HEALTH

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Mr. Chairperson (Marcel Laurendeau): Will the Committee of Supply please come to order. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health. We are on item 1.(b)(2).

Would the minister's staff please enter the Chamber at this time.

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, the minister has been encouraging me to perhaps re-ask the question that preceded us in Question Period, so the minister can attempt to answer the question with respect to his own Estimates and the figures in his own Estimates.

Just to update the minister, if the minister were to review last year's Estimates book, the minister would note that compared to this year, by the department's own Estimates and by the department's own figure, there are 173 fewer personal care home beds scheduled to be occupied.

My question, of course, to the Premier (Mr. Filmon) and the minister is why this is the case, why this year there are fewer beds. Despite the fact that the government has indicated that they are closing acute care beds and building more personal care home beds in order to offset the closure of acute care beds and to expand community service, not retract community service, how is it that there are 173 fewer personal care home beds this year than there is last year?

Hon. James McCrae (Minister of Health): Mr. Chairperson, I appreciate the opportunity the honourable member is giving me. Just as I speak, Ms. Murphy is preparing for me a complete rundown on the increase in personal care home spaces, which the numbers referred to by the honourable member, as I will explain in a moment or two, do not reflect. There is, as I said, a massive increase in personal care home spaces in Manitoba.

In the meantime, in answer to one commitment I have made, I want to share with honourable members a map which sets out the northern and rural health regions, which include the Churchill Health Association, Burntwood, Norman, Parkland, Marquette, South Westman, Central, Interlake, North Eastman and South Eastman.

In each of those 10 regions, ultimately there will be formed 10 regional councils, which has been the subject of so much work by so many people over the last couple of years, and the work will continue. I would ask that I could pass this information to those honourable members.

The honourable member's question today dealing with personal care home spaces reflects some numbers that appear in last year's supplementary information to the Estimates process and comparison with this year's. What it shows is a number of personal care home spaces as recorded in the documents last year versus the number of personal care home spaces as recorded this year.

Last year's listing, as I will explain in a few moments, includes--I better explain it in a few moments, because I am still compiling the information.

Mr. Chairperson, the number in last year's listing included 160 personal care home beds, which were at that time under construction and not yet open. They are planned to be open in this fiscal year. That is 100 beds at the Betel Home and 60 at the Lions Manor.

The honourable member's question also did not take account of the fact that 240 beds opened at River East, two centres with 120 beds each. It does not take into account additional beds in Ste. Rose, I believe it is.

What the honourable member is doing is taking a snapshot at a given point in time, but in overall terms, we have constructed hundreds and hundreds of personal care home beds additional to what we had previously. Basically, for every personal care home bed, a health care job is also created. That needs to be stated as well.

Mr. Chomiak: Mr. Chairperson, the minister indicated that a hundred additional beds were created at Betel Home and 60 other beds were created somewhere else and 200 other beds were created somewhere else. Yet in sum total for the year, the minister's briefing Estimates book says there will be 173 fewer beds this year than last year. That begs the question, which beds have been closed and where have they been closed? Quite clearly, more beds have been closed than have been opened since last year.

Mr. McCrae: I think the reason for the confusion, Mr. Chairperson, is that in the 1994-95 listing it shows 9,077 beds in approximately 123 personal care homes. That number included the Betel Home for a hundred beds and included Lions Manor for 60 which were not open. They were under construction at the time--new personal care home beds under construction. For whatever reasons, construction delays or whatever, they did not get the beds into operation in time for that snapshot picture to be taken.

I think the main point that the honourable member is trying to make is that somehow you can spend all of these hundreds of millions of dollars on capital construction and put all these hundreds of personal care home beds, and somehow you can take this snapshot picture, which I acknowledge does not reflect the situation that the honourable member is pointing out, and make some kind of a case, but the facts do not justify the point the honourable member tries to make.

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Mr. Chomiak: With all due respect to the minister, I do not think the minister's facts quite justify the point that he is trying to make.

The fact is, construction delays or no construction delays, the effect of the 160 some-odd beds in place last year can only impact on this year if there were less beds constructed or open this year or somehow those 160 beds that were supposedly constructed last year did not open up. But the fact is there are still 173 fewer beds, which begs the question, where have the beds been closed?

Mr. McCrae: What I am trying to get the honourable member to understand is that last year's number of 9,077 was an inflated number, because the beds were under construction and not yet open due to circumstances beyond the control of the writer of the Supplementary Estimates information. But those beds will be open, because they have been under construction and remain under construction and will be open.

The honourable member asks about closed beds, and the honourable member and I were involved together in the issue related to the Kiwanis Courts and the resolution of the problem that we had there with some older hostel-type personal care home beds. We worked very carefully with the community to resolve that problem in a way that worked for the concerned residents of St. James as well as the Kiwanis Clubs involved with the project.

In fact, the honourable member for Sturgeon Creek (Mr. McAlpine) received a very nice thank-you card signed by--it must have been a hundred or more--concerned citizens of St. James for his efforts in helping to resolve that problem. But in total terms, I regret if the honourable member has been misled by the numbers, because they in fact do show an inflated number.

I cannot explain that in any other way except the way I have, to say that those beds were under construction and were included in a list of beds open which were not open.

Mr. Chomiak: I can understand that perhaps there was an inflated number and they were beds that were under construction to be opened and were not opened. I can accept that, which brings a total of 9,077. The question is then, why do we have less beds this year?

Mr. McCrae: I think, if the honourable member takes the 9,077 beds and accepts my acknowledgement that it included 160 beds that were not yet in service but under construction--I am going to get my pen out, and the honourable member can work this through with me. interjection] Now he is down to the point here. So we take 9,077, and then we take from that 160 beds and subtract 160 from 9,077--my arithmetic is no better than the member's. That is 8,917 beds. Pardon my arithmetic. So that is the real picture.

Now I am told by staff that in future we will ensure that these numbers reflect--if you went out and counted each and every bed, that is what you would have on the day that it is reported in our Supplementary Information. So those 160 beds, what it does is creates an inflated number for last year, and then, if you look at this year, now we are going to have to deal with this year's number, 8,904, which is recorded in there. That does not take into account 20 new beds going into Beausejour, East-Gate Lodge, does not take into account 30 new beds under construction in Fisher Branch, Manitoba, in a personal care home there. Now I know that there is construction going on in Killarney and various other places where either replacements, sometimes replacements, there are fewer replacements for closed beds, but those amount to small adjustments which would account for nothing more than a dozen or so beds.

We should also remember to look at the capital planning of the department to get more accurate figures. I am sorry to say to the honourable member that these numbers appear incorrect, and no doubt would have been a good reason leading to his question today. It does not reflect what the honourable member is trying to put across, that there is somehow a major reduction in personal care development in Manitoba because quite the reverse is the case.

Mr. Chomiak: I do not want to belabour this point because I think the point has been made. I just want to again indicate to the minister that he indicates last year there was an inflation of 160 beds because they were not actually occupied. Presumably those 160 beds are occupied this year, because they are still not under--

Mr. McCrae: They are under construction.

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Mr. Chomiak: They are still under construction. So the minister is saying 160 beds that were last year under construction are still under construction, so they were reflected in last year's statistics but they are not reflected in this year's statistics. Can the minister therefore explain, does the 30 and 20 beds that he was talking about just recently include the 160 that were under construction last year in the inflated statistics but are outside of this year's statistics?

Mr. McCrae: No, and that is the trouble here, Mr. Chairperson. The 160 beds that I referred to refers to the Betel Home in Winnipeg, the Lions Manor in Winnipeg, but does not include the Beausejour beds and the Fisher Branch beds and others that are under construction.

Mr. Chomiak: So the statistics this year do not include beds under construction, but the statistics last year included the beds under construction, do I get that correctly?

Mr. McCrae: That is correct, and the department, when it compiled the numbers last year, had expected that the construction would be complete, and it did not turn out that way which I hope explains the discrepancy in the numbers.

Ms. Marianne Cerilli (Radisson): I appreciate the chance to participate in the Health Estimates and raise a few questions of concern to my constituency. I am going to begin by talking about a situation that I have discussed at length numerous times in this House, and that is the situation in west Transcona for residents that have suffered the accumulated impact of a contaminated site, the former Domtar site which is in the Lakeside Meadows area, and I have a letter that I was preparing to send to the Minister of Health trying to initiate a community health study for this area. I would first of all like to have the minister clarify what is the procedure for initiating a community health study done by the provincial government and involving any other bodies in the province of Manitoba.

Mr. McCrae: Mr. Chairman, I wonder if the honourable member will be available in about 15 or 20 minutes when our assistant deputy responsible for that area would be here to assist us with these deliberations. If so, then we could discuss it then. If not, I could answer the honourable member's question when I see her in the Estimates again.

Ms. Cerilli: I would be pleased to have the question answered when the staff that have more expertise in the area are present.

I would then just like to clarify if the government is open to undertaking this kind of study. I believe that it has been done for a different section of Transcona also affected by an industrial health hazard, and I am quite concerned that there is a higher incidence of asthma, allergies and other respiratory illnesses in this community. I would hope that the health records for the residents in this community could be analyzed to see if there is any higher incidence in any illnesses that could be attributed to the type of ongoing chemical exposure that these residents have been subject to.

Mr. McCrae: As I say, Mr. Chairperson, I will be pleased when Ms. Sue Hicks joins us a little later to discuss this matter further with the honourable member.

Ms. Cerilli: I will move on then to a couple of questions I have about Concordia Hospital which services the East Kildonan, Transcona area. Concordia Hospital is in the boundaries of Radisson, and I have a number of constituents calling me frequently with concerns about changes in programs there.

The first one is in changes to the home IV program. It was, until recently, available through the Concordia Hospital in the emergency department where residents could go there and have IV treatment in their own community. They are now participating in a home IV program where they are having to get materials, medicine, equipment, couriered to them from I believe it is the Health Sciences Centre. They also then have to go all the way to the Health Sciences Centre three times a week to have their IV site changed. They can have VONs coming to their home periodically.

One of my constituents is concerned that this is not saving money, and it is also causing a lot of inconvenience because they can no longer go to their community hospital to have this provided. It is providing problems for some patients if they are having problems with the IV and are not having it looked at frequently enough or taken care of frequently enough. So I guess the big question is can the minister confirm that this is part of the health reform and why this is no longer being offered through Concordia Hospital?

Mr. McCrae: I appreciate having the honourable member raise this topic, because I think it allows us an opportunity to discuss community care services and whether they are adequate or whether they are delivered appropriately, and if they are not then we should do something about it. I am persuaded that intravenous therapy programs do not all have to be delivered in a hospital setting. There are some who agree wholeheartedly with me.

If there is any question about safety, though, in the delivery of a home IV program, I would be very interested in knowing about it, because I think that a proper assessment of any patient would reveal whether an IV therapy program should be administered in a hospital setting or at home. If it can be done at home safely, then I would be supportive of that, because that is in my view an efficient way to do it as long as you can show me that it is being done safely.

People do like the opportunity to be at home as opposed to in a hospital setting, but I hasten to underline my concern that it be done in safe circumstances by the appropriate professionals and so on. I do not know off the top of my head the details of the case the honourable member refers to. It may be that there was a less-than-positive experience in a home-delivered IV therapy service, and I would always be interested in knowing details about that so that we can learn from those things.

I do not claim that all services delivered are always delivered appropriately, and when they are not I need to know about it so we can make appropriate adjustments. I know that the Seven Oaks project with the We Care home health care company led to recommendations for home intravenous therapy services to be delivered more frequently in Winnipeg. I understand that all the hospitals in Winnipeg are looking at the delivery of that type of service in the home. I am told by health professionals that there are a number of services delivered in hospital settings today that could be delivered at home.

We have an advisory committee to oversee the development of a provincial IV therapy program, and that was established back last December. A phasing-in process beginning with Winnipeg has been developed, and the expansion throughout the province is something that I see as a possibility. However, I would want to know the views of those who take a different view and want to know why they feel differently about it. This is the '90s. We are quite capable, I am led to believe, of delivering safe intravenous therapy services in homes. That is a good use of the health care dollars. It also frees up hospital beds for those who could more appropriately be occupying those hospital beds. So, if the honourable member knows of a case where concerns have arisen, I would be happy to review them, unless I have already been advised of the circumstances in writing in which case I could review that.

Ms. Cerilli: Mr. Chairperson, my concern was specifically that a community-based program is being centralized. This person was never using a hospital bed. They were going and visiting emergency. So I can understand that there were higher costs associated with having to go to emergency for this kind of service, but what I am wonder is why is it being centralized? Could the program not be offered in the community hospital so that this person who lives two minutes from Concordia Hospital could go there to get their needle changed for the IV rather than having the expense of having materials couriered back and forth from the Health Sciences Centre? So could we have true community based home services and have it offered through the regional community hospitals?

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Mr. McCrae: What may be missing from the honourable member's equation is the fact that people from far and wide, beyond a two-kilometre radius, use the services of the Concordia Hospital, so that it might be a good argument to make for the resident next door or down the street from the Concordia Hospital, but there are people from other regions of the city that use the Concordia Hospital, from all corners of the city, depending on the physician that is doing the admitting.

Just on the whole point of centralization and decentralization, we are talking about a small city, the city of Winnipeg. For me it is a big city because I come from Brandon and we have always thought of Winnipeg as a big city, but in health planning terms Winnipeg is not a big city. We have seven hospitals operating in this city of Winnipeg of some 600,000, 700,000 people. There are so many things that we do not do very efficiently that we should be addressing. It is not with a view to centralize everything and depersonalize everything, that is not the point. The point is we are operating in isolation, one institution from the other, when we should not be. It does not make sense.

I hear the comment from rural Manitobans. I just a few minutes ago put out the map of how we are regionalizing the province of Manitoba, and all of these regions and the people in them and the institutions in them have to make decisions to make more effective and efficient use of the dollars that they are getting from the Department of Health. They say, when are you going to regionalize the city of Winnipeg, when are you going to make the city of Winnipeg more efficient? It is a reasonable sort of comment to make.

If you describe our seven institutions in Winnipeg as seven totally autonomous institutions, you can build a lot of inefficiencies into the system. The system the honourable member is talking about should be made to work in a user-friendly fashion. I agree with her about that. But to have a system where we operate seven little islands of autonomy does not make sense in a small city like Winnipeg. So I hope that the honourable member can see the reasoning behind what I am trying to say, which is that we need to get the boards and the administrations of all of our hospitals here working together, not unlike they are in the area of shared services, organization that is being put together to deal more efficiently with issues like dietary needs of the various institutions, the laundry needs, the supplies that hospitals buy. Why should we have seven hospitals all negotiating with suppliers separately?

Point of Order

Ms. Cerilli: I would just ask that the minister could keep his questions brief to the specifics of the issue I am raising in the region that I represent.

I am not here to get into a long debate with the minister; I simply want to raise a few local issues. I am not here to debate the larger policy, philosophical issues that I am sure he is having a good debate on with our Health critic. I would just ask if he could quickly answer the questions I am raising briefly please.

Mr. Chairperson: Order, please. The honourable member does not have a point of order. The honourable minister does have 30 minutes in which to respond to any question that is put forward. The honourable minister to complete his answer.

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Mr. McCrae: Mr. Chairperson, I regret if I have rambled a little bit too much. I will try to be a little more pointed in my responses to the questions, but I do want the honourable member to understand the context within which I am answering them. This is not Perry Mason, exactly, and if I very, very directly answer a yes or no to the honourable member's questions, I do not think that properly answers the questions, but I will try to respect her wish for some brevity in my responses.

Ms. Cerilli: A brief, short question then to conclude this topic. When the home IV patients go to the Health Sciences Centre to have their needle site changed, are they going to the Health Sciences Centre emergency department? Are the patients going to the Health Sciences Centre to have their IV site changed in the home IV program? Are they going to the emergency department at the Health Sciences Centre?

Mr. McCrae: Mr. Chairperson, to what extent that happens I do not know. I undertake to attempt to find out, and I will make that answer available to the honourable member.

Ms. Cerilli: Thank you. One of the other issues that I want to raise, changes at Concordia Hospital, has been with the short-stay surgery program. I want to ask the minister and perhaps he would like to provide this information to me as well after deliberations here if it is detailed information.

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I am wanting to know the impact of this program on the level of surgery. What ends up happening is, over the weekend then, there are a number of beds, surgical beds that are closed. There are 27 I believe that are closed over the weekend at Concordia Hospital. I am wondering if this has meant that there are a number of surgical procedures that have their post-operative stay shortened. Basically, I am wanting to know then the levels of surgery done at this hospital as affected by this program or if there are other new changes that have been put in place like shortening the stay after certain procedures that have accounted for that, or if it has meant a reduction in the amount of surgery done at this hospital?

Mr. McCrae: We will ascertain from the Concordia Hospital a response for the member and pass it on to her. Certainly we know that the number of surgeries being done in Manitoba is on the rise, not on the decline. The incidence of not-for-admission surgery is on the rise. In fact, there has been a complete turnabout in some places. I know in one hospital in Winnipeg, it used to be that two-thirds of all of its surgery was inpatient surgery. It is now two-thirds outpatient. So the nature of health care is changing. Technological change is making that possible, and it is appropriate because some people require longer stays and we have to have the capacity in our hospitals for longer-stay patients. We will do that analysis though and report to the honourable member.

Ms. Cerilli: One of the other issues at Concordia Hospital that I have asked questions about before in the House is the use of the CAT scan. I am wondering if we can have a clarification of the process for determining the use of this CAT scan which was purchased through the fundraising of the Concordia Hospital Foundation, and they were then seeking ongoing operating costs to be paid for through the Department of Health. Has any decision been made, and if not then where are we in the process to make that decision.

Mr. McCrae: Sometime in July or August I expect a report from our provincial imaging committee. There is quite a history to the whole scanning issue in the city of Winnipeg with respect to not just the hospital referred to by the honourable member but others as well. There is a deep well of good will in Manitoba in our communities and monies have been raised in various places to buy various pieces of equipment. It does cost money to operate the equipment. Sometimes it has not been ascertained, when fund raising is undertaken, as to whether the operation of the equipment will be funded, and this created a bit of a problem in some community hospitals. The Department of Health has authorized, while we wait for that report, the use of the scanners for inpatients and for emergency cases, which allows the scanners to be used. It does prevent the transfer of patients from one hospital to another, that particular policy. But we will await the report from the imaging committee later this year.

Ms. Cerilli: I would look forward to that and hope that there would be then a cost benefit included in that, to see if in the long run these diagnostic tools cannot save health care dollars, even though we know that they can be expensive at the outset.

I want to ask one final question with regard to Concordia Hospital, and that has to do with the new ward that was built and the patients that have been in the new ward awaiting placement in other community care and what the current agreement is with the hospital in terms of having that ward used for its initial intended service, which I believe was rehabilitation.

Mr. McCrae: The reports we have are that the 60 beds transform to I guess the next best thing to personal care beds at Concordia Hospital. It may appear indeed to create the need that the honourable member said for the long-term and chronic use referred to, although I say the use that it is being put to is very important as we await the construction of this huge number of personal care home beds that are being constructed in Manitoba. In the meantime, though, we are embarked on a secondary care review. That is a review that follows on the--the honourable member for Kildonan (Mr. Chomiak) has called it Wade-Bell 2 simply for ease of reference, but it certainly does follow upon the tertiary review that was done with respect to the two big hospitals, at St. Boniface Hospital and Health Sciences Centre, and the secondary care review will, indeed, deal with the appropriate use of those 60 beds in the future in an integrated health system in the city of Winnipeg.

Ms. Cerilli: On to a new topic. I want to ask the minister if, in the view of this government and his department, there is a problem in Manitoba and in Winnipeg with teenage unplanned pregnancy?

Mr. McCrae: Mr. Chairperson, I believe that any unplanned pregnancies amount to a problem for the people who did not plan those pregnancies, and it is a question of degree, I think. I think it is appropriate for all of us to say, yes, that is a problem, and it is something that needs to be addressed, and I look forward to our discussion when Mr. Toews joins us, who is heading up our Youth Secretariat, so that we can deal with issues like that in a multidepartmental way. In other words, look at the whole problem instead of the immediate part of the problem, what causes these things to happen and how is the best way to deal with them.

The issue--I am told by my colleague, the Minister of Family Services (Mrs. Mitchelson), that this is becoming more of an issue instead of less of an issue. So I think that the honourable member might be interested in the discussion that follows with Mr. Toews when he arrives to advise us.

Ms. Cerilli: I will be patient then until Thursday when, I understand, this will be debated or discussed again, and I hope that the government will outline its current policy for preventing unplanned pregnancy, particularly among youth.

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I want to ask, though, if part of the plan and part of the policy of this government will be to look at the effects and effectiveness of preventative health in schools as a way of addressing this problem, and further to that, if the minister is going to track the effects of the loss of health education as a required course in our public school system and on the issue of unplanned pregnancies among young people, if there are any plans to follow up this policy change in the area of preventative health, and if the government has put that in place so we can see what the effects of the government's policy change is on the decision making or the lack of decision making on the part of young Manitobans.

Mr. McCrae: Mr. Chairman, the honourable member's comments clearly indicate ample justification for having at least three departments--Health, Education and Family Services--working together on some of these issues. Her comments also clearly justify the need for the child health strategy document Dr. Postl's group has put together. We really have an opportunity in Manitoba that you might not see elsewhere to address the problems in a way that has far more likelihood of some kind of successful outcome should we follow those recommendations. Key to that is working together as departments but also working together with communities to address problems we all recognize are in need of attention.

Ms. Cerilli: I think the report on children's health that the minister referenced also recommends that health education should be retained as a mandatory course throughout public education, and I would ask the minister to clarify his government's and his department's policy with respect to providing public schools with a required course in health education, and especially, with the intent for this coming September.

Mr. McCrae: I think the honourable member's questions touch, somewhat, on the education blueprint that was part of, and remains part of, the planning for future education of our children in Manitoba, and the Youth Secretariat advises the Education department as well as the Health department. I was pleased to note that during the election campaign that the First Minister announced that more time was going to be allowed for the development of the implementation of the blueprint. I think that helped a lot, certainly in my discussions with community people and teaching professionals. It helped a lot to give teachers some comfort around the whole issue of reform of curriculum and reform of education in Manitoba, so I would be sure to pass on the comments that the honourable member is making to my colleagues when we discuss education and health issues.

Ms. Cerilli: I just want to emphasize, again, especially given that the minister just talked about co-operation between departments in dealing with children and youths' health, that that report did clearly recommend mandatory public health education throughout all public school grades. I hope they would consider seriously that this September we would not see a drastic change, especially as I understand it, there is some review going on, looking at a new physical education curriculum and putting health into that. There are a number of concerns around that, that this September there is going to be a lot of confusion with different schools doing different things, because that physical education curriculum is not going to be ready for this September.

So I think the minister may want to direct the Youth Secretariat and the government to give some attention to that issue that is going to cause a lot of disparity, perhaps in education services for young people throughout the province, and I appreciate that he will take that forward.

The other issue that I wanted to raise in terms of personal care homes and the policy for personal care homes in providing access for residents in personal care homes to visitation and I guess other services from the public, having access to their own mailing privileges, their own mailboxes, and how much of that is done through the management in the personal care home? There are some concerns in the community that people in personal care homes have equal rights in terms of availability with the public as other residents would enjoy.

Mr. McCrae: Mr. Chairperson, Manitoba Health encourages personal care home operators to make the environment of their facilities as home-like as they can, to allow for as much independence as possible under all of the circumstances. Many, if not all of them, have volunteer components that assist in helping raise the level of the quality of life of the residents in our personal care homes.

I think I would like to ask the honourable member if there is something more specific she can raise with us so that we can either respond to it or take it as a suggestion for improvement or some such thing like that. So if the honourable member wants to be more specific with us, we could perhaps be more specific in our response.

Ms. Cerilli: I was just wanting to know if there is a policy from the government that would provide guidance to personal care homes in regulating access through mailing to the residents in a personal care home.

Mr. McCrae: Mr. Chairperson, there are some guidelines that the department asks the personal care homes to follow. We are just kind of speculating over here as to whether the honourable member is talking about protecting residents from perhaps unwelcome entreaties by rip-off artists or that sort of a thing or the whole issue of junk mail and so on. I do not know specifically but we do have some guidelines which we can review and make known to the honourable member, but in terms of being more specific, I am unable to in the light of the nature of the question.

Ms. Cerilli: Just to conclude, I would just require that maybe the policy that the government has could be sent to me. I know there needs to be some balance in a personal care home between having every vacuum cleaner salesman and solicitor going in and knocking on every door, but also we do not want to restrict the freedom and privileges and rights of residents in personal care homes. So that is what I am after, is to get some kind of policy sent to me that would answer some of the questions of my constituents.

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Mr. McCrae: We will go into that part of the manual and share that information with the honourable member. I suppose that in some places it could be a question of interpretation, and it might not be interpreted exactly the same everywhere across the province. But we would be very concerned if residents of personal care homes were subjected to undue and inappropriate sorts of approaches by people whose motives are not the kindest for our residents.

Ms. Cerilli: Just to conclude even further I would just ask--I am going to have to leave the Chamber now, I am unable to continue questions related to the first issue I raised, perhaps we can do that another day--but I also want to just request that when the discussion on teenage pregnancy occurs that there would be some kind of a breakdown provided on the different regions on both the city and the province in terms of the frequency of incidence?

Thank you for the indulgence of the minister and the House.

Mr. Chomiak: The first line of questioning that I wish to pursue is the issue of the foreign doctors. I am wondering if the minister feels it is appropriate I deal with it with the people that he has, the staff now, or on some other occasion.

Thank you, I see nodding in the affirmative. I am going to get very specific on this because I want to clearly understand the issue myself. Part of the reason I am following this line of questioning is that I received a memo from the minister dated February 6, 1995, in response to a memo I had directed to the minister concerning foreign graduates.

The minister took great pains to very accurately--and I know he must have spent many nights up drafting this letter, because it is a very precise letter, and it is very accurate. I am going to use it as the basis of my questioning, because I want to understand the issues, particularly in light of what appeared in the paper yesterday concerning the proposed solutions for foreign doctors and where the difficulties lie and where the next steps might be.

I want to ask the minister first about the conditional register. The conditional register is being proposed to be for five years. I assume from that that it will permit physicians to be registered to practise medicine in the province of Manitoba for a five-year period, and the minister's memo indicates that it replaces the one-year temporary licence that was put in place previously. Have I got that correctly?

Mr. McCrae: Mr. Chairperson, it was really two six-month temporary ones, replaced by this five-year conditional, which means that after the five years, you still have to meet the requirements of the Manitoba College of Physicians and Surgeons, and you must also practise those five years in an underserviced area as directed by the, I guess it is the Physician Resource Committee who will give us the plan.

(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)

Mr. Chomiak: I thank the minister for that response. Now, the two-year internship is still required by those individuals who participate in a conditional registry. They still would be required for two-year internship, or not, or how does that relate to the five-year conditional registry?

Mr. McCrae: The two-year licensure requirement can be waived under this five-year program in the appropriate circumstances, waived in favour of the one-year licensure. That is seen to be a transitionary measure because the move from a one-year requirement to a two-year requirement creates transitional problems, we have learned. That waiver may not always be necessary in every case, but it is there if it is necessary.

Mr. Chomiak: I could only hope. Yesterday's newspaper report and the minister's letter to me of February 6 indicated that the college had reviewed the qualifications of 10 of the international medical graduates in Manitoba and found that only two were eligible for the conditional register. This is reflected in yesterday's paper as well as the letter that the minister sent to me in February. Can the minister indicate what criteria those individuals do not satisfy that does not allow them to, therefore, fall under the umbrella of the conditional registry?

Mr. McCrae: Well, I am glad the member asked because sometimes you get incorrect reporting in the newspapers. This happens and it happens because newspapers operate on a day-to-day basis and have to meet deadlines and get their stories in and very often are wrong which is the case here.

It is true that two initially were identified, but there are six who meet the requirements. There are five who are being viewed as being favourable prospects, five more. That makes 11, not two. I can understand why the honourable member would refer to that two. As I say to him all the time and to my friends, do not believe everything you read in the papers because you could go off in some direction that is not necessarily always right.

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With respect to the rationale and so on, we will request of the College of Physicians and Surgeons to correspond directly with the honourable member to answer that question. Their criteria are theirs. They developed them as an organization, they are given a legal mandate to do those things. I do not know the answer to the question, the college does. The college, we will ask them if they would correspond directly with the honourable member to answer his question. Maybe he will give me a copy so I can know that too.

Mr. Chomiak: I thank the minister for that response, I look forward to that. I believe it is probably related to educational requirements that do not meet college standards.

Yesterday's press report also indicated the conditional registry would exempt South African doctors from the two-year internship, but not foreign-trained doctors. I think that is probably inaccurate. [interjection] Yes, in the minister's first response to the first question he indicated it was broad and that it would apply to everyone.

If I look at the presentation made by the association of foreign medical graduates in Manitoba, in their presentation to the Physician Resource Committee, I think they recommended a five-year conditional registry which is being put in place. They indicated an agreement to commit themselves to practise for specific periods of time, but somehow, pending my receiving information from the college, there is still the question of the educational standards which seems to exclude a number of individuals. I still have a sense that there is something that we are missing in this.

Even if we accept the college's--I will receive information from the college indicating what the education requirements are. If the two-year internship can be waived, if there is a five-year conditional registry, it seems to me that the majority of the 50 or 60 foreign medical graduates ought to be able, given the demand in rural Manitoba, to almost immediately start up practice, but I know that is in fact not the case. I am just wondering where the impediments are to movement in that area?

Mr. McCrae: What it comes right down to, according to my advice and understanding, Mr. Chairperson, is not something the IMGs, the immigrant medical graduates, really want to hear, but it is a fact according to the Manitoba College of Physicians and Surgeons. It is that in the countries they identified--those being Great Britain, Ireland, Australia, New Zealand, South Africa, United States--it is felt that the standards of training and education in their medical schools resemble Canadian standards or come to a level high enough to be satisfactory to Canadian regulatory authorities, including Manitoba regulatory authorities at the College of Physicians and Surgeons, and that the standards in the remainder fall below that.

So that is why the IMGs, the Immigrant Medical Graduates referred to by the honourable member, the ones that did not make the list, were trained in medical schools whose standards fall far below a level which is acceptable to them as a college. Now we can go behind that, I suppose. I think that is what we are doing by asking the college to report to us on just what it is, in more detail, that you expect of these graduates, that you seem to be satisfied with from Canadian and commonwealth and U.S. graduates but not from these others.

There have been those who have wanted to make the point or allege that this had to do with a bias. I do not know if anybody said racial bias, but bias. I said if there is any of that, that would be a matter of some concern to me because that is not the way Manitoba works, and that is not my understanding of the way Canada works. Do not forget we are talking about a Canadian regulatory agency. I forget the name of it but it is Canadian College, I guess it is called, then there are our own Manitoba requirements.

You see, we do not just make our rules in isolation from everybody else. I think other provinces have similar requirements. There is good reason, as the honourable member would recognize, that you want to, as a legal practitioner who went through all the motions of becoming a lawyer, all the study you had to go through and the tests you had to pass, I think it is probably reasonable for me as a consumer of legal services to want to know that the person who is going to provide those things to me has been properly graded or tested or whatever by the Law Society of Manitoba, the law school, and so on.

I, as a Health minister, have met with the foreign medical graduates and have lots of sympathy for their point. I would like the college, the department and everybody to be as open as possible, especially at a time when we have requirements in rural Manitoba, open with these graduates in the sense of giving them a proper chance to qualify. But if they do not qualify, they do not qualify. Let us, at the end of the day, at least come to grips with that, that that may exist in some of these cases. Nobody wants to be unfair but we have a cap on the number of practitioners that are allowed to practise in our province, and we have shortages in some rural and remote areas that need to be addressed. It is with that backdrop that we are dealing with a very, very important issue of physician resources. I am glad that we have six who qualify and five more who may yet do so in a reasonable period of time. That, to me, is encouraging.

Now, somebody might say, well, there are 76 of them, so what is encouraging about 11? Well, what is encouraging is that it was not 11 not very long ago, it was zero. So we are making some progress, but I certainly have met with the representatives of these graduates and can understand how they feel, having gone to a fair amount of trouble in their lives to become educated in medicine, but that does not mean they meet the Manitoba standards, which we have to insist on in the interests of proper care for our fellow Manitobans.

I think I will stop at that point. I was going to say something else, but I think when the honourable member asks his next question, what I was going to say may come forward in my mind.

Mr. Chomiak: Can the minister clarify for me whether or not it is a question of their credentials in the form of their former training, or it is a question of them having to pass an exam?

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In other words, are the ones who fall in the excluded list now, are they precluded from participating in a conditional registry because of their training, or will they have an opportunity to pass the qualifying exams in order to allow them to take part in a conditional registry? In other words, is it as a result of their training or as a result of their having to pass an exam, because if it is as a result of their training, then they are in serious trouble, because that means they will have to receive further training or additional training, and that is very difficult. But if it is a question of passing an exam, that is a much easier, I think, opportunity for some of them to demonstrate their skills. Is it a question of their previous training or the fact that they have to pass qualifying exams?

Mr. McCrae: We are going to ask that direct question of the college and get a response, rather than try to speculate on what it is. We are going to get a direct response from the college.

Mr. Chomiak: Just wanting to continue along with the same line, we had this sort of discussion yesterday or the day before. What we did not enter into was the discussion with other credentials that are brought to the province, in particular, through nursing professions.

I quite often, for example, will hear of individuals who have practised nursing in other countries. They come to the province of Manitoba, and they are not able to continue that practice along. I am wondering if the minister can indicate if there are any committees that are out there that are looking at this particular problem.

Mr. McCrae: Mr. Chairperson, as I am able to make good on some of my commitments, I would like to do it. I will be brief in doing so, and then I will get on to the answer to the present question.

The honourable member for Inkster asked about revenue estimates reflecting reduction of established programs financing. Established programs financing, the Estimates of Revenue for the four-year period 1992-93 to 1995-96 are as follows: 1992-93, $424,700,000; 1993-94, $436,000,000; 1994-95, $420,000,000; 1995-96, $416,000,000. This is a complex issue because federal transfers are based both on tax points and cash payments. To ensure that this issue is clearly understood, I suggest that further questions be directed to my learned colleague the Minister of Finance (Mr. Stefanson), in whose department this responsibility lies.

Mr. Chairperson, with respect to the honourable member's question, I think it is directed that ascertaining the kind of input we get from the nursing profession per se into issues related to nursing education, would I be correct in--[interjection] Immigrant credentials of nursing. Immigrant credentials of nursing are credentials of nursing generally; you have to get licensed by the Manitoba Association of Registered Nurses. So some of the comments that we might have made respecting the College of Physicians and Surgeons, respecting credentials of nurses from out of province or from outside our country would be in the purview of MARN. I believe it is safe to say that the standards set by MARN are the same standards as other nursing regulatory agencies across the country. I think I am correct in saying that the standard of nursing education is the same across our country, so when I said out of province, I meant outside Canada.

Mr. Kevin Lamoureux (Inkster): This is in fact an issue that comes up quite often with me with respect to nursing as a profession, and the question that I had asked the minister was, do we have or does the minister have, out of all the health care committees that have been established, a group that is looking at this particular issue?

I understand that it is MARN, or the Association of Registered Nurses that is ultimately responsible for certification, if you like, but I am wondering if the minister could give some sort of indication whether or not we have something in place to review, to look at those who come from foreign lands to Canada and acknowledging the credentials that they might be bringing with them.

Mr. McCrae: Mr. Chairperson, we do not in Manitoba have a committee or a subcommittee of MARN that we are aware of that deals with the issue raised by the honourable member. However, we will undertake to find out whether the Canadian Nurses' Association has such a subcommittee or authority which is part of its mandate to deal with the credentials of foreign nurses.

Mr. Lamoureux: I would ask the minister, and to the minister's staff, if you will, are they aware of the situation, and to what extent would they be aware of it?

I give you a specific example and that might be the best way of going about it. Whether it is, let us say, from the West Indies or from the Philippines, a nurse can be practising in a hospital scenario, at least this is what I have been led to believe. They come to the province of Manitoba where their credentials and their background are not given the recognition that allows them to continue on in the profession. I have been even told further that in many cases they can go to numerous American states and go right into a working atmosphere of a hospital, of a mental institution, a hospital setting, if you like.

This is something that comes up at least for me in particular when I am talking to immigrant groups, and I am wondering if the department is aware of this as an issue, or has it been brought to their attention in any fashion?

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Mr. McCrae: I invite the honourable member to make direct contact with the Manitoba Association of Registered Nurses to make sure that anything we say, or I tell the honourable member today, he could have confirmed, or otherwise, by the MARN which is the recognized legal legislatively sanctioned organization for this purpose. I guess maybe in some places you can walk into a hospital and get a job as a registered nurse. You cannot do that in Manitoba. You have to--nor should you. You have to be registered by the Manitoba Association of Registered Nurses.

There are some nurses who come from offshore who may not be able to meet the requirements of the MARN, and they might take employment as a nurses' aide or some other type of work in the health system, or you can, subject to what the MARN might tell the honourable member, as I say, challenge the--how do you put that? Challenge exam, take an exam to show your proficiency, and if that comes out appropriately then you would be registered by the MARN. But I would urge the honourable member, maybe through his research people, to get this information from, or on his own, the MARN. If he needs my assistance, I will help.

Mr. Lamoureux: Maybe what I can, because we do have somewhat of a limited research capability nowadays, but what I will do is attempt to get a couple of individuals that can maybe get in touch with the minister's office with this particular issue. We see it when the member for Kildonan (Mr. Chomiak) is referring to the doctors just prior to me standing up. It became an issue because there is a shortage of doctors in rural Manitoba. I would imagine, if what I have been told is true and I have no reason to believe that it is not, but if there was a drastic shortage of nurses and a very high demand for nursing in rural Manitoba that then might raise the issue a bit more.

I do not know why it is, maybe we have not had the thorough debate on this particular issue. It would be better to have some facts on the table. I appreciate the minister has indicated that he is, in fact, going to look into the matter. I will do what I can in terms of providing a couple of names, if at all possible, to him just so that he can have that follow-up.

Mr. McCrae: Let us close this topic with one more thing. We are fortunate in Manitoba that in January of '94, we appointed Dr. Carolyn Park as our provincial nursing advisor, and I really have to say that since that happened, our relationship with the nursing profession, as a government, I believe has improved quite significantly. We have made a lot of efforts to work closely with the nursing profession to take account of their concerns as we reform our health care system, and I think that much good progress has been made.

I just wanted to say that Dr. Carolyn Park could also be available to the honourable member or his colleagues, and if he wants the telephone number, I can make that available: 945-6782.

Mr. Chomiak: The minister made an announcement yesterday concerning the nutritional compound known as Lorenzo's Oil, and I asked of the minister yesterday, and I am repeating it today, whether any consideration is being given towards dealing with this issue of experimental and new drugs in a more comprehensive fashion, rather than a case-by-case basis, recognizing that it is a problem, not just in this jurisdiction, but in all jurisdictions.

But, quite clearly, some kind of mechanism is going to have to be put into place in order to deal with these kinds of drugs. The specific drug that I am using as an example, and I have corresponded with the minister on it, is betaseron. It is the drug that deals with MS patients which, as I understand it, may or may not have a certificate of compliance from the federal government.

I do not want to get necessarily into the specific issue of this particular drug, but yesterday's announcement concerning Lorenzo's Oil only seems to me to be indicative of a problem that is going to become increasingly a problem, and there is going to have to be some kind of mechanism to deal with the issue, because clearly, the Life Saving Drug Program does not capture all of the drugs that are out there that increasingly are coming on line to deal with many illnesses. I wonder what the departmental response to that might be.

Mr. McCrae: I appreciate the point being raised by the honourable member. The honourable member knows that from time to time our Pharmacare eligibility list gets changed, too. That reflects the fact that a committee of people who are professionals and specialists make determinations about various pharmaceutical products, about some that maybe have outlived their usefulness. Another way of putting it is something better has come along that it could be replaced with so they get removed from the formulary and we have a debate about that when that happens. In fact, one year I recall, not that many years ago, we added 66, took off four and got into serious trouble because we took four off the list. That is the way the debate goes.

However, the Lorenzo's Oil discussion has an important distinction and the honourable member said it in his comments, that this product is not a drug so therefore does not really come under the certificate of compliance provisions in the same way that pharmaceutical products do. Lorenzo's Oil is a nutritional supplement. I do not think the honourable member disagrees with what we did but he does raise a question that has occurred to me, obviously, but this substance is not a drug and so therefore I do not think we can engage in a useful comparison of this product with a pharmaceutical product.

There is a process in the United States and in Canada for compliance, and there are issues related to safety and issues related to effectiveness and issues related to liability for governments, I suggest, that want to insure the cost of some of these products. So I thought about it pretty carefully with respect to the kind of precedent that might be set, and I felt that the precedent might be more in the way of a perceptual problem as opposed to a real one, because we are faced with some pretty strong evidence that Lorenzo's Oil is going to do what its proponents say it is going to do, whereas in the case of other pharmaceutical products very much the jury is out and requires further testing and study and monitoring and so on.

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So I hope that addresses what the honourable member has said. I know that every time governments do something that is deemed to be in the best interests of a particular group in the population, you run the risk of hearing from other groups, as well, but I think there are distinctions here that help us make our case with regard to Lorenzo's Oil.

Mr. Chomiak: I probably will return to this item when we get under the specific appropriation and deal with some detail with drugs, but I will let the general issue suffice at that.

I have a specific constituency-related issue that I wanted to raise. It is a general question, and the minister may have to get back to me on the specifics. I do not have the individual's name per se, but I will outline the fact situation. The individual is suffering from quite a severe allergy and allergic reactions and is having a great deal of difficulty getting on with her life and has trouble sleeping, has trouble working, has trouble basically existing and has been referred to an allergist but cannot see the allergist until the third week of August.

To be frank, I have never had the particular issue brought to my attention before concerning allergists, but I am wondering why an individual would have to wait that long in those circumstances to see a specialist of that kind. Is that unusual? Is there a shortage of allergists in this area? Is it a question of the individual going to the wrong doctor, referred to the wrong allergist? Does the minister have any idea, roughly, what the situation might be in regard to a fact situation like that?

Mr. McCrae: Mr. Chairperson, I am advised that there is not felt to be a shortage of allergists. The length--this is a busier time, of course, for people's allergies--but if this is a serious matter, the general practitioner involved, and I cannot say this for sure, may not have made the case with allergist in terms of getting an earlier appointment. Here, again, if, off the record, the honourable member would like to share with us the name of the patient, we can track this--and the allergist--and see if there is any way we can assist.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that response, and I will try to forward the particulars to the minister, and I appreciate the offer of assistance in that regard.

I have been debating whether or not to go down this line of questioning or whether I would do it at some other appropriation, but insofar as I see who is available from the minister's staff, I think that I perhaps will pursue the line of questioning, and it has to deal with hospital funding for this year. The minister had indicated last week, during Estimates, what the budgetary shortfall, if I could put it in those terms, cutbacks, the budgetary difference between the last fiscal year and this fiscal year was going to be to the urban hospitals. I wonder if the minister might give me a list of what the shortfall would be for each hospital as a result of the 1995-96 budget year.

Mr. McCrae: Mr. Chairperson, we operate our relationship with the hospital facilities as a year-in, year-out, ongoing sort of relationship between us as a department and the administrations and boards of those hospitals. For the most part I can claim to enjoy a co-operative and productive working relationship with the various institutions.

In terms of hospital funding we are--the Minister of Finance made an announcement last winter, November, that there were going to be so many dollars available for the acute sector of the urban hospitals and personal care homes, community health centres. Since the honourable member raised the issues related to the budget at Seven Oaks recently, I have been doing some work in this area.

The trouble with these budgets--and it is troublesome. It is troublesome for the honourable member, it is troublesome for me. To understand how they work is not even as simple as the problem with the PCHs earlier today. That was not that simple and it turned out to be pretty good. When you take a hospital's bottom-line number, it is composed of a budget, and then there are all these other things. There is what they call commitments, what they call capital requirements and various things that go into the making of a budget. It would be simple for me if I could say after the year was over, last year such and such a hospital received these many dollars from the government, and this year, if everything goes the way we hope it will go throughout the course of the fiscal year, this particular hospital will receive so many dollars, either more or less or whatever it is.

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Even that kind of a statement, what does it show? What does it show to me as a Health minister who is concerned about care for patients? I am more interested, actually, in knowing how many people got well at the hospital. I am interested in statistics like how long was the average stay at the hospital this year? Was it shorter than last year? I sure hope so because we certainly have the technology to justify that particular approach on average, always on average because there are exceptions always.

I am not really clear what the honourable member is asking except he is wanting to get a handle himself on what are these budgets of these hospitals. My question is, if we knew what the budgets were, would we be any the wiser? We are going to end up having a discussion like we had earlier today about personal care homes, which I have taken my share of the blame for. The numbers were misleading with regard to last year's numbers. Within those numbers, was a number for personal care home beds not yet in service. That kind of thing can probably be said about--and I have looked at all the columns of numbers and what they all mean for a hospital. It appears to mean one thing until it is explained to you that, no, it really does not mean that at all. It means something else.

I have seen lots of things like balance sheets and financial reports in my career here and before. You can get a bit of a sense from looking at those things, but the numbers that I have seen, I am sorry to say, for my untrained eye, lead me, without adequate advice, to make the wrong conclusions, just like the honourable member has been known to do from time to time. For whatever reason, I am sure he has the same problem as I do in terms of trying to understand what all these numbers mean. So that is why it is not a simple thing for me to produce a document like the Supplementary Estimates package information with regard to the specific financial circumstances of each of the hospitals. Some of them run deficits, not very much anymore. Some run surpluses, and then what happens to those surpluses?

This is one of the more complicated aspects of the running of the Health department, is keeping track because then, if, for example, you want to operate a pilot project at a hospital, does the money that you make available for that pilot project come out of the base funding for the hospital or is it separate and additional to, and if as a result of that project there is a surplus produced, what happens to it? Whose is it? Those are all very interesting questions, but do they really help me understand whether a patient is getting better care or not? What are we talking about? We still have a mentality, unfortunately, that says, you measure the result by how many dollars you have in there. You cannot do that anymore in education; you cannot do that in social welfare. I mean, are we a better province because we spend a million dollars more this year than last year on welfare? Excuse me, that does not sound just right to me. It does not sound just right to me if we spend a little more this year on a hospital if we are not getting value for the money.

I will listen carefully to what the honourable member says and maybe get a feel for precisely what it is he wants to learn here, and I will try to be as open as I can with him in trying to get to the bottom of the question.

Mr. Chomiak: I will indicate two things to the minister. Firstly, I think it is probably time to take a short break for the benefit of everyone concerned, because I can get out all the time, but not everyone can.

The second point is, I am really actually interested in process, and we use Seven Oaks as an example. We know that there have been certain budgetary figures that have been given to Seven Oaks. There have been certain figures that have been circulated around the hospital concerning possible bed closures and possible staff layoffs. There have also been certain indications that these decisions are going to have to go back to the Department of Health or may not have to go back to the Department of Health. I do not understand how the process works. The minister indicated that it was ongoing, but at some point these decisions are final decisions that are made. I am just wondering what the process is for each of the individual hospitals in this regard.

I know that November 22, certain budgetary figures were provided, in fact sooner to the hospitals. Certain decisions are being made at the hospitals. The question is now, at what point are those final decisions made?

Mr. McCrae: I concur with the honourable member about the advisability of having a brief break here. I would like to ask the honourable member to make a note of this, if he would not mind during the break considering agreeing to deal with Healthy Communities, line 21.4(b) tomorrow. That will be Wednesday, June 7. If you would agree to do that, maybe he could indicate that after the break.

I am told that the Annual Report of the Department of Health publishes the bottom-line amount made available to hospitals on an annual basis. It is true, we do not have this year's because that annual report is not out. It is not going to be out for a while.

There are so many variables. I can give the honourable member a number today and six months from now that number might not be accurate anymore. I hesitate to get myself into that kind of position. I think that maybe I will stop there for now.

The Acting Chairperson (Mr. Radcliffe): Is it the will of the committee to recess at this time? The committee shall recess at this time for five minutes.

The committee recessed at 4:37 p.m.

________

After Recess

The committee resumed at 4:50 p.m.

The Acting Chairperson (Mr. Radcliffe): The committee will come to order.

Mr. McCrae: Mr. Chairperson, yesterday, among others, the Leader of the Opposition asked a number of questions we took as notice, and we are able to answer some of them today. Does the honourable member for Kildonan (Mr. Chomiak) advise that I go ahead and put the answers on the record or wait until the Leader of the Opposition might return, or does he have a preference?

Mr. Chomiak: I think probably the best course to follow would be to put the answers on the record, then I could confer with the member to see if he has any further line of questioning as a result of the responses.

Mr. McCrae: Mr. Chairperson, the honourable Leader of the Opposition raised a matter respecting the monitoring of drugs in personal care homes and perhaps some problems associated with that. He mentioned that the concern was raised by a Mr. Victor deCaro and that Mr. deCaro's mother had been a patient at Bethania Personal Care Home, had a drug reaction and unfortunately passed away at the Concordia Hospital.

(Mr. Chairperson in the Chair)

The process in place for personal care homes for drug monitoring is as follows: whenever a new order is written for a resident, it is reviewed by the pharmacist for appropriateness before the prescription is sent to the facility. In addition, all residents' drug therapies are reviewed every three months by the personal care home team, that is, the attending physician, a pharmacist and a nurse.

Manitoba Health, in conjunction with representatives from personal care homes, developed a formulary system which provides guidance for prescribing drugs for the elderly. This formulary is continually updated on a regular basis.

It is recommended by the Department of Health that the honourable Leader of the Opposition or Mr. deCaro write directly to me requesting an investigation of Mr. deCaro's mother's care at Bethania Personal Care Home.

The Leader of the Opposition also raised an issue relating to a patient, again at the Concordia Hospital. There has been a formal complaint lodged by Holly Hrynchyshyn regarding a number of health care issues, the majority of those issues relating or relevant to the Concordia Hospital.

Holly Hrynchyshyn's mother-in-law passed away on March 2 of this year at the Concordia Hospital. Holly Hrynchyshyn addressed a letter to the acting deputy ombudsman, who in turn contacted staff at Manitoba Health. Staff contacted the administrator of the Concordia Hospital, who has investigated the complaints and prepared correspondence for Manitoba Health.

In his letter the administrator stated that Ms. Hrynchyshyn's letter would be forwarded to their hospital standards committee and that Dr. Dirks will extend an opportunity to meet with the family to discuss the situation fully. Dr. Dirks will not be available until June 8 of this year.

A Manitoba Health staff member has contacted Concordia asking that they be invited, the representatives of Concordia be invited, to this meeting. Ms. Hrynchyshyn has been telephoned and informed that Dr. Dirks will be contacting her regarding a meeting and that two staff members from Manitoba Health will be attending the meeting. Ms. Hrynchyshyn expressed agreement that there should be a meeting and she will be taking a family member with her to that meeting.

The honourable member for Kildonan (Mr. Chomiak) asked a question about the Provincial Cancer Control subcommittee on palliative care. The subcommittee on palliative care is a subcommittee of the Provincial Cancer Control Committee. The Provincial Cancer Control Committee is chaired by Dr. Brent Schacter, who is the president and CEO of the Manitoba Cancer Treatment and Research Foundation.

That committee has been charged with the mandate to recommend a plan for cancer control from prevention to palliation for the province of Manitoba. The subcommittee on palliative care has tabled its report at the Provincial Cancer Control Committee. The Provincial Cancer Control Committee is currently in the process of summarizing and incorporating all the subcommittee reports and recommendations into the Provincial Cancer Control Committee overall report. The report and recommendations on the subcommittee on palliative care will be considered within the framework of the larger overall Provincial Cancer Control Committee report when it is submitted.

The honourable member for St. Johns asked a question about special assistive devices, and these are telecommunications devices for speech-impaired people. The honourable member gave details of the specific case of Sister Dufault, and I will tell the honourable member that Pat Charter, a representative of the patients' rights advocacy organization approached myself on behalf of Sister Rolande Dufault requesting reimbursement of 80 percent of the funds needed for Sister Dufault for the purchase of a special device from Manitoba Telephone System that would allow her to communicate clearly by telephone.

Before this request could be processed by Manitoba Health we were informed that an organization had come forward and purchased the device for Sister Dufault. Since then, officials have met with Manitoba Telephone System and have agreed that Manitoba Telephone System would provide services and that Manitoba Health would fund them.

The honourable member for St. Johns inquired about the number of residents in Manitoba that might be affected by this situation. Manitoba Telephone System has indicated that they have six requests a year, and it was felt that 12 would be the maximum annual number.

With respect to the procedure in place now, the policy now in place is to provide funding for telecommunication devices. The necessary amendments will be made to the regulations under The Health Services Insurance Act which would include a $75 deductible and a 20 percent co-payment, to a maximum of $428 per device.

I guess we could just say stay tuned because we keep getting requests for information, and as we have it we will make it available.

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Mr. Chomiak: Mr. Chairperson, I thank the minister for that response. Just continuing on that line of questioning before the break, I wonder if the minister could outline therefore what procedures--we could use Seven Oaks as an example since the minister raised it. What is the status of the budgetary recommendations concerning Seven Oaks at this point, given that we are well into the fiscal year?

Mr. McCrae: Well, let us see, Mr. Chairperson, if I can get this right, and we will use Seven Oaks Hospital for this example.

We are trying to be responsive to the hospitals in Manitoba by giving them whatever information we can, good news or bad news, and to give it to them as early as we can. In this case, this was done in November, 1994 to deal with the fiscal year 1995-96. We gave this information in November of '94 to all the hospitals.

We asked them to prepare detailed budgets based on that information. We asked them also to build into that budget certain stipulations or understandings, for example, in the past, things like Bill 22, or if we do not want to see layoffs, or if we expect to achieve a certain kind of result as a result of collective bargaining, or that sort of thing. So we asked them for budgets based on all of that, but we then asked them also--we review their proposed budgets.

If we, as a department in reviewing those budgets, see them as being appropriate then we ask them for their plan as to how they propose to achieve the budgets that they have laid out, and there is a review of that plan by departmental staff. If there is an approval of that plan for some aspects of the budget, there might be bridge funding required, there would be bridge funding required. In addition to all of that, there are adjustments of one kind or another throughout the year which really, for me, makes this more complicated as we go along.

For example, mid-year there may be a special program that a hospital wants to get going on. Well, they consult our department, we work with them on those types of programs, or there may be something that the department wants to achieve and we make that known somewhere in the middle of the year, so adjustments have to be made throughout the year depending on what circumstances arise.

After the year-end there is a final review of the performance of the previous year's budget, so you have that going on at the same time that you are also going back to the first steps that I referred to because you are into the next year's budget cycle.

That is a very general description of the process that is followed, and it has a lot to do with the relationship that we have with the hospitals. It is that kind of business that we are engaged in throughout the course of the year.

Mr. Chomiak: I thank the minister for that response. It has been helpful.

Just looking at the example of Seven Oaks--and I am going from memory here, so my numbers could be a little bit off but they are relatively close--the situation as I understand it is that the budgetary adjustment from last year, that is, '94-95, requires them to make up an additional $600,000 shortfall from their budgetary allocation last year, and in addition this year they are required to expend $1.6 million less this year, and as a result of that there is a proposal now put forward to deal with how to achieve those targets; that is, the $1.6 million for '95-96 and the $600,000 left over from '94-95 which entails some reallocation of resources, some staff cuts, et cetera. Can the minister indicate how the department at this point therefore interfaces with Seven Oaks concerning those matters?

Mr. McCrae: I am unable to accept the number that the honourable member has placed on the record, so I will not deal with that number. It is not a number that we agree with. I am not sure how best to deal with that issue except to say that, as we proceed year after year in our relationship with the various facilities, there are times when facilities perform better than they had projected. There are times when they do not perform as well as they had projected or as we had hoped, and obviously life goes on. So we have got to find ways to make adjustments to help the facilities through and still do so in a way that we feel we can be fair with the facility in question but also others who might be in a given year performing better or performing worse or whatever happens to be.

Somewhere in the recitation of the process that I referred to, we are there at this time with Seven Oaks Hospital, and we are there to assist them, regardless of what the budget is for a given year, or what it was the year before, or what it is expected to be the next year, to assist those facilities to continue to carry out their function, which is laid out in their missions and their goals and their role statements and all of those things, to get them through each and every fiscal year, providing safe levels of care to our fellow Manitobans. That is done in concert with others.

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We have hospitals seeking accreditation and achieving it, and some of them are getting it for multiyear periods. That is a positive thing. I am told that the longer you get accredited for, the higher your rating in terms of the effectiveness of your facility in the delivery of services to patients. To make a complicated issue a little less complicated, I would say that the relationship is very much an ongoing one which requires constant consultation, us with them and them with us, to get them through their years during times of recession and times of growth and during times of the inability of government to come up with the kinds of dollars that some initially would like to see.

I have noticed that in recent years--I should go right back to the beginning of my own political career in this place. It was an annual thing and the honourable member is still engaging in it, an annual thing that you fight over the budget. When appropriations to hospitals were increasing at double-digit inflation levels, it never failed. I would be involved, Larry Desjardins, or whoever, arguing one side or the other. Hospital administrators would get into the act and make public statements about how it is going to be such a hard year for us to make do. We are only getting 8 or 9 or 10 percent more than we got last year.

Well here we are this year, and we are dealing with slight reductions or holding the line. Is it not interesting the only people making the noises are people like the honourable member for Kildonan (Mr. Chomiak) and the unions. You do not hear hospital boards and administrations--you do not hear me, anyway, like you used to--you do not hear those people wailing and bleating the way we used to do. We have clearly established a different kind of playing field. People understand, Manitobans understand that we are in different times today than in those days when every year was an annual serious fight over budget allocations for hospitals. What that new way of thinking does is it encourages us to work even more cooperatively than we ever have before.

I think, with rare exceptions, what I have said is true. I know that if you asked a hospital CEO off the record, tell me, what is it going to be like, they are going to say it is going to be rough this year, just like every other year. That is what they are going to say. I think it is so indicative of the sense of cooperation that exists between my department and the hospitals. For that I have to offer my thanks and commendations to the people who work for the Department of Health and also to the people who work for the hospitals. That includes their voluntary boards and board chairs because there is a clear recognition everywhere that the playing field is different. The game has changed. We have a job to do, and it is getting hard. There is no question about that.

We are going to work together. There will be a few naysayers out there, but the fact is the people of Manitoba expect us to do more and sometimes to do more with less. It is a tall order; there are those who do not believe it can be done.

During the election campaign, I attended a health debate sponsored by the health unions and the MARN. I also attended another one put on by the Brandon Chamber of Commerce. Because my opponent was a medical doctor and identified health care as the only issue upon which he wanted to campaign, he successfully made our debate into, a large amount of it, into a health care debate. The good part of the debate was that we had good audience participation. There were some union people there and other people as well. The one nurse--I do not know if she was a union nurse or not, I think so--said, and this had to do with Brandon General Hospital: You have asked us to squeeze enough, and I can tell you there is just no more to be squeezed.

I remember feeling disappointed in that observation because I was moved to respond to that by saying, well, I regret that you feel that way because there are all kinds, thousands of nurses in this province who are prepared to continue working with us to get the results that we need for the patients in Manitoba. She did not like that response very much, but I cannot accept it when someone says there is no more that can be done.

We said that during the '70s and '80s when we were putting in more and more and more every year. We just cannot seem to manage; we just cannot manage. We have the best and the brightest in our province running our hospitals and our department. We do make very big demands on those people, and I am happy to report that they have responded, and they have responded effectively. You do not need to take my word for it. Take the word of the Manitoba Centre for Health Policy and Evaluation because that centre has determined that, even though some pretty hard decisions have had to be made thus far, levels of patient care have not suffered as a result.

Honourable members can tell me stories of something that happened in hospital A on such and such date on such and such a ward, and I can agree because I know about those things and they happen in Brandon General Hospital too. Incidents occur. Someone waited too long for a nurse to arrive or--those things have happened. I think that we should remain vigilant every time we hear something like that, that we respond and ask hospitals to be very mindful, but we do not want to see those things happening.

Yet, 30 years ago, I know those same things were happening, 20 years ago those things were happening, and 10 years ago those things were happening. In fact, in 1982 during the election campaign I read an article in the Winnipeg Free Press that spoke of a crisis looming in the hospitals in Winnipeg, and the Manitoba Nurses Union, the president's name was Vera Chernecki, commenting that this was a serious situation and the government had not done anything about it. Well, we all know which government was here in 1982.

In any event, I only mention that because I dare say vested interests are going to continue and those who speak for the vested interests in the Legislature or elsewhere are going to continue to make a case for a set of circumstances that do not exist in the way that they are being put forward.

No one has to tell me that we do not experience difficult circumstances from time to time in our facilities and elsewhere in the system. That includes the Home Care program. I mean, if that were not true, then why would we have put in place an appeal panel to deal with people who disagree with decisions made by the Home Care program. I think it was the right thing to do and, going by the results, we are achieving better care for people. Through the work of the Home Care Advisory committee or council we are achieving better policies and better services in the Home Care program.

So it is nice for us to brag about how well we are doing in these areas, and we will do that from time to time, but for us ever to conclude that there is no room for improvement, that is when we really run into difficulties.

So it is with those ideas in mind that we address the budget of the Seven Oaks Hospital each and every year. We have an excellent working relationship with the staff and management at Seven Oaks General Hospital. The people there are very co-operative in the sense of the direction that we want to take reform in.

The whole idea of the Wellness Institute there is an effort on the part of the people of Seven Oaks to address issues related to the whole person and related to wellness and how to achieve good levels of health promotion and disease prevention and those very, very important issues as we address the next century.

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Mr. Stan Struthers (Dauphin): Mr. Chairperson, I want to express my thanks for allowing me to ask a question on behalf of my constituents in the Dauphin constituency.

I would like to ask the minister some questions about two issues. First of all, mammography, does the government have any, does his department have any plans in which to expand services of a mammography unit into the Dauphin hospital into the Parklands Region?

Mr. McCrae: I have discussed the matter raised by the honourable member for Dauphin (Mr. Struthers) with representatives of the hospital in Dauphin and other matters as well. We are very pleased with the progress that we are making in Manitoba. We have not got so far along that I can directly respond to the honourable member's question today. We want to get the centres in Winnipeg, Brandon and Thompson, the ones that were announced for our breast screening program, up and running. I would like very much to see that happen in the very near future, and beyond that we would want, I hope, to address those kinds of issues in the context of the needs assessments that would need to be done, and also I would think the rural regionalization concept will have a role to play in decisions about things like that in the future.

I do not think Dauphin is calling for a full-fledged centre like the type we are talking about in Brandon or Thompson, although I could be corrected on that as well, but I know they are looking for some capability in Dauphin to provide service to the people there.

I am very impressed with what I know of the Dauphin general hospital from what I have heard from the staff of the department and from what I have seen. When I talked about incidents occurring in hospitals, I really cannot remember being made aware of any in Dauphin unless there is one that escapes my recollection. The honourable member for Dauphin (Mr. Struthers) and his fellow citizens in that area are indeed well served, from my observation, at the Dauphin regional hospital. It is a regional centre, and I appreciate the work that is done there. I have had a chance to talk to some of the staff people as well of community health in the Dauphin area. I think that compared with any other area, not only in Manitoba but anywhere else in Canada and therefore in the world, Dauphin is very well served, and it must be because of the desire of the people there to offer a range of services which might include some form of breast screening there.

We are a little early in the game for us to answer the honourable member definitively, but we are aware of the desire to provide that type of service from that centre.

Mr. Struthers: I thank the minister for information that he has just given me. I am interested in knowing about the needs assessment process. Has that process begun? Is there a time line as to when it will be wrapped up? I am sure he will find through the needs assessment process that there is a need for a mammography service within Dauphin.

Mr. McCrae: Mr. Chairperson, when I referred to needs analysis, I was speaking of a bigger picture. You are talking about a provincial picture. Population health needs and determinates of health, those concepts are the kinds of concepts that are going to play a greater role in driving our system in the future.

I can tell you today, without using any names, of perhaps three or four other centres in Manitoba which would make the same request as the honourable member is making today. Can we, as a society, do that? I know of one in even a smaller centre where demands are being made, not polite requests, as the honourable member is doing today, but outright demands are being made on the system.

As much as I would like to say yes to everybody who comes with a request, those days are over. It is that sort of approach that has got us into so much trouble in the first place, I say with all due respect to those who make polite requests and demands.

In any event, I somehow got distracted. Oh, it is the member for Interlake (Mr. Clif Evans), who did that; he has done that before, and here he goes again, Mr. Chairperson. In any event, we welcome him to this side of the House and should he decide to stay, we will do everything we can to make things comfortable here for him. He will find it so comfortable, next thing you know the member for St. Boniface (Mr. Gaudry) will start entertaining the idea of joining in with the rest of Manitobans and get on the business of running this province.

I will get to the member for Dauphin. The honourable member for Dauphin, though, reflects some of the thinking that I know exists in Dauphin when he makes this proposal to us today. When I am talking about needs assessment, I did not mean it in the context of a sort of a narrow needs assessment. We are now looking at our needs on regional bases and on a provincial basis as well. The breast screening program that we have announced for Winnipeg, Brandon and Thompson is a provincial program. Within the context of a provincial program, I think we need to look at breast screening requirements.

With the program we have announced, I have been told that statistically speaking, we could realistically expect to save as many as 50 lives a year from breast cancer. That is a pretty significant step forward, and when you are the Minister of Health, getting to be the one to make the announcement, you get to feeling pretty good about such a thing. We are saying to women between the ages of 50 and 70 years of age that this sort of programming can save lives. Early detection can be so very important with this particular disease. We have not even got that up and running yet. I ask the honourable member to keep that in mind.

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When I am talking about needs assessment, every chance I get I encourage people to get to know what we mean, to get to know how the Centre for Health Policy and Evaluation works, how population health requirements play a role as opposed to getting into the kind of problems that you can get into if you overbuild, if you overbuild services, if you overbuild buildings. Saskatchewan is a good example of that. We have had, it is true in Manitoba, some overbuilding. We did that, and I am thinking of the reductions at the tertiary centres here in Winnipeg. Obviously, if you are going to close some beds, that means you had too many. When they were built, it was not felt that that was the case. Since that time we have put so much service into the community; it is very significant. With that happening we can make better use of our hospital beds.

I digress a little bit, but I am doing it for a purpose and it is to explain to the honourable member that we are trying to look at our population health needs. I am not trying to say that the people of Dauphin do not need breast screening. Of course, they do. They are going to, for the time being, access the service from Brandon or from--no, it will be from Brandon cause that will be the closest site.

The point of it all is that you cannot have every service at every location. If I were from Dauphin, I think I would be asking the same questions as the honourable member. I say I invite him to put himself in my shoes and to look at the health of our Manitoba population provincially too. Then work Dauphin region into that and the Parkland Region, which Dauphin is going to be an important part of.

I also ask Dauphin health people to be mindful of the way the regionalization process works. There are the people in the Swan River Valley who are part of the Parkland Region. There is not an entirely unanimous agreement about that. On the other hand, the decision had to get made. So I have encouraged the CEO and the board chair at Dauphin to be mindful of that particular sensitivity, and they are. I am satisfied that they are and that they will work very co-operatively with all the other parts of the region.

When you are a big centre like Dauphin, some of the surrounding districts tend to look a little bit--how should I put it? Coming from Brandon, the honourable member will know what I mean, because we in Brandon have to be mindful of the needs and concerns of the people in the surrounding region. I think the honourable member understands the requirement for that.

Mr. Struthers: Mr. Chairperson, I am sure the member for Turtle Mountain (Mr. Tweed) would be able to point out, maybe explain a little further exactly what the minister was talking about in terms of Perimeteritis in Brandon, Perimeteritis in Dauphin, wherever a big centre looks upon smaller communities and the needs of those smaller communities.

The one thing I want to assure the minister is that I will always be polite. When I am requesting things, polite requests are the way I will start out. Even if I am demanding something, I still promise to be polite. There is no worry there. The first time I make a request, it is a request. Maybe I will fall into the same trap as some other members and start demanding, but I will always do it politely.

I have a quick question to end off my questions on mammography; it has to do with what the minister said when talking about a regional basis and a regional assessment. I would encourage him to move forward with that type of an assessment in the Parkland area, including the Swan River area, because there are folks in the Swan River Valley who would also gain by having the mammography services in the Dauphin Regional Health Centre as opposed to moving across a great distance to get this service, as an example, going to Brandon or to Winnipeg.

The Swan valley and the Roblin area and the Dauphin, Parkland area, people going from that area to receive mammography services incur a lot of costs that I think are unfair for them to be picking up travel costs, hotels, lodgings, those kinds of things, which I am sure the minister is aware of, being a rural member himself. I would like to encourage him to move quickly with any kind of assessment that is being done in our Parkland area.

The other issue that I wanted to talk about--I am just going to shift gears here. I want to go back and revisit an issue that I brought up in the House a couple of weeks ago on the Grandview-Gilbert Plains-Roblin doctor shortage. I would like an update on what has happened over the last couple of weeks in terms of this situation, because it is very much a crisis in those centres.

Mr. McCrae: If the honourable member would agree, we could give him a status update tomorrow. Otherwise, I might leave something out if I try to do it today.

Mr. Struthers: I suppose that would be acceptable. I will make an attempt to come back and listen to the answer that the minister has for me.

Just so you would be aware, I am also interested in knowing what kind of recommendations Dr. Moe Lerner has come up with in that area.

Mr. McCrae: That is a problem. Dr. Moe is not available to us today. We can touch bases with Dr. Lerner for tomorrow and have a report for the honourable member. I am sorry, Mr. Chairperson.

Mr. Struthers: The other two areas that I will be looking for answers for are some ideas of where we are going to get doctors from. It is okay to talk about guaranteeing so many doctors to a certain area, but where are we actually going to get them from, and whether your department would be willing to compensate the boards involved at Roblin, Gilbert Plains and Grandview for any of the costs they have incurred in trying to locate doctors for their area, maybe that too can be in your response tomorrow, and I will be here to listen to you then.

Mr. McCrae: I hope that I am not asking the honourable member to change his schedule too much to be here for discussion tomorrow, because I will be better prepared tomorrow to discuss the Grandview, Roblin, Gilbert Plains, Dauphin situation having had a chance to consult Dr. Lerner prior to that discussion.

Mr. Chomiak: Mr. Chairperson, when I last left off with the minister, the minister had indicated that he disagreed with the figures that I had offered up concerning Seven Oaks. I wonder if the minister might correct me, therefore, and indicate where I am inaccurate with regard to the figures that I put on the record concerning Seven Oaks?

Mr. McCrae: Well, in the sense that sometimes it is a question of the honourable member getting the numbers wrong, and on other occasions, it is the incorrect interpretations that he draws from numbers that are correct. So I just have trouble sometimes with the honourable member, as he knows, and I am not telling him anything new here today. He has this, well, from my point of view, annoying habit, maybe others would not be annoyed, but this habit of putting forward a proposition with which the facts do not accord.

I do not know what Beauchesne would say about that, but that is my frustration with the honourable member. I have dealt with it now--how long have you been my critic in Justice and in Health? Quite a long time now.

An Honourable Member: Most of your time.

Mr. McCrae: Most of my time, five and a half years now, Mr. Chairperson, and I have a personal affection for the honourable member, but professionally we have this problem from time to time, like every day. So that is my hesitation and also because the way these numbers work through the course of the method that I talked about earlier on, it is very easy for someone quite innocently to draw some incorrect interpretations.

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The honourable member's figures--I think I know how he will describe them--but there is no secret that we are asking the MHO and the facilities to negotiate for certain levels of remuneration for their staff, and that would work into a hospital's budget to so many thousands or hundreds of thousands of dollars or millions or whatever it happens to be. I will speak generically rather than specifically. There may be a case where a hospital did not make its budget last year and so then is being asked to make an effort to bring itself back to where it should be and at the same time meet the requirements that everybody else has to meet this particular year.

So some combination of those types of considerations go into the numbers for each and every hospital. I think the number was $1.6 million for Brandon General Hospital that was bandied about during the election campaign. I think the honourable member came out. I missed his audience there, his appearance. I had people there to hear what he had to say and his Leader (Mr. Doer) and the member for Brandon East (Mr. Leonard Evans).

Here they were coming out to Brandon, and I guess they were going to get this money from SmartHealth, too, which does not exist.

An Honourable Member: SmartHealth does not exist?

Mr. McCrae: No, money for SmartHealth does not exist, but honourable members opposite spent $100 million or more of it, even though it does not exist. That is why I call them "Doer dollars".

Anyway, the honourable member came out and lent his support to the member for Brandon East in saying we are not going to take that $1.6 million out of Brandon General Hospital's budget. We do not think it is right, and that is our promise and it is all over the place. I think the member for Brandon East's campaign literature is filled up with this--how they are not going to do this.

I could not help but think, well, what are they saying for Seven Oaks? Are they being consistent throughout Manitoba? What are they saying for Grace? What are they saying for Health Sciences Centre? If they can make that promise in Brandon, what are they saying for Concordia? The member for Rossmere (Mr. Toews), I was looking for some help from him, but he does not know exactly what they were saying. [interjection] He tells me they are all over the map.

The point is, maybe the honourable member can answer that question for me since this is an opportunity for us to examine these matters. How can you say we are going to treat Brandon General Hospital different from all the other hospitals in Manitoba? This is what they said because I followed the New Democratic campaign fairly carefully because they were talking about health quite a bit and the Health minister had to be there to respond to various things. I do not remember them saying they were going to cancel all requirements of all the other hospitals. They singled out Brandon General for special treatment.

I appreciate that, mind you, coming from Brandon, but is that fair? Now I put on my minister hat again and say, is that fair across the province of Manitoba? Are the people of Brandon really wanting something that is unfair? Are the people of Brandon really wanting something that places them at an advantageous position over and above their fellow citizens in the rest of the province? No. Brandon people simply want their fair share. They do not want a special deal, which is what it appears was being offered. It is that sort of business that makes it difficult for me to have a reasoned, logical discussion of hospital budgets with the honourable member as much as I would like very much to have that sort of a discussion.

Maybe they--yes, I believe they did. Did they not, in Flin Flon, make a promise not to go ahead with the implementation of the staffing guidelines? They may have done that, I am not sure--or at The Pas. Did they do that in Dauphin? I do not know. Did they do it in Morris? I do not think so. Did they do it in St. Pierre or in the other places where we have facilities of one kind of another, make that promise? That specific promise was strictly for Brandon. I am always trying to get a good deal for Brandon, but a good deal that works fairly with the rest of the province, too.

They never really did explain that. Maybe the honourable member can do that today. While he is doing that, it would be so much more easy for me to understand if the honourable member's figure for Seven Oaks is correct. Let us just say that it is for the sake of argument, and he would want to do for Seven Oaks what he went to Brandon to promise to do in Brandon. Would he use the SmartHealth money to walk away from the requirement that Seven Oaks is presently attempting to meet? If so, how would he do it--because when I say Doer dollars, Doer dollars do not exist. They have spent a hundred million of them or more, but they do not exist. We have now found out that every problem in the world--not in the world, but every problem in Manitoba that requires money to solve can be simply taken out of the money the government is proposing to spend on a new arena in the city of Winnipeg.

Let us come clean with the people and not try to fool them all the time. That is all I am getting at. If I thought the honourable member was going to try to be forthright with the people on these issues then I think we could have a better discussion on it.

Mr. Chomiak: Mr. Chairperson, the figures I quoted from Seven Oaks are part of a memo that was faxed to a local radio station today from Seven Oaks that outlined those specific figures. I could have been off by a little bit. [interjection] I understand that memo circulated around Seven Oaks Hospital, for the minister's information, with those particular figures in it containing the staff cuts, et cetera, and it came out as a result of management, the CEOs of Seven Oaks Hospital. The figures jibe precisely with the numbers that I related last week in the Legislature which were contested and denied. I understand that memo has been faxed in writing, and it comes out of the hospital administration, as does all of the information that we circulate.

The minister may not be prepared to accept those particular figures, but those are the ones that are being distributed by the administration. I might add, last week when we raised this issue in the Legislature for the first time, the CEO of Seven Oaks Hospital confirmed that the cut to Seven Oaks this year would be $1.6 million. He confirmed precisely the cut that I indicated earlier in my remarks, and in fact the only area that I am not entirely certain of is the area of the $600,000 shortfall from last year which I also understand appears in the memo, the typewritten memo, but I could be off by a few figures since I am going from memory.

Notwithstanding that these figures appear in written documentation, notwithstanding that the CEO of Seven Oaks Hospital indicated that the figure for '95-96 was $1.6 million, notwithstanding that we raised these figures last week in the Legislature, notwithstanding that I have discussed these figures with individuals in the hospital who have had these figures pointed out to them, the minister still tries to create the illusion that we are making all of this up or that we are using it--[interjection] The minister denies that from his seat, but he certainly leaves the impression that somehow we draw these figures out of the air when in fact our sources are excellent. A hundred times out of a hundred we have been accurate in terms of the numbers we have used.

Secondly, I point out to the minister that one should talk about the allocation of figures when we have just heard this afternoon of inflated numbers for personal care home beds--and I am using the term "inflated," the minister's word. Last year's figures for personal care home beds were inflated. Now whether that was done deliberately or done inaccurately, the point is that documentation information was given out by the department which we relied on and which we used which we have now found out to be inaccurate. Now I am not going around assessing blame for that. The fact is that we can only deal with numbers that are provided by the department and we usually deal exclusively with numbers provided by the department.

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My question was, he has indicated that my numbers are inaccurate; will he correct where I am wrong or will he at least indicate or confirm the $1.6 million for '95-96?

Mr. McCrae: Mr. Chairperson, I think the honourable member should give us a little credit once in awhile where credit is due. My staff and I, I believe, have acknowledged that a number contained in the Supplementary Information, while perhaps not technically incorrect, was somewhat misleading.

I think that at least the honourable member has said that he never makes a mistake. We do. I know the honourable member is perfect. We do make mistakes, and we own up to it when we do, and we attempt to correct those mistakes. That is the best way for us to proceed, I suggest, because people will believe us when we tell them that sometimes we make a mistake, and they will be prepared to work with us. That is what we try to do in this government and in this department. If we claimed perfection, I would not have wanted anybody to vote for me because nobody who claims that should be believed including the honourable member.

I think in other cases I have spoken unwisely, and I would like to think when I have done that and it has been brought to my attention, I have tried to address and make right the situation because I do not want honourable members to be drawing conclusions from information that is not as clear as it should be. I make that acknowledgement, but I certainly do not make any apology in the sense that we are attempting to be very straight and open with the people of this province.

I speak for the people in my department when I say that because they have had to go through the very difficulties that honourable members opposite have attempted to put all of us through, and they have helped to steward a difficult department, in a difficult time in the history of this country, through to the point where we can claim--nay, we do not have to claim, we are told by others that we are leading this country in many, many areas of health renewal.

I am proud of that, and I am proud of the people who work for this department, and hopefully through my efforts we can use the good work they have done to the best advantage. I just get a little upset sometimes when the members opposite, for all the wrong reasons, attempt to discredit the good work that is done by their fellow Manitobans throughout this province, whether it be in the Department of Health or in a facility somewhere where they are dealing with difficult circumstances and doing their level best to do a good job for the people who require their care.

I am not questioning numbers the honourable member is throwing out, so much as I am questioning his interpretation of those numbers. I did not know Nick Kalansky was in the habit of faxing documents to radio stations and stuff like that, but we will review that. If that is what the honourable member is saying happened, well, we will review that situation. That certainly has not been my experience with Nick Kalansky.

What I want the honourable member to understand is that the budget is not a finalized thing at this point. That is why I hesitate to get too far down the road in a discussion of numbers when the Seven Oaks Hospital is busily working away trying to respond to the demands and questions of my department while my department is trying to understand what it is that Seven Oaks needs to achieve in its particular fiscal year. It is for that reason that I am not out to fill the honourable member's head with a bunch of numbers that all too often are bandied about early in the game and turn out not to be true or turn out to be changed later on. It is for that reason I think some precision is exactly what the people of Manitoba want.

The people of Manitoba are tired of hearing people respond and calling everything a crisis and responding to facts or figures that are far from clear in terms of being brought to a conclusion in a sense of preparation of budgets. Why do we not stop with all that business? Why do we not get on with presenting the people of Manitoba what really is rather than what might be. Let us present the people of Manitoba with what really is rather than what we think we might be able to scare them with.

Really and truly I believe we have a serious case of attempted abuse of the taxpayers of this province on two fronts. The Taxpayers Association, through its efforts, maybe overstated the case a little bit during the election campaign, maybe not. They did it certainly graphically to point out that we are engaging in the abuse of the next generation in the sense that we are asking them to pay for all our bills. I agree with the Taxpayers Association that that is wrong, and I am part of a government that is doing things to prevent that from happening.

I do believe that there are too many occasions when we attempt to scare senior citizens and vulnerable Manitobans about the real state of affairs that exists in our province. I think it is a repugnant way of conducting a political party. That is not my party, so I do not have to be responsible for that. I just say that it is a disservice, in my view.

Today we did tend to get into a little bit of rhetoric again, although we went for two or three days with not very much. I do not propose to spend my whole Estimates engaging in rhetoric, but I do have concerns and I feel as a member of the House that I should have an opportunity, too, to have a chance to give voice. So sometimes my frustration comes through and I have to tell honourable members why I feel the way I feel. It is simply a question of interpretation.

Well, one of my rural friends said that if you took two farmers and put them in a room you would end up getting three opinions out of that room. Well, I do not know if that is true or not, but I know that you are going to get at least two in this Chamber and maybe sometimes three depending on the position taken by our colleagues in the Liberal Party. However, I have not seen as many occasions of the Liberal Party attempting to scare senior citizens. In fact, I cannot say that I have seen that happen. I think that is a credit to the Liberal Party, and we certainly have not been trying to do that.

What we see as our role is an attempt through good government and careful attention to the needs of senior citizens, that we can provide some reassurance to them about services today, at the same time providing reassurance to the next generation that those services will be there, too, for them when they need them and if they need them. I think one of the expressions was service when you need it and that is something I would like to be part of a team that delivers those services when they are needed. The way to do that is to pay careful attention to annual hospital budgets and to pay careful attention to the issues the honourable member is raising.

He is certainly right to raise them and to demand answers and accountability, and this is the place to do that. I do want to remind the honourable member that I think the time is here for us to build. In fact, I think one of his party's slogans was to rebuild. During the election, was it not rebuilding Manitoba or something like that and ours was keeping Manitoba strong. The message was so very similar in health care that I can understand why some voters would claim not to see very much difference or not to hear very much difference in what was being said.

In health I believe that our policies, the honourable member's party's policies and ours, were remarkably similar, in fact, sometimes taken from exactly the same reports. There is nothing wrong with that. Imitation is the highest form of flattery and, frankly, I was flattered many times during the election campaign by the New Democratic Party, because if you stripped away the rhetoric and looked simply at what was being proposed, a remarkable resemblance, not only the child health strategy but the whole area of community health service delivery and various other pronouncements made by the New Democrats and the Liberals as well. In a way, that is good because I think that reflects a general consensus amongst the population in Manitoba. Those are the directions we want to see you go in. We want to see you go there carefully.

We want you to do it sensitively and with an eye on who should be the focus of all of our efforts. That is, in the acute sector, the patient, and in the rest of the system, the members of the population, so that we can improve the health status of all of us and make some of the discussions honourable members and I get into more academic with the passage of time.

Mr. Chairperson: Order, please. The hour being 6 p.m., committee rise. Call in the Speaker.

IN SESSION

Mr. Deputy Speaker (Marcel Laurendeau): The hour being 6 p.m., this House now stands adjourned until 1:30 p.m. tomorrow (Wednesday).