrosclerosis and interstitial

nephritis; (3) focal myocarditis; (4) no evidence of trauma or

violence."

The other question raised by the hon. member for

New Westminster yesterday afternoon concerned a Mr. Rinke. This is a

rather current matter in the ministry. I received a letter on July 11

which was a copy of a letter dated July 8 from Mr. Ross, who is the

administrator at Richmond General Hospital, to Mrs. K. Yamamoto,

secretary-treasurer of the United Fishermen and Allied Workers' Union.

Unfortunately I haven't yet received a copy of the report prepared by

Mrs. Rinke. At this point I have acknowledged receipt of the

correspondence — I acknowledged that on July 15 — and I've requested my

staff to obtain the details concerning this accident. I assure the

members opposite I will review the matter as soon as I possibly can,

and as soon as the information is available I'll make it available to

them.

I might say, Mr. Chairman, in regard to the Hicks

matter, that on the file, ready for my signature when I returned to my

office last night, was a letter directed to Mr. Charles Hicks dated

July 17 in answer to his letter which has raised concerns about the

very unfortunate death of his wife.

I hope that answers the two questions raised by the member for New Westminster yesterday afternoon.

MR. COCKE:

The answers with respect to the Hicks and Rinke cases are to some

extent, I think, a valuable contribution — particularly in the Hicks

case. There has been some doubt in my mind, created mainly by the fact

that there was not staff on the scene and it was the husband who

discovered this most unfortunate situation.

I guess the

trauma of that has probably, if anything, emphasized in his mind what

had occurred. I also have a copy of the coroner's report, as does Mr.

Hicks. One isn't impressed with technical aspects such as that when

there's so much emotion involved. However, as long as the minister is

looking into this case and is in touch with Mr. Hicks, I think that's

the main thing. There was a rather off-the-cuff letter written earlier,

on March 13, by the previous minister. I think that probably

re-stimulated his desire to get something going.

Mr.

Chairman, I started out the estimates of health care by saying that the

government has not shown that health care is a major priority with

them. I have seen very little to change my mind or my attitude toward

this particular situation. For instance, I see here a letter from a

woman who's very badly affected by closure of beds in the VGH — a very

traumatic thing as far as she is concerned, because she requires

elective surgery.

I have here something that I will read into the record from a person who works

at VGH. It is about the whole question of an entire ward, that's very badly

needed, being closed down for one reason or another. I hear all the talk about

the lack of nurses, nurses on holidays and so on and so forth. Each month of

the year has its own excuse. In the summer months there are nurses who are away

on holidays. The winter months are heavy because people prefer to go to the

hospital during the winter, etc., etc. There's a different excuse for each

month of the year.

we were in these estimates in January or February when we probably

should be if this government would only call the House on time.... Yes,

Mr. Chairman, I remember the days when we used to discuss the health

estimates in this House in the month of February. Now we never even

start this House until the end of February, the beginning of March and

sometimes later than that. Mr. Chairman, this is the government that

says the opposition is holding things up.

Mr. Chairman, one

of the matters that convinces me.... I want to make it very clear that

I'm not aiming any particular barb at our hospitals per se. They're

trying their best. Some are not as well run as others, but basically

the people working in hospitals work there because it's a cause as far

as they're concerned. It is not easy work; it is not the soft touch;

it's a very difficult kind of work, because they're dealing every day

with tragedy. Nurses, licensed practical nurses, nurse's aides and

other hospital workers and doctors, of course, are all in the same

boat. But when those people are constrained by the amount of care they

can give, by a government that doesn't really give health care the

priority they should, this is the kind of thing that happens — and I'm

dealing now with the Rinke case.

This is a very shocking,

very sad situation, and I think that since the minister hasn't got it

available, I'm going to give him the information. This is a report on

that case written by Mrs. Rinke:

"My late husband, Rudolf Rinke, a hard-working

labourer all his life since he was 14 years old, died on Saturday June

21, 1980" — just the other day, Mr. Chairman — "at the age of 73. This

is actually nothing new, because people die every day — even much

younger — but Rudolf's death was very unusual; maybe not that unusual,

because it may happen many times in our city, only people, specifically

nearest relatives, are not talking about, it, because they are too

upset with grief, too stunned to believe something like this can happen

in our society in the year 1980 — not 1880 — or just do not know what

to do.

"Well, I do not intend to be quiet about this, even if I'm

not able to help my husband any more, but maybe bringing this into the open

I may be able to help other persons die in dignity.

"To start with, my husband did not die in dignity. He died

five minutes away from hospital under the most degrading circumstances. So I

will write in my simple words what happened on Saturday, June 21, 1980. Before

I do I would like to give you just a short picture of the history of his illness.

"He had angina pectoris, which we kept under control with

medication, a balanced diet, usual visits to our family doctor, and every one

or two years an examination by a specialist. He survived several heart attacks

and only on the first one, eight-and-a-half years ago, was he hospitalized.

At the end of May, after seeing our family doctor because he had low blood pressure,

I asked for an appointment with our specialist, which was June 2. He discovered

a tumour in the rectum and ordered further tests and also made an appointment

with a surgeon. The diagnosis: inoperable malignant tumour and also malignant

spots in the upper lungs. He was set for an appointment at the cancer clinic

on June 27, 1980. On Friday, June

[ Page

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20, his only complaint was that he felt very slack and retired

about 9 p.m.

"Saturday

at 10 a.m. he had an appointment with the family doctor to tell him

about the cancer. He woke me at 4:30 a.m. on June 21 (feeling sorry to

do this), but he could not stand the pain in his back and shortness of

breath any longer. From now on I go by what happened during those 14 or

15 hours. The time is not completely correct by minutes, but very close.

called the answering service and asked for a return call from a

substitute doctor — the family doctor was not on call. The doctor

phoned back and advised me to take my husband to the hospital by

ambulance. My understanding was he was going to meet me there. The

ambulance gave him oxygen. The emergency ward was empty. One or two

walking patients were treated for minor injuries. The admitting nurse

took blood pressure and asked what the problem was and I gave a short

history. The substitute doctor did not show up. A lady doctor finally

came and checked his lungs. She told me he had some fluid on his lungs,

she would give him a syringe, and also told me that he would urinate

for quite some time, for the next hour or two. I asked if he could stay

but they said: "No, because there are no beds." I found out later he

could have stayed until 11 a.m., because at that time other patients

were being discharged and beds were available at that time.

insisted on talking to my family doctor. He told me to take him home

and bring him back to his office at 10. I called a taxi. I had to bring

him outside in his pajamas with no wheelchair.

"He

could not get warm in bed and it was quite tiring for him to go from

the bathroom. We finally gave up. From 7 to 10 a.m. Pain in the back

getting worse. Nitroglycerin doesn't seem to help. Pulse 68. He

complains of being very cold and is very restless. I try to calm him

down. Have promised to phone the doctor at 10, because he's having an

appointment anyway.

"At 10 a.m. I phoned

answering service to get in touch. She said that it was impossible

because this was his day off. Even after explaining to her that he was

waiting for us, she told me that he was only notified if somebody was

gravely ill or dead. After I threatened to call the police she finally

put me through. The doctor promised to come after he was finished with

his patients.

"From here until he finally came

my husband got worse by the minute. After 1 p.m. the doctor came,

checked the blood pressure and lungs, gave him a hypodermic needle to

ease the pain, ordered some liquid medicine and advised that I should

continue the heart medication. He told me on the way out that the best

for him would be if he had another coronary and could die quickly.

"The injection helped him for about 20 minutes. From then

on until he died shortly after 7, he was in agony. When I tried to give him

medicine he choked. He could not lie down, even with the pillows. I had him

on his back. He couldn't sit up. He tried because he could breathe a little

better. He was sweating and shivering at the same time. Because he could not

swallow he sucked on a wet cloth. I could not leave him because of his condition

and never felt more helpless in all my life. Every minute seemed like an hour

to him.

"Finally

a neighbour phoned an answering service again and made it urgent that

some doctor come quickly. Then I lost track of time and he finally

phoned between 4 and 5. I told him my husband was dying, and he said I

should give him his medicine. I told him: 'He can't swallow.' He said:

'You should find a way to get it down.' I could hear my husband crying

from upstairs and told him I had to get off the phone and attend my

husband. He never phoned back and he never showed up.

"For the last two hours of his life my husband was crying

in agony: 'Momma, help me. Please help me. I can't take this any longer.'

He was fully conscious until the end. His pulse was around 60 but got slower

closer to the end. He just had pain all over his body, especially in his stomach

and back. Two of my neighbours were at my house when he died. I could only feel

a great relief that he did not have to suffer any longer. I also felt so much

bitterness and anger and still can't believe that this could happen in the

year 1980 with all the modern facilities in hospitals to help a human being

not suffer in the last hours of his life."

Mr. Chairman, there is some philosophy here and there are some things that

happened after the case. I suggest that this is the kind of thing that happens

when hospitals are pressed by virtue of one thing or another — shortage of funding,

lack of leadership or just general lack of priority for the provision of health

care. This person didn't die in dignity. This person died in a great deal

of pain in an age when it's not necessary. If it were in fact 1880 or, for

that matter, if it were 1920 there would be some excuse for this. But in an

age when we are surrounded by potential care, by hospitals and practitioners....

I've

talked to doctor after doctor and they have told me that they have

extreme difficulty getting people into beds. One of the problems they

have beyond that is that if they take up one bed with this person, then

they lose access for their next patient. So if this minister wants to

do health service and the provision of health a favour, then I suggest

this minister is going to have to get on with it; he is going to have

to get out there into the health community and assure that community

that they are going to have the backing of this government. If they

don't, Mr. Chairman, this government deserves to be turfed out

immediately.

To back that one up, let me read you a letter from a nurse in Vancouver: "Dear

Mr. Cocke: Thank you for your phone call. It again renewed my will to

fight in my own way" — I was answering her call — "and otherwise by the

present government, especially in health delivery. The history of this

situation...." I'm dealing now with Vancouver General Hospital. I want

to tell you, Mr. Chairman, we know who runs VGH. The Minister of Health

is the official administrator of that hospital. That hospital has never

been taken out of administration since the former minister put it under

administration. You have a board, but it is not a board of trustees. It

is an advisory board. From that standpoint it is as much a

responsibility of the Minister of Health as Pearson.

"The history of this situation is this: On January 2, 1980,

we (wards FP-3 and HPA-4, VGH) received word that the government had advised

the hospital administration that these rehabilitation wards were to

[ Page 3384 ]

be closed and become extended care. The 'become extended

care' might have been an assumed possibility, but what else could one assume?

This closure was to be April 1 and then June 1. The word now is three phases

to the end of September as half extended care and half holiday for rehab, which

is what we do now, except much more in the rehab area and a little in extended

care. I feel a patient is the last consideration, or the least, and a poor vision

of health care amounting to warehousing. These are reasons I feel these wards

should not be misused."

Mr.

Chairman, G.F. Strong Rehabilitation Centre is absolutely loaded. There

needs to be an interim for these people with neurological disorders,

backs, accidents, etc. so that they can get them into G.F. Strong in an

orderly way. For that matter, they could go to the Holy Family Hospital

in Vancouver, which is also a rehabilitation hospital and also loaded

to the scuppers. It's the one that takes care of those with victims of

circulatory disorders such as strokes, heart attacks and so on who

require surgery.

Anyway, this is one of the areas for

holding these people, and instead of keeping that area with some

rehabilitative medicine going on, we're closing it down and turning it

into an extended-care hospital — a desperation move. I understand the

need for those extended-care beds. But, for heaven's sake, Mr.

Chairman, we also require those beds that are going to lead people back

to health, back to a productive life. You don't have that when you

start closing down these very important beds.

Mr. Chairman, I'll go on to quote the letter:

"These

are reasons I feel the wards should not be misused. At the present

there is a good functional medical-surgical team of doctors, nurses,

orderlies, physiotherapists and occupational health therapists serving

both FP and HPA-4. The concentration of the whole team is the aim and

all members have an input, as well as sharing of information. The

patient care is not fractured by passing through many hands as it is

when they are scattered throughout the hospital. Their progress has

been facilitated by this concentration, and enough patients have

confirmed this in their progress, combining specialty nursing, therapy

and doctors. The concentrated aim of the team is all members' input,

shared daily information, no fracturing of patient care — as in many

wards — recognition by the patient of their excellent progress,

transportation to acute-care areas if this is necessary, through the

tunnel. This includes acute medical care, acute surgical care and

planned return to surgery, like chondroplasty, bone replacement and any

repair. These wards rehabilitate to accepted levels for the G.F. Strong

Centre, Shaughnessy Hospital, Workers' Compensation Board, and

outpatients level or community care facilities."

You see, this is the ward where they prepare them for these rehabilitation hospitals. The letter goes on to say:

"The

screening process is done every Monday to assess the best possible

candidates to promote the best use of the beds, those requiring

immediate rehab to better return more quickly to work or home."

Mr.

Chairman, this person writes like I do, and sometimes it is a little

difficult to read. Nonetheless, any mistakes are mine, not hers.

"These are what I consider as highlights against closure.

But there are many more reasons, like patients' feelings and peace of mind,

rather than mechanical approaches. You will find enclosed a résumé of the ward

admission and breakdown."

have that in my office, Mr. Chairman, and I don't really think it's

necessary, but if the minister would like me to, I can quote from it as

well.

Now the case is this, Mr. Chairman, put as best I can.

For heavens' sake, let's pay some attention to health care. The

minister can get up in this House and tell us of this fantastic budget

that they have set aside for hospitals. I agree, it's an extremely

large budget, no doubt of it. Inflation has taken care of some of it,

and a terrible budgeting system which I dealt with for some time, and I

felt had to be changed, and still has to be changed. It is a system

that rewards a person working at a hospital for burning supplies when

it's getting close to the end of the year, rather than let it be shown

that there are supplies left at the end of a fiscal year. Because the

budget is on an incremental basis. That goes for staff, supplies — the

whole thing. Incremental budgeting, Mr. Chairman, should have gone out

in the mid-fifties, and it had better go out very soon, because that's

one of the things that's breaking us. Anyway, aside from all that, I

suggest that the minister is going to have to show absolutely superb

leadership in order to get this back on the track.

His

predecessor has spent far too much time preoccupied with other areas

that were of little significance, and far too little time, Mr.

Chairman, in the area that's so important to all of us. Everyone in

this chamber, in this town, in this province, is just a step away from

the health care system. If they, themselves, have a long step, they're

lucky. But I bet they know a lot who are right on the threshold of

requiring help. That's what this minister is confronted with, Mr.

Chairman. And I just hope that he's going to give us some kind of

indication that there isn't going to be this frustration, because

there's frustration now. There is frustration throughout the whole

health care system in this province.

I think I know better

than most, because I've been involved either as a critic or as a

minister, and then again as a critic for some 11 years, with the

exception of two — but even then I was closely involved in the delivery

of health care from the standpoint of a politician. Therefore I know

many people involved at every level. I'm charging that there is chaos

and frustration in the health care delivery system and there's a

government in this province that better start doing something about it.

MR. GABELMANN:

This morning I want to talk about three separate issues. The first is

the question of health care in Alert Bay. I was puzzled earlier this

morning in listening to the minister making his ministerial statement.

I tried to determine what it was he was announcing that was new.

Perhaps I didn't listen very carefully or don't hear very well, but I

didn't hear anything new in that statement concerning health care

facilities and services in Alert Bay. It may be that the minister was

just trying to demonstrate a concern that he has, and if that was the

case, good. I would welcome that.

I want to spend a few

minutes this morning talking about health care in that community and I

don't want to do it in a partisan or political way. I want to talk

about some of the feelings that I think exist in the community and try

to talk about, very frankly, some of the dilemmas that I face as the

MLA for the area and for that community in particular.

Alert Bay is a community that is very, very sharply

[ Page

3385 ]

divided.

No one will ever argue about that. It's made very clear when you come

in off the ferry. If you turn left you go to the Indian community and

if you turn right you go to the white community. Those demarcation

lines are very, very clear. You feel them when you get off the ferry

going into Alert Bay. It's a feeling in the community; you cannot help

but feel the sharp divisions between the two communities. In fact,

whenever you talk about Alert Bay you must, I think, talk about two

communities, because whether we like it or not, whether we believe in

an integrated society or not, that community is not integrated. That is

in many ways.... I'll get back to this in a moment. I understand there's something else that needs to happen in the House.

MR. CHAIRMAN: Thank you very much, hon. member. The hon. member for Omineca.

MR. KEMPF: Thank you very much, Mr. Chairman. I would ask leave of the House to make an introduction.

Leave granted.

MR. KEMPF:

Mr. Chairman, just arrived in the gallery are two very hard-working and

enterprising individuals from a community in my constituency, Fort St.

James. They are Josie and Tosh Hirowaturi. I would ask this House to

join me in making them welcome.

MR. CHAIRMAN: I thank the hon. member for North Island. Please continue.

MR. GABELMANN:

As I was saying, the community is a very divided one. I began to talk

about — and I will use the word, although I want to use it carefully

and in its proper context — the racism that does exist in that

community. Local residents will, of course, deny that automatically and

naturally and I understand why that would be denied. But in all of my

travels in many parts of the world and certainly in many parts of this

country I haven't ever seen a community as clearly divided on racial

lines as the community of Alert Bay.

Before I proceed

further I just want to read a statement that the Indian chief in that

area made in 1914 to the McKenna-McBride cutoff commission. It was

Chief Lagius in 1914. In speaking to the commission he said: "I would

like to speak on a hospital for me and my tribe. Speaking for the

Kwakiutl people, I feel that we ought to have a hospital of our own and

a doctor of our own, because although there is a hospital at Alert Bay

it is not an Indian hospital."

Those words were uttered in

1914, 66 years ago, and they are true today as they probably were then.

There is an overwhelming feeling on the part of native people, from the

Nimpkish band, from the All Nations band, and from native people who

live in various communities in and around that area, Tuynour Island and

others. Whether we agree with it or not, they very much want to have

their own health system. Many of them want to have their own education

system: many of them want to have their own structures and control over

their own lives in a variety of ways.

When I go into Alert Bay, as I've done half a dozen times since the election,

I am confronted on one hand by the white community.... I should point out

the politics of Alert Bay. Both communities vote for me, by and large. We have

party members in both communities. As you can imagine, that makes travelling

into Alert Bay fairly difficult for me, because I have to try to continue to

get along with everybody in that community. I have tried very hard not to appear

to be clearly on one side or the other in the internal arguments that go on

in that community, but I have come to an overwhelming personal conclusion that

before we can have an integrated community, and an integrated health care system

we must have a more segregated one for some years to come.

Let

me try to explain to you why I believe that. I have tried to explain

this to white people in the community, most of whom reject what I say,

some of whom are beginning to understand it. In my judgment, one of the

fundamental and most basic causes of problems with native people —

health care, alcoholism, social problems, unemployment and on and on —

relates to a question of pride. They are no longer a proud people, by

and large. They were once a very proud race. Over the last 100 or 200

years, we have knocked that pride out of them in a number of ways. I

believe we will not take the first step on the road to curing

alcoholism, to resolving health care problems, to making the Indian

communities self-sufficient and vibrant again, until Indian people are

allowed once again to be able to be proud. For that reason the

construction of museums, the restoration of all the artifacts that were

taken from them, in Alert Bay's case in 1922, the almost-completed

museum in that community.... The development of a clearly defined

community with its own leadership and control is very important,

because those steps are the first toward the ability to be once again

proud as a people.

In Alert Bay that is happening. In other

reserves in North Island it is not happening. It is beginning to

happen. One of the things they argue that they need — I agree with them

— is control over their own health system. They perceive they can gain

that control more effectively through federal administration of health

as opposed to provincial administration. In this House we might all say

it is not logical. Why not have one health care system for all the

people on Cormorant Island or some of the situations elsewhere?

It doesn't make sense to have two separate systems in a small community

like that with 600 whites and 1,000 Indians or thereabouts. But it does

make sense if you look at it from the perspective of a downtrodden

people, a people who are grasping and fighting, clawing their way back

to their roots, as it were.

I appreciate that the minister

has been temperate and cautious in his statements about Alert Bay; I

have tried very much to use similar judgment in commenting on the

problems. But after repeated visits into that community and visits to

others.... I have a great many, because 25 percent of my

constituents are native Indians. There are a lot of native Indians with

whom I deal, and probably the worst reserve in the province is in my

riding, Tsulquate in Port Hardy, and probably one of this wealthiest,

Cape Mudge on Quadra Island, is in my, constituency, and the whole

range in between.

This is not a political question in a

narrow sense, but what I have decided is that the most important thing

we can do as whites is to allow natives to regain their pride, using

whatever mechanisms they require. If we can assist them along that

route we will solve, in a generation or two, some of these problems

that have gone unsolved for many generations. Allow them their pride

and I suspect we will be on the road to ending the massive

unemployment, massive alcoholism and the fair degree of illiteracy that

exist. In that context, having made that judgment, I am very much in

support of the federal government having its own health care system in

the corn-

[ Page 3386 ]

munity

of Alert Bay, as much as possible administered locally by the native

people. I say Alert Bay, but it is the Nimpkish band, the All Nations

band and others around there — for the sake of simplicity, the Alert Bay

natives.

Allow them that, Mr. Minister. Many of my

supporters in Alert Bay in the white community won't agree with what

I'm saying. I have made every effort when I talked to them to try to

persuade them that even though this is going to take a couple of

generations, this is the right beginning for the solution of native

Indian problems, particularly related to health care. It's going to

cost a bit more money in sheer capital dollars doing it this way; I

think it will be money well spent. I leave that for the moment; I may

get back to it if we get into a bit of a discussion about it.

[Mr. Kempf in the chair.]

the question of the hospital, there is a lot of confusion about why we

need a new hospital in Alert Bay. There is a 35-bed hospital there now.

I don't want to get into whether we do or don't need a new facility.

There is divided opinion about it. Certainly the village council in

Alert Bay wants it; the regional district wants it. They want a 25-bed

hospital, as you know. I'll just read something from the Mayor of Alert

Bay, as quoted in Gary Goldthorpe's report — and this is Gilbert

Popovich, the mayor:

"After many studies and

much debate, including two reports — the Grey and Pitkethly reports in

February '79 — the Mount Waddington Advisory and Planning Commission

unanimously recommended a new 25-bed hospital for Alert Bay. This

recommendation was supported overwhelmingly by the regional directors.

Eight voted in favour and one was opposed.

recent letter from the provincial Minister of Health" — your

predecessor in this case — "confirms that hospital utilization in Alert

Bay exceeds that of the provincial average. This fact, in our opinion,

justifies our demand that a new 25-bed hospital be built in Alert Bay."

You're

talking about a 15-bed.... I understand the design of the hospital

may allow for 20 at some future date. I hope that's the case. I hope

you would consider that the health care situation in general in that

community is not typical. We won't disagree about that. It is so

atypical as to demand entirely separate and independent evaluation of

the need. The alcoholism in that community — it's not confined to the

native community, I might add — is a widespread problem in North Island

because of the remote nature of the communities, etc. Much of the

hospital use is alcohol related. The use on a per capita basis is just

so much more than anywhere else in the province. Some may argue that's

because people use it as a bit of a hotel and a drying-out place; if

so, maybe that's all right. You know, we have to make those kinds of

judgments as well. So I would urge that in any consideration of

health-care needs, particularly relating to the hospital, you should be

very careful to investigate the unique nature of that particular

community.

For the moment I'm going to leave the Alert Bay

question. The most important message I want to leave is that if we can

do something to assist natives in regaining their pride in their own

culture and their own lives, we will go a long way toward that first

step to repairing the terrible state that exists in most reservations

and in most Indian communities.

I'm going to talk about

rural health care and rural medicine for a few minutes in a broader

sense. One of the features of our society that always strikes me as

funny is that we have.... Let me just pick on two very important

services that society demands and government provides: one is policing

and the other is health care — both important, both urgent. When it

comes to providing policemen in communities, we don't have any problems

in our society making sure that there is a proportionate representation

of policemen in each community. We don't have any difficulties making

sure there are four RCMP officers in Alert Bay in the land division and

four more in the marine division. We don't have any difficulty

throughout the country allocating police resources. We say it's an

absolutely required resource, therefore we're going to create a system

that makes sure policemen are going to go into these communities, and

we assign them.

When it comes to health care we say: "Let

free enterprise take it over." So what we have is an excess of doctors

in Kelowna where the living is good, and a shortage of doctors in

remote communities where the living is not so good. And for some reason

we say that because doctors work on this fee-for-service basis, it's

their choice as to whether or not they go into a community. We don't

say that about RCMP officers. Could you imagine how many RCMP officers

would go to Alert Bay if it was based on fee-for-service? You wouldn't

have anybody in there.

You might have the odd person with

the rare qualities of the kind that led Dr. Pickup to go in there in

the first place. You might find the odd RCMP officer with those rare

qualities too. But don't we have a double standard, a unique way of

dispensing what must be at least as important a service to the

community — health care — as policing? Yet we leave health care up to

the vagaries of the marketplace, and we say about policing: we're going

to make it compulsory, we're going to assign people. It does not makes

sense; it is not a fair system.

Many of these communities in

North Island require — whether doctors are in there on salary or on

fee-for-service — additional supplementary allowances from the

government. I was pleased to hear yesterday that you have a chap

working on rural and remote health care. That's a very good step, in my

judgment — overdue and most welcome.

Let me give you

examples. On the whole west coast of Vancouver Island, from Hot Springs

Cove all the way up to the north end of the coast in my riding, we've

no doctors except for a couple in Gold River. We had a couple in Tahsis

and now we have one.

Let me just deal with Tahsis for a

minute. When we had two doctors in Tahsis, a husband and wife team,

they were able to look after the medical needs of Tahsis, Zeballos,

Kyuguot, all the west coast communities. There was a great deal of

travel and time spent just getting around. But because they were

husband and wife they didn't require the kind of income, nor did they

demand the kind of income, that doctors normally would. There is not

sufficient work on a fee-for-service basis in that part of the province

to justify two doctors in Tahsis. They can't make enough money on

fee-for-service. So we now have one, but one doctor is so insufficient

that it's beyond describing. One doctor has to travel and to be

available for basically a full caseload in the community of Tahsis. Yet

they can't attract another one because there wouldn't be enough money

generated from fee-for-service.

I would urge very much that when you are considering the rural and remote health care, the whole idea of subsidiz-

[ Page

3387 ]

ing, putting on staff, or finding some way of making sure there is adequate health care in those communities is looked after.

The

final issue I wanted to deal with this morning is mental health.

There's a group in North Island called the North Island Mental Health

Committee. That's the North Island as North Islanders understand it,

which is the northern half of the constituency of North Island.

HON. MR. MAIR: That's the real North Island.

MR. GABELMANN:

That's the real North Island, and they never let me forget it. Campbell

River, as they say, is mid-island; people tend to forget that.

However,

in this report — I won't go through it all; I'd just like to read a

couple of paragraphs from part of their report — it says. "In Port

Alice, according to statistics gathered by Dr. Emanuel over the last

nine months" — this is more than a year old — 23 percent of his

patients are suffering from psychiatric problems." One out of four of

the patients of the doctor in Port Alice were suffering from

psychiatric problems. "Of these, 19 percent are neurotic and psychotic

symptoms, the remaining 5 percent are due to alcoholism."

the Nimpkish Valley, according to statistics gathered by the physician

serving this area, 50 percent of the female population, and 15 to 20

percent of the male population, are on Valium. Half the women in the

Nimpkish Valley are on Valium, a drug commonly prescribed.... We

all know what Valium is. And it goes on; they talk about Port Hardy and

other areas in North Island.

We have — and it's not just

true there; it's true in other parts of British Columbia, and other

parts of our country — some very severe emotional and psychiatric

problems created by the isolation of the area and the nature of the

work. The workforce is predominantly male. The women are living in

situations where often the men are working more than the 40-hour week.

They're often out in the bush working six, and sometimes seven, days a

week. The women are left. As my colleague for Comox (Ms. Sanford) says,

many of them are on shift work. Certainly at Utah Mines and other big

concerns it's constant shift work, leaving women in those communities

with some very real psychological and emotional problems because there

is nothing to do. There are no resources, no facilities, no transition

houses. The kind of emotional and physical battering that goes on in

those communities is quite dramatic. I think that, although some of

what I'm saying moves on into Human Resources — transition houses and

what not is a Human Resources matter — it all ends up in the Ministry

of Health's lap. When you look at what's available for mental health

it's totally insufficient. There are not the workers or the facilities.

had one particular case of a young man in his twenties who should have

been institutionalized but couldn't be. He was threatening to kill his

father and that kind of thing, and he was still living at home. This is

in Port Hardy. They finally put him in a room in an old building. The

mother is terrified. I'm not going to go into the details of the

particular case, but I have them if the minister is interested — off

the record. The facilities and resources are just not there, and the

need is absolutely tremendous.

[Mr. Strachan in the chair.]

must try to leave with the minister my concern as a person who has

lived and represented both urban, and now rural, constituencies. The

resources that people have in greater Vancouver or Victoria are beyond

description as to their plenitude in comparative terms. Now I know that

you will say that people choose to live in these communities and that

is the kind of lifestyle they want, but that is not always true. Many

people are forced because of the economic situation and the job market

to live in those communities. They don't have very many resources.

The women in particular don't have the kind of resources that they need

to try to deal with the isolation and the macho nature of those

male-dominated, macho, heavy-drinking communities. I think some

preventive health care work, particularly with mental health, in those

communities would be a very worthwhile investment in our future.

HON. MR. MAIR:

Mr. Chairman, first of all I want to assure the hon. member for New

Westminster (Mr. Cocke) that I will look into the Rinke matter. As a

matter of fact the letter from Mrs. Rinke has now reached my office. I

don't think one can comment any further on the letter, other than to

say it is of course a tragic situation. One could hardly help but feel

very sad indeed, listening to the letter read out by the hon. member.

We are hopeful of course that the palliative care program that we are

now bringing in will do something to overcome these difficulties.

think all of us have a revulsion about dealing with dying people. It is

something that is bred into us. Even though it happens to all of us, we

don't seem to want to take the time to assist people who are going

through that very natural process. This goes for doctors as well as for

other people. I think we have a great deal of educating to do in the

medical field, with doctors, nurses and all people involved in that

situation, so that these kinds of things are rare instead of common

occurrences.

I feel very sad at hearing what I heard this

morning. I certainly will look into the matter. I don't know that there

is anything that I am going to find out that will assist me that I

don't already know. That is that we do need to do a great deal more in

terms of bringing palliative care to the various hospitals around the

province.

The member for New Westminster spoke about closing

the rehab beds in Vancouver General Hospital. I want him to know,

through you, Mr. Chairman, that this was done in consultation with

Vancouver General Hospital and G.F. Strong. It was coincidental with

the opening of the fifth floor of G.F. Strong, which created beds that

weren't available before. The rehab beds, of course, were converted

into extended care. I understand that Shaughnessy is going to take up

some of the slack for the problems that the member talked about.

far as the problems with funding that the member mentioned, yes, I know

the old army game. Of course it went on and it probably still does go

on to some extent. That is why we brought in the joint funding study in

1978, to see if we could overcome these difficulties. It was instituted

by this government and I have great hope for it. I'm not going to stand

here and say to the members opposite that it is going to solve all the

problems, because of course it isn't going to solve all the problems.

Any time you are running large institutions such as Vancouver General

Hospital, the hospit-

[ Page 3388 ]

als

in Victoria and even hospitals the size of Royal Inland in Kamloops,

you are going to have difficulties when it comes to funding. You are

going to have people who are going to play budgeting games, and you are

going to have governments that are going to anticipate budgeting games

that sometimes aren't being played. All these kinds of problems happen,

but I think that this is going to go a long way towards putting the

funding of hospitals and their budgets on a sensible, modern basis.

I'm

not going to argue at great length with the member for New Westminster.

Just let me say that I don't agree that there is chaos, great

unhappiness and so on in the health care field in British Columbia.

You're not going to have a field such as health, where there is so much

emotion involved and so many things like the Rinke case that are going

to happen no matter what you do in terms of palliative care, where

there isn't some unhappiness bubbling up to the surface from time to

time. I'm not going to suggest that there aren't problems. I've tried

to be very candid with the member for New Westminster and this House

about some of the problems we do have. I've also tried to be very

candid about what we're trying to do and the time frame within which we

are trying to do those things.

I don't want to be trite in

my answer to the member for New Westminster, but I really have to go

back to something that I said when I became Minister of Health. Usually

one regrets things that one says upon becoming a minister. One usually

says something very stupid that one has to live down thereafter, but I

have no such fears about this.

I said that you could double

the budget in British Columbia and you still wouldn't solve the

problems. You could quadruple it probably, and there still would be

problems bubbling up to the surface that would give rise to lengthy

debate in estimates. I suppose it's a matter of semantics. The member

opposite says that it's chaotic, and so on. I just don't agree with

him. I think, generally speaking, we have one of the world's best

health delivery systems in British Columbia. It has problems, to be

sure, but nevertheless, I think that it still is extremely good and

we're tackling the problems as best we can.

I'd like to deal

for a moment with the member for North Island (Mr. Gabelmann). I don't

know whether he was taking me to task about the statement I made in the

House today. It seems that a minister is damned if he does and damned

if he doesn't. What I've been trying to do, Mr. Member, is to keep the

members of the House abreast of developments in that very, very

sensitive area. Rather than have you come to me and stand up in

question period and say, "Why don't you ever let us know what's

happening? Are you doing anything?" and "What has the minister done

except sit on his duff and ignore the problem?" I've been trying to do

just the opposite: keep abreast of the situation and at the same time

keep you aware of it.

There are some new developments in

what I said today. I think the key one — and this doesn't sound like a

big deal unless you've been dealing with the feds, as some of your

colleagues have in the past — is that the federal assistant deputy

minister of Health is going to come to British Columbia to take a look

at the situation and talk to us about it. Instead of sending Dr.

Goldthorpe out with a stick to poke into a hornet's nest, which is

precisely what he did and no more, they're sending somebody out who

really wants to deal with the problem and try to tackle it. I think

that part of the news is that we are willing to plan the hospital with

the federal government. We're willing to plan a detox centre with them.

We're willing to create any type of organizational setup which will

help racial lines to be crossed.

Now I know that the

member's point is that these matters must remain "segregated," for

want of a better word, until such time as the Indian band has recovered

the pride that it lost, and all of the things that the member said. I

think there is some wisdom in what he does say. Fine. I said today, as

a matter of fact, to the press outside when I was asked about the

situation in Alert Bay, whether the plans I had would solve the

problems: "Of course not. You're not going to solve 300 years of social

problems with a hospital." And I fully recognize that. But what I say

to the member is that if the federal government does want to get in,

does want to handle the situation, fine. I have no quarrel with that.

Let

me make it clear. I think we could do a better job. But if the federal

government does want to get in and take care of the health problems of

the native peoples of British Columbia, then let them do it. That's all

I say; let them damn well come and do it, instead of doing a

half-hearted job and every time there's a problem, blaming the

provincial government. Whether it was your government, our government

or future governments, that is traditionally what has happened. Whether

it's Alert Bay, Kamloops, Omineca or Atlin doesn't matter; they do a

half-baked job and then blame the provincial government and anybody

who's close at hand for the deficiencies in their system. I am quite

prepared to stand back and let the federal government walk into Alert

Bay and tackle that entire problem, as far as the native population is

concerned. But for goodness' sake, don't come to us and ask us to form

committees with them, ask us to step in and do some of the planning,

ask us to come up with some of the funding, ask us to come up with some

of the doctors and blame us when we can't, or blame us for the doctors

who do come up, at the same time that they're supposed to be taking on

the responsibility. Either take on the responsibility 100 percent and

do a good job or let us do it, and we will do our very best to do a

good job.

You say we couldn't do as good a job. I accept

that criticism; I don't know that I agree with it, but I accept it. Our

problem is that we simply cannot get the federal government to come in

and do more than, as I say, poke a stick in the hornet's nest. I know

that you probably think Dr. Goldthorpe did a much better job than that.

Well, I frankly and candidly don't agree with you. I think that whether

his report, in a private way to the minister, might have been helpful

or not is no longer an issue, because he made it public, and I think

that he's done no more than exacerbate the tensions and the problems

that already existed there without providing any answers or any

solutions.

Dealing with the member's comments on rural

medicine, I think, quite frankly, that the analogy between doctors and

policemen is a little thin at best. For one thing, if policemen were

required to carry with them hundreds of thousands of dollars worth of

equipment and labour, for each one of them, it might be more analogous,

and you might find that society would have a different priority about

policemen as well. The fact is that they don't. The fact is also that

they are under a discipline; they are under a "force" mentality. They

belong to a police force that carries with it traditions, and carries

with it also a hope of escape. When one goes to a remote community,

presumably, unless one misbehaves oneself, one gets a reward and later

on goes into a larger community. I think that the situation is somewhat

different. Those of us who have lived in not necessarily remote

communities, but remote in the sense that they're not the lower

mainland, know

[ Page 3389 ]

that

quite often these remote communities, from the policeman's point of

view, are where they learn their jobs. You get them fresh-faced and

fuzzy-cheeked out of Regina all the time, and you don't get the same

kind of quality even in police service that you do in other places.

Yes,

I think there is a problem, however. I'm not trying to brush it aside.

I think that we're going to have to find, and we are searching very

diligently for, other incentives to get doctors into remote

communities. Sometimes it isn't just a matter of money. As you know, we

do fund doctors in remote communities. But when you don't have doctors

under the discipline of a "force" then you can't very well go to them

and say, "You must go to Alert Bay," or "You must go to Bella Bella,"

or "You must go to Namu," or wherever it may be. There's just no way

under our democratic system that you can do that, and we're all, of

course, very content with that.

As you know, we tried a type

of incentive through the licensing system in British Columbia, and the

Human Rights Commission struck that down as being undemocratic, or

whatever the words were that they used. So it's not that we're not

trying to find incentives; it's just that I want to point out to the

member that they are difficult to find.

Dealing with the

question of mental health in North Island, I assume that the member was

really informing me rather than questioning me on that particular

thing. I want to tell him that as a result of what he has said I will

see that both Mr. Gee and Dr. John Gray are made aware of the

situation, and I will dispatch one or both of them into that community.

I would be very pleased if the member would provide me with some

contact person with whom I can put them in touch.

Dealing

with the other remote community problems that you have mentioned, Mr.

Member, I'm sure once again you were more telling me about the problem

than asking for my solutions, because frankly I don't have them. I

concur in what you're saying. There's no doubt that sometimes those are

great communities for the bachelor, and quite often the married man

becomes a bachelor as soon as he gets there, because he's working for

eight hours a day and hunting, fishing and drinking the rest of the

time. That creates a terrific void in the life of his lady. I don't

know what the answers are. I suppose, really, one has to look at it

from a community problem point of view, and communities are going to

have to be encouraged, whether by government, private organizations or

otherwise, to develop community resources that are going to help people

in that situation occupy their time in a meaningful way.

MS. BROWN: Mr. Chairman, I ask leave to make an introduction.

Leave granted.

MS. BROWN:

I just noticed sitting in the gallery the baby daughter of the member

for New Westminster (Mr. Cocke) and her new husband. I wonder if the

House would bid them welcome.

MR. HALL: I listened to

the Minister of Health making a response to the member for North Island

(Mr. Gabelmann) regarding the analogy of policing and health care. For

a minister who had spent a great deal of his time recently bending his

mind to the intricacies of the constitution and coming up with some of

the original ideas he told us, I really expected better of the minister

in dealing with the analogy than saying: "a bright, shining,

fuzzy-cheeked constable going to Alert Bay." I think that that kind of

conventional wisdom coming from the minister was really almost too much

for this side to take. You could have dealt with the analogy a little

better than that, I think, Mr. Minister. I don't think anybody should

ever allow that kind of cliché to go past in this House without some

comment being made about it.

I share the concern of the

member for New Westminster (Mr. Cocke) about the Health ministry. For a

short while I shared the onerous duties of Health minister, because in

1972 the delivery of health service in this province was split between

two ministries. The Provincial Secretary had part of it and the

Minister of Health had the other part. I soon got rid of my part to the

Health ministry, which I think was a sensible thing to do. I was

interested in following it through over the ensuing three years, and

even today, like the minister himself and the member, I try to keep as

abreast as I can of not only the happenings on the large scene but

what's happening in the delivery of the health care system at the

constituency level — at the level where it really counts.

remember, Mr. Minister, that in 1975 a completion of a massive

reorganization of the Ministry of Health occurred. For many years the

ministry had been in three parts, even allowing for the fact that the

medicare part of it was in another ministry altogether. That

reorganization was in place in 1975, was inherited by this government

that I sit opposite to, and went into 1976 and 1977. In 1977 the

mandatory retirement of two senior deputies, Dr. George Elliot and Mr.

Bill Lyle, occurred. They were two men who had served the ministry well

and had been part of that reorganization. They had both been deputy

ministers, but in the reorganizational process took the rank of

assistant or associate deputy ministers — whatever was current at that

time.

I am fearful of some of the things that are happening

— particularly as laid down in a bill currently before the House, which I

cannot discuss at great length but may touch fleetingly on as I move

through the estimates — which we will call, for sake and ease of

reference, the politicization of the public service, in my opinion not

contained in explanatory notes of the bill.

In 1977 another

reorganization of the ministry took place, not as large as that which

took place in 1975. But it was very unusual for that kind of

reorganization to follow so quickly. During that reorganizational

period, you will be interested to know, Mr. Chairman, the following

happened. First of all, the deputy minister, Mr. James Mainguy, a man

with 35 years' service, left at 58 years of age. Secondly, Dr. K.

Benson, an associate deputy minister with over 30 years of service,

went to Kootenay as a medical health officer. Thirdly, an assistant

deputy minister, this time in mental health, with 29 years of public

service — 57 years of age — left the public service altogether.

Fourthly, an associate deputy minister of Hospital Programs went out,

having had 24 years of service. Two years after 1975, that little

reorganizational exercise took care of.... Well over 110 years of

public service went out the door after two years — all well before

mandatory retirement. That kind of shock that goes through the public

service takes any minister some time to handle, takes any new deputy

minister, any new assistant or associate — supernumerary, temporary,

acting, unpaid, any rank at all — some time to get over.

What effect does that have on senior staff? I'll tell you what it does. The next thing that happened was that Mr.

[ Page 3390 ]

Scott,

the director of public health inspectors, chose to retire after 31

years of service, seven years in advance of his retirement date. The

chief of information services chose to retire with 28 years of service,

again seven years before mandatory retirement date. The director of

epidemiology chose to retire with 30 years of service. That kind of

wastage, that kind of reorganization, that kind of loss of experience

of public servants is really awfully difficult to understand on this

side of the House.

This minister now has to look at those

gaps. He filled them all — I don't know if he filled them or if his

predecessor filled them — with good people, I'm sure. Time alone will

tell that. I don't want the advisers who are sitting opposite and

advising the minister to take any of my remarks in such a way as to

think I am suggesting they are not going to do a first-class job. What

I am saying is that the full effect of over 200 years of public service

by men and women leaving the public service well before retirement age

is, as I say, a shock, a loss of morale and a wonderment about what is

happening in Health.

I say that because that is not the only

department it has happened in. This happens to be one that is very,

very important, and one in which I happened to have more than a passing

interest from 1972 to 1975. I don't mention it to the minister in any

critical way at all — he has only just arrived on the scene in terms of

Health. I wish him well in putting the ministry together, but I want

him to know that we've noticed that. I want him to know we are watching

him very carefully. I want him to know we have got our barometers,

thermometers, litmus paper out as well, taking the soundings, searching

through the entrails, rattling the bones and finding out what is going

on over there just as he has.

It is not really a question of

semantics, although I know what the minister means when he

says: "It's not chaos." But I'll tell you, it's trouble. There is some

confusion there, there is some difficulty, and we do wish you well,

because, frankly, it is one of the most important things we are dealing

with, one of the most important things in this province. I want you to

understand, if I can say this to you directly, that that should never

happen again. Somebody should be brought to task over that kind of

situation.

Now to things in Surrey, if I may — some

constituency matters. First of all I'd like to deal with the Boundary

Health Unit. Dr. Meekison, in his report to the special meeting

involving the municipal council and the MLAs, reported that the

Boundary Health Unit is at this time unable to offer to the residents

of Surrey a comprehensive speech service. He states that people with a

speech problem have to wait up to six months to get attention or they

have to leave the municipality and go elsewhere for it. He stated that

there is a hearing aid program available from the provincial

government, but it's not provided for here in one of their largest

health units in the province. I'd like, if I could, to get an update

from the minister on that. Again it's a question of making decisions

and putting them into operation. Surely in the largest riding and in

one of the largest health units in the province we can do better than

that.

The next question is in regard to the staffing of the

Boundary Health Unit with physiotherapists. Again, the Boundary Health

Unit has the largest caseload of any health unit in the province, but

we have no staff — only temporary employees. Dr. Meekison reports

inability to have permanent employees in that regard.

The

second part of his annual report deals with the provincial Long-term

Care Program, which leads us into the question of the Peace Arch

District Hospital. Here I would like to elaborate a little on the

member for Burnaby-Willingdon (Mr. Lorimer), who happened to visit my

riding the other day. Maybe the minister has some answers. I'd like to

report to you, Mr. Minister, that in the Peace Arch District Hospital

24 long-term care patients are in acute-care beds. We're monitoring the

situation, but we are, as in the case of other MLAs, reporting to you

the same kind of situation: that acute-care beds are being taken up by

long-term care patients. In the 1979-80 year 6,362 long-term care days

required the use of 18 acute-care beds in that hospital. It was

reported in February of this year that long-term care days totalled

4,944 for the fiscal year ending January 31, 1980. That's 4,600 over

the

BCHP approved budget. For January of this year alone the long-term care

days are 665 over budget in that hospital.

The reason why we

get upset about it is that all the planning has gone on. I refer to the

report of the special board meeting of the Peace Arch District Hospital

and point out that the plan is the completion of the fifth floor of the

acute-care hospital to accommodate patients from the extended-care

unit, concurrent work on the sixth floor, and all that's really waiting

is the approval of the Minister of Health to activate some of these

decisions. The timing of the stage will depend on the hospital's

ability to prove need. This report is dated March 6; I received it the

following month.

What I want to deal with is the hospital's

ability to prove need. I again refer you to what appears to be a

growing problem with the government in all its works and the gathering

of information south of the river. I have some difficulty understanding

what's going on. We've got the Minister of Education (Hon. Mr. Smith)

besieged by parents regarding the school system in Surrey, South Surrey

and White Rock now having to authorize temporary portables and readjust

capital expenditure programs. The municipal council has got planners

reworking figures. We've got the only school district with a burgeoning

school population. Everybody who lives there knows the place is

growing. The Minister of Municipal Affairs (Hon. Mr. Vander Zalm),

who's also the member for Surrey with me, knows what's going on. I

can't understand why you, the Minister of Education and whoever else is

involved with social services or public services based somehow on

numbers or the presence of people, can't get that information. I'm not

berating you or any individual, but it seems to me to be a sorry state

of affairs when the Delta-Surrey-west Langley area is growing and

growing — and you see it in the newspapers — but the information

doesn't seem to get in the cabinet room. I just don't understand that.

I don't understand why — unless you're going to nod your head and say

it's all done, it's all built since I was last there three weeks ago.

HON. MR. MAIR: Where have you been the last three weeks?

MR. HALL: I've been in here.

The

hospital's ability to prove need. I just don't understand that any more

than I could understand the response of the Minister of Education when

he said: "The pupils have got to be at the door in September before

we'll build a school." It's that kind of thing, I think, that

infuriates my and the other member's constituents.

The next thing in Surrey is public health inspectors. Here

[ Page 3391 ]

a memorandum: The ministry directed that public health inspectors

cannot initiate work outside the regular workings at the local level.

"Any overtime must have the prior permission of the ministry or shall

be of an emergency nature, relating directly to food poisoning or

communicable diseases" — i.e., rabies — "only."

In the

Boundary Health Unit we've got several yearly events that require

public health inspections, We have the Cloverdale Rodeo, we have the

White Rock Sea Festival, we've got the Cloverdale Fall Fair. For years

the Boundary health unit has always looked after those kinds of

inspections, and I don't see why they shouldn't continue to look after

those inspections on behalf of the local boards of health and the

sponsoring societies. Unless the ministerial authority is obtained the

public health inspector isn't covered by compensation, should he be

involved in an accident. Is that part of the trade union agreement'? Is

that a ministerial edict or regulation? If a person is working, surely

he is covered. How can you send somebody out to do work for a

municipality, to do inspections or to assist in a community effort, and

not keep the person covered? That is my short question. I don't

necessarily expect to have the answer off the top of your head but

sometime, maybe, you could come back.

I see Mrs. Kelly isn't

with you today, but I was going to ask if there is a firm, if not

rigid,

schedule of inspections for care homes, and if one can inspect

that register of inspections without getting involved with MLAs who are

frequently called and given stories about the conditions in privately

operated homes horror stories which may or may not be correct. I think

all MLAs know — that they listen to stories and they aren't necessarily

always correct. I want to know if there is a register of when the last

inspection was made and if there is either a statutory obligation on

the part of the director of long-term or community care to inspect at

frequent intervals or what frequency that interval is, so the MLA can

be assisted in knowing when the inspection last took place and so some

evaluation can take place in his or her mind and we can help our

constituents.

Now

for one that I've had on my desk since

1968 — the King George private hospital. I first suggested to Mr. Dan

Campbell when he was then the Minister of Social Welfare, I think it

was called then, that we should buy the King George Hospital. I don't

want to get involved in negotiations. All I want to know is: have they

finished yet, are we in negotiation, or are we out of negotiations? It

seems to me that we had an opportunity here, not only in 1968 but

recently, to pick up a private hospital in not bad shape for about $1

million less than we could build one for. I was wondering if the

minister had completed his negotiations and whether or not we could

look forward to some easement in the long-term care situation at the

north end of the riding by the purchase of that establishment.

next question is on laboratories. I have mixed feelings about the

presence of the private enterprise motivation in the provision of

laboratory services and, if we have it, what kind of control features

are on it. I remember we used to have debates in this House when Mr.

W.D. Black was the minister responsible for the payments to

laboratories. We had many, many debates about this. There has been some

discussion that we should use our hospitals and our hospital

laboratories. In January of this year a survey was taken in my riding,

with the exception of the actual city of White Rock, to see what is

happening in the identifiable five communities of Surrey.

Whalley, with 47,000 people, there are two laboratories. In Guildford,

with 26,500 people, there's one laboratory. In Cloverdale there are

10,300 people, with a lab recently approved. Sunnyside has 16,800

people with no laboratory. Newton, with 22,800 people, has a laboratory

that has been going two weeks after some struggle between Mr. Weir and

a group of doctors. What I'm trying to ascertain is: is there a magic

figure? Are we going to use the hospital facilities? Again, are we

going to do something before we start to be inundated with requests

from south Surrey for improvement, because if you saw the building

that's going on in south Surrey and the school population figures that

we've already debated in the budget and we will be debating again

during education.... No, we've already done education estimates. We

debated you in education estimates.

HON. MR. MAIR: Like the Dodgers: wait until next year.

MR. HALL:

We did do it. I remember doing it now, a couple of months ago. Again,

the kind of figures we will be doing in Municipal Affairs.

seems to me there's got to be some lead time with this.... It

doesn't take much lead time for a laboratory. But why should patients,

for instance, in Sunnyside have to go to White Rock if we're totally

and utterly committed to this doctor–private enterprise system of

handling the laboratory system? What criteria is the ministry laying

down about this? What's going on? We could tell these people to get

lost; I don't mind telling people to do that at all, it doesn't bother

me one bit. I'd like to know whether to pursue the matter or to give

them any encouragement whether we should be debating it from a policy

point of view in another matter or whether we should be introducing

some fresh ideas.

I, too, have a case which I would like the

minister to make just a private response to me at some time on, and

that is again in the Peace Arch emergency ward. It's the Diak case. I

misheard my colleague for New Westminster (Mr. Cocke). I thought he had

somehow gotten my file. That can happen.

HON. MR. MAIR: Usually it's across the floor, but I guess you can steal each other's too.

MR. HALL: Oh, there are seagulls down here like you've no idea.

The

Diak case was publicized. I can certainly share my correspondence, if

the minister doesn't have it. I'm sure he has. It was a bad scene, let

me put it that way, where a gentleman did die in very poor conditions

in the emergency ward of the Peace Arch. There were editorials written

and so on in the local newspapers. It's the Diak case. It's not

necessary to respond by any means today in estimates.

I have

a couple more things. Elderly people are becoming more and more

conscious of their political clout. They group together in the

constituencies in old-age pensioner branches and clubs, and so on. They

are, I think, becoming aware of the fact that there are certain

regulations, which do, to a certain extent, discriminate against them.

For instance, there's the chiropractic regulation. It doesn't bother me

that there are only 12 treatments for chiropractic per year. It bothers

somebody who's older, who believes that that is helping them and they

need it, perhaps more than I do,

[ Page 3392 ]

although

sometimes after a long day here one could argue that that's not the

case. The provincial Health Act places limitations on the number of

chiropractic treatments conditional on age. That's an odd thing. I

don't like that at all — conditional on age. In short, you can get 12

treatments if you are over 65, and 9 if you are under 65. I think

that's a bad law. I'm wondering if the minister.... While I know

estimates is not the time to ask for changes in the law, perhaps

estimates is the time to point out that there is some discrimination

there, although one could argue that reverse discrimination might be a

good thing. But that seems to me to be a poor law. Certainly elderly

people would have some reason to say: "Let's have more." So I'd like

some response on that.

[Mr. Strachan in the chair.]

interesting case came to me the other day. It was an interesting point

that I never, ever considered before. A gentleman with a child — I

suppose an adult now — in one of our institutions is being

treated.... The institution is Woodlands, and the condition is

paranoid schizophrenia and partially retarded. The question is simply:

why can't the parent choose a doctor to treat his child? Let's use the

word "child" for descriptive purposes. In 1972, which is some time

ago, a doctor gave a treatment which resulted in exceptional changes in

the daughter's behaviour. After the doctor left, the next doctor

refused to follow the same mode of treatment and withdrew this

particular treatment and this particular drug.

That

continued for about two years when that treatment was reinstituted.

Again there was another recovery — and this doctor who recommended the

treatment is available to treat this person in this institution — and

the parent came to see me and said: "Why can't I have this doctor —

Dr. X — treat my child in this place?" And I have no answer for him.

Why can't he? I can choose my doctor; you can choose your doctor. This

institution is now that child's home; why can't that child be treated

by a doctor...? I know some of the answers; I'm not that innocent.

In terms of some radical treatments I think I would share the view

that, no, you can't. But where the treatment has been tried once, left

alone and tried again, and there have been measurable improvements, why

can't the patient's or the child's father or parents or guardian have

some say in that kind of situation?

It seems to me that the

province's Mental Health Act fails to guard some of the patients'

rights in that way. I'm not getting terribly excited about it, but

there seem to be some loopholes there. We now have a lawyer in charge

of Health.

HON. MR. MAIR: A former lawyer, Mr. Hall.

MR. HALL: It might be an interesting thing for you to look at, now that you're not spending so much time on the constitution.

HON. MR. MAIR: I think about it a lot, though.

MR. HALL:

Next question. We all have deaths in our family, and I had to deal with

one — in another country, obviously — and I was amazed and heartened by

the marvellous treatment relatives of mine got in England in a hospice.

"Palliative care" is what my colleague from New Westminster (Mr.

Cocke) said is the correct description we use here to describe care for

people who are dying. He also advised me that a hospital — the Royal

Columbian, I think — has on its own set up its own hospice. Having had

some experience of going to one of these places and seeing what can be

done, as distinct from the normal or acute-care hospital and the

situation that could prevail there, I am asking the minister if he has

any plans, if there is any way in which we, as a government, could

encourage our own hospital boards, if there are any funds set aside —

and I realize there are some problems developing with revenue — to

encourage the setting up of hospices.

MR. CHAIRMAN: Hon. member, since I wasn't able to give you a three-minute warning, I'll extend the three minutes from this point.

MR. HALL:

That's the last thing I have: whether or not there is anything we can

do as a government, as a Legislature, to encourage our hospital boards,

etc., to move into that field, because I believe that's a really

marvellous situation that I saw operating in the U.K., and one which I

would certainly — if the minister hasn't seen it, I'm sure he must know

of it — describe to him.

HON. MR. MAIR: Mr. Chairman,

I was rather interested when the member was speaking and he mentioned

that very obviously he had come from another country. It reminded me of

a speech I gave in the North Island constituency four or five years

asking me questions, said, "By my absence of accent you can certainly

it, when you really think about it.

I've got pieces of paper

all over hell's half acre here, Mr. Member, through you, Mr. Chairman,

so I hope that you'll forgive me if I ramble all over the place here in

answering your many questions. But first of all, with respect to the

staff that you talk about that have left, I don't know what case you're

making out. If you're suggesting that most or all or any of those

retired because of dissatisfaction with the Ministry of Health or the

system, then I'd be pleased to hear of it, and we can deal with that

one by one or in groups, as you choose. But so far as I'm able to

determine, the people that you mentioned — and you happened to miss

Doug Weir, who retired early just a couple of weeks ago, much to our

sorrow — the information I have is that they simply took advantage of

the rather generous terms of their contract with the government and

took early retirement. Most of those that you mentioned, too, in making

your case, did have long service. I think perhaps after I'd spent 30

years in the government with the Ministry of Health or any other

ministry, I'd be inclined to look at Victoria's weather and fishing

capabilities and golf courses and give retirement a whirl too. But in

any event, we can talk about that further, if you wish.

the Boundary Health Unit problems that you mentioned, we now have a

temporary mobile unit giving speech and hearing services in Ladner. It

has been there for six weeks, pending new premises being built in North

Delta — the new health centre. I have spoken to the mayor and council

in the North Delta area. The member for Delta (Mr. Davidson) has been

in touch with me on that. It is going ahead. That's the short answer to

that question.

On the long-term care patients in the acute-care beds at Peace Arch District Hospital, first of all, that is a general

[ Page

3393 ]

problem

that we have discussed in this House in question period and during

these debates over and over again. I assure the chamber that we are

building long-term care beds as fast as we possibly can to take care of

the problem that has developed. Dealing specifically with Peace Arch

District Hospital, I understand that discussions are taking place and

have been taking place for some time between my staff and the hospital

in terms of overall planning as to what precisely that hospital ought

to have and what role it ought to play in the community. In talking to

one of my staff next to me here, I understand that process will be

completed this fall. From that point on we will presumably be able to

solve the difficulties that you raise, Mr. Member.

On the

question of inspectors, I will accept your invitation if I may, Mr.

Member, and come back to you with an answer. I might say to you, if I

may — and other members opposite, that in past estimates that I have

done in this House I have always scanned Hansard carefully afterwards

and provided answers, where I can, to questions that I was unable to

answer. Sometimes, of course, members opposite are, for good and

obvious reasons, making speeches rather than asking questions. I don't

try to get myself into that dichotomy, but where there are specific

questions like this I do try to come up with the answers. I'm sure if I

don't you will remind me in due course.

The inspection of

private hospitals is done through the local medical health officer. He

or she should have the information that you need. They are not

necessarily done on a regular basis, I think for the obvious reasons.

You don't want to do it regularly; you want to do it irregularly so

that people don't know that you're coming. I think I mentioned

yesterday at some length the two studies we have going on both the

financing of those facilities and the way they are being run. Those

reports will be down very shortly and I will have a much better idea of

where we stand on that.

On King George Private Hospital, my

note indicates that we expect a call this afternoon from their lawyer

giving a counter-offer to the offer that we made. I might say that

either the day I took office, or the Monday following I think it was, I

was confronted with a demonstration on the Legislature lawn concerning

King George Hospital. My remarks should not be taken as being critical

of that, but only to point out that you can get yourself, if you are

not careful, between a rock and a hard place on these kinds of private

hospital deals.

I will put it in example form, rather than

say King George Hospital, so that I don't offend anybody. You can get

into the situation where the people who own the hospital in effect hold

you up, because they know that they can get great public sympathy and

have all sorts of demonstrations and that sort of thing simply by

threatening to close down the facility if the government doesn't pay

them their price. In cases like that, yes, we do like to buy them where

we possibly can. We have negotiations going for quite a number of them

at this time. However, there are some — and I will make it very clear

to the members opposite — that I have absolutely no intention of paying

their price. It's highway robbery and I just won't have it. We'll

build our own facilities long before we'll pay that price. I think you

recognize that we do have some difficulties there, but we are very

hopeful that we will be able to bring King George Private Hospital to a

happy conclusion,

Laboratories are another difficult problem. I'm sure the member for New

Westminster (Mr. Cocke) had the same difficulties wrangling with this one as

I am now having. Quite frankly, I have chosen to postpone making a decision

on policy there until I get through my estimates and have time to direct myself

to that and to that alone. I'll tell you why. I've got five or six —

I'm not sure which — appeals now on my desk, arising out of applications

for laboratories. While the policy in the past has been — and I can see no reason

why it would ever change — that we prefer public facilities to private, the

problem is a little more complicated than just saying that.

Sometimes

the private facilities can make out the case that they do a better job,

and they will produce books to show that they in fact do a much better

job than the public facility. When you examine the situation further,

though, you find that the reason for that is that all of the good stuff

is being referred to them and all the bad staff is going into the

hospital; then there is a curious connection between the people who are

doing the referring and the people who are running the laboratories.

it is a complicated matter. As I say, I beg your indulgence for my

lethargy in coming to grips with the matter. However, I do intend to

lock myself in my office with it, and with my staff work out some

policy which is, I hope, going to work a little better than the one we

now have.

I should also say that we have an advisory

committee through Medical Services with respect to laboratories —

through you, Mr. Chairman, to the member. They are the ones who do

advise us on it and we do have a process whereby applications must be

made to Medical Services, with an appeal to me. As I say, that's what

stacked up this problem in my office at this point in time.

dealt sometime yesterday with chiropractors, and I told the members who

were in the chamber at that time that I presently have got something

before Treasury Board that I hope will alleviate some of the

difficulties. I'll certainly take a look at the question of the over-65

and under-65. That does seem to me to be a bit of anomaly too. Off the

top of my head — and that's all I can do at this point — it doesn't

make a great deal of sense to me, but I certainly will take a look at

it.

On the question of Woodlands School, I suspect without

knowing that that is probably a policy of Woodlands. I would hope that

you would take that up with the Minister of Human Resources at the

appropriate time. If you wish I'll certainly take it up with her and

see if I can get an answer for you. From what you tell me the only

conclusion I can come to is that that must be a policy of the

institution rather than a policy of our ministry, because nobody around

can tell me it's our policy. So I can only assume that it's a policy of

the institution, which, as I say, is run by the Ministry of Human

Resources.

You've got a twin who sits right down there. He

looks just like you, you know, except he's a mean one. He always loses

his temper, challenges me to fights and things like that. You don't want to get to know him.

Regarding palliative care, this, to me, is.... Everybody has moved!

MR. KING: You're totally intemperate.

HON. MR. Mair:

Well, I intend to be tonight. I'm going to Seattle and I'm going to

watch a baseball game tomorrow and I intend to break my diet and be

just as intemperate as I possibly can be tonight, Mr. Member.

MR. MACDONALD: Did you insult me or not?

HON. MR. MAIR: You're uninsultable!

[ Page 3394 ]

did want to be serious about this matter, if I may. We are now

operating two pilot projects on the palliative care program. I have no

doubt whatever that this will become ministry policy in a big way. In

our view, this is not something that can be done just through the

hospitals. It's not just an institutional type of a program; it's a

program that has to not only have the hospital and the Ministry of

Health involved, but, probably most importantly, must have the

community involved in it as well. We want to see just how it does work

and learn from our mistakes as we go along. After all, our mistakes

can't really hurt, because nothing is being done at this point. So

anything we do has got to be beneficial.

We want to come

forward with a program that, as I said to the member for New

Westminster earlier, will take care of this void in health care. It is

a shocking state of affairs, and all of us — I assume everybody in

this room — would find it very disagreeable indeed to deal with that

subject. As a result, people who are dying simply are cut off from

care. It rather reminds me of that scene in the movie Farewell to Arms ,

where they put people in the dying tent and just sort of left them

alone. That's something that we are addressing, and I have very, very

high hopes indeed for these two pilot projects.

MS. BROWN:

I'm really very pleased to hear the minister say that even after the

estimates are over he goes over Hansard very carefully and takes a

second look at some of the suggestions that have been made, because I

think if nothing else, certainly out of this series of question and

answers, if we can get the minister to really look at the whole

business of the Human Resources and Health access and the way in which

Health, by not providing resources, is creating a real hardship for

Human Resources, that would be a good result of this.

When I

spoke a couple of days ago I talked about this in terms of adolescence,

and I just want to touch very briefly on where the same thing happens

as it applies to health care services to women. The one area in

particular that I want to talk about is the whole area of post-partum

counselling. There are all kinds of debates going on around the whole

area of depression, whether it really is medical or is socially

induced, and who should really take the ultimate responsibility for it.

However,

I don't think there's any debate around the post-partum depression

issue. For many, many years the medical profession has recognized and

has taken full responsibility for the fact that some women, for one

reason or another, after the birth of a child, very quickly — maybe

within a few days — experience a very severe depression. For other

women it is not until six months later, perhaps, when they have a very

severe depression, and what we're beginning to find now is that with

some women it doesn't occur until even a year or two years later. The

medical people themselves have tried to come up with some kind of

physiological explanation for this and those of us who have been

through the process of having babies recognize that there are some

social reasons too. I personally believe that a lot of the depression

is rooted in sheer exhaustion. This business of trying to introduce a

new infant into the world, feed it every three hours, keep it clean and

all these kinds of things, especially if you're breast feeding, takes a

tremendous toll on the body of the mother.

There are social

reasons too. Nonetheless, the medical profession has taken

responsibility for that in terms of saying that there are some kinds of

physiological things happening as a result of giving birth and the body

readjusting itself, especially at the termination of breast feeding.

The end result of this depression is sometimes really severe. We have

had some very tragic instances of suicides — there was a very sad case

of a woman recently in Surrey — and instances of severe child abuse,

even resulting in the killing of the newborn infant in some instances.

I say, this is recognized as a responsibility of Health. Yet in the

Vancouver area we find that the only post-partum counselling service

that exists is totally funded by Human Resources. I would like the

minister to explain to me why that is so. Why is it that Health is not

taking any responsibility at all for not just the funding of the

post-partum counselling unit that exists presently in the Vancouver

area? I am willing to see the funding shared because I recognize that

there are some social reasons too. Certainly the research that has come

out seems to indicate that more and more social reasons are tied into

exacerbating the physiological phenomena which result from this kind of

thing.

Why

isn't Health funding this kind of resource and

why are not more post-partum counselling referral units being developed

around the province? It is not just in Vancouver that women have

babies. It is certainly not just in Vancouver that women experience

post-partum depression. Maybe the minister could answer that question

or at least make some kind of commitment in terms of his department,

because the post-partum counselling unit needs more money than it has.

It has to expand its service. This woman in Surrey, for example, who

took her own life, didn't have access to this. Surrey doesn't have

this post-partum counselling service. Health has to move in and take on

more of these responsibilities. They can't be left entirely to Human

Resources.

The other thing I wanted to talk to the minister

about was the Vital Statistics Act. It is a very strange phenomenon

with the Vital Statistics Act.

HON. MR. MAIR: You know, I prepared for everything but that.

MS. BROWN:

Well, you know, the Vital Statistics Act is not keeping up with the

rest of the world. It is still somewhere back in the dark ages, and I

wonder if the minister would be prepared to take a look at two things

in the Vital Statistics Act. Apparently it is still not legal in

British Columbia to register a child in anything but the surname of the

father when the two people are married to each other. The minister, I

know, got a letter from a couple who are married to each other but

decided both to keep their own names. What they would like to do is

register their daughter with a doublebarreled name, such as Mair-Cocke

or Mair-Brown or something like that.

HON. MR. MAIR: Mair-Brown is satisfactory, but Mair-Cocke never! [Laughter.]

MS. BROWN: Sorry, not Mair-Cocke. I withdraw Mair-Cocke. Mair-Brown or Brown-Mair, whichever you want.

AN HON. MEMBER: The old Brown-Mair....

[Laughter.]

[ Page

3395 ]

MS. BROWN: This is possible if you live in other provinces.

In Alberta or Ontario it is possible but in British Columbia it is not

legal. The act is very clear that when two people are married to each

other the child can only be registered in the father's name. That is

not keeping up with the changing times. There should be some

flexibility.

The other thing the act still does is to

question the legitimacy of the child. The Attorney-General's

department, as you know, is working very hard to change the laws to do

away with all the stigmas attached to legitimacy, yet the act still

asks not who the parents are but whether the parents are married to

each other. There are those two amendments that the minister should

take a look at. It is probably time to pull the act up anyway and look

at it and bring it into the twenty-first century. That wouldn't be a bad

idea.

The third topic, very quickly, that I want to touch on

is that the Long-term Care Program has one rather inflexible thing

about it. That is, what happens to older couples who are at different

levels of illness? Surely there is some way we can keep them together.

It is ludicrous to start separating people in their eighties and

nineties just because one needs a different level of care than the

other member of the couple. Maybe the minister could take that into

account as well.

The fourth point, very quickly, is the

level of care given to women in corrections facilities. It is not good

enough. As a matter of fact it is so bad that the Registered Nurses

Association has submitted a brief asking that Health take over this

responsibility, not leave it under the Attorney-General's department. I

think the minister has a copy of the brief; if not I would be very

happy to share my copy with the minister. They did some research called

"Health Care Facilities in the B.C. Corrections System," and it's

just absolutely disgraceful. If the minister doesn't have a copy of

this brief I'd like to pass it on, and very, very strongly support the

recommendation that it be taken away from the Attorney-General's

ministry.

Sometime later in the minister's estimates I would

really like to speak at great length on the whole business of the

overuse of drugs and tranquilizers by women of all ages. especially

older women, and the ways in which doctors are using Valium and other

tranquilizers to deal with the problems of isolation, aging and that

kind of thing. But I won't deal with that now. If the minister would

just handle those four questions I'd appreciate it.

HON. MR. MAIR:

The first question is very easy for me to answer: it's simply I don't

know. I don't know why Human Resources is the sole source of funding

for the post-partum group. I'll find out and I'll let you know what I

do find out, Madam Member.

MS. BROWN: No, don't tell me, just take it over. It's a health thing, that's all I'm saying.

HON. MR. MAIR: All right. I'll find out what it's all about and see what the position of the government is. I just don't know.

On the Vital Statistics Act, I tend to agree with you. I think we could clean

up some of those sections and bring them.... I don't know whether I

can get it into the twenty-first century yet, but I'll certainly do my best

to get it into the latter part of the twentieth century. I'll take a look

at that. I had the opportunity of using that act not long ago. I changed the

spelling of my name. I didn't change my name: people keep saying I changed

my name, but I didn't. I simply changed the spelling to conform with that

which I've used all my life. It was an interesting exercise.

The

long-term care problem that you raise, Madam Member, is probably one of

the most vexing problems that comes up in the Ministry of Health. It

happened in my constituency several times over the last few years, and

it's an extremely vexing question. We can handle it in new units;

that's fine. We're now putting into new units sufficient- sized rooms

so that we can handle that kind of problem, but the devilish problem is

in the older units where it just can't be accommodated properly. If

it's any consolation to you to know that I feel very, very strongly

about it, very unhappy about it, and that in my constituency I have the

same kind of problems that you do and I want to try to do something

about it, I suppose that's the best I can say at this point. I don't

have an instant solution other than that we are addressing it in the

new units as they come along.

Corrections.

I think that

you're probably going to have to take that up with the Attorney-General

(Hon. Mr. Williams.) in his estimates. It's impossible for me

to walk over and say: "Look, there's a coup d'état and I'm going to

take them over." I'm sure that if you bring it up to the

Attorney-General, if there are any objections he might have to that

process you'll learn of them then, and if there aren't any there

doesn't seem to be any reason why it can't be accommodated. Presumably

when his estimates come up you'll discuss that with him.

MS. SANFORD: I'll be quite brief. I just have a couple or three issues that I would like to raise briefly with the Minister of Health.

know that a number of people have raised with the minister the

deplorable situation with the accommodation for ambulance attendants in

various parts of the province and the serious situation with

understaffing of ambulance attendants and services in B.C. There is one

particular situation in Parksville that I would like to draw to the

minister's attention. The understaffing there is about 50 percent. They

are entitled to approximately twice what they now have based on the

1979 volume allotments.

Fortunately, Mr. Chairman, the

ambulance people are moving into a new building, and hopefully that

will make their accommodation somewhat more suitable. But they are

seriously understaffed.

What particularly concerns me is

that the people in the community have been very supportive of the

ambulance program, and want to have the best possible ambulance service

available to them. As a result, they have gone out and raised funds so

the ambulance will be properly equipped. They have purchased a

defibrillator for the ambulance. They have also purchased a special

drug equipment kit, which the ambulance people are not able to use.

They are unable to use either one of these items, because they have

neither the staff nor the necessary training in order to make use of

this equipment that the community has gone out and purchased for the

ambulance people.

They have to have five staff in order to

get the additional training. They only have four staff. They are

entitled to twice that number. There are only four there, so they're in

a vicious circle. They need five in order to get more training so they

can operate this equipment; there are only four of them, so they can't

get the training. As a result, these two units are sitting there

unused. The community has gone out to raise the money to purchase the

equipment, and they can't use it.

It's a shame, because in Parksville there is no hospital

[ Page 3396 ]

immediately

nearby. They have to travel down to the hospital in Nanaimo, which I

realize is only 30 miles or so. But if they have to travel up to the

Bowser area, for instance, they have a lot longer to travel to get to

the hospital — either at Nanaimo or Comox, because that then becomes

the choice.

I'm really saying to the minister today — along

with all of my colleagues who have already raised this issue on a

number of occasions — that the priority has to be changed so that they

have the necessary training, and so that there are enough people to

staff these various ambulance stations throughout the province. It's a

disgrace.

If we just took the money that was utilized for

the dishes that are sitting out there on the lawns or took the money

that has been spent trying to figure out whether we should have a

tunnel to Vancouver Island or not and trained a couple of these guys,

then we'd be able to give that basic health service to people that

they're not able to obtain, even though they've gone out themselves and

raised the money and bought the equipment so that they could have that

basic service. It just is not good enough, Mr. Chairman.

know that we have talked time and time again during this whole week

that these estimates have been under discussion about the priorities.

Health care has never been a priority with this government. When we see

the kind of projects that they're spending money on at this stage, it

angers the people in the Parksville area who've gone out and raised

money and find that the ambulance people can't even utilize the

equipment that they've gone out and purchased. It's another appeal, Mr.

Chairman, to change priorities, to get some training done and to get

the additional staff. I know that the people in the emergency program

feel very discouraged, because time and time again they put in appeals

to get additional training done and additional staff members and are

unable to do so. Of course, Mr. Chairman, now we have a freeze on

hiring, so I guess I'm speaking here without any effect whatsoever

until that policy is changed, as obviously they're not going to hire

anybody until then.

I'm pleased to hear that the minister is

going to go over the Blues, because I have an issue that I wanted to

raise. I hope the minister, once his estimates are over within the next

few weeks or so, will go back and look at the Blues in order to deal

with this one specific issue that I have. Again it relates to a

situation that exists in Parksville, Mr. Chairman, where a couple of

senior citizens living in Parksville are having some difficulty meeting

the financial commitments that they are now forced into. The wife

became very ill, was in the hospital in Vancouver and ended up in the

G.F. Strong unit for a period of time and is now in a wheelchair. She

has been undergoing physiotherapy treatments from a physiotherapist

who, through the Ministry of Health, has been coming to her home — this

is the community physiotherapist — in order to give her the necessary

treatment. She has been doing very well with this community

physiotherapist. That program is a good one, Mr. Chairman, and I

certainly support it. Unfortunately, the physiotherapist, for whatever

reason, is leaving the area, meaning that there is no longer anyone who

can go into that home to assist this woman who is in a wheelchair.

Fortunately

they were able to obtain physiotherapy treatments through a private

physiotherapy unit located in Qualicum. Unfortunately they don't have a

car, so they had to make arrangements to get transportation up there.

But she is now able to get some treatment through this privately owned,

privately operated unit.

The only thing is that she now has

to rely on her medicare premiums to cover the cost of paying for those

private treatments. The total amount that medicare will pay is $100,

which doesn't cover that many treatments. She must have them two or

three times a week. I have attempted, through the ministry, to obtain

some kind of coverage for her under the Long-term Care Program, so that

whatever costs are incurred above and beyond the $100 that is

available for coverage under the medicare program would be picked up by

the Long-term Care Program. I have been turned down. These people are

senior citizens. They cannot afford the additional cost of the private

treatments. The community physiotherapist has left the area, and as a

result I am appealing directly to the minister today. I hope he will go

back over the Blues in order to ascertain whether or not there is some

way that those costs can be borne through the Long-term Care Program.

At the moment I have been turned down.

I have one other

brief point. I cannot understand why it takes as long as it does to get

approval for the various intermediate-care units that are being built

throughout the province. I understand some of the problems — that the

ministry has to work with societies sometimes; they have problems with

property acquisitions; they have problems with designs, in that they

have to go back and forth between the architect and the society and the

regional district, and all these problems that are involved. But it

still seems to take far too long to get the necessary approval to begin

the construction of these very urgently needed intermediate-care

units. There are two within my constituency that are currently going

through this process, and it seems to take month after month before we

can actually resolve those problems. I am again appealing to the

minister to see what he personally can do in order to cut down on the

length of time that is required to go through the various processes. I

appreciate that they have to be careful, it has to be done properly and

everything else, but it is still too long.

I'm wondering if the minister might comment on some of those issues.

HON. MR. MAIR:

Mr. Chairman, I noticed that the member opposite said I only have some

weeks of estimates left, which disappoints me. I understood we had

agreed on six to seven months when I started. As probably the only

person in this place who is goofy enough to actually like doing

estimates, I really would rather that you didn't cut them any shorter

than you feel is necessary.

Interjection.

HON. MR. MAIR: Don't worry about that. If I've got to be in this crazy place I'd just as soon be in here as downstairs, so it's fine with me.

the question of ambulances, first of all I think I should tell you that

the optimal suggestion of numbers of staff in our ambulance system —

the largest number ever suggested to us that I know of — is 754. Our

current estimates will provide an increase of 101 , or 18 percent over

what we now have, and bring that up to 698, which if my mathematics is

correct is 56 short of what some people consider to be the optimal, the

very top of the house. So I think we are getting to the point where we

are going to be able to be quite satisfied with the staffing we have in

the system.

As far as the particular problem in Parksville

is concerned, I assure the member that I will address myself to it and

try to get an answer to her as quickly as possible. I do not

[ Page

3397 ]

accept her suggestion that health is not a priority

with this government. I'm not going to get into an argument: it is; it

isn't; it is; it isn't. I'm not going to let the record show that I was

silent on the subject, because I think that health is the number one

priority of this government and has been since we took over in 1975.

far as the couple in Parksville is concerned, I note that the member

did not give me the name of the couple. That may be that she doesn't

want it on the record. If she does want to give me the name on the

record, fine; if not, perhaps she could let me have the name of the

couple privately, on the record or whatever you wish, so that I can

look at it.

MS. SANFORD: They have it in the ministry.

HON. MR. MAIR:

Okay, but I don't have it. If you want me to look at it, please get

their names to me. I certainly will look at it and see whether we can

do something. Maybe it will be through Human Resources; I don't know.

The

last point that the member raised concerned approval of long-term care

facilities. The member to some degree answered her own question by

giving all of the hoops that these things have to go through.

Interjection.

HON. MR. MAIR:

I'm constantly being interrupted, Mr. Chairman, by that menace over

there. I don't know whether he is challenging me to another fight, or

what he is doing. He strikes the fear of God into my heart every time

he is in this chamber, in any event, so I hope that you will watch very

carefully and afford me not only the verbal protection that you usually

do but physical protection if necessary.

Some of the hoops

that people have to go through — and we have to go through — and you've

mentioned a number of them: the societies, acquisition of property,

designs. and so on. I suppose there's always going to be some of the

delay that can be laid to the bureaucracy in our own ministry. I'll

accept that and try to do what I can to clean that up.

Let

me tell you where one of the big problems is, and I guess it's going to

sound like Ottawa-bashing again, but it really isn't. It's just that

CMHC have a number of restrictions, rules, regulations, hoops, etc.,

of their own. We traditionally find that the very last approval that

you get, the very last hoop that you go through with the big delay

between the one just before it, is CMHC. I don't say that critically

or unkindly; it's a big organization across Canada. It's got thousands

of these and other things to concern themselves with. But that is one

area that perhaps you would ask one of your colleagues in the federal

House to question the appropriate minister about there, and perhaps

with his help and my help, we can do some good.

I'm sorry,

there was one other question raised about the physiotherapists that I

should also point out. I did undertake to look at the specific problem.

We are having problems hiring physiotherapists in general. There is a

general shortage of them and that does cause us some difficulty. When

we do need a replacement — quite apart from the other difficulties the

member has raised with me — that is an additional difficulty.

MR. LEVI: Mr. Chairman, I....

HON. MR. MAIR: Are you back?

MR. LEVI: Yes,

I'm back. It's the third time for asking. I don't have anything from

the riding other than to, not necessarily give the minister a bouquet

about the Eagle Ridge Hospital, but to compliment his deputy. I was

present at that public meeting and I thought to myself afterwards that

the minister made a good choice. He decided not to come himself and

sent somebody else. The deputy did very well. It was very impressive

because it was a pretty heavy crowd and they were kind of hostile. He

laid down a very interesting point of view, and we did get a chance

afterwards to say a few words to one another. So I don't want to deal

with that. That's now, as I understand it, hopefully, in the works, and

it's going to be built.

What I'd like to talk to the

minister about is something I touched on earlier in the debate, which

is the whole question of access and utilization in terms of the health

care system. I want to deal, to some extent, with the Black report. As

you know, Wes Black, who used to be a member of this House, was asked

to head up a committee. It was actually an advisory committee on

medical manpower. What I'd like to do, in case the minister forgot

about the.... There was a very interesting foreword by the chairman

which, in the way it was written, very much reflects the way that

former member of this House used to think. I think in reading it I'd

like to comment on it. He says in the foreword to the report:

"The

problem presented to your advisory committee on medical manpower was

one which has progressively worsened with the passage of time. There

are those in the Canadian community who are convinced that the problem

defies solution and that the committee will be spinning its wheels and

spending taxpayers' dollars with no result. Those are the pessimists.

On the other hand..."

This is really Black-sonian prose.

"...there are those who think that right is equidistant

from two points of view. These are the compromisers."

He's making available all sorts of

definitions here.

"While

the committee has listened, it has not been influenced by the

pessimists nor the coin-promisers, rather it has taken a point of view,

a positive point of view. Your committee's attitude has been one of

optimism that a problem does not exist that defies solution."

This is a little bit at odds with what we've heard sometime this week. That's from his point of view.

''Our

concern has been for what is right rather than for who is right. In

presenting this report your committee was under no misapprehension that

the report would please everyone. Indeed it may anger some who will

find some recommendations bitter pills to swallow. If such be the case

then so be it. We realize that this is a time to stand up and be

counted, a time for bold decisions and so we grasp the nettle. Finally,

may we suggest that the report be read with an open mind remembering

the following basics: 1) control of the delivery system is vital; 2)

accountability of everyone involved in it is also vital; 3) the time

has come to choose between being part of the problem or part of the

solution; 4) through excessive demands by consumers and providers on

the health care system the possibility exists of destroying the system,

of killing the goose that lays the golden egg.''

[ Page 3398 ]

presume Mr. Black wrote the foreword. He was part, as members know, of

the early history of the medicare plan in British Columbia, because he

was the minister at the time who negotiated it and retained interest in

the B.C. Medical Services Plan. He has made 68 recommendations in his

report. The minister might make note that the questions I'm going to

ask him deal with some of the recommendations and whether the

government has done anything about the report, which it has had since

March 1979.

One of the problems that I started to discuss in

an earlier part of the debate was the question of access. Until Mr.

Black did his report, at the request of the government, I am not aware

that the government had looked at the problems of access to the system

and who in fact gets the greater benefit from the system. We do have

some studies across Canada. We certainly have the study that was done

in Ontario. We have another study, which is called the Interline Study,

which was done in Quebec in 1975. Then we have the studies that were

done in Saskatchewan in 1976. These studies really dealt with looking

at a profile of the people in terms of