May 21, 1992 SOCIAL

SERVICES ESTIMATES COMMITTEE (HEALTH & JUSTICE)

Pursuant to Standing Order 87, Mr. Oliver Langdon,

M.H.A. (Fortune-Hermitage) substitutes for Mr. Walter Noel, M.H.A.

(Pleasantville); Mr. Danny Dumaresque, M.H.A. (Eagle River) substitutes for Mr.

William Ramsay, M.H.A. (LaPoile); and Mr. Harold Small, M.H.A. (Baie Verte-White

Bay) substitutes for Mr. John Efford, M.H.A. (Port de Grave).

The Committee met at 7:00 p.m. in the Legislative

Chamber of the Colonial Building.

MR. CHAIRMAN: Order, please!

Before we have the continuance of the estimates for

the Department of Health, the minutes should be adopted and approved, Social

Services Estimates Committee, May 20, 1992. May I have a proposer and seconder?

On motion, Minutes adopted as circulated.

MR. CHAIRMAN: I want to welcome the Minister of

Health and his officials to the Colonial Building to conclude the estimates of

his department. First of all, for the people from the department I would like to

introduce the people who are on the committee.

Ms. Verge, who is the Vice-Chair and myself, Oliver

Langdon in the Chair. We have Harold Small from Baie Verte-White Bay; Jim Walsh

from Mount Scio - Bell Island and Danny Dumaresque from Eagle River; and for the

benefit of the committee members, Mr. Minister, would you introduce your

officials please?

MR. DECKER: Mrs. Joan Dawe, the Assistant

Deputy Minister; Dr. Williams is the Deputy; Gerry White, Assistant Deputy; Roy

Manual is Acting Director of Hospital Services and Cec Templeman is Director of

Administrative Services.

MR. CHAIRMAN: Okay, what we have been doing is

letting each person have ten minutes, so we will have the Vice-Chair, if she

would.

MS. VERGE: I would like to start with mental

health services for young people. It is a topic I have raised each year since I

have been in Opposition and have had an opportunity to question this Minister of

Health. There is a desperate need for mental health services for children and

adolescents in our Province that has come about with a dramatic rise in the

number of reports of child abuse, reports to the Department of Social Services

with the number of prosecutions for child abuse, with the increase in the number

of people on social assistance; there are now about 75,000 people in our

Province on social assistance.

In 1988, the previous administration established

the Thomas Anderson Centre in St. John's, as a pilot project for providing

mental health services to young people. In the winter of 1989, shortly before

the government changed, the Department of Health came to Treasury Board, as they

were requested to do, with their budget submission,; they indicated that one of

their priorities for improvement in the health care system was an expansion of

children's mental health services, saying that the Anderson Centre had proven to

be extremely successful and that a similar unit should be established in Central

Newfoundland -

MR. DECKER: Which year was that Ms. Verge?

MS. VERGE: That was February of 1989. The

government changed on March 5th of 1989 and that June, when I questioned you,

this minister, about the Anderson Centre and the need for expanded mental health

services for young people, you and your officials, the deputy in particular, Dr.

Williams - I have a transcript here - acknowledged the need for the Anderson

Centre to continue to function, for the Anderson Centre to have additional staff

and for comparable programs to be put in place in other parts of the Province.

Last year, when I asked about it, there was an

extensive reply by the minister and by Debbie Sue Martin, speaking for the

Department of Health. All along, based not only on what this minister told this

committee, what this deputy minister told this committee, what Debbie Sue Martin

told this committee last year, but what I have heard from a variety of other

sources, what I heard when I was Minister of Justice, all indicated that the

Anderson Centre was an extremely good program, badly needed, providing a vitally

needed service; the only difficulty is that there was not enough of it. There

were not enough counsellors at the Anderson Centre and there was virtually

nothing in other parts of the Province, so I along with everyone else within

hearing range, was shocked to hear the minister say in the House of Assembly

yesterday, in answer to questions posed by the Member for St. John's East, that

there is some problem with the Anderson Centre and the government is apparently

thinking about changing it or abolishing it. I would like to ask the minister:

What is going on?

MR. DECKER: Mr. Chairman, the Anderson Centre

started out as a pilot project, and rightly as the member says, by the previous

administration. At the time there were high expectations for this way of dealing

with mental health problems in children. I think it goes up to nineteen years

old, does it not? I think that is the age group generally, and in some cases

older than that.

It was an initiative that was started by the

previous administration, and I on many times have given them full marks for it

because logically it should be an excellent way to deal with this problem;

however, we have never formally adopted the decision of the previous

administration to build four more throughout Newfoundland and Labrador; nor have

we said we would not build them.

For the first couple of years while I was minister

we certainly did give it every opportunity to succeed; however I do not believe

they have ever had a full complement of employees, of counsellors.

AN HON. MEMBER: Not as yet.

MR. DECKER: Not as yet. They have thirteen or

fourteen positions funded, and at the moment I think there are only five or six

filled. I do not know - what is the most that have ever been filled, Dr.

Williams?

DR. R. WILLIAMS: (Inaudible).

MR. DECKER: There have never been more than

five or six people -

MS. VERGE: Could I interject here just for

clarification because last year, and I have a transcript, there were -

MR. DECKER: Mr. Chairman, can you ask her to

just restrain herself a little bit, because it is extremely difficult to carry

on with an answer when you are interrupted all the time. Could you ask her to

restrain herself?

MS. VERGE: I think it is important, while we

have the chance, to clarify the numbers.

MR. CHAIRMAN: Well the question has been asked.

Let us have the minister give the answer first.

MS. VERGE: Okay.

MR. DECKER: Thank you, Mr. Chairman.

The Anderson Centre has never gotten up to its full

capacity. Now to work there we require at least a Masters Degree in various

disciplines. So last year the department said maybe if we could bring this under

the Janeway board, where they have their own mental health services and where

they are sort of more on the front line than the department is, maybe then we

might be able to get it up to its full potential. So it was handed over to the

Janeway hospital -

AN HON. MEMBER: January.

MR. DECKER: - In January of this year. Now to

date the Janeway has not filled the positions either, but there is one problem

which we see there. The problem is with the two union bargaining groups where

there is going to be I think the allied health services or the (inaudible).

AN HON. MEMBER: (Inaudible).

MR. DECKER: Yes.

The groups themselves and the hospital board have

not been able to resolve that, so I understand it is either gone or is going to

The Labour Relations Board to make a decision on. We still cannot say it is a

failure or it is a success. All we can say is that to date it has not been a

success. We are waiting until The Labour Relations Board deals with the issue so

the labour thing is out of the way. Then we are going to give the Janeway ample

opportunity to see if this experiment is going to work or not going to work.

If it works then we will consider going with other

such facilities around the Province - when the Province can afford it. You are

talking about three or four million dollars just to put a building in place, but

no doubt we would adopt it.

If, however, the Janeway cannot recruit any better

than the Department of Health could directly, then we are going to have to

consider whether or not we are going to go on with it. It is foolishness if we

are going to build those buildings and cannot get people to work in them. It

would not make sense, so we have to review it.

Now I heard the media story which said we are going

to close up, which is a pack of utter tripe. It is just sensationalism, which

the media does sometimes with their stories. There is no intention to close it,

but if the thing does not work then we certainly will have to consider closing

it. Then, in keeping with that of course, we have those community health care

boards. We are hoping to do more mental health services on the community basis,

which Mrs. Dawe is putting a lot of her time into.

MS. VERGE: Chairperson, that is absolutely

appalling. The Anderson Centre was working well and providing a critically

needed service. Now this minister apparently has set back progress by making an

administrative change. This is not a matter of unions or administrations or

buildings. It is a matter of thousands of children needing counselling services.

Now for the last three years I have been asking about this, and never was there

any suggestion that there was any problem.

AN HON. MEMBER: A point of order, Mr. Chairman.

MR. DUMARESQUE: Mr. Chairman, obviously the

member is not satisfied with the answer she received but I thought she got a

very thorough answer. Now, if you are not satisfied with the answer it does not

legitimate making another speech. Obviously you started off and made your

opinions known, but we are not going to sit here all night and listen to the

hon. member give speeches just for the sake of doing so. The minister is

answering the questions very thoroughly and we have to give him that

opportunity, Mr. Chairman.

MR. DECKER: Mr. Chairman, it has never been

fully staffed.

MS. VERGE: Is this a point of order?

MR. CHAIRMAN: A point of order.

MR. DECKER: If the hon. member knows when it

was an outstanding success I think she owes it to the group to tell us. It has

never been fully staffed.

MS. VERGE: Is the Chair going to deal with the

point of order first?

MR. CHAIRMAN: I think it is a matter of

clarification so I think there is no point of order.

MS. VERGE: Obviously, there is no point of

order. It is a case of the Member for Eagle River trying to run interference for

the minister again.

Let us talk about the need for mental health

services for young people. I have asked this now for the last three years, 1989,

1990, and 1991, but would the minister tell the committee what is his assessment

of the need on the part of the young people of this Province for mental health

services?

MR. DECKER: Mr. Chairman, there is no doubt

that there is a need, of course there is, but the Anderson Centre is not the

only attempt to meet that need. It is one which there was high hopes for being

an excellent experiment but not the only one. Every region in the Province has

mental health services. There are independent psychiatrists, there are

psychologists attached to the school boards. There is mental health being

delivered but like everything else we cannot say we are doing an excellent,

absolutely perfect job, but we are dealing with it. Maybe, doctor you could give

us some more examples of what we are doing in mental health for children in the

Province. I do not want to give the impression that there is only one attempt to

deal with mental health problems in children and that is the Anderson Centre,

and that the Anderson Centre has not been a success. That would be misleading.

MR. CHAIRMAN: Dr. Williams.

DR. WILLIAMS: The Anderson Centre is one part

of the program in place for services for children and adolescents. As the

minister says it has not been as successful as we would have liked it to be.

There are a number of positions that are vacant.

MS. VERGE: Can I ask why? In what respect has

the Anderson Centre failed to meet the hopes or expectations of the department?

DR. WILLIAMS: We have never got the staffing up

to the full complement and offered the full range of services that we had hoped

for initially.

MS. VERGE: How have the staff who have been

there performed in the view of the department?

DR. WILLIAMS: The staff who are there now have

performed well in our view. We have no problem with the staff that are there. It

is just that we do not have the staffing up to full complement. There is a

component to deal with early childhood mental health problems, a component to

deal with adolescent problems, a provincial court team which we would like to

get in place, and a day care program plan for the Anderson Centre. We have never

been able to get those in place as we would have liked. We are looking for very

well qualified people obviously if we are dealing with mental health problems.

MS. VERGE: Is there any reason to think that an

administrative change will improve the recruitment problem?

DR. WILLIAMS: Well, I think the Janeway are

involved in the day to day delivery of health services to children across the

spectrum of need. A number of years ago the department as a pilot project, and

again we do not get into the direct delivery of services on a long-term basis,

we started up the Adolescent Health Counselling Centre on LeMarchant Road as a

pilot project at the department. That was up and running and we moved that to

the Janeway Child Health Centre as it fitted in nicely with other components

that they had at the Janeway. In the communications area they have a Psychology

Department and a Psychiatric Department.

MS. VERGE: I would like to zero in on the

recruitment problem because this seems to be at the crux of the problem. What

significance does the salary scale have to the recruitment problem?

DR. WILLIAMS: I think the salary component is

one that we have had reclassification done on which has improved it somewhat.

Again that is tied in somewhat to the bargaining unit issue which is a

complicated issue. We are now GS and the Janeway is bargaining under HS but

there is also an AAHP group and most of the psychologists and social workers are

in that bargaining unit so these issues need to be dealt with at well. Salary

was one and we have made some improvements in the salary.

MS. VERGE: What is the salary scale now?

DR. WILLIAMS: I would have to look that up.

That was a couple of years ago. I cannot give you the exact figure so I do not

want to quote any figure unless I have the exact one.

MS. VERGE: Okay. Could you provide that to me

or other members of the Committee later?

DR. WILLIAMS: I can look back and get that

information on salaries, sure. That's no problem. I will get the old

classification and the current classification.

MS. VERGE: What recruitment efforts have been

made in the past year? Now I noticed last year Debbie Sue Martin talked about

special recruitment efforts. She said there had been advertising outside the

Province as well as within the Province. The year before the same thing was

said, and in 1989 the same thing was said. What has been done in the past year?

DR. WILLIAMS: In the last number of months

where we were transferring to the Janeway there hasn't been any active

recruitment and there is not at the current time. The Janeway is currently

assessing the programs there to see how they fit in with the other four or five

programs in mental health that the Janeway operates. Then by the end of June I

understand they will be making another approach to get additional staff.

MS. VERGE: What's the waiting list in the

meantime?

MR. CHAIRMAN: Okay, Ms. Verge. We had agreed I

think at the beginning to have ten minutes for each person. I've allowed you

fifteen. So we will go to Mr. Harris, and afterwards we will come back again.

MR. HARRIS: Thank you, Mr. Chairman. I have

with me a document called Child Sexual Abuse: A Guide to Services and Resources

in Newfoundland and Labrador. Produced by the working group on child sexual

abuse through the Community Services Council. In that it lists a series of

victims' services for victims of sexual abuse. In that is listed the Thomas

Anderson Centre.

Now it describes the agency as follows: that the

Dr. T. Anderson Centre provides a comprehensive package of services related to

the assessment and treatment of all types of childhood mental health or

psychiatric problems. This includes children and adolescents affected by sexual

abuse, and adolescent sex offenders. Counselling is done on an individual and

family basis and specialized programs are developed for groups of individuals or

families with similar needs. Is that an accurate description of the Thomas

Anderson Centre?

MR. DECKER: That is a description of what the

Anderson Centre is supposed to be.

MR. HARRIS: In what respects is it a failure?

MR. DECKER: The hon. member came in a bit late,

and I explained earlier that when it was begun there were high expectations for

it. But it has never been fully staffed, it has never been able to work at full

capacity. Therefore it is extremely difficult to use it as an example when we

don't know - we've never had that one up to scratch.

MR. HARRIS: Is the counselling that is being

provided by the inadequate staff itself improper? Is there something wrong with

it?

MR. DECKER: (Inaudible).

MR. HARRIS: No, the counselling that is being

provided, is it deficient, is it poor quality? Is it lacking in quality and

professional standards?

MR. DECKER: Mr. Chairman, I don't know what

reason he would have to ask that unless he knows something I don't know. I have

nothing but glowing praise for the people who work there. I don't know where the

hon. member is coming from.

MR. HARRIS: My difficulty is this. That you are

describing the operations of a centre. You haven't used the word 'failure' to

me. You've said that they are not a success. Are the services being provided

improper services? Are they poor quality? Or is there just not enough of them?

MR. DECKER: All the services that were supposed

to go there, they are not enough. All the services that they intended were never

offered like, I just gave some examples before you came in, I think. The program

has never been complete. It was set up for twelve or thirteen or fourteen

counsellors. The most we've ever had was five or six. Now, surely God, unless

you're totally dense, you are going to have to question whether or not you are

going to build four more if you can't staff one.

MR. HARRIS: If I may ask about staffing, when

was the last recruitment done? Can I ask when the last recruitment was done?

MR. WALSH: Mr. Chairman, just a point of order.

MR. CHAIRMAN: The hon. the Member for Mount

Scio - Bell Island.

MR. WALSH: All I want to say -

MS. VERGE: Running interference.

MR. WALSH: It's not interference, Mr. Chairman,

but we're not in a court of law. The minister should at least be allowed to

answer the question before the bantering starts back and forth. When you can't

pause to catch your breath or to wet your whistle with a glass of water and

someone is coming at you again, I mean, we are not in a court of law here. We

are here to try to deal with the estimates, get the answers that you are looking

for. The minister I'm sure and his staff are more than willing to give it to

you, and we are more than willing to let you have all the time you want.

But please, allow someone to catch their breath or

to put a glass to their mouth before you jump back down their throats again.

That's all I want to say. I don't know what we had for supper. Ours was

obviously not with as many spikes and razor blades as the hon. members who are

joining us. At least allow an answer, that's all I'm asking.

MR. HARRIS: Thank you, Mr. Chairman.

MR. DECKER: The last recruitment, Mr. Chairman,

I could refer the hon. member to Hansard. He came in late. But as we just

pointed out the last recruiting effort was made last winter in January some

time. Since it has gone over to the Janeway they are reviewing the program

before they start recruiting. As I also pointed out, there is a problem there

with the bargaining units.

MR. HARRIS: I'm not certain where in Hansard

that refers to a recruitment in January, but I know last May when the Social

Services Estimates Committee met we were told that there was a formal

recruitment program done a year before that. So there would have been an attempt

in May or June of 1990 and not another attempt until December of 1991. Would

that be correct?

DR. WILLIAMS: I will have to get the

information for exactly when the last recruiting effort was made.

MR. DECKER: That is a detailed question that we

are on.

MR. WILLIAMS: There was some discussion going

on with the Janeway for a considerable part of the 1991 year. We hoped to have

the service transferred to the Janeway before January but there was a delay

there. So during that phase there was no recruitment efforts at the time of the

transfer.

MR. DECKER: Before we say we are going to

cancel the experiment, we want to get the thing up and running under the Janeway

Hospital Board. If it is outstanding and it succeeds then we will continue on

and decide whether or not we will build more. But we just can't keep the thing

going if we can only recruit half the number of people we require. I think I

would be remiss if I did not do that. It is totally illogical to go and build

four or five more if you can't get one fully staffed.

MR. HARRIS: Can we get the specifics on the

recruitment efforts that were made? Was effort made in January this year or

December of last year, and what kind of positions were they trying to fill?

Which positions were trying to be filled that were impossible to fill?

DR. WILLIAMS: The positions at the Anderson

Centre are a sort of generic type of position for mental health workers. Some

are supervisory but some are direct workers. The people we are looking for are

people who have a background in social work, a background in nursing, a

background in psychology. These are the three main levels of disciplines with a

masters level of training and preferably some experience in children's mental

health. That is the type of people we are looking for.

MR. HARRIS: But they would not have to be all

three of those. You wouldn't have to have -

DR. WILLIAMS: No.

MR. HARRIS: - a social worker, nurse and

psychologist degrees.

DR. WILLIAMS: As long as you are from one of

those disciplines, that is the three key discipline, it is a multi-disciplinary

team. They will work hand in hand with the psychiatrist at the General Hospital.

From time to time the psychiatrist has been a consultant to the service, so if

one of these workers feels that a psychiatric opinion is necessary then they

will consult a child psychiatrist who works at the Janeway. These are the front

line workers.

MR. HARRIS: Is it the conclusion then of the

Department of Health that there are no social workers, nurses or psychologists

available with this type of training or ability?

MR. DECKER: What conclusion would you arrive at

if you were trying to recruit people and you just couldn't get them. You can't

force it. We don't have the authority to go out and take people and say you must

- you know what I mean?

AN HON. MEMBER: (Inaudible).

MR. DECKER: We can't force people to work and

manage this if they don't want to.

MR. HARRIS: Yes, we are just looking for the

details. So I guess then that there was a recruiting effort made in December

which was unsuccessful.

MR. DECKER: Mr. Chairman, (inaudible) -

MR. HARRIS: I am not certain who did the

recruiting and what the results were. Last year we were told that in May or June

of 1990 there was some recruiting done. That was like last May. Is it December

of last year there was a recruitment effort?

MR. DECKER: Mr. Chairman, I have undertaken to

get that information for the hon. member.

MR. HARRIS: Okay.

MR. DECKER: If he can't get through another ten

minutes without the information, let's rise the Committee and we will go and get

the information and bring it back. Does the hon. member want to do that?

MR. HARRIS: No. That is quite satisfactory.

MR. DECKER: We are dealing with eight hundred

and eighty-something million dollars in the Department of Health.

MR. HARRIS: I didn't understand that could be

the answer.

MR. DECKER: Now, whether or not recruiting was

done December 12 or December 31, I honestly don't know. But I do know there was

an ongoing effort made to recruit. Anyone in this Province, who knows anything

about mental health, knows there are openings at the Anderson Center. Now, if

that is not satisfactory for the hon. member, let's rise the Committee, we will

get the information and then we will come back again. That is exactly what we

should do, Mr. Chairman.

MR. CHAIRMAN: You had already consented to get

the information, so there was no need for the member to continue to prod for

that. The information would be forthcoming.

MR. HARRIS: Thank you, Mr. Chairman.

In addition, there is a description in this

publication of a child and adolescent guidance service at the Western Memorial

Hospital which describes it as a multi-disciplinary unit providing mental health

services to children and adolescents and their families in the Western Region of

the Province. The clinical team includes the Director, a social worker, a

psychiatric nurse, a psychologist and a special education teacher. Can you tell

us whether that agency is fully staffed?

MR. DECKER: Mrs. Dawe.

MRS. DAWE: Thank you, Mr. Chairman.

To my knowledge, yes, that service is in place in

Western Memorial, to my knowledge.

MR. HARRIS: And are all the positions filled?

MRS. DAWE: I am sorry but I can't answer that.

MR. HARRIS: You are not sure?

MRS. DAWE: I would be happy to get the correct

information for you.

MR. HARRIS: Okay. While you are getting that,

my information and some other members of the Committee may have greater

information, is that not all those positions are filled. If that is the case,

could we find out the reason for that as well?

MRS. DAWE: Yes.

If I could: As the minister indicated earlier, we

recognize that mental health - and I think we indicated that at the last session

-is a concern to the department and we are focusing a considerable amount of

attention on trying to develop community mental health services, as I had

expressed the last time, through the establishment of the community health

boards. So we are not saying that all areas in the Province which currently have

mental health services are satisfactorily and fully staffed, but I would be

happy to get the details for you with respect to Western.

MR. HARRIS: Thank you. Just one final question.

Can someone tell us, if the real difficulty is lack of trained people, how that

would change because you establish a community mental health board as opposed to

the Anderson Center or the Janeway Hospital directly hiring, a community health

board trying to fill positions? If that is the problem, then do we have any

programs to solve that problem?

MRS. DAWE: Again, with respect to mental health

services generally, including children's' mental health, I think one of the

initiatives that is underway in the St. John's area, to answer your question, is

to review and establish a longer term plan for mental health services for the

St. John's metro area. That initiative has been underway since last June and we

have determined that about eighty-five different organizations, many of them

voluntary and some funded, are providing some components of mental health

services in the St. John's area. Many of these groups themselves have indicated

that part of the problem in the delivery of this service is that it is

fragmented and that some groups are really not aware of the existence of some of

the voluntary groups.

Part of our initiative, with respect to community

services, is to better co-ordinate the existing services so that we can offer a

range and build on these. So it is a co-ordination of existing services, both

funded and voluntary, first, so we can make better use of the existing

resources.

MR. HARRIS: Is there any program to provide an

incentive, as you have in medical practitioners serving in rural areas, or any

program to ensure that people in the fields of psychology, social work or

nursing are made aware of a program or a need in this area to provide special

courses or to ensure that the university is offering that type of program? Are

there any efforts being made there?

MRS. DAWE: There are some discussions,

particularly with the medical school, with respect to psychiatrists and we have

offered for additional funding this year for bursaries to recruit and retain

psychiatrists in the Province, as well as the bursary program for other

professionals. There are discussions currently under way with respect to

psychologists in that area, particularly for child services. So there are

discussions, yes, to look at bursary programs and so on.

MR. HARRIS: Perhaps the minister, when he has

obtained the information regarding the recruiting efforts, could identify

whether it is psychiatrist positions or these positions for social worker,

nursing or psychologist positions that are, in fact, going wanting. We know

there is a shortage of psychiatrists, but I would suspect that it is easier to

either recruit or give existing social workers, nurses or psychiatrists the

required training to be involved in this program. So if we could get that

information it might be helpful.

MR. CHAIRMAN: Mr. Walsh.

MR. WALSH: Mr. Chairman, I guess, for the sake

of Hansard, Jim Walsh, Mount Scio - Bell Island.

I am not as much concerned about the line of

questioning because I have had an opportunity to experience that over the last

number of weeks, but I am very concerned about the impression that may be left

by the questioners so far tonight. The thing I am most concerned and most

disturbed about is that I almost sense that there are dispersions being cast

upon the Janeway.

Now, the Janeway is probably one of the finest

facilities for children in Atlantic Canada, if not in Canada. I am really

concerned that the kinds of comments being made here tonight are as if to say

the Janeway is either 1) no good, or 2) is not doing an adequate job.

I want to ask the minister and his officials, under

the circumstances, where obviously you are trying to find people and you can't

get above that five or six mark, while you are looking for thirteen or fourteen,

how is the Janeway, which I believe to be, as I said, one of the finest

hospitals in Canada for children -I don't want any impressions left that the

Janeway is no good, and listening to the previous speakers that is what I am

sensing. How is the Janeway coping under the circumstances?

MR. DECKER: Well, as we pointed out, one of the

biggest problems they have with this specific program is the union issue. They

tried to resolve it with the different bargaining groups and they were unable to

do it. Whether it was the Janeway's fault or the union's fault is not for me to

judge. So they have not really been able to give the Anderson Centre the

attention they would normally give to their other programs.

So, basically, they have to come to grips with the

labour problem that has been passed over to the Labour Relations Board. They are

also evaluating the program, what has been done to date, to see what they have.

They are also evaluating what kind of program they should deliver. So,

hopefully, once the labour thing is out of the way - I would think that should

be out of the way when, Ms. Dawe - in another month or so?

MS. DAWE: Within a month.

MR. DECKER: Within a month the labour thing

should be resolved. Then the Janeway will be able to give it full attention and

see if it can get up and running.

MS. DAWE: (Inaudible).

MR. DECKER: Yes. The Labour Relations Board

might be later meeting and that could be complication, but anyway, once the

labour thing is dealt with, then the Janeway can give it its full attention.

If the Janeway - which, as you rightfully point

out, is one of the top children's facilities hospitals in Canada and possibly in

the world - if the Janeway cannot make this experiment work, then I would

challenge anyone else in North America to try to make it work. I think if they

can't make it work we are going to have to come to the conclusion that the

experiment is going to have to be changed.

MR. WALSH: Following through with that, for me,

I suppose having been in the free enterprise side of things, recruitment works

both ways. One, when there is a need for people, you carry on your advertising

campaigns in as many areas as you can when you are looking for specific kinds of

people, but it works the other way, too. People with experience and knowledge in

a certain field tend to come looking for employment. I am sensing that if three

or four people who were qualified were to come through the door tomorrow whether

there was an ad in the paper last week or not, that they would be welcomed and

you would say, 'Please, come in. You are hired.'

MR. DECKER: Absolutely. They would be welcomed

with open arms.

Now, there is a shortage of psychiatrists in the

Province. I am not aware of any major shortage of psychologists or the masters

in sociology; nevertheless, for whatever reason - maybe it is the fault of the

Department of Health, I don't know, but I don't think it is. I think we gave it

a good shot. We could have pulled the plug on the thing six months ago and said

we just couldn't seem to get it fully staffed. But rather than do that we wanted

to give it to an expert group. They have it now, and let's hope they can make it

work.

MR. WALSH: Just one final question. Is that the

reason also for the reclassification, that you were trying to move more money

into that system? Or was the reclassification done for other reasons?

MR. DECKER: Yes. A year-and-a-half or so ago, I

met with some people from the Anderson Centre. Among other things, they told me

that they thought there was a problem with the salary scale. So I went back to

Treasury Board and we got some reclassifications done. But it seems to be more

than money. I suppose, if you paid them half a million dollars each, you might

have a better shot, I don't know. But, in my opinion, the salaries now are

adequate in comparison to the same qualification in other fields.

MR. WALSH: Thank you, Mr. Chairman.

MR. CHAIRMAN: Ms. Verge.

MS. VERGE: Let's get back to the Anderson

Centre. It really bothers me to hear the minister say that the government might

cancel the program because of a difficulty in recruiting staff. There is an

identified need for mental health services for young people. To make a

comparison, you don't stop offering cancer treatment because there is a shortage

of cancer doctors or cancer nurses. Surely, if the incidence of cancer outstrips

the medical and nursing personnel to treat the cancer patients, then the answer

is not to cut out what you are doing, it is to use innovative approaches to get

more personnel. Doesn't the minister recognise the critical need for mental

health services for young people? Given the rise in the reports of child abuse,

given the number of prosecutions, given what we all know now about child abuse

and neglect?

MR. DECKER: Two issues, Mr. Chairman. The first

is her opinion, for which I thank her. The second I have already answered and

explained that I'm concerned with the issue.

AN HON. MEMBER: (Inaudible).

AN HON. MEMBER: Mr. Chairman?

MS. VERGE: I'm not finished my ten minutes.

AN HON. MEMBER: Have you finished?

MS. VERGE: No, I have not. There are other

topics I would like to move to now. Three or four -

AN HON. MEMBER: Well, I would just like to say

something on this very same topic, too, that we are discussing.

MR. CHAIRMAN: She hasn't finished her ten

minutes (inaudible).

AN HON. MEMBER: Okay.

MS. VERGE: Thanks. I think it was three or four

years ago the Department of Health did a review or study - I'm not sure what

word would be appropriate - of pap smears. Now, I am not sure of the correct

terminology, but I have heard it referred to as a cytology study or review. I

wonder if the minister or one of the officials would let us know the results of

that study, and also let us know what is happening throughout the Province in

terms of the provision of pap tests and the lab analysis of pap smears. Three or

four years ago there was a fairly serious backlog of samples. The lab capability

couldn't seem to keep up with the need. What is happening now?

MR. DECKER: I'll ask Dr. Williams, here.

MR. CHAIRMAN: Dr. Williams.

DR. WILLIAMS: Yes, that was about - I'm not

sure of the exact date but it was two or three years ago. Wait now, I think

probably in 1988?

MS. VERGE: Yes, that sounds right.

DR. WILLIAMS: That's the date that rings a

bell. There was a problem with a backlog of pap smears. Some arrangements were

made, with the assistance of the British Columbia Cancer Foundation and Control

Agency, to do some of the pap smears where the backlog occurred. Most of the

backlog occurred in St. John's. We had some help from places like Clarenville in

clearing up the backlog, as well.

I am not aware at this point in time that a backlog

exists. I have not heard that there is any problem in having a reasonable

turnaround time for routine pap smears at this point in time. We have done a

study of the issue of pap smears in the Province. We are linking that study with

a federal-provincial study that was done on the issue of pap smears in Canada,

and the approach to cervical cancer control in Canada. We are hoping to have

some discussions with the Cancer Treatment and Research Foundation and other

agencies in the Province to look at how we might approach the whole pap smear

issue.

One issue relates to quality. Quality is a big

issue in the pap smear area. There have been some studies and stories in the

media recently about the failure rate, the false negative rate in the area of

pap smears. We want to make sure that, first of all, pap smears are taken

appropriately. It is a simple test, but I think, in order to increase its

accuracy, it has to be taken properly. That is an education issue we will be

looking at on that front. The whole issue of quality, efficiency and

effectiveness of the program, we will be looking at that, as well, in terms of

the number of organizations now providing Pap smear services in the Province.

Different provinces have different approaches. If

you look at the Province of British Columbia, they have a totally centralized

system for Pap smears. All the Pap smears are done centrally at the Cancer

Control Agency in B.C. They operate the only service in the Province. Other

provinces have different setups.

In Newfoundland, we have cytology services at

Western Memorial, Central Newfoundland, Gander and Clarenville, as well as the

large adult hospitals in St. John's. So this is another issue we are going to

look at, the issue of centralization versus decentralization in terms of

quality.

MS. VERGE: Will the department release the

study report?

DR. WILLIAMS: We haven't finalized our review

of the study report as yet but, sure, when we finish doing that. Plus the

national report is available as a public document right now.

MS. VERGE: How long has the provincial study

report been completed?

DR. WILLIAMS: I would have to check the exact

date for you.

MS. VERGE: Okay, but you will make it public?

DR. WILLIAMS: Yes. It is done but we haven't

had a final meeting with the committee yet that has done the report, and we

haven't taken a position in the department on which way we want to go. We have

been waiting for some developments to occur at the Cancer Treatment and Research

Foundation because we would like to get that agency involved in the program a

little more than they have been in the past. They have been on the periphery,

whereas, if you look at their mandate and role, I think they should be more

intimately involved in the organization and management of the program.

So, I guess, on a philosophical basis, I can only

say that at this point because there is no policy at this point. We are looking

at the program in British Columbia as a fairly good model and it may be a model

that we might want to adopt in the Province, but that will require some policy

changes and some discussions with the organizations that are going to be

affected, because there are a variety of organizations providing the service

around the Province?

MS. VERGE: So the B.C. model would be one

central lab for -

DR. WILLIAMS: The B.C. model is one that we

would like to look at carefully -

MS. VERGE: Okay, thanks.

DR. WILLIAMS: - because of the quality issue.

Again, if you are doing a high volume and a lot of expertise, there is that

issue of quality in Pap smears. If you want to make the program work, you have

to be sure that the false positive rate is very low.

MS. VERGE: Is our false positive rate very high

now?

DR. WILLIAMS: I am not aware. I think you would

probably have to do some studies on that and look at the data and statistics. I

am not sure that has been done, to be honest with you.

MS. VERGE: Okay. I would like to ask about

nurse practitioners. It is a topic I brought up at our last session. There is a

pilot project that has been underway, co-sponsored by the Association of

Registered Nurses of Newfoundland, involving nurses operating what I think is

called a primary care service or a primary care clinic on the Southern Shore.

How is that going, and is the Department of Health monitoring it and looking at

it as a possible model to be copied elsewhere in the Province?

MR. DECKER: It is in the third year now, isn't

it, doctor? I think we have funded it for the third year. You are on top of that

one, are you, Joan? By the way, at a recent Health Ministers' Conference that I

attended, there was a doctor representing the Canadian Nursing Association who

gave us credit for it. She said it was one of the most outstanding programs in

Canada. Maybe Mrs. Dawe can respond.

MRS. DAWE: That is correct, Minister, and there

is an

article in the Canadian Nurses, The National Journal, this month, with

respect to the primary care project. It is being looked at very carefully by the

rest of Canada. The program will be evaluated during this next year, because it

is a pilot project, and then it will obviously be determined where we go from

there. But thus far the results are very positive, particularly in promoting

primary care and putting more emphasis on health promotion and prevention with

the community very much involved. Again, I would have to go back. We are looking

at that very closely because it is the same concept as we are talking about

through the community health structures where you get the public involved and

put more -

MR. DECKER: Community health orientation.

MRS. DAWE: Yes, community health structures.

But thus far the results are very positive.

MS. VERGE: Is there any consideration being

given to setting up another nursing primary care service in any other part of

the Province now?

MR. DECKER: Well, by its very nature, it is a

pilot project and before we start setting them up all over the Province we would

certainly have to evaluate what we are doing there and see how it is doing. We

have had a lot of primary care delivered by nurses in Northern Labrador and the

Northern Peninsula for years. There are some similarities, but there are other

things which are unique to this one, as well, plus the fact that we have the

World Health Organization involved in this, so it is not totally our own

program. We are funding it, but we have a lot of input from them. We would like

to have the pilot project over and done, evaluated, and then determine whether

or not they are going to go on with it.

DR. WILLIAMS: The federal government is

involved in providing some funding for a thorough evaluation of it, so that is

part of the whole package.

MS. VERGE: I see - okay.

The last question has to do with drugs. From what I

have read in popular literature, it seems to be a fact of life in many part of

the western world that too many drugs are being prescribed and taken, more than

patients need and, in some cases, the excess either causes new problems or

complicates the problems that the patients went to the doctor to see about in

the first place.

What is the view of our Department of Health about

the extent of the prescription of drugs and the use of prescription drugs, if

there is a feeling that there are too many prescription drugs being taken? Is

there any strategy to cut down on the prescription of drugs?

DR. WILLIAMS: Well, maybe I can just make some

comments.

MR. DECKER: Go ahead. I wouldn't touch that

one.

DR. WILLIAMS: The whole issue of the

utilization of drugs is a concern and, in particular, the utilization of drugs

in some of our elderly population is a concern, as well, the number of drugs

some people are on and this type of thing. People in that age group obviously

have more chronic disease and problems than people in the younger age group, so

you would expect probably higher drug utilization, but it is an area of concern.

Mrs. Dawe, here, chairs The Provincial Quality Assurance Committee, which is a

committee made up of representatives from the ARN, The Medical Association, The

Medical Board and The Hospital Nursing Home Association. I don't know if I have

left anybody out - have I Joan?

MS. DAWE: The Department of Health.

DR. WILLIAMS: The Department of Health.

Joan can probably tell you about a project that we

have under way now with the Clinical Research Unit at Memorial University to do

a study in the Province about utilization of drugs. We thought we would start at

nursing homes where we have traditionally probably a high consumption of drugs

and people with chronic diseases, and see what findings are there. So we started

the project in co-operation with the medical school to review the utilization of

drugs in the nursing homes in the Province. Maybe Joan could give you a little

more detail.

MS. VERGE: I would like to interject one

related question. It is a question I have asked before. Does the Department of

Health agree with, or is the Department of Health inclined to take a position in

opposition to physicians who prescribe drugs owning or having a financial

interest in drug dispensaries or pharmacies?

It seems to me, where a physician has a financial

interest in a drugstore or a pharmacy or a dispensary then, obviously, the more

drugs prescribed, the more business there is for the dispensary and the more

income from that source. So it seems to me there is a conflict of interest, or a

potential conflict of interest.

MR. DECKER: There is really no process from the

Department of Health.

DR. WILLIAMS: The medical board monitors that.

MR. DECKER: The Newfoundland Medical Board

would have to monitor that. If the hon. member wants to see the Minister of

Health pushed over the wharf or shot, let me start telling physicians how to

prescribe drugs. That would be the end of it. The only process is the medical

board.

DR. WILLIAMS: The medical board has some

regulations. It is a conflict of interest for a physician to participate in a

drugstore, as I understand it, and they monitor that.

MS. VERGE: Well, that's news to me, because

other years when I have asked that question, I have gotten a different answer.

But it is a very common practice, you know, doctors typically locate their

offices in the same building as a dispensary.

MR. WALSH: I have no problem with the question

(inaudible) but if we are going to refer to directly, 'I have asked this

question in other years and I have gotten a different answer', then I would like

to see the answer tabled. I mean, that is a wild statement. I think I was here

last year and I don't know if the question was asked or not.

All I am saying is, if we are going to say that, we

should at least be willing to - but let's quote the page and the paragraph. It

is a wild statement to say, 'I have asked it before', but not be willing to

table where it was asked. It is unfair.

MR. DUMARESQUE: It is only (inaudible). We

should move to the headings, I think.

MR. CHAIRMAN: I think that is a point well

taken. Do you have any other questions?

MS. VERGE: No, I would like to have Ms. Dawe's

DR. WILLIAMS: I understand there is no problem

in having a physician located in the same building as a pharmacy, as long as

there is no financial gain relationship.

MS. VERGE: Yes.

DR. WILLIAMS: That is, I guess, within the

medical board's prerogative. They set the ethical standards for medical

practice. They tell us that is part of their standard, and that where they have

a reason to believe there is a problem, they look into it. That is my

understanding of it.

MS. VERGE: Oh, I see. Is that a recent change,

do you know?

DR. WILLIAMS: Maybe in the last few years. They

have been doing a lot of work on their by-laws and upgrading their Act.

MS. VERGE: Okay.

MR. DECKER: Thank you, but. Mr. Chairman, I

know the member would probably answer the question, but I was aware for the last

five or six years that a doctor couldn't own a drugstore, for example. I believe

there was a time when a doctor could own a drugstore.

DR. WILLIAMS: There was a time when a doctor

could own a drug store but in the last few years there has been a lot of work

with the Medical Act. Gerry?

MR. WHITE: I don't remember the date, but I

think there are some new conflict of interest regulations brought in, some

amendments to the current Medical Act regulations -

MR. CHAIRMAN: In the past two or three years?

MR. WHITE: - which delineated, if I remember

correctly, the various situations which were prohibited in terms of ownership or

relationships between physicians and drugstores.

MR. CHAIRMAN: Thank you very much, Mr. White

and Dr. Williams.

AN HON. MEMBER: We should get the specific

regulations.

MR. WALSH: Mr. Chairman, I want to relinquish

my right to ask questions and hope that my colleagues will join, but I would

like to serve notice that at about 8:00 p.m., we are going to be looking to deal

with the headings themselves, so we will let it be wide-ranging until then.

MR. CHAIRMAN: Thank you, Mr. Walsh. I

understood from Mr. Harris, that was the last of the questions he had just now.

MR. WALSH: What is that?

MR. CHAIRMAN: I understood, when you gave up

your right just now that was the end of the questions you had?

MR. WALSH: No, I assumed that was an

appropriate period of time and I was going to pass to someone else.

MR. CHAIRMAN: Okay, alright. Ms. Verge, have

you finished?

MS. VERGE: Yes, but I don't think Miss Dawe had

finished her explanation to my question about curbing the prescription of drugs.

MS. DAWE: I think the question was the activity

that is underway through the Provincial Quality Assurance Committee, which is,

we have surveyed - and it is a current activity, so I could tell you the status

right now - we have surveyed all the nursing homes in the Province and gathered

information on the number of prescription drugs for each of the residents in the

nursing homes. We have just received that information now and the data is being

collated and analysed. We have a preliminary report which is under review by the

Provincial Quality Assurance Committee and then we will be proceeding. There are

two more phases, so we are in the midst of the process.

MR. CHAIRMAN: Thank you very much. Mr. Harris.

MR. HARRIS: Thank you. I have a few questions.

One follow-up question on the area of adolescent health counselling. The

Adolescent Health Counselling Service on LeMarchant Road in St. John's also

advertises a multidisciplinary psychology, medicine, nursing, social work

service with psychiatric consultation. It is listed as a satellite service to

the Janeway. Has this been a successful program, to use the minister's words?

Has that been fully staffed and operating?

MR. DECKER: Yes, that is correct.

MR. HARRIS: That is operating and up to staff.

How many staff work out of there? Does anyone know offhand?

AN HON. MEMBER: We would have to look and get

the figures.

MR. HARRIS: You don't really know, but as far

as - so that is a satisfactory operation - it stands alone, operation on

LeMarchant Road for referrals for various groups.

DR. WILLIAMS: That was set up by the department

as a pilot project with the intention of seeing how it would work and it was

subsequently transferred to the Janeway as part of a plan. We are trying to do

the same with the (inaudible).

MR. HARRIS: So, from that, can we assume, as a

model for adolescent counselling, that, in fact, does work and the department is

satisfied it is an appropriate way of delivering that type of service?

DR. WILLIAMS: That model is working and is part

of a broad spectrum that the Janeway is operating on all fronts with this issue,

yes.

MR. HARRIS: Is there any reason why that cannot

be duplicated in places like Gander, Grand Falls, Labrador City, Goose Bay and

other areas where this service is needed?

DR. WILLIAMS: I guess we will have to work that

particular issue in with the plans that were ongoing at the regional bases or

the regional community health boards. No, but we have good experience with that

particular service; it was a little broader than just the Mental Health Service,

as well; it might be listed with the Mental Health Service but it was set up -

MR. HARRIS: Well, lifestyle, growth and

development, mental health.

DR. WILLIAMS: Yes, that's right, it is looking

at the whole lifestyle and this type of thing and not just concentrating on

mental health.

MR. HARRIS: No, no. It is not specific. So I am

assuming that this can be expanded under the community health service program

that you are talking about? I confess to not knowing whether I have a chance to

ask this last time, but I had it marked in my copy of the Estimates. Under

sub-head 2.3.01, Mental Health, there is a decrease in budget of approximately

$240,000, or $225,000, I guess, from the revised estimates for last year for

salaries in the Mental Health division. As I say, I don't know that I got to

that last time. What is the explanation for that?

DR. WILLIAMS: It represents the transfer of the

Anderson Centre.

MR. HARRIS: That is the transfer of the

Anderson Centre.

DR. WILLIAMS: That's right, and additional

funding will be provided as new staff are hired.

MR. HARRIS: Okay.

Another matter I would like to raise - it is

topical, but it is also structural, presumably under the Department of Health -

is the issue of community health concerns in the Placentia area, suggestions

that there are possible problems as a result of air quality, or air emissions,

or various other, what the minister has referred to as scaremongering, but what

people have a genuine concern about, which has been raised publicly of late.

My question is not on the specifics of that event

that is being looked at. What I am interested in is, is that kind of issue

something that is dealt with outside of the normal operations of the department,

or is there a particular division or responsibility within the department for

what might be called environmental health or environmental health issues? I

know, the minister, in the House the other day, said that we were consulting

with people at Memorial University, and well you might, if there were experts

available for that. Is that something that is handled at a political ministerial

level, or are there people already in place who are ready to respond to these

kinds of concerns as they are raised?

MR. DECKER: Dr. Williams, just explain what we

are doing there. You're on top of that more than I am.

DR. WILLIAMS: You don't want to deal with the

specifics of Placentia, you just want to deal with the general issue of how you

deal with issues such as that.

MR. HARRIS: If you want to use that as an

example, feel free. But I am asking, is there a responsibility, or is it

something that because it is raised then the wheels start turning to see what we

can do about it to figure it out?

DR. WILLIAMS: There are five health units in

the Province, four operated directly by the Department of Health, and one under

the Grenfell Board. Grenfell has responsibility for public health, as well as

the institutional side in the North. At the department we have four health units

where each is a responsibility of a medical officer of health, a physician who

is trained in public health issues. So those physicians and the staff are

dealing with population health issues, community health issues, on a regular

basis. As well, the Department of Environment and Lands has a role to play in

monitoring the environment, the quality of the air and the quality of water.

We have a public health, I guess, environmental

health, or public health inspection division which deals with bacteriological

quality of water, which deals with restaurants and proper food handling

techniques, and inspection, this type of thing. The overall mandate for

monitoring the health status of the people in the Province rests with the

Community Health branch. So they are looking at population health issues, issues

that can affect the population's health, and specific health hazards as they

come up.

The responsibility for monitoring the environment

in terms of air quality and overall water quality is with the Department of

Environment. We link in with them from time to time on various issues where they

have responsibility and we have responsibility, such as certain community water

supplies, certain disposal systems, and this type of thing.

MR. HARRIS: It is treated, I take it then, as a

public health issue, although it is a very specialized branch of that and you

don't have any experts on staff in that area.

DR. WILLIAMS: I guess our public health

physicians are trained in public health matters and public health practice. I

would say, a lot of these issues fall within the purview of their background and

training. They would have a knowledge, and we have other people in the

department with public health training who have a knowledge of some of these

issues - since the Placentia issue, and the issue of radiation biology and this

type of thing - to a degree necessary to, I guess, deal with it in a general

sense. For instance, in Placentia, we need some specific epidemiological and

some research people with a special interest in that area. So we are getting, in

terms of that, that particular expertise from the medical school. They have a

health research unit which has people trained in public health, who are

specialized in epidemiology and certain other aspects of the public health

spectrum. So we consult a lot with them.

In certain areas, of course, if we had a specific

issue - such as the issue in Placentia, where we have arranged with the health

research unit to do a review of the health issue that has been brought forward

recently - they would do a thorough review of that and present a report to the

department outlining what the issue is, how they view it as a health issue, what

potential it has to be a health issue, or has not, I guess, in that sense, and

make recommendations to the department on what course of action we should

follow. We have asked them to do that specifically on that issue.

MR. HARRIS: Although I didn't intend to home in

on the issue, since you mentioned it, that report is in progress now, it is?

DR. WILLIAMS: They are in progress. We had a

recent update yesterday from them and their target date is, I guess, late June

when they will have a full report in to the department on that specific issue.

MR. HARRIS: Thank you.

I want to ask a question about drugs. The last time

we met with the minister we talked about the increase in the cost of drugs and I

think Dr. Williams indicated that we have been looking at, for the last number

of years, at least, about a 12 per cent, or thereabouts, increase in the cost of

drugs. Since then, in the last week, there has been some national publicity on

it. The federal government is looking at that issue and there is some

controversy about what the actual increase in costs were. Green Shield, I

believe, is the name of the insurance organization that came up with a figure

very similar to ours, in that the actual cost of providing the drugs was about a

12 or 13 per cent increase.

My question is about the prescribing of drugs. It

is not so much health-oriented, although there may be implications, given side

effects and things, but in terms of cost. One of the criticisms of health care

costs is that we are dealing with a lot of new drugs that the public,

individuals and the governments are expected to pay for. Sometimes they are

referred to as designer drugs. The drug company will take a drug and change a

few molecules here and there and put it out at a price that is ten times higher.

I am not a scientist, but there is sometimes marginal increase in results in

certain populations, etc., but the end result is that the cost of drugs

continues to skyrocket. These are drugs that, although you couldn't tell a

physician not to prescribe them, from a public policy point of view you could

probably say they are not necessary. I am wondering whether government has any

method of dealing with that? Do these drugs have to go through some procedure

before the government decides they are going to put them on the list to pay for

them, and what methods are being used to control these costs?

DR. WILLIAMS: That is a very timely question

because it is an issue that is on the national agenda now between health

ministers and, I guess, health deputies and, in turn, the advisory committee

that advises the conference of health ministers and deputies on the whole issue

of drugs. It is a statement about just changing a radical here or a radical

there and coming up with a new version of a drug that has a different name but

probably is just the same thing as the previous drug. It is a good marketing

strategy, I guess, if you own a drug company or have shares in it, of marketing

your product. There are a lot of new entities coming on the market but in a lot

of cases they do represent just a different version of the same old drug. At a

national level, all provinces are trying to come to grips with that issue and

the cost of drugs runs anywhere from 10, 16, to 17 per cent across Canada in

terms of various drug plans.

One issue we are looking at with the federal

government and with Health and Welfare Canada, the licensing authority for new

drugs coming on the market - we are looking to them in co-operation with the

provinces in developing a cost analysis of the new drug to give, I guess, a cost

base, as well as doing an assessment: if the drug works, is it safe and all

these other things they do in the regulatory process, asking if they would

consider another regulatory process and the cost benefit analysis of the drug in

terms of the drugs that are already on the market, and including that in the

specs when the drugs are licensed. As well, in Atlantic Canada we have a

committee of senior officials looking at perhaps developing an Atlantic approach

to a drug formulary. It may be very difficult at the national level to develop a

drug formulary where we say, we are sorry, we are going to pay for these drugs

but because this is a new drug it doesn't offer anything in terms of cost

benefit over the drug that is already on the market. We are not going to approve

it for our drug plans. That is one approach to it.

It may be difficult to do at the national level,

given the diversity of the country, but we are looking at it very seriously, as

well as what we are trying to do at the national level, at the Atlantic level,

with the other Atlantic Provinces in terms of trying to look at maybe developing

an Atlantic formulary. We think we might be able to manage that, and together we

can use our collective expertise to do an assessment of drugs when they come on

the market and say, 'Well, sorry, although this drug costs twice as much, the

drugs that are now on the market offer the same therapeutic value at half the

cost, therefore it is not going to be covered under our drug program,' and

probably try to provide that information to the practitioners who are ordering

the drugs, and to the general public, more importantly, who are buying the

drugs, to help them be better consumers of drugs.

MR. DECKER: We haven't done that. That is what

we are looking at.

MR. HARRIS: Yes, that is part of the plan.

MR. DECKER: Because right now we have the

formulary, as the hon. member knows, where if a particular drug is prescribed

and there is a generic drug available of the same quality then the pharmacist

would have to give the cheaper drug. But what the deputy is talking about would

be a brand new initiative where we have to make a value judgement on whether

drug A which costs $26,000 a year is better than drug B which costs 50 cents a

week. That is not a simple matter but it is one of the things that all Health

ministers and deputies are looking at across the country.

MR. CHAIRMAN: I understood that Ms. Verge was

finished, but she said she has two short questions.

MR. HARRIS: I am not finished either, Mr.

Chairman, but if my time is up I will welcome going back again another time.

MR. WALSH: (Inaudible).

MR. CHAIRMAN: Okay, two short questions and

then we will go back to -

MR. WALSH: (Inaudible) all over the place and I

would like to deal with the numbers.

MS. VERGE: Chairperson, we are here to deal

with the numbers (inaudible).

MR. HARRIS: You can make a motion if you want.

You can't give notice (inaudible) the Committee.

MR. WALSH: (Inaudible). We're all over the

place.

MR. CHAIRMAN: The Chair will entertain one or

two more questions and then we will call the subheads.

Ms. Verge.

MS. VERGE: I would like to ask the minister

about MCP coverage for abortions. Why isn't the government extending MCP

coverage to abortion procedures done in the private Morgentaler clinic in St.

John's, since the Morgentaler clinic does abortion procedures at a lower cost

than the hospitals are doing them?

MR. DECKER: Mr. Chairman, we have a policy -

which we haven't changed, by the way, the previous administration had the same

policy - whereby government will not pay for significant medical procedures that

are carried on outside of an accredited hospital. I don't know what reason you

people had for having that policy when you were in power, but one of the reasons

we have it is we want to discourage a proliferation of clinics. If you have an

abortion clinic, the more you could have someone doing heart surgery in clinics,

you could have someone doing gallbladders in clinics, you could have someone

doing any procedure in clinics which are outside of government, outside of

hospitals.

Now, if this were to happen, in my opinion, it

would have a terrible impact on the cost of our health care system. I believe

one of the reasons Ontario is paying in excess of 30 per cent of their budget

for health care is because they do have a proliferation of clinics, and my good

friend, the Minister of Health, Frances Lankin, is disgusted with me. I remember

just a little while ago there was one, I think, to do with a dialysis clinic or

something, from which she was trying to pull back the funding. In the States you

will find clinics all over the place, one of the reasons, I believe, why they

have one of the most expensive health care systems in the world.

We could well be challenging the courts, and we

could well be made pay for the abortions. I suppose, if that comes, we will have

to deal with it.

MS. VERGE: Well, that was going to be my next

question.

MR. DECKER: The worst thing that could happen,

Mr. Chairman, in this Province, would be to have LeMarchant Road full of

clinics. I think it would drive the cost of health care through the roof, and I

believe it would ultimately see the demise of a university-funded health care

system.

Medicare in Canada, health care in Canada, I

suppose it is just as well to call it like it is - it is controlled. It is

rationed to a certain extent. Once you lose control of it the other alternative

might well be the destruction of the universal health care system that we have.

That is why we have the policy. Now, I don't know, you probably understand why

you fellows had the policy when you were in government.

MS. VERGE: Does the minister have a legal

opinion on the current policy of discriminating against the private abortion

clinic? - on the one hand, extending MCP coverage to hospitals -

MR. DECKER: There have been several cases. We

did not summon a lawyer in and say, give us a legal opinion. All we can do is

look at what happened in the other provinces.

Bob, would you want to give a rundown through them,

the ones which have been challenged? Most of them have lost in the courts and

they ended up having to pay. Nova Scotia, I believe, is still in the courts?

DR. WILLIAMS: I am not sure. Nova Scotia may

have appealed the decision. I believe they lost in the courts. Manitoba, I

think, has the same policy as Newfoundland. Is that correct, Gerry?

MR. GERALD WHITE: Pretty well the same, yes.

DR. WILLIAMS: Ontario does pay -

AN HON. MEMBER: Yes.

DR. WILLIAMS: That's my understanding - Quebec,

probably, as well.

MR. DECKER: Wasn't British Columbia challenged,

and lost?

DR. WILLIAMS: I am not sure.

MR. DECKER: Most of the provinces had a similar

policy as we have. As I said, we might end up - we probably will be challenged,

we will probably lose it. Then we have to deal with it.

MS. VERGE: If you are challenged, do you intend

to pay out taxpayers' money to contest the challenge? What's the likelihood that

you are going to end up losing?

MR. DECKER: That's hypothetical, Mr. Chairman.

MS. VERGE: Pardon?

MR. DECKER: We will deal with that if and when

the issue arises.

MS. VERGE: Okay. How many abortion procedures

outside the Province has MCP paid for in the last year or two?

MR. DECKER: We could give an approximate, but

we would have to get the exact numbers from Medicare.

DR. WILLIAMS: We'll get the figures. You want

the exact figures (inaudible).

MS. VERGE: Isn't it true that MCP has been

paying for women to go from the St. John's area outside the Province for

procedures that could have been done at much lower cost here at the Morgentaler

clinic?

MR. DECKER: You see, assuming that it is just a

doctor's fee, at the Morgentaler clinic, I think it's $85 or $90 for an abortion

but, in addition to that, the clinic asks for a facility fee, which drives the

cost up pretty close to what we are doing it for in our hospitals.

MS. VERGE: It would be a lot less than what it

would cost to pay somebody to go to Montreal, though, wouldn't it?

MR. DECKER: Those who are going outside the

Province, if I am not mistaken, Mr. Chairman, are in excess of fourteen weeks, I

think, are they not?

DR. WILLIAMS: Yes. The General Hospital

provides a service for up to twelve or thirteen weeks.

MR. DECKER: In excess of that we send them

outside the Province.

MS. VERGE: But the procedure is done here at

the Morgentaler clinic for women who are more than twelve or fourteen weeks,

while MCP is paying the cost of these women going to Montreal or some other

mainland centre, which would be astronomically more than the cost of having the

procedure done here at the private clinic.

MR. DECKER: I'll try to explain. In the short

term, if we were to pay the Morgentaler clinic for abortions we might end up - I

don't know; the hon. member is suggesting it would - we might save some money. A

few nickels and dimes. But if we were to see a proliferation of clinics - not

just abortion clinics - in this Province it would drive the cost of health care

probably in excess of 30 per cent of our Budget, in which case, it would

threaten universal Medicare. That is why I believe our policy is a good one;

that is why, if we are ever forced to abandon that policy, I think it will be a

nail in the coffin of the health care system, universal health care, in this

Province. That would be devastating.

MR. CHAIRMAN: Thank you very much, Mr.

Minister. Is that it?

MS. VERGE: One other question, a totally

different tack now. One of the odd responsibilities of the Department of Health

is the Solemnization of Marriages Act.

MR. DECKER: Yes.

MS. VERGE: Right now, we, under legislation,

have authorized to perform marriage ceremonies, in addition to clergy, only

provincial court judges and the mayors of the cities. This government is

centralizing provincial court services. There is no longer a provincial court

judge resident in Wabush or Labrador City, Port aux Basques, St. George's, Bonne

Bay, the Northern Peninsula, Springdale, or Holyrood. So, in all these areas of

the Province where there used to be provincial court judges who could perform

marriage ceremonies, now there is no civil authority with that power.

I am wondering if the minister would consider

authorizing more civilians or more non-clergy, be they justices of the peace or

mayors or members of the House of Assembly, or some civil authority to perform

marriage ceremonies for people in every part of the Province who, for their own

reasons, would prefer not to have to go to the clergy to be married.

MR. DECKER: Yes.

MS. VERGE: When?

MR. DECKER: As a matter of fact, I just

appointed one yesterday in Labrador West, the Mayor of Wabush has been appointed

a marriage performer under the legislation of 1974, I believe it was. The

Minister of Health can authorize anyone to perform a wedding, so I shall take

advantage of that.

MS. VERGE: But will you do that in a consistent

way across the Province? The Mayor of Wabush may be a political colleague and

friend, but what about -

MR. DECKER: The reason we did it in Wabush, Mr.

Chairman, as the hon. member points out, where the judges are being centralized,

there is no judge going to be in Labrador West for the next little while. A

couple up there want to get married and for their own reasons they want a civil

ceremony. We could have sent a judge in at a cost of $1,200, or whatever it

costs to send one into Labrador West, and maybe, next week have to do the same

thing all over again, so we said, here is one case where it makes a lot of sense

to appoint someone.

Now, if we find a similar case in Conche or in

Nain, or if the need arises, the leeway is there and I suggest we will consider

it. I am not saying we are going to make marriage performers, commissioners -

what is it? -

MS. VERGE: Marriage licence issuers.

MR. DECKER: - of every single citizen over

eighteen years of age, but where the need is found, I certainly will be only too

happy to appoint -

MS. VERGE: But why would you wait for people to

come to you? I mean, most people who want to get married ask around and -

MR. DECKER: Well, you know, I could appoint

everyone over eighteen, Mr. Chairman, but somewhere between the extreme of that

and appointing where the need is, I will make the appointment.

MS. VERGE: Sure.

MR. CHAIRMAN: I think the question has been

well answered, and we have been on this long enough.

MR. WALSH: I move the numbers 1.1.01 through

4.5.02.

MR. DUMARESQUE: I second that.

MR. CHAIRMAN: It has been moved and seconded

that subheads 1.1.01 through 4.5.02 be submitted.

MR. HARRIS: Just this one set of numbers?

MR. CHAIRMAN: Which number are you speaking to

now?

MR. DUMARESQUE: First to last.

MR. WALSH: I am moving the Estimates.

MR. HARRIS: We'll do them all. I (inaudible)

specific one, Mr. Chairman, if the question is going to be allowed or whether

the Liberals don't want to have any further questions asked.

MR. CHAIRMAN: Well, I think you have had a fair

amount of time; we have had four hours and twenty minutes and lots of leeway

where you could have asked particular questions, you digressed and that is the

thing about it. If the Committee chooses to give you leeway to ask a particular

question, sobeit. If they want it to be passed inclusive from 1.1.01 through

4.5.02 and they have the majority, then it would be done.

MR. HARRIS: If there's a final vote on all the

issues at once instead of discussing the particular subheads and they want to

run the Committee that way as a majority, then they have the power of the

majority, but -

MR. SMALL: Mr. Chairman, I think we spent more

than half-an-hour on the Anderson Centre and there was lots of time then that we

could have had.

MR. CHAIRMAN: What is the wish of the

Committee?

MS. VERGE: I would like to speak to this. I

have been participating in these committees for thirteen years, ten as a

Minister, and we have always taken as much time as all members of each committee

wanted. I can remember, as Minister of Education, coming before the Committee

for ten or twelve hours of questioning. This department has the largest budget

of all the government departments, over $800 million, and I think we should

allow Mr. Harris as much time as he needs to finish his questioning.

MR. CHAIRMAN: Well, you said we would go to

8:30, so that is ten minutes, and you have it both ways, you know.

MS. VERGE: It is not 8:30 now.

MR. CHAIRMAN: I said there are ten more minutes

to 8:30.

MS. VERGE: Well, instead of wrangling over time

and procedure, let us let the Member for St. John's East ask his questions.

MR. HARRIS: I have a lot of questions.

MR. WALSH: Do I have an understanding I was not

aware of, that the Chair and Vice-Chair said, at 8:30 we are going to be doing

that anyway? If that is the case, that is fine because we have another group

with whom we are going to be meeting tonight and that will be good for an

hour-and-a-half or maybe two hours. So, if, unbeknownst to me, the Chair and the

Vice-Chair have talked about an 8:30 time limit, if Mr. Harris has a couple of

questions that he can get in by 8:30, I will leave my motion on the floor, but

will allow him to ask those couple of questions and at 8:30 we will then move

the numbers.

MR. HARRIS: I am not aware of any understanding

and I don't know what your understanding is. As it happens, my own questions are

very few; I just have a couple of questions to clue up something that I was

asking, but I do resent, as the Vice-Chair says, the idea that we are able to

ask questions at the leave of the majority of this Committee.

MR. WALSH: Well, to that, I will take that -

MS. VERGE: Let him ask his questions and get it

over with and then we will get out of here.

MR. WALSH: I will accept that as a point of

order, with one understanding; and speaking to his point of order, for four

hours, which, if we were to take equal time, would have turned into about nine

or ten hours, this side of the Committee have agreed to allow free-flow

questioning from the Opposition members. I don't know if Hansard will show us

with much more than one or two questions, most times for clarification. So, in

actual fact, if we had taken our own equal time we would be here for ten hours

or more. We have relinquished our time and given it to the hon. members on the

other side of the House. Even though it has been four hours, if you were to

compute that through we have probably punched in ten hours.

I say, by all means, ask your few questions, and

then we are moving the numbers.

MR. CHAIRMAN: Mr. Harris.

MR. HARRIS: Thanks very much. I recognize that

the hon. members opposite have been -

MR. DUMARESQUE: Ask your questions now, unless

you want to get into partisan debate.

MR. HARRIS: Does the member have a point of

order, Mr. Chairman? I was recognizing the generosity of members opposite in

leaving all the time to the Opposition members, and I wanted to thank them for

it. But if the hon. the Member for Eagle River wants to interrupt, sobeit.

My follow-up question on the cost of drugs relates

again to the issue of marketing. I haven't seen any recent estimates, but I

know, a couple of years ago, when Bill C-22 was being debated - the federal

government seems to have slipped another act by most people recently to extend

the generic drug option or to foreclose a generic drug option for another six

years - a statistic was released that the drug companies spend approximately

$20,000 per doctor to market their drugs through that individual. It seems to me

that that cost is obviously passed on to the public through the cost of drugs to

individuals or the cost of drugs to government.

I wonder: Has the department ever looked at somehow

or other trying to control that type of expenditure? We do know that the drug

companies spend an awful lot of money in that area of marketing, quite often

sponsoring conferences, and not only conferences but social gatherings or other

types of affairs, to bring doctors, at no cost to them but at great expense to

the drug companies, together to promote their drugs. Has the department ever

looked at ways of influencing that or does it see that as something beyond its

control altogether and left entirely to the medical associations to control?

MR. DECKER: Mr. Chairman, that is not under

provincial jurisdiction, but there is a national drug board of which Mr. White

is a member. If you would like to talk about that, Mr. White.

MR. WHITE: Well, the whole issue of, I suppose,

the marketing development and promotion of drugs is an international issue and a

national issue. I think on the provincial level it would be pretty difficult to

regulate how drug companies promote and market their products. I think it would

have to be done on a national basis.

MR. DECKER: Canada, I think, is 2 -

MR. WHITE: I understand that Canada is about 2

per cent of the world market, that is for drugs.

MR. DECKER: That is Canada?

MR. WHITE: And Newfoundland is probably around

the same proportion of Canadian consumption of drugs.

MR. DECKER: Two per cent of that, too.

MR. WHITE: I don't know what levers a province

could take that would be able to effectively come to grips with the concern you

are raising here.

MR. DECKER: We don't have a lot of levers.

MR. HARRIS: Then there is the relationship

between the drug companies and the doctors, that kind of money, the marketing,

that angle, not international advertising.

MR. DECKER: I am not sure.

MR. HARRIS: No province regulates that? Is this

what you are saying?

MR. DECKER: I am not sure I can substantiate

that $20,000 figure. I know there is some promotion, I know there are some free

samples, but I am not sure of the $20,000 figure per doctor. Are you, Dr.

Williams, familiar with that?

DR. WILLIAMS: I guess what you are probably

saying is that you are looking at the drug companies' major expenditure, which,

instead of in research, is in advertising and promotion. That is their major

expenditure, if you look at any multi-national drug company, I guess, if you

look at their books.

MR. HARRIS: No, I am talking about at the

physician level. I know that they -

MR. DECKER: You are not saying a physician

receives $20,000, are you?

MR. HARRIS: No, I am saying that per physician

in terms of the effort that is spent in promoting to that individual's

physician, not by advertising in a magazine, but promoting -

MR. DECKER: Sure. It is related to the number

of physicians or you could relate to the number of Newfoundland dogs. You could

say it is $50,000 per Newfoundland dog or you could say it is ten cents per

Chinese. You know, there are different ways to equate -

MR. HARRIS: So what the minister is saying is

that you don't intend to have anything to do with trying to regulate that.

MR. DECKER: But you have equated it with

doctors, and you gave the impression that every doctor gets $20,000 for a drug.

That is just playing around with words.

MR. HARRIS: It is not my statistic, Mr.

Minister.

MR. DECKER: It is just a matter of what you

equate it to, but I would not want to give the impression that every doctor in

this Province is receiving $20,000 for every new drug that a drug company puts

on the market. That is just playing with words.

MR. HARRIS: So the Province, then, has no

interest in attempting in any way to regulate the relationship between the

doctors and the drug companies?

MR. DECKER: Mr. Chairman, as Mr. White pointed

out, Canada represents 2 per cent of the international drug market. Newfoundland

represents 2 per cent of the Canadian drug market. I suppose we could stop

buying drugs from the manufacturers.

MR. HARRIS: So is the minister saying that he

is not at all concerned about the amount of money spent by the drug companies in

promoting directly to individual physicians in this Province these new and

expensive drugs?

MR. DECKER: No, Mr. Chairman.

MR. HARRIS: No. Thank you.

Last year, Mr. Minister, I asked questions about

The Midwifery Act, and was asking whether the minister was looking at forms of

health care delivery involving licensed midwives as an option available to

people. At the time, the minister, by his response, indicated that we were

trying to get away from that; that was not something he wanted to see promoted.

I noticed last September in a series of articles in

The Evening Telegram that the minister's views may have changed in that respect,

and I welcome that. May I ask the minister what steps the government may be

taking to consider perhaps using The Midwifery Act to licence midwife

practitioners and to encourage the continuation of a midwifery program that had

been offered at The School of Nursing, but because of, I suppose, lack of

response by the government in licensing midwife practitioners, interest has

waned in it. Can the minister tell us what changes are taking place in this?

MR. DECKER: Mr. Chairman, I have to address the

first part of the accusation. I am being quoted as having no interest in

midwifery and wanting to get away from it. I am not sure if that quote is taken

out of context or not. I think I might have talked about when I grew up and

nurses did all the deliveries, and that was not ideal.

I also said, I think, to the media that we would

look at a pilot project of midwifery in the Province. We obviously didn't fund

it.

I should point out that on the Northern Peninsula

and in Labrador, the role of the midwife is very important. However, it has been

accepted as a policy of the Department of Health, and with advice from The

Association of Registered Nurses, that generally, where the midwife or GPs

practice deliveries, we would like to have the obstetrician within shouting

distance sort of thing, and I think that has to do with the quality of the care.

Now, these are some general terms, and maybe Mrs.

Dawe would want to add to that. That comes under her jurisdiction.

MS. DAWE: Thank you, Mr. Minister.

We have already referred that matter to The

Provincial Perinatal Committee, to develop terms of reference to look at a study

which would consider the potential and implications of introducing midwifery

into the program, and that is currently under discussion.

MR. CHAIRMAN: Thank you very much.

It is now 8:30 p.m. We had agreed with the

Vice-Chair that we would have equal time for Justice. Could we, then, have the

subheadings?

On motion, 1.1.01 through 4.5.02, carried.

MR. CHAIRMAN: I want to thank the minister and

his officials for coming back and doing a thorough analysis of the questions

that were being asked. Minister, you have been very diligent and we appreciate

the effort of you and your officials. On behalf of Committee members, I would

like to thank you.

MR. DECKER: I want to thank you, Sir, for the

way in which your Committee treated the people from the department. I want to

say, after spending four years in Opposition, that I am really amazed at the

scope the Opposition was given. I sat in this very building and was shut up by -

in Opposition, one night they were inebriated, and I have had to say in the

House that they were inebriated with their zeal because I couldn't say liquor.

And it is a credit to this Committee, the way it allows the Opposition to carry

on its affairs. It is too bad they cannot be a little bit relevant to the

subheads, but we have to live with that, of course.

MS. VERGE: What a nasty individual!

AN HON. MEMBER: You are just getting your

(inaudible) back.

SOME HON. MEMBERS: Hear, hear!

MR. CHAIRMAN: We now welcome the acting

minister and his officials, and we will begin the questioning. I understand

there have already been what - three hours?

AN HON. MEMBER: Well, about that.

MR. CHAIRMAN: Okay. We will, as we did before,

give the Vice-Chair ten or fifteen minutes and then we will go on from there.

MR. HARRIS: (Inaudible) three hours?

MR. CHAIRMAN: No, no.

MR. HARRIS: (Inaudible) these committees and we

are only entitled to a certain amount of time?

MR. CHAIRMAN: Well, we were of the

understanding, and the Vice-Chair informally said to me -

MS. VERGE: I'm only one member. I wasn't

speaking for any other member.

MR. CHAIRMAN: I know that, but it is the

consensus of the group that we should be out of here within the 10:00 range, an

hour-and-a-half on each one. That was, I think, informally suggested between us.

I was hoping that we could get out before that, probably within the next ten or

fifteen minutes. We will see as time goes.

Anyway, we will allow the Vice-Chair to begin.

MS. VERGE: Thank you. I would like to welcome

the acting minister. Some time in our first meeting was taken up discussing the

inappropriateness of the unelected minister -

AN HON. MEMBER: Let's hope we go through this

rather quickly this time.

MS. VERGE: - being before the Committee

(inaudible) an elected minister.

Anyway, I have half-a-dozen topics here I would

like to ask about. I will start with law reform because the acting minister, as

the Government House Leader, would be in charge of the government's legislative

program. The Law Reform Commission, which the government is disbanding, did a

considerable amount of extremely high-quality work, making detailed

recommendations for law reform. Their reports on limitations of actions and

mechanics liens haven't yet been implemented. I know those reports were

completed just before the government changed and I am wondering what happened to

those recommendations. Is the government intending to act on them and bring

before us bills with revised limitations of actions and mechanics lien laws?

MR. BAKER: Yes, I don't know the exact position

that is in now. Perhaps Ms. Spracklin could respond.

MS. SPRACKLIN: The Limitations Act is in pretty

close to final form, I think, for some final decision-making. The mechanics lien

legislation, I think it was felt, should be part of a more complete regime, and

I'm not aware that is as far advanced at this point. However, I would point out

that Chris Curran, who was with the Law Reform Commission, has been brought into

the department to stay on as a policy initiatives person, if I can put it that

way.

MS. VERGE: Good.

MS. SPRACKLIN: It would be directed and

preserved for that role, and we hope to carry on with most of their projects and

see them to completion, including, I might say, the health care initiative that

they were involved in.

MS. VERGE: Good. What about a new personal

property security act? It has been recognized as a need for quite a while. Is

there any effort being put into that?

MS. SPRACKLIN: Not at the moment, in all

honesty, but it is something that, again, Mr. Curran will be directed to fairly

shortly, I would anticipate.

MS. VERGE: What was the rationale in disbanding

the Law Reform Commission? The commission itself was made up of volunteers,

lawyers and judges who served without - I am going to say without any

remuneration. I think there was a per diem available although, from what I

recall, for an extensive period of time the commissioners didn't claim per

diems. At any rate, it was a group of very knowledgeable, able people who

provided a valuable advisory service to the government at minimal cost. What was

the rationale in disbanding the Law Reform Commission?

MR. BAKER: I guess the rationale comes from the

overall approach that was taken. We were in the situation where we were forced

to look for all kinds of ways to save $20,000 here, $100,000 there and so on,

and there were a number of these things that were done throughout government. As

a part of the whole approach, The Law Reform Commission was one of the things we

decided to abolish. The savings are minimal. There is not a lot of money in the

greater scheme of things in terms of the $3 billion Budget, but it was one of

the many small things that were cut. That is not to say that at some time in the

future you can't have a law reform commission again. That is not to say that you

can't still use the volunteers that are still there to give advice in terms of

the reform of the law of the Province, because you can still go ahead and do

that. We do have one individual who is dedicated to carrying on that kind of

work within the department. There are very minimal savings, you are right, and

it was part of the larger scheme of things.

MS. VERGE: Well, I would urge the government to

reconstitute the Law Reform Commission. I am glad to hear that Chris Curran, who

has been the Executive Director of The Law Reform Commission, will be employed

by the government. He has done just excellent work that has been praised by

people involved in the law, literally all over the world.

Now, I will switch to asking about the crimes

compensation program. It was a great disappointment for me to see the government

cancel the whole crimes compensation program. I appreciate the problem created

for the provincial government with the federal government withdrawing funding,

and I condemn the federal government for that; but, from the beginning it was a

cost-shared program, meaning the Province did fund part of the cost all along.

Why couldn't the Province, or why didn't the Province at least continue to fund

some kind of program?

The Province of Nova Scotia, which would have

similar financial pressures to our government, opted, instead of cancelling the

works, to continue a program which would provide awards for counselling and for

reimbursement of people's out-of-pocket expenses. They have discontinued

providing awards for pain and suffering, but they are continuing to provide

awards to repay people for out-of-pocket expenses for ambulances, for

prescription drugs, for counselling, for transportation to counselling or

medical services, or for loss of income from time missed from work due to

criminal injuries. Why didn't our government continue at least some kind of

program?

MR. BAKER: Well, that is a rather involved

answer, I suppose. First of all, I could start off by saying that it is a matter

of money. I don't deny that a need exists in our society to help people who need

help. I don't deny that, but I would point out to you that there is no way

government can provide every need for every individual in our society. That

would be impossible. So there is a need that exists. We don't have unlimited

funds; as a matter of fact, the squeeze comes on every year more and more and

more. In this particular instance, like we had budgeted last year for federal

revenue of $300,000 or something at the beginning of the year. Of course, then,

that disappeared and all of a sudden the Province had to pick up the extra cost

last year. So there was no federal revenue. It was just an instance where costs

seemingly were mushrooming. We are in the mode, at this point in time, and I

hope it doesn't last too long, where we cannot allow that to happen. So I guess

some hard decisions were taken, and the decisions basically were that what money

we had available we would put into assisting people through the process, and I

don't know if we have enough money in there for that, even; but there's an

amount of money in there to assist people through the process.

As we agreed to carry on with the requests that

were in, therefore a large chunk of that million dollars you see in there this

year is for cases already in progress.

MS. VERGE: Applications that were in the system

before the Budget?

MR. BAKER: Yes. Now what happens next year, we

decided to cut off at a certain point, and then the question becomes: What

happens next year? How much money will be available? I hope there will be more

available under Victims Services then to do a little more (inaudible).

MS. VERGE: I hope the minister appreciates that

the Victims Services Program - that's head 4.2.06 - which the government is

pointing to as the substitute or the replacement for Crimes Compensation -

MR. BAKER: It's only a part of it.

MS. VERGE: - that exists only in four urban

centres: St. John's, Gander, Corner Brook and Happy Valley - Goose Bay - in each

of those four urban locations there is one worker, and in St. John's there is a

provincial supervisor. Each of the workers is attempting to cover only a small

radius. For example, the worker in Corner Brook is attempting to cover only the

Corner Brook - Bay of Islands - Humber Valley - Deer Lake area, that small part

of Western Newfoundland.

In the meantime, there are literally hundreds of

victims of personal injury crimes - child sexual assault, for example - on the

Port au Port Peninsula, in Stephenville, Stephenville Crossing. We have heard

about some recent cases through the news media. They don't have access to the

victim court worker in Corner Brook.

MR. BAKER: Yes. The answer is that, of course,

we will try to expand the court services, or the services through that court

trial period, to as much of the Province as we possibly can. But again, I will

go back to the first part of the answer, when I indicated that a need is there.

There are a lot of needs there, and at a certain point in time, I guess, if you

don't have the money, you have to make decisions. One of the decisions was that

we couldn't carry on the Crimes Compensation. I regret that, as I know you do. I

guess you could argue that perhaps there is money spent in other ways that is

better spent here and so on, and we could get into that kind of argument.

MS. VERGE: Speaking of which, have you looked

at closing the adult correction centre in Bishop's Falls or Clarenville in terms

of cutting costs? The minister was talking about the difficulty of making the

right choices, and with the pressure that is on the government, trying to make

the best choices to meet the gravest needs. I am asking, in terms of an option

for cost reduction, if the government has looked at closing the adult correction

centre in Bishop's Falls or in Clarenville?

MR. BAKER: Yes, this is one of the things you

could look at. However, the courts keep sentencing people. There is a pressure

on us now to try to somehow make more space available like that, you know. We

are overcrowded in the prison system.

MS. VERGE: Could we have statistics?

MR. BAKER: You know, there are these pressures.

I don't know what the answer is, to be honest with you. Some people would say

better preventative programs and all this kind of thing. I don't know if that is

the answer or not, and what do you do in the meantime? It is one heck of a

problem, no doubt about it. Should we be responsible for compensating for

crimes? If we had the money (inaudible) the money. But we have a real problem

with the prisons, too.

MS. VERGE: Could you tell us about the problems

with prisons? At our last meeting, I think it was the Member for St. John's East

who asked questions about current prison populations. We have in the Province

something like - what is it - five or six correctional centres? They are in St.

John's, Clarenville, Bishop's Falls, two in Stephenville and Happy Valley, six

correctional centres. What is the occupancy rate for each of them?

MR. BAKER: I think we are probably 10 per cent

overcrowded.

MR. EDWARD KENT: We have 350 authorized cells

or places, and we have averaged 400 people occupying those for the last six

months. We are using mattresses on the floors, in some cases, to accommodate

people.

MS. VERGE: Are all the spaces in the men's

centre in Stephenville currently in use?

MR. KENT: Currently, you have a capacity in

Stephenville for fifty and we have seventy occupancy.

MS. VERGE: Okay. What about Bishop's Falls and

Clarenville?

MR. KENT: Both of those are at thirty-three and

their occupancy is over forty - forty-three, forty-four.

MS. VERGE: So there has been a dramatic

increase in prison population, hasn't there? Why is that? Can you give us a

profile of that population? What are they in for?

MR. KENT: The sentence length has increased by

about a week and there is a greater level of activity with more cases in the

court system. Perhaps we are also catching up a bit on the backlog of cases in

the system so a lot of them are going through. Whether that is a short-term

thing is debatable but we feel we are going to have a 10 or 15 per cent under

capacity for the foreseeable future.

MS. VERGE: Could you give us a profile of what

they are in for? How many are in for inability to pay fines or debts, how many

are in for crimes against a person, and how many for crimes against property?

MR. KENT: For fine defaults, 17 per cent are

in, on average. There were 447 people admitted during the year for fine defaults

which represents 17 per cent of the total people admitted. I don't have the

information in front of me with respect to crimes against property or people,

but we can get that.

MR. CHAIRMAN: Mr. Harris.

MR. HARRIS: Just for accuracy, Mr. Kent. The

447 who are 17 per cent of the total population, you call them admissions, the

total people incarcerated, in which year would that be?

MR. KENT: That would be for 1991-1992 - 447.

MR. HARRIS: That is the 1991-1992 fiscal year?

MR. KENT: That is the fiscal year. Yes, 17 per

cent.

MR. HARRIS: Can you tell us the average length

of stay of those 447?

MR. KENT: I think the average length of stay

for all inmates is thirty to forty days.

MR. HARRIS: It strikes me that that may not be

consistent for overall. If that is the overall average then that may not be

consistent for the fine defaults.

MR. KENT: No, it is probably lower.

MR. HARRIS: I would think it would be lower. Is

that statistic available or can someone get it at some point?

MR. KENT: Yes.

MS. SPRACKLIN: So you want the average length

of stay?

MR. HARRIS: The average length of stay for the

fine defaulters.

I am going to ask one question. I think I should,

just as a comment, echo the Vice-Chair's concern about the Law Reform

Commission. I, too, am delighted that the full-time researcher has been retained

to the service of government. As the minister said, it can be re-activated as a

law reform commission and I think it is particularly of concern in this Province

where there is no law school. There are no academic lawyers who are contributing

to the body of knowledge or critique of our provincial laws and, of course, as a

provincial jurisdiction we have a responsibility to give some thought and

comparison to other jurisdictions and innovate for ourselves; that is just as a

comment. I would like to see it back and although the individual who is

full-time -

MR. KENT: I guess it would take a lawyer to

fully appreciate that.

MR. HARRIS: It may be.

MR. KENT: It is not something that is generally

appreciated in the Province - it would take a lawyer to appreciate it.

MR. HARRIS: I think that is correct which is

why I am making the statement - because, as a lawyer, you are aware of that. If

you are in a province which has a law school there are all sorts of papers being

written and presented, presentations are being made, people are speaking at

gatherings, people are writing briefs for governments and to governments on

changes in the law that might be needed or desirable, and rationales for things

such as - crimes compensation, I suppose, is a good example. In that area again

the rationale for crimes compensation, for example, is not just another need in

the community. The rationale for the promotion of crimes compensation is that

there is a public responsibility. Just as the public takes responsibility to

arrest, incarcerate, and pay the cost of rehabilitation of a criminal, the

public takes a certain responsibility to assist the victims. Once again, I think

the legislation is still in place for crimes compensation, and I take it that

even thought no applications are being accepted now, there is a possibility for

a modified program to be re-instituted as an alternative to the full - well, the

full program is there now, with the payment suffering awards. Is that under

consideration or could it be under consideration by the department as a way of

delivering the ability of the individuals to pursue or buy services perhaps,

with a more limited budget?

MS. SPRACKLIN: Mr. Harris, no, that is not

under active consideration per se in the form of which you speak. I don't think,

though, that there is any reluctance to admit in the department, that there is a

need to deliver counselling, the question is how; and it was not being

effectively delivered to people by paying them money in their hand two or three

years after - well, actually, many years after their offence, but two or three

years, sometimes, after the conviction.

We tried a couple of projects, one of which you may

have been familiar with this year, which was to deliver services - to purchase

services for group counselling, individual and group, actually, and to actually

sort of contract with service providers, that is one model. Other models will be

looked at. Funding community groups and training them is another model that is

being looked at. There is no intention to withdraw, I don't think, from

providing counselling, although there is some lag time; had the federal

government I think hung in a bit longer, we would not have had this hiatus. But,

you know, we had hoped to get the Victims Services program up an running before

discontinuing, or moving away from crimes compensation.

So, to answer your question, we are looking at

various models, but I think that compensation, trying to deliver counselling

monies through a board, trying to hear claims all over the Island is not an

effective way. I was looking at the statistics from a crimes compensation board

and they showed, for example, in blended awards, that would mean awards that had

a component of periodic payment, only $4,180 in 1991-1992. You can see that

there wasn't as much being done - it was very important that people had got it,

but it wasn't effectively getting counselling services to the people who need

it, and I think there are more effective ways of doing that.

MR. HARRIS: I think it is fair to say, and I

can say from my own minimal experience, that individuals who have received

awards - I mean, there is difficulty finding someone to deliver the counselling

even if the money is available to them, or if the Crimes Compensation Board has

agreed to pay for counselling; at least, in this Province it is difficult to

find them. But my sense was that that was a growing thing and that individuals,

knowing there are people who can afford to pay for that process, that kind of

service becomes more available. And I think we have, in the St. John's area at

least, the beginnings of a counselling community that could deliver some

services.

MS. SPRACKLIN: Well, that may continue if there

is funding. It doesn't have to be delivered through giving it to individuals to

purchase it. These groups may well contract. The other thing is that when you

have very scattered population as we have, and that sort of thing, you might

create enough demand in a place like St. John's but it is not going to work in

the rural areas, for sure, and it's a very expensive delivery mode and not

timely enough.

Now, having said that, you know, nobody took any

pleasure in discontinuing crimes compensation, least of all me, but when there

are choices to be made and you have to choose which way you are going to deliver

services to victims, you have to start looking at how you can buy the most for

your dollars, I guess.

MR. HARRIS: Thank you. The Hughes Commission,

Mr. Baker, recommended that there was an inadequate number of Crown prosecutors

and I see in the Budget - I am just trying to find the subhead, I had it a

moment ago - under subhead 2.2.01 on page 217, the minimal increase in salaries

under line 01, but a significant increase under professional service, line 05

from what was budgeted last year, a slight decrease in what was spent last year.

I take it that is the Crown agency work out of the department?

AN HON. MEMBER: Yes.

MR. HARRIS: Is it expected to continue, the

same level of expenditures for two years in a row rather than hire Crown

prosecutors in other areas?

MR. BAKER: Yes. Obviously, if you have the

proper number of Crown prosecutors, then that cost goes way down because you are

not contracting out to lawyers.

MR. HARRIS: You are not paying hourly fees.

MR. BAKER: Actually you should be able to

provide more service, I guess, more cheaply, if you have enough Crown

prosecutors.

MR. HARRIS: So the question is: Why are we

continuing, then? In 1991-92 we spent $1 million in professional services and we

are spending $900,000; is there -

MR. BAKER: That had to be put in there. The

plan was, if I remember, during the budget process, and the explanation given to

us was that they wanted to increase the number of Crown prosecutors, but an

amount had to be put in there in case they couldn't get the people to do the

job. So there is an amount of $900,000 in there which, again, is fairly close to

what we spent last year. Hopefully, with the increase in the number of Crown

prosecutors, then that money can be shifted to regular salary money to provide

more service with it than we did last year.

MR. HARRIS: So there may, in fact, be less than

$2.9 million spent on prosecutions, if that goes through. How many new

prosecutors are you hiring?

MR. BAKER: We have hired what? Seven? Five?

Seven now?

MS. SPRACKLIN: We have two vacancies left. We

have managed to hire and fill all but two of the old vacancies. We have created

five new positions and we are recruiting presently for those. Recruitment is not

always easy, particularly when you get away from major centres.

MR. HARRIS: Those five new positions, are they

in St. John's or are they -

MS. SPRACKLIN: They are in St. John's.

MR. HARRIS: So there are five new positions in

St. John's?

MS. SPRACKLIN: I shouldn't be so quick on that.

AN HON. MEMBER: The new ones are allocated in

other centres.

MS. SPRACKLIN: Jack, I am not sure about that

right off the top of my head. I am going to have to try to find that in here,

and I don't know if it's in here.

There are some for St. John's, I think. We have, I

think, Goose Bay and Gander. My problem is, I am not sure which are the new ones

and which were old positions. Pardon?

AN HON. MEMBER: Stephenville.

MS. SPRACKLIN: Stephenville?

MR. HARRIS: I know there is a Crown agent very

active in Stephenville.

AN HON. MEMBER: Dave Mills.

MR. HARRIS: Dave Mills.

MS. SPRACKLIN: Yes, Dave Mills.

MR. HARRIS: Dave Mills is doing a lot of agency

work.

MS. SPRACKLIN: Well, we have been trying to

recruit for there for a long time, and obviously, there is no incentive for him

to apply.

MR. HARRIS: No.

MS. SPRACKLIN: But we have been unsuccessful up

until now.

I can provide you with the information as to where

those positions are. To be honest with you, I cannot recall off the top of my

head exactly for which centres they were.

MR. HARRIS: Okay.

Line 6, Mr. Baker, Purchased Services there is

almost as high as Professional Services. I have no idea what that is. Perhaps an

explanation can be provided as to what is included in that subhead.

MR. BAKER: There must have been $780,000 or

$781,000 budgeted and over a million was spent.

MR. HARRIS: A million was spent and they are

going to spend another $895,000.

MR. BAKER: These are witness expenses I quoted

in there. They were just higher than expected and assuming that we can stay

within budget this year.

MR. HARRIS: So that is like travel for

witnesses and expert witnesses, perhaps, as well?

AN HON. MEMBER: Both.

MR. BAKER: Would experts be in that, too?

AN HON. MEMBER: Yes.

MR. HARRIS: The government is spending $475,000

on forensic pathology services - it is a slight increase from last year - of

which there is $97,000 for Professional Services.

It has been suggested from time to time, and a

number of times, in fact, over the years, that the Province ought to institute a

medical examiner position. It is often explained by the individual who seems to

know more about it than anybody else that this would provide two services: one,

there would be an office that could establish procedures to be followed in the

case of sudden death, and also have some forensic value, in that there are

established procedures as to what police or other actions should take place,

whereby perhaps the procedure for whether or not there ought to be a judicial

inquiry, for example, that discretion will be in the hands of a forensic officer

as opposed to a decision being made by the minister or by the director of public

prosecutions, sometimes taking months to decide.

What consideration has the government given to

that, and why would they not adopt that type of approach, rather than as it is

now with our kind of antiquated system, leaving it as a decision for the

discretion of a legal officer, as opposed to a properly trained forensic

pathologist operating from a medical examiner's office?

MR. BAKER: I think, if I remember the

legislation, it is not really at the discretion of a legal officer, is it? For

instance, if there is a death that is - and the conditions are laid out in the

legislation, then an inquiry follows. It seems to me, that is pretty

specifically laid out, isn't it? It's not the Department of Justice that makes

that kind of decision, is it?

AN HON. MEMBER: Colin Flynn.

MR. BAKER: In the first instance.

MS. SPRACKLIN: (Inaudible).

MR. HARRIS: The DPP, I believe, makes that

decision.

MS. SPRACKLIN: In practice, the DPP makes the

decision.

AN HON. MEMBER: Based on the police report.

MR. HARRIS: I think the practice - Ms. Verge

just reminded me of it, but I recall in a recent incident, in fact, that the

DPP, in practise, makes the decision or the recommendation to the minister,

which is almost invariably followed, but not until after the police report comes

in - after an autopsy, after a police report, after an investigation. It seems

to me that an awful lot of time is wasted.

I've had, over the years, a number of families

quite concerned about that. In fact, I recall one family who wanted to have a

judicial inquiry, insisted on a judicial inquiry. I wrote a number of letters on

the family's behalf to ask for a judicial inquiry. Lo and behold, six months

later I found out that they held a judicial inquiry, didn't advise me, didn't

advise the family, didn't advise anybody, and the judicial inquiry was over. The

family wasn't participating in it, didn't get a chance to ensure that the death

had been properly investigated. This is an unusual occurrence, I should think -

we would hope. This happened three or four years ago.

AN HON. MEMBER: It was four years ago.

MR. HARRIS: It was four years ago? More than

three years ago, perhaps.

AN HON. MEMBER: (Inaudible).

MR. HARRIS: I will take it up with the former

minister after the hearing. In fact, the judge who held the judicial inquiry

recently attempted to get himself elected in Mount Pearl.

MR. BAKER: Yes, but that would be the problem

with the judge, wouldn't it?

MR. HARRIS: I don't know if it's a problem with

the judge.

MR. BAKER: The judge doing the inquiry would

decide who to contact, who to call, who to talk to.

MS. SPRACKLIN: There is consideration being

given to a medical examiner system. We are reviewing that and I don't think it

has been rejected, by any means. It just has not been fully considered at this

point.

MR. HARRIS: So it's not being actively

considered at the moment but it is something the department is looking at?

MS. SPRACKLIN: Yes, actively.

MR. CHAIRMAN: Ms. Verge.

MS. VERGE: I would like to come back to the

penitentiary/adult correctional centre problem. There were problems before, but

with the increase in occupancy, I would think the problems are greater. When I

say 'problems' I am thinking about suicide attempts, about violence, which

occasionally erupts, about the over-prescription of drugs, about the lack of

programming, the lack of meaningful activity for the inmates while they are

incarcerated.

I understand, an inmate at the penitentiary in St.

John's attempted suicide the other night. I just happened to hear about that

today. I wonder if the minister or the officials could elaborate on the

incidence of suicide attempts in our adult correctional centres, the incidence

of violence, and talk about whether there are greater difficulties and what

strategies there are to deal with this sort of thing.

MR. BAKER: Yes, they can deal with the

specifics in a moment. I would just like to comment on the problem. It is a

problem. As a matter of fact, very recently I had a discussion with the real

Minister of Justice -

MS. VERGE: You mean this is not the real

minister?

MR. BAKER: - and we agreed that we would have

further discussions on it in terms of what to do next year. We are going to go

down and see for ourselves what the situation is. Obviously, as there is more

overcrowding, there is more difficulty in giving programs, no doubt about that.

And I guess the conditions change - I mean, the security conditions change

within the institution. It is something that the real minister is concerned

about, and that we have had discussions on. But I will let the officials attempt

to answer about the suicides and the incidence of violence, and so on.

Obviously, there is going to be some.

MS. SPRACKLIN: I don't have statistics with me,

and I don't have the kind of memory, frankly, for that, but I can say that we

have one of the best if not the best record in Canada with respect to suicides.

I think there was one successful suicide at the penitentiary ever, and that is a

remarkable record in the context of Canadian penal institutions. Having said

that doesn't minimize the fact that there are incidence of attempts, some of

them more serious than others. I don't have the statistics. I don't know if Mr.

Kent has them with him, but we can provi