2003 Legislative Session: 4th Session, 37th 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)

MONDAY, MAY 12, 2003

Afternoon Sitting

Volume 15, Number 9

CONTENTS

Routine

Proceedings

Page

Introductions by Members

Introduction and First Reading of Bills

School Amendment Act, 2003 (Bill 50)

Hon. C. Clark

Teaching Profession Amendment Act, 2003 (Bill 51)

Hon. C. Clark

Private Career Training Institutions Act (Bill 52)

Hon. S. Bond

Pharmacists, Pharmacy Operations and Drug Scheduling Amendment Act, 2003

(Bill 54)

Hon. C. Hansen

Pension Statutes Amendment Act, 2003 (Bill 49)

Hon. S. Santori

Agriculture, Food and Fisheries Statutes Amendment Act, 2003 (Bill 48)

Hon. J. van Dongen

Insurance Corporation Amendment Act, 2003 (Bill 58)

Hon. G. Collins

Statements (Standing Order 25 b )

Mining industry in B.C.

B. Bennett

Surrey RCMP award recipients commended

D. Hayer

Financial services industry in B.C.

R. Sultan

Oral Questions

Impact of Children and Family Development

ministry reorganization

J. Kwan

Hon. C. Clark

J. MacPhail

Management of Forests ministry recreation sites

R. Harris

Hon. M. de Jong

Physical education in high school curriculum

S. Brice

Hon. C. Clark

Impact of Children and Family Development ministry reorganization

J. Kwan

Hon. G. Collins

J. MacPhail

Reduction of government regulations

T. Bhullar

Hon. K. Falcon

Committee of Supply

Supplementary Estimates: Ministry of Health Services

Hon. C. Hansen

J. MacPhail

Estimates: Ministry of Health Services

Hon. C. Hansen

J. MacPhail

Tabling Documents

Ministry of Health Services, service plan,

2003-04 to 2005-06

Ministry of Health Planning, service plan, 2003-04 to 2005-06

Second Reading of Bills

Transmission Corporation Act (Bill 39)

Hon. R. Neufeld

P. Nettleton

B. Penner

J. MacPhail

R. Hawes

Utilities Commission Amendment Act, 2003 (Bill 40)

Hon. R. Neufeld

J. MacPhail

[ Page 6657 ]

MONDAY, MAY 12, 2003

The House

met at 2:04 p.m.

Introductions by Members

Mr.

Speaker: Good afternoon, hon. members. I'm pleased today to introduce a

longtime friend. In fact, we've known each other since we were about "that

high," and there are not many people who can make this claim. Both he and I

were born in the town of Blue River. Now, not many people can say that; not many

people really want to say that. We had a great time up there as little kids. He

now lives in the constituency of Kamloops–North Thompson. He's a constituent

there. He's here representing the forest industry to meet with the government

caucus today. Would you please welcome Carman Smith.

[1405]

Hon. G.

Plant: A few weeks ago I had the honour to meet with a group of grades 5 and

6 students at Tomekichi Homma Elementary School in beautiful Richmond-Steveston.

Thanks to the careful preparation of their teacher, Jacquelyn Johnston, I was

asked a series of much more difficult questions than I have ever been asked on

the floor of this Legislature. They have actually come to visit us all here

today. They're sitting in the gallery about to watch democracy unfold. I hope

the members of the House will all make them very, very welcome.

Anderson: I would like the House to join me in welcoming four visitors from

the Working Group on Poverty who are here today to meet with the Minister of

Labour: John Argue, Afsaneh Dashtlalli, Christina Davidson and Gurtej Gill.

Please make them welcome.

Mayencourt: It's a pleasure to introduce my constituency assistant, Mr.

Ashley Haslett, who has joined us here today in the gallery. Ashley had a stint

in the Manitoba government as the executive assistant to the Minister of Health

and a little bit of time down in the government of New South Wales as a

minister's assistant there. Would the House please make him welcome.

Introduction and

First Reading of Bills

SCHOOL AMENDMENT ACT, 2003

Hon. C.

Clark presented a message from His Honour the Administrator: a bill intituled

School Amendment Act, 2003.

Hon. C.

Clark: I move that Bill 50 be read a first time now.

Motion

approved.

Hon. C.

Clark: I'm pleased to introduce Bill 50. This act makes a number of changes

to the School Act, which is administered by the Ministry of Education. The

School Amendment Act, 2003, is about giving students a voice on school planning

councils, providing more choice for students and their parents and providing all

principals with the ability to accrue seniority. It's also about further

eliminating red tape for school districts.

The bill

will ensure that students have real meaningful input into school planning which

will, in turn, improve student achievement. It will give boards the ability to

permit students to continue to attend schools outside their enrolment boundary

or catchment area, and it will give boards the flexibility to maximize

recruitment efforts as more principals reach retirement age. It will also allow

boards to spend short-term lease revenue where it will benefit students most,

and that is in the classroom.

I move that

the bill be placed on orders of the day for second reading at the next sitting

of the House after today.

Bill 50

introduced, read a first time and ordered to be placed on orders of the day for

second reading at the next sitting of the House after today.

TEACHING PROFESSION

AMENDMENT ACT, 2003

Hon. C.

Clark presented a message from His Honour the Administrator: a bill intituled

Teaching Profession Amendment Act, 2003.

Hon. C.

Clark: I move that Bill 51 be read a first time now.

Motion

approved.

Hon. C.

Clark: I'm pleased to introduce Bill 51. This act makes a number of changes

to the Teaching Profession Act, which is also administered by the Ministry of

Education. The Teaching Profession Amendment Act, 2003, is about increasing

public accountability, clarifying the role of the College of Teachers and

enhancing its efficiency.

[1410]

The bill

will ensure that parents have the right to register complaints about teacher

conduct and help increase public confidence in the teaching profession. It will

change representation on the College of Teachers governing council to encourage

the participation of parents and other educational partners and the public. It

will require college members to report professional misconduct of another member

to promote professionalism within the teaching profession. It will require the

College of Teachers to prepare an annual report to increase financial

accountability and to include a report on teacher competence. It will give the

college the authority to set standards for teacher certification but not approve

how teacher education programs are taught or administered. This bill will permit

the college to dele-

[ Page 6658 ]

gate the power of decision-making to a discipline committee to ensure

procedural fairness for all parties.

I move the

bill be placed on orders of the day for second reading at the next sitting of

the House after today.

Bill 51

introduced, read a first time and ordered to be placed on orders of the day for

second reading at the next sitting of the House after today.

PRIVATE CAREER TRAINING

INSTITUTIONS ACT

Hon. S.

Bond presented a message from His Honour the Administrator: a bill intituled

Private Career Training Institutions Act.

Hon. S.

Bond: I move that Bill 52 be read a first time now.

Motion

approved.

Hon. S.

Bond: This bill will repeal and replace the Private Post-Secondary Education

Act in order to implement the core services review recommendations concerning

the current private training policy and legislative model.

The bill

will establish a new legislative framework for private training in the province.

It will replace the Private Post Secondary Education Commission with a

self-regulating board composed of industry representatives and will minimize the

regulatory burden on the private training sector by narrowing the scope of

registration to include only those private training institutions providing

career-related training programs beyond a specified time and cost threshold.

addition, this bill will establish a student training completion fund to provide

consumer protection for the tuition fees of students attending registered

institutions.

I move that

the bill be placed on orders of the day for second reading at the next sitting

of the House after today.

Bill 52

introduced, read a first time and ordered to be placed on orders of the day for

second reading at the next sitting of the House after today.

PHARMACISTS, PHARMACY OPERATIONS

AND DRUG SCHEDULING

AMENDMENT ACT, 2003

Hon. C.

Hansen presented a message from His Honour the Administrator: a bill intituled

Pharmacists, Pharmacy Operations and Drug Scheduling Amendment Act, 2003.

Hon. C.

Hansen: I move that Bill 54 be read a first time now.

Motion

approved.

Hon. C.

Hansen: I'm pleased to introduce the Pharmacists, Pharmacy Operations and

Drug Scheduling Amendment Act, 2003, which will transfer the responsibility for

dealing with requests to access PharmaNet from the College of Pharmacists to a

new PharmaNet stewardship committee within the Ministry of Health Services.

We are

making this change to respond to a request from the College of Pharmacists that

it be allowed to discontinue its responsibility for dealing with access requests

to PharmaNet. Quite simply, the college has concerns over the workload

associated with managing these requests, and they also feel many of the requests

they receive are outside their day-to-day work and scope of interest, as

requests are typically for research purposes.

The

database that we know as PharmaNet contains medical histories including

allergies, adverse reactions and patients' medical conditions. PharmaNet is

invaluable in preventing harmful drug interactions and allergic reactions. The

network also contains invaluable data on drug use patterns and trends that can

significantly benefit health care planning, research and program evaluation in

this province. In order to protect patient confidentiality, access to this

information is severely restricted.

[1415]

Our

amendments will transfer the responsibility from the College of Pharmacists to

the PharmaNet stewardship committee within my ministry. In order to protect

patient confidentiality, this committee will be independent and will include

representatives from the College of Pharmacists as well as the College of

Physicians and Surgeons.

These

amendments will allow access to this database for the purpose of health policy

research and monitoring and evaluation of Pharmacare. In response to some very

useful advice from the information and privacy commissioner, amendments to this

bill will be introduced to clarify our intent in that regard.

Patient

confidentiality will continue to be protected. Measures currently in place under

the Freedom of Information and Protection of Privacy Act and the bylaws of the

College of Pharmacists ensure that privacy of patients is protected and will

remain in place.

I move that

the bill be placed on the orders of the day for second reading at the next

sitting of the House after today.

Bill

54 introduced, read a first time and ordered to be placed on orders of the day

for second reading at the next sitting of the House after today.

PENSION STATUTES

AMENDMENT ACT, 2003

Hon. S.

Santori presented a message from His Honour the Administrator: a bill intituled

Pension Statutes Amendment Act, 2003.

Hon. S.

Santori: I move that Bill 49 be read a first time now.

[ Page 6659 ]

Motion

approved.

Hon. S.

Santori: Bill 49 provides the statutory framework for the four public sector

pension plans. The amendments in Bill 49 will remove or replace obsolete

terminology in this act and simplify the appointment process for the B.C.

Pension Corporation management board. It will provide the College Pension board

of trustees with the authority to make retroactive regulations. It will remove

obsolete and inconsistent provisions in various other statutes regarding pension

contribution for statutory officers.

It will

legislatively transfer responsibility for the negotiation and administration of

group health benefits for retired plan members from government to the pension

board of trustees. It will clarify that post-retirement group benefits are not

subject to the Pension Benefits Standards Act, and it will provide authority for

the partners to the college pension plan to enter into non-statutory joint

management agreements.

I move that

Bill 49 be placed on the orders of the day for second reading at the next

sitting of the House after today.

Bill 49

introduced, read a first time and ordered to be placed on orders of the day for

second reading at the next sitting of the House after today.

AGRICULTURE, FOOD AND FISHERIES

STATUTES AMENDMENT ACT, 2003

Hon.

J. Van Dongen presented a message from His Honour the Administrator: a bill

intituled Agriculture, Food and Fisheries Statutes Amendment Act, 2003.

Hon. J.

van Dongen: I move that Bill 48 be read a first time now.

Motion

approved.

Hon. J.

Van Dongen: I'm pleased to introduce Bill 48. This legislation amends the

Farm Practices Protection Act and the right-to-farm provisions of the Local

Government Act. Together those statutes provide the legislative framework for

the right-to-farm system.

The

right-to-farm system enables the province to ensure that there is a proper

balance between provincial objectives for agriculture and aquaculture and the

farming industry standards of practice and local government regulatory authority

over these activities. The system requires local governments to which the system

has been applied to get the approval of the Minister of Agriculture, Food and

Fisheries for zoning and farm bylaws. The system was established in 1995 and has

operated with a high degree of success.

[1420]

Through

operational experience we have learned, however, that local governments have on

occasion avoided or sought ways to circumvent the intent of the legislation.

Also, the current wording of the act does not cover aquaculture as effectively

as was originally intended. The amendments I'm introducing today address both of

these matters and ensure that the legislation provides the legal support needed

to achieve the province's policy goals for the right-to-farm system for

agriculture and aquaculture.

I move that

the bill be placed on the orders of the day for second reading at the next

sitting of the House after today.

Bill 48

introduced, read a first time and ordered to be placed on orders of the day for

second reading at the next sitting of the House after today.

INSURANCE CORPORATION

AMENDMENT ACT, 2003

Hon. G.

Collins presented a message from His Honour the Administrator: a bill intituled

Insurance Corporation Amendment Act, 2003.

Hon. G.

Collins: I move that the bill be introduced and read a first time now.

Motion

approved.

Hon. G.

Collins: I'm pleased to introduce the Insurance Corporation Amendment Act,

2003. This bill amends the Insurance Corporation Act to provide the B.C.

Utilities Commission with responsibility and authority to independently regulate

the Insurance Corporation of British Columbia.

The

legislation will ensure that basic mandatory automobile insurance provided by

the Insurance Corporation of British Columbia will continue to be provided on a

financially sound, efficient and fair basis to all drivers and vehicles in

British Columbia. In addition, the bill will encourage and enhance competition

for those automobile insurance products that are not mandatory, such as

collision and comprehensive insurance coverage.

I move that

the bill be placed on the orders of the day for second reading at the next

sitting of the House after today.

Bill 58

introduced, read a first time and ordered to be placed on orders of the day for

second reading at the next sitting of the House after today.

Statements

(Standing Order 25

b) MINING INDUSTRY IN B.C.

Bennett: This is Mining Week in B.C. Miners, whether they wear a plaid shirt

and boots or a pin-striped suit, are some of the most independent and

entrepreneurial people in our society.

When you

think about what it takes to make a mine from a chunk of rock in the mountains

to the point, ten years later, when the first product is sold, you can

understand how this amazingly resilient, can-do mining

[ Page 6660 ]

culture has developed over the past 150 years in B.C. However, some people in

today's B.C. believe the whole concept of mining is anachronistic. The new,

high-tech BlackBerry generation has evolved beyond that primitive activity of

digging stuff out of the ground, despite the fact that our televisions contain

35 different minerals and our computers almost as many.

In my

riding of East Kootenay the five coalmines employ about 2,500 workers. They each

make $82,000 a year on average, including benefits. What other industry pays

like that?

Mining has

gotten a bad rap. Mines make only a tiny footprint on our land base. Mining is

an industry that has embraced high-tech more than most industries. Mining is the

safest heavy industry in Canada. Mining today has a highly respectable

environmental record. For B.C. to try to build back prosperity without utilizing

our mining wealth is like volunteering to run a race on one leg.

This

government has done a lot to get the mining industry going again in B.C., like

the elimination of sales tax on mining machinery and equipment. We have the best

flow-through share benefits in Canada, the two-zone land use designation and a

simplified permitting and regulatory process.

But we have

much further to go. After the decade of anti-mining policies from our

predecessors and the loss of half of our mining industry, we must show the

international investment community that we are serious about mining in B.C. We

must protect mineral-rich lands for potential discovery and not lock them out of

reach of our children and grandchildren. We must encourage people to go out and

search the land base for minerals, we must encourage mine construction, and we

must ensure that B.C. becomes competitive once again with the other mining

jurisdictions in the world.

SURREY RCMP

AWARD RECIPIENTS COMMENDED

Hayer: I rise today to honour those who protect us, those who make our lives

safe. On Thursday the Surrey community honoured the Royal Canadian Mounted

Police men and women — honours that began seven years ago when I and a team of

volunteers worked very hard to develop the awards program during my term as the

president of the Surrey Chamber of Commerce in 1996-97. We established the

Police Officer of the Year Awards in Surrey. Last Thursday the Solicitor General

was in my riding of Surrey-Tynehead to honour those who have served above and

beyond the call of duty. The Surrey RCMP detachment is the largest in Canada and

is also the best in the nation. I hope they will remain our police force in

Surrey for many, many more years to come.

[1425]

The

officers whose names I want to introduce in this House today have been exemplary

in their services. Sgt. Terry Kopan was chosen police officer of the year by the

community for his efforts in crime prevention and for assisting in the

presentation of our 2010 Olympic bid in Switzerland. Police officer of the year

chosen by his peers at the Surrey detachment is Const. Marc Searle, who has

contributed hundreds of volunteer hours to making Surrey a better place to live.

The award for the community policing initiative went to Christine Farrar. Rod

Greenwood was named policing volunteer of the year. Corrine Marelli was the

police municipal employee of the year for 2003, and the GIS Unit of the Surrey

RCMP received the special achievement award. The Central City shopping centre

received the police and business partnership award.

I would ask

that the House join me and my fellow Surrey MLAs in offering congratulations to

those exemplary members of the Surrey RCMP who worked very hard to make Surrey a

safe place to live, work, play and do business in.

FINANCIAL SERVICES INDUSTRY IN B.C.

Sultan: The government has designated 2003 as B.C.'s year of forestry. The

government should consider designating 2004 as B.C.'s year of financial

institutions. Three developments are the reason why.

First, the

B.C. Securities Commission has proposed a B.C. model for securities regulation,

replacing our ancient system of prospectus disclosure with a streamlined public

offering process. Public companies would continuously disclose all material

information all of the time. The commission would also eliminate the

registration of individuals in the securities business — thousands of them —

placing onus for responsible conduct on the firm.

Second,

work is underway to resuscitate international financial centres in Vancouver.

The federal government gave Vancouver privileged IFC designation years ago,

along with Montreal. Quebeckers with strong provincial backing picked up the

ball and ran with it, and we played catch in the backfield in B.C., trying to

figure out how the game was played. Today Montreal activity outnumbers Vancouver

by at least 10 to 1. All of that can change with commitment from government and

the financial sector.

The third

leg can be further expansion of our venture capital capacity, particularly in

the heartlands. The new VCC act has been well received and is doing its job.

However, labour-sponsored funds are still not operating in a fully competitive

mode. On another government's watch they drained $147 million of risk capital

from the heartlands and put back only $12 million. They can and should change

that.

These three

developments can be the cornerstones of the year of financial institutions.

There's a lot of employment and prosperity riding on it.

Oral Questions

IMPACT OF CHILDREN AND FAMILY

DEVELOPMENT MINISTRY REORGANIZATION

J. Kwan:

In prepared comments read in this House on March 24 of this year, the Minister

of Children and

[ Page 6661 ]

Family Development said that there is no evidence to support the claim that

vulnerable children are being put at risk as a result of budget cuts and the

reorganization of the ministry. While the rules of this House do not permit me

to note the presence — or lack thereof — of a member in this House, I wonder

if the Deputy Premier can explain why the minister would make this claim when

his own officials are saying that is not true.

Hon. C.

Clark: I would be delighted to take that question on notice on behalf of the

minister.

MacPhail: We have a crisis on our hands here. The opposition has come into

possession of a risk register. According to the risk register, there is a high

likelihood that as a result of budget cuts, none of the services required to

implement his new model will even exist — resulting in mass confusion, loss of

confidence and erosion of trust in the child protection system right here.

[1430]

The Deputy

Premier may want to just take this on notice in the absence of effective

colleagues at her side, but without the support of the people who prepared this

assessment the government can't proceed with the new model, and it's proceeding

now. There is no time to take questions on notice. They're telling the

government it's impossible right here. It's labelled the risk register. It

simply won't work.

How can the

Deputy Premier, on behalf of her colleagues, take a question on notice when we

see that with this plan, children are at risk as we speak?

Hon. C.

Clark: Despite the rhetoric of the opposition, despite the fact that they

like to fearmonger and they like to try and create crisis, the Minister of

Children and Family Development is continuing to work on this plan. He is very

sensitive to the needs and concerns of the community out there, and this

government — just like when we were in opposition — remains very, very much

committed to ensuring the safety of children in our society. Children are the

best investment any government can make, and we will continue to make that

investment.

Mr.

Speaker: The Leader of the Opposition has a supplementary question.

MacPhail: The risk register that we have, in which the Ministry of Children

and Family Development officials participated, goes directly against what the

Deputy Premier just said. It's a risk register. The minister's plan to cut the

child welfare budget by 40 percent on the south Island, while implementing a

massive reorganization of child welfare, is failing. It's that simple.

Service

providers, even ministry officials, can see the writing on the wall: $25 million

spent on a reorganization that's failed. It's only led to confusion. But most

importantly, what this risk register says is that it threatens kids and puts

them at risk. Will the Deputy Premier agree to put this whole plan on hold, look

at the risk register, show how her government — bottom to top — is putting

kids at risk? Will she then go back to her Premier, to the Minister of Finance,

and demand that the funding cut to the Ministry of Children and Family

Development be restored? If so, will she do that this afternoon so that the risk

register cannot put children at harm?

Hon. C.

Clark: The Minister of Children and Family Development has been working

very, very hard on making sure this works. He makes a virtue out of the fact

that he listens — not an attribute that is often seen in the Leader of the

Opposition. He has gone out, and he has listened, and he has heard. That is why

he is looking at the plan. That is why government is reviewing the plan. That is

why we want to make sure we get this right.

This isn't

just a simple matter of political posturing and using kids as political

footballs in the Legislature. This is a question of making sure this plan is

done right. We need to make sure that children, who are the greatest investment

any government can make, are protected in British Columbia.

Interjections.

Mr.

Speaker: Order, please.

MANAGEMENT OF

FORESTS MINISTRY RECREATION SITES

Harris: My question is for the Minister of Forests. My riding is home to a

number of forestry campsites, which prove to be very popular for both

constituents and tourists. The decision to comanage some of these sites,

however, has raised the concern in my riding and all across the north.

While being

interviewed on CKPG radio, the Premier said the Ministry of Forests was

conducting a review of this issue. Can the Minister of Forests tell us what

progress has been made on this issue and when the review will be completed?

Hon. M.

de Jong: As most members of the House know, last year we announced we were

looking for partners…

Interjection.

Mr.

Speaker: Order.

Interjection.

Mr.

Speaker: Order, please. The Minister of Forests has the floor.

Interjections.

Mr.

Speaker: Order, please. The Minister of Forests has the floor.

[ Page 6662 ]

[1435]

Hon. M.

de Jong: …to comanage the more than 900 rec sites that British Columbians

value. Thus far we are in negotiations with groups that will lead to

comanagement agreements for well over half and, as a result of a portion of the

review that the member referred to, have been in a position now to offer

assistance with respect to ensuring there is liability coverage for those

partners. We expect that will further enhance our ability to create those

comanagement partnerships that will allow us to keep that valuable recreational

infrastructure open and available to all British Columbians.

PHYSICAL EDUCATION IN

HIGH SCHOOL CURRICULUM

Brice: My question is to the Minister of Education. I realize the

consultation which the minister engaged in, in terms of graduation requirements,

came as a result of extensive consultation with parents and students and

educators. The decision was to not include physical education as a requirement.

Given the….

Interjection.

Mr.

Speaker: Order, please. Order, hon. member.

We'll wait

till we have order in the House, please. Then you may continue.

Brice: Given the very serious situation of child-youth fitness, I was

personally disappointed in the decision. However, I was encouraged that there

was to be a requirement in the graduation portfolio for demonstrated physical

activity. I wonder if the minister would elaborate on that and give this House

some assurance that there would be some rigour required in that very important

aspect of our children's development.

Interjections.

Mr.

Speaker: Order, please. Order, please. The Minister of Education has the

floor.

Hon. C.

Clark: When we did the public consultation on the discussion about grad

requirements — we were out there for about a year and a half talking to people

— we talked about a phys ed requirement, making it mandatory in grades 11 and

12. It was something that I was quite interested in seeing happen, but 90

percent of the people we spoke to and who made submissions didn't think it was a

good idea. It was a question of listening to the people and making sure that the

grad requirements that we brought in met their expectations.

That

doesn't mean we don't think that physical activity and enhancing a level of

physical activity is important for kids. We need to make sure that kids have a

love of an active lifestyle. We also need to make sure that young people,

particularly young women, graduate from high school with a healthy body image

and a good approach to eating and to their lifestyle, which will mean a healthy

society.

Here's what

we've done. We are going to require that every child who graduates demonstrates

that they have had at least 80 hours of documented physical activity in addition

to the required mandatory physical education up to grade 10 inclusive. We are

going to be looking at the curriculum, and we're going to be working with the

Ministry of CAWS to make sure we have healthy kids graduating from our schools.

IMPACT OF CHILDREN AND FAMILY

DEVELOPMENT MINISTRY REORGANIZATION

J. Kwan:

If the Deputy Premier actually cares about children and their education, maybe

she should take a look at the risk assessment here. According to the risk

registry, there is a high likelihood that as a result of budget cuts, none of

the services required to implement this new model will even exist, resulting in

mass confusion, loss of confidence and an erosion of trust in child protection

systems.

The Deputy

Premier may want to deny there's a problem, but without the support of the

people who prepared this assessment, the minister responsible cannot proceed

with this new model. They're telling the minister that this is impossible, that

it simply won't work. How can the Deputy Premier continue to say that everything

is fine and things are proceeding accordingly? The government needs to step

back, put this model on hold….

Interjections.

Mr.

Speaker: Order, please.

J. Kwan:

The government needs to step back and put this model on hold and ensure that

children and youth are protected as this government claims that it's going to be

doing.

Mr.

Speaker: The question has been taken on notice.

The

Minister of Finance.

Hon. G.

Collins: The risk assessment is done for exactly the reasons….

MacPhail: It didn't come from your side. You were forced to participate in

it. It's the agencies that deliver the services, not you.

Mr.

Speaker: Order, please.

[1440]

Hon. G.

Collins: Without a doubt, I think that there will be, from time to time,

disagreements between the agencies that are paid to provide services and the

government who pays the bills. However, on this very serious matter, the

member…. I have not seen the document she has in front of her, although I've

seen

[ Page 6663 ]

other documents that indicate there are challenges in this ministry in

2004-05 as the changes and the implementation of this plan come into phase. That

is why…

MacPhail: Mental health risks escalate. Sexual exploitation on the increase.

Hon. G.

Collins: …we are reviewing the plan that the ministry….

Interjection.

Mr.

Speaker: Order, please. Order. Will the Leader of the Opposition please come

to order.

Hon. G.

Collins: That is the exact reason why we are reviewing the plan and the

service plan of the Ministry for Children and Family Development. The goal

remains to make sure that children and adults that are vulnerable and that need

attention and need care are provided with that. That is the whole goal. The

whole review of this ministry's plan is based on the feedback that we've

received from people out there around British Columbia. Comments….

MacPhail: It didn't come from you. You were forced into this.

Hon. G.

Collins: That is why we have engaged in the review. It is because….

Interjections.

Mr.

Speaker: Order, please. Order.

Hon. G.

Collins: Mr. Speaker, we all care about children. The challenge is to listen

to what we hear from people out there — to listen to service providers,

families, the aboriginal communities and the professionals in the ministry —

and make sure we have a plan that will work. That's why we are reviewing the

plan. We're reviewing it now — unlike what was done by the previous government

when that individual sat around the cabinet table, when they swept it under the

carpet month after month, year after year. We know what the impact was on

children in British Columbia.

REDUCTION OF GOVERNMENT REGULATIONS

Bhullar: My question is directed to the Minister of Deregulation. Can the

Minister of Deregulation tell the House about deregulation and if he is meeting

his self-imposed deadlines on deregulation?

As a side

note, I did read a letter from the Barbers Association. They don't sound very

happy. Just some free advice — it's not legal advice, so it's free: do not

attend any barbers, or we might have a by-election in Cloverdale.

Hon. K.

Falcon: Well, I'd like to thank the member for that question. The member

will be happy to know that my visits to the barber are more infrequent as I get

older.

For the

question that the member posed, I thank you. We did have a target in the

ministry to achieve a 12 percent net reduction by March 31 of the proceeding

fiscal year. I am pleased to inform the member and the House that we have, in

fact, exceeded that target. We're just over 13 percent. That represents over

60,000 regulations that we no longer are burdening British Columbians with.

We're doing that, member, while protecting the important interests of public

health, safety and the environment.

[End

of question period.]

Supplementary Estimates

Hon. G.

Collins presented a message from Her Honour the Lieutenant-Governor:

supplementary estimates for the fiscal year ending March 31, 2004.

Hon. G.

Collins moved that the said message and the estimates accompanying the same be

referred to Committee of Supply.

Motion

approved.

Orders of the Day

Hon. G.

Collins: I call Committee of Supply. For the information of members, we will

be debating the supplementary estimates for the Ministry of Health as well as

the estimates for the Ministry of Health Services.

Committee of Supply

The

House in Committee of Supply B; J. Weisbeck in the chair.

The

committee met at 2:45 p.m.

The

Chair: I call the committee to order, and we will take a ten-minute recess.

The

committee recessed from 2:45 p.m. to 2:57 p.m.

[J.

Weisbeck in the chair.]

R. Lee:

May I seek leave to make an introduction?

Leave

granted.

Introductions by Members

R. Lee:

It gives me great pleasure to introduce to the House 28 grade 5 students of St.

Helen's School from my riding of Burnaby North. Joining them is their teacher,

Mr. Ramalho, as well as several parent volunteers. They are Ms. Frafca, Ms.

Bruschetta, Mrs. Alberti, another Mrs. Alberti, Mrs. Luongo, Mrs. Whol, Mrs.

[ Page 6664 ]

Cortese, Mrs. Herdman and Mrs. Debenedetto. Would the House please give our

visitors a warm welcome.

Debate Continued

Hon. C.

Hansen: There are actually two motions that will constitute the votes for

the Ministry of Health Services, and one is the main vote, which is vote 29,

that was tabled in February. The second is the vote that reflects the increase,

the supplemental estimate that was tabled today.

I'm going

to propose to the opposition, Mr. Chair, that we put the vote 29(S), which is

the supplemental top-up, and we just deal with that one. Then it won't impede

any of the discussions we want to have around vote 29 itself, if that's

appropriate to the member.

SUPPLEMENTARY ESTIMATES:

MINISTRY OF HEALTH SERVICES

On vote

29(S): ministry operations, $319,400,000.

Hon. C.

Hansen: I will speak to it very briefly, and if it's appropriate, we can put

the vote on that and then get to the main motion itself — the main vote.

This $319.4

million reflects the increase in federal money that will flow as a result of the

agreement between the Premiers and the Prime Minister in early February. This is

a commitment we made as a government that every dollar that flowed from the

federal government would, in fact, be added to the budget. When our budget was

tabled in February, we did not know how much that would be in each of the coming

fiscal years. That has just been finalized of late, and we now have that number

so we're able to present that supplemental estimate.

If it's

agreeable to the opposition, we can put that vote. I will then move vote 29, and

we can deal with the whole range of issues that need to be addressed.

[1500]

MacPhail: I appreciate the minister making the point.

Just

to clarify and confirm that after the passing of this vote, any question after

the passing of this vote that would have arisen out of the original vote will be

able to legitimately be put under the general estimates debate?

Hon. C.

Hansen: Yes, that is my understanding.

Vote 29(

S) approved.

ESTIMATES: MINISTRY OF

HEALTH SERVICES

On vote 29:

ministry operations, $10,038,097,000.

Hon. C.

Hansen: I'll start with an overview of our service plan and some of the

budget highlights just as a way to introduce the whole subject. I'd first like

to introduce some of the ministry officials who have joined me in the House

today. To my immediate right is Dr. Penny Ballem, who is our deputy minister.

I'd also like to introduce Tamara Vrooman, who is the deputy minister

responsible for strategic initiatives. Behind me is Marnie Mitchell, who is the

executive director of the Pharmacare branch, and also Steven Brown, who is the

assistant deputy minister in the ministry.

I'd like to

start by just acknowledging the huge contribution that's been made by staff in

the ministry. They have done an enormous amount of work over these last almost

two years now since we formed government. I've certainly learned to appreciate

the dedication and the hard work they bring to this ministry, and I must say I

appreciate it very much.

I would

also like to acknowledge the nurses, the doctors and the other health

professionals and support workers throughout our health care system who really

make the system work for British Columbians. I think, by and large, we have a

first-class health care system in British Columbia. It's not to say there's no

room for improvements, because we all know there is room for improvement. We can

get into some of those issues throughout this debate. But it is those workers,

those front-line staff, who actually are providing care to British Columbians,

who really deserve the credit for the positive attributes of our health care

system in this province.

As members

are aware, the Ministry of Health Services 2003-04 Estimates document

that was tabled on February 18 by the Finance minister showed a $10.185 billion

budget for the Ministry of Health Services. The supplementary estimates, which

were introduced today, will increase that budget by $319.4 million to bring it

up to its total amount of $10.505 billion.

As noted in

the Ministry of Health Services new service plan, increases have also been

identified for the '04-05 and the '05-06 years. The targets that we have for

those years are for an increase of an additional $398.2 million for the '04-05

year over what had been tabled on February 8. That is an increase of this

current amount that's in our budget today and an additional amount of $78.8

million, or a 0.8 percent increase over the prior year.

Then in the

third year of our service plan, '05-06, there will be an increase of $595.6

million over what was tabled February 8, and that is an increase of $197.4

million, or 1.9 percent over the immediate prior year.

We are

requesting approval for the supplemental estimates, which we have dealt with

earlier. This will apportion the amount that was increased as a result of the

first ministers' accord on health care renewal. Because none of these additional

funds were reflected in the ministry's '03-04 estimates and the interim service

plan, it is the combination of the supplemental estimates and the amounts tabled

in February that will constitute our full budget.

The federal

accord that was originally announced in February will result in the allocation

of approximately $1.3 billion in additional federal funding to British Columbia

over the next three years. That new federal funding is in three distinct

categories. The first is the Canadian health and social transfer — CHST, as we

refer to it — which will provide to British Columbia

[ Page 6665 ]

$333.1 million over that three-year period. There is also the health reform

fund, which is an additional $780 million over three years. Then finally, there

is a diagnostic and medical equipment fund of $200.1 million over the three-year

period.

[1505]

We are

pleased to note that the office of the auditor general has agreed to support the

province in the recognition of the CHST fund increases over the three-year

period, starting with this current fiscal year. This fund will be used to

protect British Columbians against catastrophic drug costs as a result of the

new Fair Pharmacare program. The Ministry of Health Services has also

incorporated new performance measures into its new service plan to measure and

report on the number of British Columbians who are adequately insured under

their prescribed drug costs, and this year the Fair Pharmacare policy will be

evaluated by the Centre for Health Services and Policy Research, which is

located at the University of British Columbia.

This

addition was requested by the office of the auditor general, and we are

certainly pleased to incorporate his suggestions for enhancing our ability to

ensure maximum effectiveness from this funding. Defining and meeting clear

targets is certainly nothing new to this government, and we welcome the

opportunity to develop further performance measures. It is all part of

government's demonstrated commitment to a system that focuses on openness,

results and accountability.

We've

established the following priorities with regard to the new federal funding. The

first is to buy system improvements; secondly, to provide a stable, predictable

funding base for the health authorities; thirdly, to provide one-time health

authority transition funding to invest in redesign; and finally, to meet the

requirements of the federal government.

I should

perhaps point out that the federal dollars come with expectations that are yet

to be defined. Although the accord specifies the types of services the funding

must be used for, the level of enhancement will be determined partly through the

performance indicators and targets that are not yet agreed upon by federal,

provincial and territorial governments. They are being worked on now, and it's

our expectation that those will be finalized by this fall.

However, we

are concerned about the lack of information at this point about what levels of

new services health authorities will have to provide in order to meet the

requirements of the accord and whether the funding will indeed prove to be

adequate to meet those future provisions. The new federal funding is a valuable

part of our reforms to provide better patient care and sustainability for our

health care system. However, we face increasing pressure and demands on health

care and will continue to explore long-term solutions with our partners.

As members

are aware, the Ministry of Health Services previously issued an interim 2003-04

to 2005-06 service plan — so the service plan to cover that three-year period.

The Ministry of Health Services has now updated that service plan, which is also

being released today, and this revised plan presents the objectives, strategies

and performance measures for the ministry and for B.C.'s health care system. It

also includes information pertaining to the Minister of State for Mental Health

and the Minister of State for Intermediate, Long Term and Home Care.

The key

changes from the interim service plan to the final service plan are as follows:

the restructuring of core businesses to better define the role of the ministry

versus the role of the partners, such as the health authorities and physicians

who deliver front-line services; to reflect new strategic priorities that the

ministry is initiating to meet budget targets in '05-06 and beyond; to ensure

long-term sustainability of the health system; and, finally, to reflect

performance measures and targets that have been updated to reflect both the

ministry's new strategic priorities and the potential reporting requirements for

federal health accord funding.

As stated

earlier, given the relative timing of the federal-provincial discussions, it is

possible that further changes will be required to the '04-05 through '06-07

service plans to accommodate new performance indicators that may be required as

a result of that federal accord. The service plan reflects our first priority,

and that's patient care. This year's service plan has a stronger emphasis than

ever on outcome-based performance measures to improve patient care and detailed

strategies to meet them. Members should be aware that the new accountability

measures for the Ministers of State for Mental Health and for Intermediate, Long

Term and Home Care have also be included in the final service plans.

[1510]

This year's

plan refines performance measures first introduced last year to strengthen

reporting and accountability on health services provided to British Columbians.

In the service plan we have focused on a number of objectives and strategies,

including supporting the appropriate use of hospitals and health services;

helping British Columbians maintain and improve their health, including

appropriate coverage for drugs; improving primary care and chronic disease

management; and, finally, creating a broader range of care options to give

seniors greater independence, choice and quality of life while meeting their

health care needs.

We will

also focus on the continued development of plans and strategies to address the

burden of disease on society and on providing better care for those who need the

system the most. Our focus includes prevention, better management of chronic

diseases in their early stages and integrated care for the small minority with

multiple or severe chronic illnesses and extremely high health care needs.

We will

continue to refine performance expectations with our partners — the health

authorities, the physicians and the other service providers — and we will

continue with our reforms aimed at providing better patient care and system

sustainability.

We're

staying the course with health system redesign. The addition of $319.4 million

in supplemental

[ Page 6666 ]

estimates that we dealt with today as a result of the increased federal

funding brings total provincial expenditures on all health services across

government — so that's the health services provided by government, not just by

the Ministry of Health Services itself…. That total amount now increases to

$10.7 billion in the 2003-04 fiscal year. This now represents 42.3 percent of

total government spending, the highest portion ever.

Health

spending has grown by more than 78 percent over the last ten years. Between 1985

and today our health care costs have tripled, and yet the pressures keep on

mounting. Across Canada and in British Columbia our health care system is being

strained by growing demands and rising costs. We need a system that can be

responsive to challenges and change — challenges like the unexpected and

devastating emergence of SARS or the West Nile virus —, which bring new and

unforeseen costs to the health system.

There are

longer-term challenges like the aging population and aging facilities,

pharmaceutical costs that were going up 14 to 15 percent a year and new

compensation pressures. We have increased the health budget for the last two

years because we believed that it was necessary, but we recognized that simply

adding more and more money into the system will not overcome the structural

problems within that system, which is why the changes we and the health

authorities are making are so critical to the long-term survival of the public

health care system that we all cherish.

This

service plan will guide the management of the ministry and health care in

British Columbia as we work towards improving patient care and building a more

modern and sustainable health care system for the future. We have redoubled our

efforts to develop step-by-step goals, strategies and performance measures to

help us create a future where we can respond to change from a considered,

thoughtful vantage point instead of the panicked, ad hoc approach of the past.

We will continue to face these challenges by developing strong relationships

with our partners, clearly defining performance expectations and actively

engaging in our stewardship role.

As noted

earlier, the health authorities will receive a total of $130 million from the

federal health accord lift. I know there are lots of people that are looking at

the new federal moneys as some kind of a panacea for the challenges in health

care. I would like to just put that amount of money into perspective, because

$130 million in increased money is obviously important and will provide for

better opportunities for better patient care, but it also funds the health care

system for a total of 92 hours. The cost of running our health care system is

about $1.4 million an hour, so while it's helpful, it is certainly not the

panacea for the challenges.

In addition

to that $130 million, there is also $60 million that will flow to the health

authorities in additional money for medical and diagnostic equipment. Health

authorities will also receive an additional $8 million reallocated from within

the ministry's existing base budget, for a total increase of $198 million to the

health authorities in this current fiscal year. The plan is to provide base

dollars to the health authorities upfront and continue with the existing

performance expectations. These funds will support transition in this current

fiscal year so that new expectations can be established for the following two

fiscal years.

Health

authority performance agreements and acute care access standards, three-year

service redesign plans and budget management plans — all these are in place

and being refined continually. These initiatives are already demonstrating the

value of this approach in better management of the health care system.

[1515]

I'd like to

conclude by acknowledging the hard work and dedication of our health

professionals at work every day in British Columbia to provide high-quality

services. The fact is that despite increasing systemic pressures, British

Columbians continue to enjoy world-class health care in this province. Each year

approximately two million British Columbians go to an emergency room. About half

a million will receive some kind of in-patient surgery or treatment, and the

vast majority find the system works smoothly and efficiently.

We don't

always know how to show that the system is working well or how to identify where

and when it may need work. We are moving B.C. health care into the twenty-first

century, where the system will be increasingly measured on patient outcomes and

clear performance standards. The plans we are submitting today will increasingly

lead to a system where success is not just anecdotal. It is measurable, and it

will lead to a system which is even more deserving of British Columbians' faith,

pride and confidence.

I would be

pleased to entertain whatever questions the opposition would like to put

forward.

MacPhail: It is good news for British Columbians that the federal government

is pumping money into the system, and it's not a moment too soon. I wasn't

actually going to address this part of the debate until later, except that the

minister provoked me by saying that they are going to do things differently than

the panicked, ad hoc ways of the past.

Isn't it

good news that this government, since its election in 2001, has had increased

transfer payments from the federal government for health care? This government,

this Liberal government, has not had to suffer any cuts in transfer payments for

health — none whatsoever.

Let's just

be realistic about this. The health care system was not operated in a panicked,

ad hoc way in the past, but it was under duress — massive duress — not

because of anything any provincial politician did but because of the federal

government itself. The very same Liberal federal government that is now doling

out money to this Liberal government at the provincial level was making massive

cuts in transfer payments for health from 1994 onward. In '94 a cut, in '95 a

cut in federal transfer payments for health — in '96, '97, '98 and '99. At the

last half of 2000 money started to flow again just prior to this government

getting elected.

[ Page 6667 ]

What did

this then opposition, now government say while those massive cuts were being

made in transfer payments to the health care system? The now Premier stood up

and said: "Oh, those cuts aren't deep enough." In fact, at the time

that the health care system was being funded to the tune of about $6 billion in

this province, he said: "That should be enough. That should be enough for

the health care system." Not one iota of slack or understanding or positive

feedback did the then opposition give to the then government at all about those

cuts in transfer payments — not one.

Yet

throughout that whole period of time health care funding wasn't cut by the

provincial government. Even in dire economic straits because of the Asian

economic downturn, the then administration funded the health care system, making

up for every cut dollar from federal transfer payments, and the then opposition

said: "How awful." Not one iota of understanding — not one.

In fact,

they would use surgical wait-lists — isn't that interesting — as an example

of how awful the health care system was. Isn't it interesting? We'll get to that

to see how well we're doing there. They would prey upon seniors and the effect

of the health care system on seniors even though the system was fully funded.

Every single dollar cut by the federal government…. Paul Martin, the then

Minister of Finance who got his great fiscal record on the backs of the

province, was cutting dollars every year, and British Columbia was the only

province who didn't pass those cuts through to the patients or families of

British Columbia.

[1520]

It was a

cheap shot — completely unnecessary for the Minister of Health to talk about

the 1990s as being panicked and ad hoc. If anything was ad hoc, it was the way

the then Liberals in opposition defended our health care system against the

federal Liberal cuts.

In fact,

they didn't defend the health care system at all. They embraced the cuts the

federal Liberal government made. But it's good news. Thank God, the federal

Liberal government is restoring health care payments to British Columbia. This

government will benefit from that. They won't have had to do one iota of health

care management in the face of massive federal transfer payment cuts — not

one. Their record will be judged on their well-being, their efficiency and their

expertise alone in managing the health care system. They won't be able to turn

to Ottawa and do anything except say thank you to Ottawa for giving back the

money that was cut miserably from the health care system in the 1990s.

The first

area we need to look at in terms of the well-being of the health care system is

in the area of Pharmacare. I want to quote from a study that was released last

month, on April 23. It's from the Canadian Institute for Health Information. It

was released out of Ottawa. I'm quoting from the news release attached to the

study. It says: "Expenditure on prescribed drugs continues to increase,

occupying a larger proportion of total drug spending in Canada, according to a

new report released today by the Canadian Institute for Health

Information."

The report

is called Drugs Expenditure in Canada, 1985 to 2002 . It is a study that

includes a discussion of factors affecting drug expenditure. The report covers

all drug expenditures, both drug expenditures made privately and publicly, both

prescribed and not prescribed. There's a wide variation in terms of provincial

comparisons, but the study does make provincial comparisons. It says:

"There

is considerable variation in the level and growth of drug expenditure across

the provinces. In 2000, the latest year for which comparable data are

available, estimated drug expenditure per capita ranged from $407" —

per person — "in British Columbia to" — a high of —

"$534" — per person — "in Ontario. The share of prescribed

drugs in total drug expenditure ranged from 74.5 percent in British Columbia

to 83.1 percent in Quebec. The proportion of prescribed drugs financed by the

public sector varied from 32.1 percent in Prince Edward Island to 53.7 percent

in British Columbia."

For

those watching, British Columbia is at the head of a lot of the tables, but

what does that mean? Let me go through the table, if I may. This was released

less than a month ago, three weeks ago.

The

Canadian Institute for Health Information is a non-partisan…. I think it's

even non-political; I'm not sure. No, it's funded by the provinces. It's funded

proportionately from provinces, but it is an academic research body based on

real evidence that it gleans from expenditures from every province. Here's what

it says: "The total drug expenditure, as a percentage of total health

expenditure, in British Columbia is 12.5 percent."

[1525]

Well,

that's a lot. I agree; that's a lot. That means one out of every eight dollars

in the health care budget is spent on drugs. But what are we in comparison to

other provinces? Well, it turns out that the Territories are, across the board,

less, but in terms of the provinces, we are the second lowest in drug

expenditure as a percentage of total health expenditure. Newfoundland spends

14.5 percent; P.E. I., 17.5 percent; Nova Scotia, 16.7 percent; New Brunswick,

16.7 percent; Quebec, 17.6 percent; Ontario, 16.1 percent. Manitoba spent 12.1

percent; Saskatchewan, 13.9 percent; Alberta, 13.7 percent. British Columbia is

the second lowest of the provinces at 12.5 percent.

However,

what does it mean for real people? That's a statistic; that's a percentage. What

does it mean for real people? The total drug expenditure per person is the

lowest, except for Nunavut, in all of Canada. The total drug expenditure is

$406.80 per person. What did they spend elsewhere? Newfoundland, $453; Prince

Edward Island, $501; Nova Scotia, $497; New Brunswick, $490; Quebec, $506 per

person; and Ontario, $533 per person. Manitoba spent $424. Sorry, Manitoba is

again lower than we are, and Saskatchewan is $423. Oh no, I'm sorry. I'm

misreading it. Ours is $406 per person. Manitoba spent $424; Alberta, $435; and

then B.C. at the lowest, $406 per person. We have the second-lowest percentage

expenditure of the budget on drugs,

[ Page 6668 ]

of the total health expenditures in the country. We have the lowest

per-capita costs, per-person costs of drug expenditures.

The next

one is the prescribed drug expenditure as a percentage of total drug

expenditures. That's the percentage of all drug expenditures prescribed by

doctors and, therefore, affected by our Pharmacare program. Well, let's see. How

does British Columbia fare there? It turns out that we're at the low end — not

quite. We're at the second lowest amongst the provinces. Oh no, I'm misreading

again. I've got to get my glasses checked. That'll cost me ninety bucks. We're

the lowest of all the provinces in terms of the prescribed drug expenditure as a

percentage of total drug expenditures.

In British

Columbia, out of all the drug expenditures, the prescribed drug expenditure is

74.5 percent. Other provinces are 80 percent, 76 percent, 78 percent, 83

percent, 76 percent, 76 percent and 77 percent. There's British Columbia,

amongst the provinces, at the bottom. We're doing pretty good compared to the

rest of the provinces. In fact, we're the best. We're the best in terms of

managing expenditures and the percentage we spend on drugs.

What does

the public get for that, though? What do British Columbians get for those good

numbers? Well, they get the best coverage of all of the provinces. Isn't that

interesting? The public prescribed drug expenditure, as a percentage of the

total prescribed drug expenditure — now, what does that mean? That means: how

much is paid out of the public expenditures as a percentage of all the drugs.

In other

words, what do your tax dollars get for you? British Columbia is at the top.

Well, they were, as of 2000. Of all prescribed drug costs, 53.7 percent came out

of the public purse for British Columbians. What did other Canadians get? Other

Canadians got 44 percent covered — that was Alberta — 43 percent in

Saskatchewan, 45 percent in Manitoba, 43 percent in Ontario, 48 percent in

Quebec and 39 percent in Newfoundland.

British

Columbia has the lowest per-capita cost of drugs. British Columbia has the

lowest total prescribed drug costs per capita. British Columbia has the lowest

prescribed expenditures as a percentage of total drug expenditures, and they

have the highest amount of their prescribed drugs covered by public expenditure.

What was wrong with the Pharmacare program that's specific to British Columbia?

[1530]

Hon. C.

Hansen: Certainly, I have a lot of respect for CIHI and the work that CIHI

does. They provide some very valuable and objective data. I think it is very

useful.

I don't

believe that you can measure the success of a health care system by simply how

little you pay per capita for medications. There are medications developed that

actually take pressure off our acute care system. There are certainly conditions

that in the past would have required surgical intervention, which now can be

treated with a pharmaceutical product. Therefore, in those cases, an increase in

expenditure in a drug budget might actually save the overall health care system

money and provide better care for individual British Columbians.

I think the

point the member raises…. To address her specific question, I think the

problem we had with the Pharmacare system before was that it was not fair to

certain families in British Columbia compared to other families. I'm sure the

member, like all MLAs in this House, each January or February receives letters

from low-income families, non-senior families, who are struggling, under the old

Pharmacare system, to come up with their $800 deductible, where they have to pay

out of their own pocket 100 percent of their drug costs until such time as they

would hit their $800 ceiling. Only then, in the past, would the Pharmacare

system click in. At the same time you had high-income seniors who would be

paying a maximum of $275 per person for their drug costs over the year.

While it's

true that British Columbia was paying the highest percentage of prescription

costs of any province in Canada, which the member noted, we could not say that

that financial assistance being provided by the taxpayer was in fact fair to all

families in the province. The new Fair Pharmacare program that took effect on

May 1 addresses that, so that low-income non-senior families will in fact see

their benefits under Fair Pharmacare increased. They will get more financial

assistance under this new plan than they would have before.

MacPhail: Well, that's a new argument that the minister has had to come up

with in order to justify the labelling of his program, called Fair Pharmacare.

We'll get to individual cases. We'll get to how fair Pharmacare is under this

government.

This

minister and his colleagues said over and over again that Pharmacare wasn't

sustainable, and he would label the increases every year. That was why, he said,

money had to be cut out of Pharmacare. Indeed, that's why they cut the growth of

the Pharmacare budget for two years. In fact, the Pharmacare budget, under the

previous vote, was going down by $90 million. Now, thank God for the federal

government, because the federal government sent a whole whack of money to

British Columbia, and this minister is being forced to put some of it into

Pharmacare, so the Pharmacare budget's going up now.

What was it

about the Pharmacare success story I just read out to the minister that he

disagreed with? He said that it was good, that certain health outcomes are

better managed by prescription drugs than not. What was it that made him so

upset about Pharmacare that these wonderful outcomes listed — where B.C. was

at the top of every good statistic, led the country in every good statistic

around Pharmacare…? What was it that made him so upset? What was it that made

him change his mind from saying that Pharmacare was unsustainable to saying that

it wasn't "fair"?

Hon. C.

Hansen: I just want to start by reminding the member that when she was the

Minister of Finance

[ Page 6669 ]

in this House, she actually brought down a budget that showed only a 2

percent increase in the Pharmacare budget. Yet they knew at the time there were

cost pressures in Pharmacare of over $90 million that they did not fund, and

they did not explain at all in that budget how they were going to manage those

risks. One of the things I think the member has to admit is that we have been

transparent with all of the issues and the challenges around our Pharmacare

budget — indeed, the whole Health budget.

[1535]

What we

were facing under Pharmacare was a budget of approximately $714 million that was

increasing at a rate of 14 and 15 percent a year. That would actually result,

over the long term, in not being able to sustain a Pharmacare system. I think

that we want to make sure there is financial assistance for low- and

middle-income families in particular, so that they can afford the medications

their doctors prescribe to them. It's only by changing the system so that it is

sustainable into the future and we can live within our means that we're going to

be able to assure there is access to necessary prescriptions.

I think

when the member talks about B.C. being number one in all of those indicators,

she fails to recognize that while B.C. may have paid out of taxpayers' funds 53

percent of the health costs, they weren't always going to the right people. Some

of that 53 percent of medication costs in the province funded by the taxpayers

was going to some very wealthy families in British Columbia, at the same time

that some very poor families in British Columbia were not getting assistance

under the Pharmacare program.

We have

changed it to bring more fairness to low- and middle-income families in British

Columbia. It's the right thing to do.

MacPhail: We'll get to that in a moment — how much people support this

government's change. Again, let me be clear. This is a new message. This is new

spin from the minister — that it's fair and that they had to do it because

Jimmy Pattison was getting his drugs for free and poor people weren't getting

their drugs. Well, that's balderdash. That's absolute balderdash, and we'll get

to that in a moment.

The shift,

in terms of applying an income test, is nothing more than this government trying

to reduce Pharmacare. That's why they started out: to cut the amount of access

British Columbians had to Pharmacare. Let's be clear. Any work this government

does around Pharmacare better improve those numbers and not make them worse. We

have the lowest per-capita cost of drugs, and that's because the previous

government actually took on the pharmaceutical companies. This government won't.

We had the

lowest per-capita costs of drugs. We had the lowest percentage of our health

care budget going into prescription drugs. We had the greatest portion of

prescription drugs being paid out of the public purse. I'll just read this last

one here. We also in British Columbia had the lowest amount of prescribed drugs

as a percentage of overall drugs. Therefore, the number of prescriptions wasn't

out of control. That was great news for British Columbia. Everything this

government does to Pharmacare will be tested against these numbers — from best

in Canada in every category to now. We'll see what happens.

Of course,

unlike the previous government who had one hand tied behind their back by the

cuts in transfer payments from the federal government, this government is

getting — let's see — how much more money from the federal government to put

into Pharmacare? Their budget for Pharmacare prior to the largesse earlier this

year from the federal government was going to be $614 million — a cut, a real

cut of about $87 million.

Now we see

that the revised estimates…. Let me just see. The revised estimates are that

there will be $743 million into Pharmacare, an increase of…. Yeah, that's

right. Maybe the minister could confirm for me. Because of the federal

government largesse, instead of cutting the Pharmacare budget by about $87

million, they will be increasing it year over year by about $41 million because

of the federal government. Is that correct?

Hon. C.

Hansen: The numbers that the member indicated are correct. We will see an

increase, or we do see an increase in the Pharmacare budget for this year by $41

million. We will also, as she knows, see an increase the year after, the year

after and the year after that. We do not project that there will ever be a

decline in the Pharmacare budget.

[1540]

I do want

to come back to a point the member said about the fairness message. I don't know

if she had a chance to listen in on the press conference when we announced Fair

Pharmacare back in February. That message around the need to address the

inequality of benefits to different families in British Columbia has been very

much central to all of the discussions and all of the messages — whether it's

been things I've said in this House or whether it's been interviews that I've

engaged in or, indeed, the initial press conference when we announced it.

I would

also point out…. She mentions that right now British Columbia, as she

indicated, is the top when it comes to the percentage of prescription costs

borne by the taxpayer. She mentioned that the CIHI numbers for 2000 show that at

53 percent. I'm not sure that's necessarily something that shows B.C. is the

best. It just shows that B.C. taxpayers are footing a greater percentage of

those costs than any other province. Under the new Fair Pharmacare system, what

we anticipate is that instead of being at 53 percent, it will be at 47 percent.

Of all the prescriptions purchased in British Columbia, 47 percent of the costs

will, in fact, be borne by the new Fair Pharmacare program.

MacPhail: Yeah, it would be awful for British Columbians to actually have

their government deliver the best service in the country. I can see why the

minis-

[ Page 6670 ]

ter would object to that — the best record for public resources being used

to pay for prescription drugs. That's not a good statistic. I say that

sarcastically for those who only read these words. Of course it's a good

statistic. Value for your tax dollars, it's called.

But when

you also combine that with that we have the lowest per-capita costs of

prescription drugs, it makes a wonderful statistic. It means British Columbians

are getting better value out of their tax dollars and greater coverage because

they ain't giving it away to the pharmaceutical companies — until this

government was elected. That's what it means — lowest per-capita cost of drugs

and highest coverage out of your tax dollars. That's what that means. It's a

wonderful story that can simply not be challenged by anybody in the Liberal

government as not being good for British Columbians. But we'll see. We'll see.

I already

know now that one of the stats is going to be decreased by over 10 percent.

We're going to go from 53.7 percent of prescription drug costs paid out of the

public purse — after you've paid your taxes, of course — down to 47 percent.

Let's see. That's 7 percent on 53 percent. It's about a 12 percent cut. It's

about a 12 percent reduction in the benefit that British Columbians get from

their taxes. That's what it is. Lots and lots of British Columbians will be

paying more for that reduced coverage. Gee, that's good news, isn't it?

The

minister said that he was going to be taking on drug costs in British Columbia.

I noted that one of the announcements he made to a question — in the fake

question period, I call it, but whatever…. It's when the Liberal MLAs…. The

member for West Vancouver–Capilano asked a question about a particular drug,

and the minister stood up and said: "Oh, that particular drug is working.

We've got a low-cost alternative." Perhaps the minister could just refresh

me about the answer that he gave to the member for West Vancouver–Capilano,

because I have some questions about it concerning the Pharmacare program.

Hon. C.

Hansen: The announcement that we made last week was the listing of a new

drug that has been developed. It's called rabeprazole, or I guess the more

common name that we may come to know it as is Pariet. This is a proton pump

inhibitor. There are three drugs existing from three different companies that

had been listed previously. This one, evidence shows, is equally as effective as

those products. So we have listed this drug with a preferential listing over the

other drugs, and it is a saving to the Pharmacare budget over the next three

years of $42 million.

MacPhail: How was that decision reached?

[1545]

Hon. C.

Hansen: The company that developed this new drug approached the ministry

with a proposal that this drug be listed. We then went out to the other three

companies and asked for their suggestions regarding how we could better control

the very rapidly rising costs of proton pump inhibitors in our Pharmacare

budget. Each of those three companies came back with various proposals, but

nothing really achieved the kind of savings that the preferential listing of

this one drug would achieve.

MacPhail: Okay, so the drug company approached the ministry directly. Then

what procedure did the ministry follow to put the listing of that drug company

forward?

Hon. C.

Hansen: I think, as the member knows, a very thorough review is done of new

medications that come forward to assess the clinical trials that have been done

and the other evidence that is available. We also looked at what other

jurisdictions had done. In the case of Ontario and Newfoundland, they had gone

down a similar route — although not exactly the same — with regard to the

listing of this drug. This then, ultimately, came before the drug benefit review

committee. The drug benefit review committee, which is a body within the

Ministry of Health Services, came forward with their recommendation to me.

MacPhail: I want to know what process was followed that didn't involve the

minister's own officials.

Hon. C.

Hansen: One of the things that the provinces and the federal government have

collaborated on over the last two years is a common drug review process. What we

found was that each province was going through its own review in terms of the

efficacy of a new drug. It was really a duplication of what should be the same

scientific process of evaluation, and yet there was a duplication of costs,

effort and time delays with all jurisdictions undertaking the same process. So

the provinces collectively, the Territories and the federal government, with the

exception of Quebec, agreed to come together to collaborate on what is now

referred to as the common drug review.

What will

happen is that as a new drug comes forward, one of those jurisdictions will take

the lead in doing the assessments necessary. While I'm not sure off the top of

my head exactly which jurisdiction did the assessment for the common drug

review, it was done and then shared with all of the other 13 jurisdictions that

are participating.

MacPhail: I'd like to know which jurisdiction. I'd like to know.

Hon. C.

Hansen: I don't have that information at my fingertips. I will endeavour to

get it for the member.

MacPhail: What role will the therapeutics initiative play?

Hon. C.

Hansen: The therapeutics initiative in British Columbia is certainly part of

the common drug review process. As drugs come up for review, there will be new

products assigned to the TI to review on

[ Page 6671 ]

behalf of the other jurisdictions. The whole idea of the common drug review

process in Canada is to avoid the kind of duplication we saw in the past and the

unnecessary duplication of costs.

MacPhail: Well, if this drug review was done, why was it the drug company

that approached the minister? Why wouldn't it be the minister initiating this?

If there was a common drug review program done, why did it come from a drug

company approaching and lobbying the ministry directly? I don't understand.

Perhaps the

minister could explain to me the changes that have been made in how a drug gets

listed for the drug of choice. I simply don't understand it.

Hon. C.

Hansen: As the member, I'm sure, knows, when drug manufacturers come out

with new products, they will bring that information to the provinces. Once the

notice of compliance has been agreed to by Health Canada, which indicates that a

product is safe, then those products are brought forward to the various

provincial governments.

In this

case, that was no exception. What this particular company came forward with to

all provinces in Canada was their pricing. They proposed that this be put

forward as a preferential listing in British Columbia. In doing so, we wind up

with the same benefit to patients that is needed and yet at about a 40 percent

saving to the taxpayers — and not just the taxpayers. For the 50 percent of

drug costs that is not borne by the taxpayers directly, then certainly those

British Columbians get the benefit of this lower price as well.

[1550]

MacPhail: The minister somehow says: "As the member knows…."

Well, I don't know. That's not the way it was done before, so things have

changed, and I want to know how they've changed. Whoever is listening from the

Ministry of Health Services, could they please tell me which province did the

drug review on that particular drug? If they could get it to us soon, that would

be great. Thank you very much.

That's not

the way it was done in the past. It was a completely independent process. Is the

listing of that drug…? The member says it was a preferential listing. Is it

part of the reference drug plan, or has the minister created another category?

Hon. C.

Hansen: No, the preferential listing is a program that was created when her

government was in office. It is not part of the reference drug plan, but

certainly there have been no changes in the various programs that fall under

Pharmacare — whether it's reference drug, low-cost alternative or the…. I

forget exactly what the other terms were, but this is under the preferential

listings.

MacPhail: So we'll see, because when I heard the minister give the answer to

the member for West Vancouver–Capilano, my antenna went up — about, "Wow,

this is a change, a drug company working directly with ministry officials" —

and I wanted to know what the independent assessment was for the choice of

that drug company. Who did the independent assessment is key to this debate

right now, Mr. Chair, because the minister put that forward as a wonderful

example of how this government is keeping drug costs under control.

Harvard

Medical School said — they released a study, and the minister is well aware of

it — that the reference-based pricing for prescription drugs should not be

scrapped. They said: "Implementing an entirely new policy could have severe

consequences for patients and Pharmacare managers." This was an

article by

researchers in the Canadian Medical Association Journal published, I

think, in December. Yes, it was at the beginning of December. It says… Let me

see — what else? The study said more intensive cost containment is needed,

achieved by refining the pricing plan, adding more categories of drugs and

simplifying it administratively. What's the status of the reference drug plan in

this province?

Hon. C.

Hansen: As the member was referring to, there was a review done by the

panel. That report was released by my colleague the Minister of Health Planning.

In that report it recommended there be a review of Pharmacare that would look at

some of these other options, and that review will be undertaken over these

coming months. No final and ultimate decision has been made with regard to the

reference drug program, but the interim decision was made, which was recommended

by the panel, and that's that the reference drug program remain in place while

that review is undertaken.

MacPhail: So we have the Harvard study saying that reference-based pricing

shouldn't be scrapped. Is the minister referring to the report of April 2002 by

George Morfitt, John Esdaile, Marshall Moleschi, Andrew Saxton and Arlene

Gladstone? Is that the report?

Hon. C.

Hansen: That's correct.

MacPhail: That was a year ago. What's happening?

Hon. C.

Hansen: Well, I think as I just said, the Minister of Health Planning

released that report in February of this year. We indicated that we were

accepting the panel's recommendation that the reference drug program stay in

place for now and that there be a more comprehensive review of Pharmacare. That

has not been started yet, although the planning for that is underway, and we

should have that initiated in the consultations we plan to embark upon. That

should happen fairly soon.

Basically,

within the ministry, with the rollout of Fair Pharmacare, it was a question of

the capacity of the ministry to roll out the review at the same time that Fair

Pharmacare was being launched. We are now fo-

[ Page 6672 ]

cusing, turning our attention to that, and it should be underway very soon.

MacPhail: Well, as you know, Mr. Chair, the opposition has been advocating

through question period that the government, before it attacks British

Columbians and forces them to pay more for their Pharmacare coverage, should

maybe attack the pharmaceuticals and reduce the costs of drugs. But oh no, we've

got a full-fledged Pharmacare change going where British Columbians are going to

pay more, and yet we have a report that this government has had sitting, with no

action, for over a year — 13 months now. The minister isn't planning on doing

anything in the near future except plan for what he's going to do with the

report from the reference drug program consultation panel.

[1555]

Well, let

me ask this. Here's the Picture of Health advertisement that I am reading from.

It was December 13, 2002. It's interesting the way the minister was spinning an

affordable, sustainable Pharmacare plan then and the reaction he got from the

public. Here it says, "We are acting to control costs," and one of

them…. I'll read it aloud. This is the government's own ad. It cost quite a

bit of money, I'll tell you. It's a full page.

"Reducing

inappropriate drug use and avoiding use of unnecessary drugs." Well,

British Columbia's got the lowest ratio of prescription drug usage in Canada.

"Improving patients' health by increasing emphasis on prevention and

wellness." I have no idea what they're doing there, but I'll be asking

questions later. "Ensuring we get the lowest prices from drug

companies."

"Working

with other provinces to develop a common drug review process." It says

right there that they're working to develop a process. Apparently that process

is already in place. I can hardly wait to hear who did it. There we are.

Here's what

they say about why Pharmacare needed to be changed. It's because

"Pharmacare costs are growing faster than any other health program — over

75 percent in the past five years." So it was certainly an economic issue

back in December, and of course, there was quite a bit of reaction from the

public. The minister had to delay his program, and here we are now. To the

minister: why 13 months of inaction?

Hon. C.

Hansen: I'm a little bit…. I'm trying to figure out what the point is that

the member is trying to make with this. What we have done with Pharmacare is

bring in some changes that will make sure it's sustainable in the years to come.

It was growing at a rate of 14 or 15 percent a year. Clearly, when she was

Minister of Finance, she was not prepared to fund that, because she didn't. She

brought in a 2 percent increase to the Pharmacare budget.

We want to

make sure it is structured in a way that is sustainable. We brought in some

changes that bring more fairness to low-income families. High-income families in

British Columbia, we think, can pay a bigger percentage of their pharmacy costs.

When the member talks about 53 percent of pharmacy costs being borne by the

taxpayers, that's not to say that every single British Columbian should get 53

percent of their pharmacy costs paid for when they go to get a prescription

filled. It's saying that low-income British Columbians deserve and should get a

higher percentage of that support.

We wind up

with low-income families under the new Fair Pharmacare system that will wind up

getting 90 or 93 percent of their prescription costs paid for by the new Fair

Pharmacare program. On the other hand, you're going to wind up with some

higher-income families in British Columbia that are going to get nothing in

terms of taxpayer assistance with their pharmaceutical costs, because our

assessment is that with that household income, they can afford to bear those

costs,

whereas low-income families can't.

When the

member talks about 13 months, there has been an enormous amount of activity,

over the course of almost two years now since we formed government, to make sure

that we bring pharmaceutical costs under control. The member seems so hung up on

just the reference-based pricing debate. That is but one small issue that has

been on our desk in terms of dealing with Pharmacare changes so that in fact

they are sustainable. There has been a huge amount of work done over that period

of time to make sure Pharmacare is there for families that need it.

MacPhail: Well, let me just paint the picture if the minister is missing my

point. He's brought in changes to Pharmacare that are going to have hundreds of

thousands of people pay more for their Pharmacare that they didn't pay for it

before. They paid their taxes; they got sick; they got their drugs prescribed.

Hundreds of thousands now are going to have their coverage reduced, and a lot of

them will be poor. I'll get to those letters in a minute. There will be poor

seniors, as a matter of fact. That's the change this government has made. Now,

we'll get to how effectively that program is being introduced. I hope the

minister has better results than he did at the end of last month on how the Fair

Pharmacare program is actually working.

[1600]

What point

am I trying to make about drug costs? My point is this. Why didn't the minister

try to control drug costs first rather than who pays for the drugs? Why didn't

he tackle the pharmaceutical companies to keep drug costs under control and then

decide what portion taxpayers in British Columbia should have to pay for that?

That's my

point. No, what he first does is a big cash grab from British Columbians not

only in increased medical services premiums but in changes to Pharmacare, so

that we're no longer having the best coverage and the lowest per-capita costs

for prescription drugs. We're going to lose that position. Why should B.C. be

the best in that area?

There's

absolutely no action on reducing drug…. Well, there's been one example from

the member for West Vancouver–Capilano, which I'm dying to find out how it

actually came about. But there's been no action on this report that the

government spent tens of thousands of dollars on — in fact more than that —

on how

[ Page 6673 ]

to reduce drug costs — not how to make British Columbians pay more for

their drugs but on how to reduce drug costs.

In fact, if

the minister is so curious as to why I would care about this report, let me just

read the recommendations. This is now 13 months old — 13 months. All I'm

trying to find out is what the government's doing about this report. They're

planning on doing something.

Here are

the recommendations:

(1) The

reference drug program should be maintained at least on a short-term basis.

(2) Pharmacare's program structure should be redesigned in such a way as to maintain

the ability to manage costs within a more integrated framework. Such a framework

should provide improved transparency and greater clarity.

(3) Program

redesign should include meaningful consultation with stakeholders, including

health care professionals, academics, industry representatives and others.

(4) In

particular, frank discussions should be held with the pharmaceutical industry to

explore the possibilities of substantially improved investment in research and

development in British Columbia.

(5) Various

co-pay and incentive systems — e.g., sliding scale, stepped scale, percentage

allocations, etc., — should be reviewed to identify those that provide the

optimum balance of cost containment, incentives for physicians and patients to

choose cost-effective alternatives, as well as protection for the poor and

critically ill.

(6) Drug

utilization reviews should be reactivated either through the College of

Physicians and Surgeons of B.C., the body currently responsible for them, or by

transferring responsibility to another agency willing to undertake this role to

support program development.

(7) Physicians, pharmacists and the public should

be provided with better information to encourage shared responsibility and

support informed and cost-effective decision making with respect to drug use.

(8) British

Columbia should continue to play a lead role in encouraging coordinated

interprovincial drug approval, access and cost-containment measures.

(9) British

Columbia should work with other provinces to urge the federal government to

include prescription drugs within the provisions of the Canada Health Act and to

work toward a national Pharmacare program.

(10) The

reference drug program should be expanded in appropriate additional therapeutic

categories in order to maximize its cost-saving potentials.

Perhaps we

could go through these recommendations one by one.

[H.

Long in the chair.]

Hon. C.

Hansen: As I indicated earlier, that report was released in February of this

year. We indicated at the time that while we were accepting the first

recommendation of the panel, we were also going to embark on a review of the

Pharmacare program that would take all of those recommendations into

consideration. That will be undertaken by the ministry over these coming months.

We hope to have it completed within this calendar year.

MacPhail: The minister seems to be making a point that they released it to

the public in February 2003. Is the date on the report of April 2002 wrong?

Hon. C.

Hansen: The report was completed in April 2002. It was released in February

[1605]

MacPhail: That's like waiting to find out what the special prosecutor said

about the Minister of Agriculture, Food and Fisheries. The public is only well

informed when the minister decides to actually release the report. Sometimes

we'll never be well informed. The government has had this report sitting on a

desk for over 13 months now. They don't seem to hesitate to attack people in

making them pay more for Pharmacare out of their own pockets, but the drug

companies…. Let's not move too quickly on those drug companies, shall we? It

is completely unacceptable that this government has done nothing on this report.

I'm

wondering whether anybody has had a chance to say what jurisdiction reviewed the

drug that the minister talked about earlier.

Hon. C.

Hansen: As I indicated earlier, the new common drug review is an independent

process. It's independent of governments. It's really to take out some of the

politics we've seen in other jurisdictions.

One of the

things I didn't realize until just now — in fact, senior officials didn't know

until they searched it out — is that the review that was done of this

particular product was actually done by the TI here in British Columbia.

MacPhail: When was it done?

Hon. C.

Hansen: It's my understanding that it was done about the middle of last

year.

MacPhail: Is there a report from the therapeutics initiative on that, which

the minister can produce?

Hon. C.

Hansen: The report that was prepared by the therapeutics initiative would

come to the drug benefit review committee. It has not been a policy of

government now or in the past to release those reports.

MacPhail: I just asked: is there a report?

Hon. C.

Hansen: Yes, that was my understanding — that there is a report that came

forward from the therapeutics initiative.

MacPhail: Can the minister actually give me a time line of when the drug

company approached him

[ Page 6674 ]

or the ministry, when it went to therapeutics initiative, when the report was

done and when it was put back to government?

Hon. C.

Hansen: It is my understanding that the review was done, as I said, in the

middle of last year; that the company, I think, approached the ministry with

their proposal regarding preferential listing in the fall of last year; and that

it had been reviewed over these following months by the drug benefit committee.

MacPhail: So did the drug company approach the ministry before the

therapeutics initiative looked at it? And by the way, the therapeutics

initiative does issue reports; they issue public reports. I couldn't find that

as part of their reports. That's why I'm just curious.

I need to

know the time frame of this. I need to know the new way of doing things in this

province. Did the drug company come to the ministry first and then go to the

therapeutics initiative? Did the therapeutics initiative do this? Did they then

refer the report, and the minister said: "Gee, a drug company was just by

earlier today"? I want to know the exact timing of this, please.

Hon. C.

Hansen: I can assure the member that the process for the review of new drugs

has not changed under this government. It is still the same process that was put

in place by the previous government, with the exception of the fact that we now

have a common drug review where provinces, nationally, are sharing some of the

costs and the other resources necessary to do reviews across Canada. So that is

a process that is being phased in.

As I

mentioned, once the company got notice of compliance on this new drug, they

would have applied to government. That would have been sent to the therapeutics

initiative so they could do their review around efficacy and the review of

clinical trials that would have taken place and other evidence that would be

available. The proposal with regard to preferential listing came from the

company in the fall of last year. So that is the sequence of events that led up

to the decision.

[1610]

MacPhail: Yes. I'd like specific dates, though. It's not good enough for the

minister to stand up and say that nothing has changed. I want specific dates for

all of this, please. I don't know whether anything's changed or not. The

minister's various colleagues accuse us of fearmongering, etc., and doing poor

research. I'm asking the minister for the dates himself. Has there been a change

in the way the therapeutics initiative reports publicly?

Hon. C.

Hansen: Again, there has been no change. The therapeutics initiative

produces regular reports that are circulated to physicians throughout the

province. They continue to do that, and I think those are actually posted on a

website if the member wanted to look at that. The actual evaluation of the

efficacy of a new product that comes…. The report that comes to the drug

benefit committee within the ministry is a different kind of report, and I think

the member may be getting the two reports mixed up.

MacPhail: I'm not getting anything mixed up; I'm just asking for

information. I'd be happy to provide it.

Manhas: I'd like to ask leave to make an introduction.

Leave

granted.

Introductions by Members

Manhas: I'd like to introduce to the House two individuals visiting this

House, Kellie Callahan and her very intelligent son Jak. Jak aspires to be the

world's foremost pastry chef one day. They're here touring the Legislature and

visiting. Would the House please make them very welcome.

Debate Continued

MacPhail: What discussions has the minister or ministry had about drug

utilization?

Hon. C.

Hansen: There is actually ongoing work within the Pharmacare branch around

drug utilization, and clearly it is an area where there are some opportunities.

The member may be aware of work that has been done over the last number of years

around over-prescription of antibiotics, and we have had some considerable

success in this province in getting the prescribing rates down or at least

moving towards more appropriate utilization of antibiotics in this province.

Another

recent example is the listing of Remicade, which accompanied a utilization

agreement that allowed us to target those who would benefit the most from this

new and very expensive medication. That was worked out between the

rheumatologists as well as the manufacturer and the ministry itself. There is

considerable work that has been done around utilization, and there will continue

to be. We will explore all opportunities to get utilization rates down.

MacPhail: I want to know what this government's done. Remicade — great,

but I want to know what this government has done on its watch in the last year,

since this report came out. Are the drug utilization reviews being conducted

with the College of Physicians and Surgeons of B.C.? That's the body currently

responsible for them.

[1615]

Hon. C.

Hansen: Just to add to some of the examples I indicated before, there is

also the work being done around chronic disease management strategies.

Appropriate drug utilization is very much a feature of the chronic disease

management strategies. To date we

[ Page 6675 ]

have rolled out the ones for diabetes, congestive heart failure and several

others that I can't remember off the top of my head. Drug utilization is very

much part of those, in addition to the Remicade example I mentioned earlier and

in addition to the antibiotic utilization I mentioned. There are also

federal-provincial initiatives that are really being looked at, at a national

level to ensure that we can move towards appropriate drug utilization.

MacPhail: How does the chronic disease management with diabetes affect drug

utilization?

Hon. C.

Hansen: In the case of diabetes management, the chronic disease management

program is moving toward ensuring that patients have the education, the

instruction and the information necessary to properly evaluate their blood sugar

levels so that they're actually using their medications when it is most

appropriate and to ensure there's not overusage or underusage. Certainly, there

is a utilization dimension to that one, as there is to the other chronic disease

management strategies as well.

MacPhail: We'll get to the chronic disease management programs, but I'm

curious as to why the minister's bringing up this overlap — that the chronic

disease management is what this recommendation meant by drug utilization review.

This is a very specific recommendation from a report 13 months ago that meant

much more than what the minister has just described. Is the B.C. College of

Physicians and Surgeons active at all with the ministry now on drug utilization

review, generally?

Hon. C.

Hansen: I apologize to the member. I didn't realize she was still focused on

that one specific recommendation. I thought she was talking about drug

utilization in a broader context.

The College

of Physicians and Surgeons is still actively involved in reviews around the use

of methadone and narcotics, but their program is now limited to those products

at this stage.

MacPhail: Well, it seems there's quite a bit of room to move on that

recommendation. The other recommendation says: "In particular, frank

discussion should be held with the pharmaceutical industry to explore the

possibilities for substantially improved investment in research and development

in British Columbia." The latest statistics I've looked at about the

percentage of investment that British Columbia gets in pharmaceutical R and D

haven't changed in the last two years.

Hon. C.

Hansen: I certainly don't see it as falling within my scope of the Ministry

of Health Services — the issue of R and D investment in British Columbia. I

think the member should properly put those kinds of questions to the Minister of

Competition, Science and Enterprise.

MacPhail: Excuse me? I'm to ask this question about investment in R and D

for pharmaceuticals to the Minister of Competition, Science and Enterprise?

Who's in charge of Pharmacare? Who's actually reducing the costs of drugs here?

There are four ministers of Health, and I've got to ask a question about taking

on the pharmaceuticals for making sure they invest in British Columbia to the

Minister of Competition, Science and Enterprise?

[1620]

Hon. C.

Hansen: Certainly, there is an interest on the part of many organizations to

invest in research in this province. That file is managed by the Minister of

Competition, Science and Enterprise. It's certainly not something that we are

going to alter health policy decisions in order to simply attract more R and D

to British Columbia. We obviously welcome it. It's an important part of building

our post-secondary institutions and building our economy in British Columbia,

but the decisions around R and D do not affect decisions regarding Pharmacare

policy.

MacPhail: I guess the minister, even though he has done nothing with this

report, has rejected that recommendation from George Morfitt. Is that correct?

Perhaps he could tell me: has the Minister of Competition, Science and

Enterprise informed the Minister of Health Services about what his activities

are in this area, or has the government made a decision to reject that

recommendation?

Hon. C.

Hansen: In terms of the recommendations that were outlined in the report

George Morfitt came forward with, there are a variety of ministries that

obviously have to be involved in that. The Ministry of Competition, Science and

Enterprise is clearly one of the stakeholders that will be consulted as this

review goes forward, specifically with regard to that recommendation.

MacPhail: Well, I checked the stats. I don't want to be accused of doing

poor research here and fearmongering, but the stats for 2002 showed absolutely

no increase in investment by the pharmaceuticals here in British Columbia. Is

this kind of, like, a low priority by the government, or is the Minister of

Competition, Science and Enterprise not interested in this area? Great progress

was supposed to be made in this area.

Hon. C.

Hansen: Under my responsibility as Minister of Health Services, I don't

track the R and D that is coming into British Columbia from whatever

organization. I apologize that I don't have that at my fingertips.

MacPhail: It's ridiculous that somehow this is the responsibility of the

Minister of Competition, Science and Enterprise when it's this very minister who

is making all the changes to Pharmacare, where one of the great advertisements

they're making — let me just get that again, Mr. Chair — is "ensuring

we get the lowest prices from drug companies."

[ Page 6676 ]

Part of

that message that the pharmaceutical companies gave all throughout the 1990s —

unless maybe they give a different message to the Liberal government now that

they're in power — was: "If you lighten up on the reference drug plan or

your low-cost alternatives, we'll invest more money here in British Columbia; if

you lighten up on your Pharmacare program, we'll invest more money." I was

just seeing whether the pharmaceuticals were telling me the truth all throughout

the 1990s. I have no idea. Certainly, there's been no evidence of it yet, and

there certainly seems to be no interest whatsoever by this minister in actually

seeing whether the pharmaceuticals are treating British Columbia fairly.

By the way,

the minister keeps referring to my last budget as Minister of Finance. I'm very

sensitive about my last budget as Minister of Finance, because the minister may

remember I resigned shortly after tabling that budget. My last budget that I

tabled in 1999 was a balanced budget. It turned out to be balanced, and

Pharmacare was fully funded even in that context. Just the same way that their

estimates are off completely and they have to change, my last budget in 1999 was

a balanced budget.

Interjections.

MacPhail: Yeah, it was. Oh, I'm sorry. Is the auditor general wrong?

The

Chair: Order, order. I think we should stick to vote 29.

[1625]

MacPhail: The last budget was balanced, and Pharmacare was fully funded —

absolutely fully funded. You'll note that Pharmacare didn't have any cuts during

1999, my last budget, and the budget was balanced at the end of the year —

great news for British Columbians, one that this government tries to hide from.

I guess this is a government that likes to make cuts to seniors under Pharmacare

and still tables not one, not two, but three of the largest deficits ever in the

history of British Columbia.

And where

are we in economic growth? We're number ten. No, I'm sorry; we're almost number

eleven now. In fact, personal disposable income is falling in this province. Not

only are people going to have to pay more for their drugs, they're going to have

less money in their pockets to do it. That's great news — absolutely great

news.

The

Chair: I'd like to remind the member that we are on 2003 estimates.

MacPhail: I know, Mr. Chair, but I have to correct the record of the

Minister of Health Services. He keeps saying that I, as Minister of Finance….

I have no idea what he's talking about — absolutely none.

What's

happening with this recommendation? "Physicians, pharmacists and the public

should be provided with better information to encourage shared responsibility

and support informed and cost-effective decision-making with respect to drug

usage."

Hon. C.

Hansen: We have several initiatives to try to get more information for

patients so that they can make informed decisions — and not just patients but

doctors and other health providers. There are the reports we talked about

earlier, which the therapeutics initiative sends out to doctors throughout the

province. There's also, as we talked about before, the chronic disease

management strategies that put more and effective information in the hands of

individual patients as well as care providers.

MacPhail: Can the minister be a little more specific? What form does it

take? Is there a publication? Where does that occur?

Hon. C.

Hansen: There is information around the chronic disease management

strategies that's available on the website of the Ministry of Health Planning.

There is also, as we mentioned earlier, the reports that go out from the

therapeutics initiative and that are also accessible through the website.

MacPhail: No, no. That's to belittle this recommendation, to somehow suggest

the public should go to a therapeutics initiative website. I had trouble enough.

Physicians, pharmacists and the public should be provided with better

information.

How is that

program working? What changes has this government made to a program like that?

Now, I fully acknowledge that the latest study has shown that 5 percent of the

population uses 30 percent of the health services because of chronic disease. I

fully acknowledge that. But that leaves 70 percent of usage that hasn't been

addressed.

Hon. C.

Hansen: Sorry, Mr. Chair. I guess I'm trying to figure out exactly what kind

of a response the member would like to that. I think what I indicated earlier,

in terms of the George Morfitt report, is that we have accepted the first

recommendation, and we are going through a process to look at the other

recommendations that he's put forward.

I'm

certainly not standing here before the member trying to pretend that we have

fully implemented any of these other recommendations, but we do have programs in

place already that meet some of these objectives that the particular

recommendation speaks to. Hopefully, out of the review we might identify more

opportunities.

I know one

of the things that I've always enjoyed out of the estimates process in the seven

years that I've been in this House is the idea for some new and constructive

suggestions to come forward. Perhaps the member has some additional suggestions

that she would like to make with regard to getting better information out to the

public.

[1630]

MacPhail: Well, here's one. The last recommendation from Mr. Morfitt is

this: "In the event that the

[ Page 6677 ]

recommended Pharmacare program redesign, as discussed in recommendation 2

above…." I'll just pause for a minute. Recommendation 2 above is that

Pharmacare's program structure should be redesigned in such a way as to maintain

the ability to manage costs within a more integrated framework. Such a framework

should provide improved transparency and greater quality. Then the final part of

that recommendation says, in effect, that this proposed design would eliminate

the reference drug program as a separate program based on therapeutic

substitution while retaining its cost-containment effect. In effect, that's the

recommendation, to say: "Get a replacement for the reference drug plan and

do it, but make sure that the effectiveness of it stays there."

Here's the

last recommendation of Mr. Morfitt. "In the event that the recommended

Pharmacare program design as discussed in recommendation 2 above is not feasible

within a reasonable period of time — for example, one to two years — the panel

recommends that the reference drug program be expanded into appropriate

additional therapeutic categories in order to maximize its cost-saving

potential."

Let's see.

At the outside, Mr. Morfitt gave this government 24 months from April 2002.

Let's see — 24 minus 13. Quick, quick, you — 11 months, and that's at the

outside. That's 11 months left before the recommendation kicks in about

expanding the reference drug program, and that's the outside deadline from Mr.

Morfitt. Does the minister have a flow chart showing that if he misses…? What

plans does he have to expand the reference drug program?

Hon. C.

Hansen: As I have indicated, we will have a group that will work on this

review. I wouldn't want to prejudge what the outcomes of that will be, but

certainly they will be looking at all of the recommendations in Mr. Morfitt's

report, and they will be advising us accordingly.

MacPhail: So we have a situation now where, I guess, it's going to be….

The government's really dragging its feet on taking on the pharmaceutical

companies and reducing drug costs or expanding the effectiveness of programs

that have worked to give British Columbians the lowest per-capita prescription

drug costs in all of Canada and the best coverage…. But let's not go there.

We've

changed the Pharmacare program. How's it going? How's the registration going on

the Pharmacare program?

Hon. C.

Hansen: I find it curious that the member keeps coming back to this. Well,

she's trying to spin a message that just doesn't have any validity to it, and

that's that somehow we're not taking necessary steps to keep drug costs down.

The one

decision we made around rabeprazole will save the Pharmacare budget $42 million

over three years. That member cannot point to a single initiative they

undertook, in the ten years they were in office, that saved the Pharmacare

budget that kind of money in terms of reducing drug costs not just for the

Pharmacare budget but for all British Columbians, whether they were benefiting

from Pharmacare financial assistance or not.

To answer

the member's specific question regarding the registration, we were very pleased

that those individuals who benefited from Pharmacare in the past, who counted on

that financial assistance and really depended on continued coverage…. As a

result of the direct mail we did to those individuals starting in February when

we first announced that the changes would be happening and as a result of the

advertising we did and the other communications, we wound up with about 96

percent of those individuals registered well before the May 1 launch. So far we

have over a million British Columbia families registered for Fair Pharmacare,

and we are quite confident that overwhelmingly those individuals that count on

continued financial support under Pharmacare are, in fact, registered and are

receiving it today.

MacPhail: How many people are still left to register on May — what is

today — 12?

Hon. C.

Hansen: It's not a case of how many people still need to register. It

depends on their particular family circumstances. If you have an individual or a

family that has high income and very low prescription needs, there is nothing

that says they have to register at all. It certainly doesn't hurt, and

families…. It's a one-time registration. It then gets updated automatically

every year as we get new and updated information from CCRA, Canada Customs and

Revenue Agency.

[1635]

If a family

wants to be registered just in case there was some event that required them to

have large prescription costs, then they're in the system. Certainly, today

there's nothing that says a family needs to register if they don't think they're

going to be eligible for benefits. We think that those individuals who will

benefit from Fair Pharmacare are overwhelmingly already registered and in the

system and benefiting from that financial assistance.

MacPhail: Mr. Chair, through you: please ask the minister to answer the

question. How many people does he suspect are left to register? The minister and

his bureaucrats know how much money they'll save or what the reallocation of

money is according to the family usage, etc. Just stop avoiding the question.

How many families are left yet to register that would probably uptake the

system?

Hon. C.

Hansen: As I indicated, of those families that benefited from financial

assistance under Pharmacare in the past…. There were about 440,000 or 450,000

that were eligible in the past and that received benefits. Those individuals are

overwhelmingly already registered.

You know,

I'd love to be able to say we've got 100 percent of them. We've got about 96

percent. There are

[ Page 6678 ]

4 percent that may have moved. They may not be eligible for Pharmacare for

other reasons. We certainly have set up a system where if somebody finds they

are eligible for assistance, they can get themselves registered very quickly.

If the

member is looking for how many people are actually registered — and this is as

of today — there are 1,011,813 families registered. If the member wants to

figure out how many B.C. families have either not registered or chosen not to

register, you can subtract that number from the total number of families in

British Columbia.

The

Chair: The committee will take a five-minute recess.

The

committee recessed from 4:37 p.m. to 4:48 p.m.

[H.

Long in the chair.]

MacPhail: How does the minister calculate the effects of the Pharmacare

changes if he doesn't know how many families would be eligible or affected by

the changes? Why can't he give me a number? Why can't he give me the number of

families who are affected by the changes — either positively, negatively or no

change — and subtract the number who have registered? Why is he refusing to

put that number on the table?

Hon. C.

Hansen: I am advised that there is a total of 359,100 senior families in

British Columbia. There are 1,196,900 non-senior families. If you add that

together, you come up with about 1.56 million families altogether. As I

indicated earlier, we already have in excess of one million families registered.

Clearly,

there are families that will not be at a level of prescription expenditure that

would qualify them for financial assistance. They may well choose not to

register for Fair Pharmacare. That's totally up to those individual families.

[1650]

MacPhail: So 550,000 families, fully one-third of the families in British

Columbia, have not yet registered. That's what it is. Gee, it's lucky I'm here

to ask those questions, isn't it?

Now, could

the minister outline for us what happens to the families whose registration

takes place after May 1? What happens to them for the calendar year 2003 and

then the calendar year 2004?

Hon. C.

Hansen: First of all, a family can register at any time, and it's a very

quick process. Quite literally, an individual could get a prescription from

their doctor, go over to the pharmacist, and the pharmacist tells them it's a

very expensive prescription and asks if they are registered for Fair Pharmacare.

If they're not, they could literally pick up a telephone, a pay phone or a cell

phone, or whatever they want to do, and they can register then. By the time they

walk back over to that pharmacy counter, they'll be in the system. There was a

point, I think, in the first day where there were some little technical glitches

that delayed that process by a little bit, but it is, in fact, fully fun