HEALTH

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Mr. Chairperson (Marcel Laurendeau): Good evening. 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. Administration and Finance (b) Executive Support (2) Other Expenditures.

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

Mr. Gary Doer (Leader of the Opposition): I have a couple of constituency questions that I would like to raise with the minister, the first one being Mrs. Holly Hrynchyshyn, 136 Edward Avenue East.

I wrote the minister in early May about this case. I have met with a couple of people about this case, and I sent the material on to the Minister of Health, dealing with some very, very serious concerns they had about the treatment of their mother-in-law while she was a patient at the Concordia Hospital. I would like to ask the minister, has he reviewed the letter I wrote to him, and can he report back on his findings on this letter I wrote to him approximately four weeks ago?

Hon. James McCrae (Minister of Health): Mr. Chairperson, the usual procedure we follow when we get a complaint or a request for information or a concern expressed in writing from a member of the Legislature on behalf of a constituent or directly from a constituent or a member of the constituent's family, if it has to do with treatment received at one of the hospitals, is to refer the matter over to the hospital for their investigation and review. Once we receive a report from the hospital, it is our usual practice to respond and if any action is required to be taken to address or change anything as a result of the incident or treatment complained of, then we are given assurances by the hospital.

However, I am told by staff who are with me this evening that if it would be of assistance to the honourable member we could attempt to expedite that for the purposes of these Estimates so that we could respond in short order for the honourable member. If we could please have the spelling over again we could go from there.

Mr. Doer: Perhaps I could follow it up later on when we are on the minister's line, but I was quite concerned when I met with the constituents. The last name is Hrynchyshyn, and the lady, her mother-in-law was Margaret.

There were a number of concerns about the fact that staff were very hard working at the Concordia Hospital, but she felt her mother was in conditions that were very unsanitary because of the short-staffing and the reductions in staff. She documents a number of incidents and situations where her mother-in-law was in very, very difficult circumstances, that she feels very, very angry and upset about it.

She really feels the Department of Health should deal with this. She felt that her mother-in-law was not complaining at all, but sometimes she had to go to assist her mother-in-law because of the shortage of staff, and she just happened to be at her mother-in-law's side when her mother-in-law was in very, very unsanitary situations in the health care system. I know that she feels now to redress this, that it is really difficult to find out where to turn to find out how to deal with it.

She did pass away on March 2, 1995, and I will come back and ask the minister this question at the end of his Estimates under Minister's Salary, but I would like to alert him to that while we are here on this line. I was very, very concerned about it, and I have gone through the correspondence, which I do not want to repeat at this point here because I would like the minister to investigate it, but, suffice it to say, people are really hurt and angry about what happened and they do not feel it was because of the dedication of staff. They felt there was a shortage of staff at Concordia Hospital, and I would like the minister's office to please investigate the letter I sent them.

I have a second concern from a constituent that I want to raise. The gentleman's name is Victor deCaro. His mother was at the Bethania Nursing Home. I believe the Department of Health has looked at this case as well. I am not sure, but I will raise that with the minister so I can find out where it is in the system.

He believes that his mother had a heart attack, an allergic reaction to drugs at the Bethania Nursing Home. He has a number of concerns about the monitoring of medication at that home. Even though his mother was at the home receiving care, he felt that the drugs that she was receiving should have been monitored, and the death of his mother could have been prevented.

He was also very, very concerned and still very upset about the lack of follow-up from the doctor at Bethania to him. Subsequently, his mother was transferred to the Concordia Hospital. Again, he felt that there was not--it was on a long weekend, I believe, if I can recall from my conversations and meetings with him, but he felt that there was not, again, the kind of follow-up that he should have had. He thinks this was a preventable death.

He is looking at getting legal counsel. He also feels he cannot because he has the kind of income that is a moderate income, or a decent income, I should say. He is one of these people who cannot get Legal Aid, and he has not got obviously the money to take the case forward to get his day in court about how his mother was treated, he feels, incorrectly at the nursing home, Bethania. He really is concerned about the care of his mother. He is very hurt. I could not meet with him for, it has been almost a year. His mother passed away, Mary deCaro, and he is still extremely, extremely hurt and upset about it and feels it was a preventable death.

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He would like the Department of Health to review this matter. I said I would take it to you in the Estimates process, which I am doing today. Perhaps it is another case I can deal with later on in the Estimates process, but I just wanted to raise that on behalf of the constituents, Mr. deCaro, in the memory of his mother. As I say, he is very concerned about it. He has written to the Chief Medical Officer and some others. He has responses from Dr. Henry Dirks at Concordia. He has responses from the doctor who apologized for not communicating directly to him. The doctor's name was Christine Loepp, and, as I say, he feels the death was preventable.

It looks like the Chief Medical Examiner, in letters he wrote to Mr. deCaro, acknowledged, and I should get the quote: apparently your mother suffered a drug reaction to an antibiotic which had been administered to her. It does acknowledge what he feels is a reaction to drugs that were administered at the Bethania Home.

The Chief Medical Examiner wrote him back but it does not answer the questions about whether this was preventable or not and he feels very strongly, in memory of his mother, that he cannot rest until he has pursued this on behalf of her memory and the love that he has for his mother, that he has taken all action to identify the fact that this was preventable in his opinion. He is very, very disturbed about it and he is not going to let this rest. He just cannot let it rest. I respect that and I would ask the Minister of Health to please follow up this case unless he has some information about it from previous communication that would be there in the department.

Mr. McCrae: The honourable member might understand that I do not have immediately at my fingertips the information I would need to respond to the matter raised by the honourable member. In this case, too, I would undertake, if we have not already done so through correspondence, to ask my department to do a thorough review from the department's point of view. I would undertake also, in both of these matters, to get back directly to the honourable member.

I appreciate the honourable member raising these matters on behalf of our fellow Manitobans. Hospitals and personal care homes are sometimes places where people can be in very vulnerable circumstances and their care is basically at the hands of others, and it is not always within their power to be responsible for all of their own circumstances. They therefore rely on the elements of our health care system to ensure their proper care.

Even so, incidents have and do from time to time occur that do require investigation and follow-up, certainly in the case of a death. There is a role in certain circumstances for the Chief Medical Examiner's office. If there is an allegation that there might have been some negligence or inappropriate performance of function by various professionals, we have various professional organizations also whose job it is to review and look into these matters.

All in all, at the end of it all, there are times when we find in our hospital system that indeed procedures can be improved. As a result of our becoming aware of some of these matters, we are able, with the help of the hospital administrations and staff, to make changes that prevent some things from happening, and that is part of quality control, to know the reaction or the point of view of the users of our health care system, those being our clients or patients in the system.

We welcome comment from patients after a hospital stay. We sometimes get very positive comment, too, and there are times when things do not go as they ought to go, and that is why we appreciate knowing about incidents that give rise to appropriate investigation. Sometimes we can rectify situations so that others do not have to endure things that might perhaps or should not have happened or should not have been done in a certain way, and that is all part of a system of quality management and quality control.

So, I do not know if the honourable member has corresponded with me on this matter previously. If he has, we will certainly review our file and bring it forward so that we can give the answers to the honourable member.

Mr. Doer: Yes, I promised the gentleman I would bring it up in your Estimates, because he feels he has written quite a few places, and I promised him, after his frustration of raising it and writing a lot of places, that I would bring it up directly to you. I thought that perhaps that would be the best forum. I am prepared to send you a letter with the material I have, pursuant to this, for tomorrow.

I just have one other question. I have one other question on this matter. The report on personal care homes--he had heard that there was a report on personal care homes that the government had commissioned. Is that report on personal care homes available, and can I send that to him?

Mr. McCrae: Mr. Chairperson, last summer we commissioned the Seniors Directorate to engage in a review of personal care and other residential institutions for senior citizens and others in our province. The chair of that was from the Seniors Directorate, and there were representatives from the Health department as well as the Family Services department involved in that review. We now have the report and we are examining the report for our responses, and I expect that within a fairly short period of time we will be sharing that report with honourable members.

Mr. Doer: I am going to call the gentleman back. When should I say that that report would be available that I could send?

Mr. McCrae: You can tell him that we expect it within a few weeks. However, if he would like to contact my office directly, we do not mind. If he would like to contact my office directly we can make sure that particular individual is apprised of the date when we bring the report forward.

Mr. Doer: Is there any procedure about utilizing Legal Aid for cases that a person feels this seriously about? I mean, I know it is a difficult situation because you are both the--legal aid is provided by the government and health care is provided by the government. You are responsible for health care. Somebody else is responsible for legal aid. How would a citizen--I mean, lawyers are expensive. Most lawyers are expensive, and this gentleman is very, very concerned. He wants his day in court. Is there any process or procedure on lawyers? I just did not have the answer for him except that when he got Legal Aid lawyers--the letter that said, your income is too high--he is one of these people that says, well, my income is too high for this, but I am not rich enough to go ahead in court. You know, what do I do?

Mr. McCrae: Well, I guess I have been away from the Justice department a little too long, because I honestly cannot remember what the services are and who gets them and under what circumstances. I suggest that we could check with the Justice department.

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Those who cannot afford legal aid for matters of a civil nature, there are arrangements apparently with some law firms by which arrangements can be made so that if there is a case there--I forget the word they call it, but it is a sharing in the proceeds should there be proceeds.

An Honourable Member: It is called contingency.

Mr. McCrae: Contingency, that is the word I was looking for. In any event, I do not know the answer off the top of my head with respect to legal services. I would direct the honourable member perhaps to the Justice department for that type of information.

Mr. Gerard Jennissen (Flin Flon): I would like to ask the honourable minister a question, but before I do so maybe just put it into some context. The Flin Flon Daily Reminder, page 3 of May 30, an article that states, doctor addresses hospital concerns. A Dr. Stefan Harms writes, and I will just quote one little bit: The attention of the administration is focused on how best to implement the government imposed cutbacks and layoffs.

My question to the minister is, well, I would like to hear his point of view actually about this. I think what I am reading between the lines here is that the infighting and the low morale at that hospital seems to be connected to the administration's inability to deal with other things because they are focused on layoffs and cutbacks. That is what I am reading, and I would be glad to give the minister a copy of this if he wants it, but I would like his view on this.

Mr. McCrae: Yes, Mr. Chairperson, I think it was earlier today during Question Period, the honourable member for Thompson raised similar questions respecting the Thompson General Hospital. I have not seen the news article to which the honourable member refers, but I do know that change, restructuring, downsizing, whatever you want to call it, does tend to put some people into a very uncomfortable position. They are used to doing things a certain way for a long time, then change is something that comes hard, especially for those who have done it the same way for a long time.

Our staffing guidelines review was the subject of a fair amount of comment in September of 1993 when I was appointed Minister of Health. In fact, some institutions had at that time issued layoff notices or layoff notices were pending at that time or just about to be issued. I recall asking that that whole process be brought to a halt until I could understand a little better what was being proposed, what was being done. I hit the road, basically at that time, visiting Flin Flon a couple of times in the last year and a half, having discussions with hospital administrations, boards, groups of staff like nurses, licensed practical nurses, and I think dietary people and others in sixty-five Manitoba communities. I got to know the wonderful highway system that we have in our province, and I have been very impressed by the quality and condition of those roads, by the way.

In any event, I engaged in a number of discussions which caused me to ask questions of the department myself; questions like, are these staffing guidelines driven simply by a bottom line requirement to save money, or are they driven by some desire to get staffing sort of organized throughout the province where there is some element of fairness between the various institutions? Do the staffing guidelines take into account levels of acuity of illness? Do staffing levels take account of the configuration of physical plant, i.e., hospital buildings, and so on and so on and so on; basically, come in from a meeting with a group of nurses and reflect to the department the concerns that had been raised with me.

It was decided that rather than go ahead with the implementation of the staffing guidelines which, at that time, had been outstanding for some time, even then, and no action taken on them, it was decided that we would review, again, the staffing guidelines and review them to make a determination. Are they fair to the various communities involved? Are staffing mixes in all the hospitals sort of taking into account the various things that I just mentioned, but are we operating some wards with a certain level of staff with lower occupancy in some hospitals than in others, and all of those kinds of questions.

I thought it was a good idea to ask the Manitoba Association of Licensed Practical Nurses and the Manitoba Association of Registered Nurses, as well as the College of Physicians and Surgeons, as well as departmental people and administration people from various hospitals to be part of a staffing guideline review. That staffing guideline review, another committee, but, nonetheless, we thought we better do it anyway, and on it, we were sure to see to it that personnel from northern Manitoba institutions were also part of that review.

They broke themselves down into three or four subcommittees consisting of staffing guideline review committees for administration, for clinical, for diagnostic and therapeutic and for nursing. This review just went on and on and on and went on for more than a year, I think it was. Finally, last December, the findings of the staffing guidelines review were made known to the institutions.

Now, that was a pretty significant thing to do, I think, because we were trying to be responsive to the concerns that had been raised. For the most part, the concerns had to do with patient issues, although at the end of a lot of the meetings that I was at, the question would become an employment question, as opposed to a health care question, which is fair ball, because in a place like Flin Flon or a place like The Pas or Gladstone or wherever it happens to be, if there should be a reduction in nursing, dietary, cleaning or other staff at a hospital, that has an impact on a smaller community. So we recognized that, too.

At the end of it all, the guideline results came out, and the northern hospitals, it was found by the review, the ones at The Pas and Flin Flon and Thompson, were working with a patient-staff ratio significantly higher than in other places in Manitoba, even after factoring in things like acuity of illness and all the other things that I mentioned.

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So then it came time, well, what are we going to do with the staffing guideline recommendations? The time was that we had to do something, because we could not just leave that anymore. It was not fair. It was not fair to hospitals which had either already complied with staffing levels of the kind set out in the review report or those which were prepared to enter into the changes that would be required to bring themselves into line with those staffing guidelines.

Even so, it was decided that there was significant enough impact on some communities that the reduction in staff should take place over a period of time, so that the labour adjustment strategies that we had in the meantime put into place--I remind the honourable member they were not there before. If they had gone ahead when I first was appointed, there would have been no voluntary separation packages. There would have been no other labour adjustment measures put into place.

We have now completed the first year of three years, the first year being the year which ended at the end of March of this year, and we have two more years to use whatever measures we can to mitigate the change on staff.

Now, I do not know what the doctor said in the article to which the honourable member referred, but we would encourage that individual to become involved in the implementation process, because we are trying very hard to do this as sensitively and as humanely as we can, remembering that there are people involved in these changes.

The bottom-line concern, right from the very beginning, and the instruction given to the staffing guideline review committee, which included people from northern Manitoba, was, put the patient first and do not make recommendations that would have an adverse impact on patients. Even at the end of it all, when we put into place a three-year implementation program, we made it clear that should administrations in some hospitals, for one reason or another, find that they are not able to implement the staffing guidelines without negative impact on patient care, just let our consultants know.

The honourable member for Thompson (Mr. Ashton) was asking when the Manitoba Health consultant would be available to the Thompson General Hospital personnel for consultation purposes, and I told the honourable member that I would pass that concern along to the department, which I have now done.

Mr. Jennissen: To the same honourable minister, I would like to quote this Dr. Stefan Harms one more time. Dr. Harms, on the same page of this article entitled, Doctor Addresses Hospital Concerns, states: However, in order to establish a feedback mechanism for ensuring that the interests of the public are maintained, I would recommend that we have an elected board.

I know before this second round of alleged cuts or slashes at the Flin Flon General Hospital, there were a lot of angry nurses. There was a public general meeting, and it was very difficult to pinpoint where the hurt was going to occur and who was going to take responsibility for it. There was quite a hue and cry for an elected board that the mayor at that point did not think was a good idea.

However, I think, since then, the Flin Flon City Council seems to be going in that direction. Basically, for my own information, for the record, Mr. Minister, I was wondering if you would comment on elected hospital boards, just your own personal view on them.

Mr. McCrae: I have found, Mr. Chairperson, it is quite often that when decisions are getting made, that is the only time you get the call for elected boards, or if there is an issue of some kind. In some communities there are issues. For example, therapeutic abortion comes up from time to time in some communities, and that is when you hear the call for elected boards.

You can have a meeting, and sometimes nobody will come to it, but if there is an issue, you can get hundreds of people to come to it. So I have no personal problem or opposition to the concept of an elected board. My main concern, which I have stressed many times to nurses, mostly in rural Manitoba, to this proposal about elected boards, is that the views of the staff of an institution be taken into an account in decision making. I think there is a conflict, very often, when it comes to salary issues that someone who can benefit from a vote on a hospital board respecting salaries or some such thing, I think that would be inappropriate.

My bottom-line concern is, however your board gets there, that it be responsive to the community. That is who it is representing. I have run across a couple of places that, in my view, the relationship between the hospital board administration and the staff is not good, and I have also observed that it is sometimes not the staff's fault. When I have noticed that, I have passed on my concerns and, somehow, they have found their way to the so-called offending party, and sometimes relationships improve a little bit, sometimes a lot, and that is good, that is very good.

I should tell the honourable member that as part of the regionalization process, and Flin Flon is part of the so-called Norman region, we are going to be getting the report within days now, and I am going to see it for the first time, of the Northern Rural Health Advisory Council which has been going through phase two of its work which is to look at the governance of the various regions. I am not taking about individual hospital boards now, but I am taking about the regions, and, in the honourable member's case, the Norman region.

That council has been engaged in public hearings on the issues of governance of health regions and regional councils. I do not know what they are going to say yet. I have not asked for any hints about that, but they may deal with the question of how these regional councils came into being, whether there were appointments or elections or some combination.

You know, in many of our communities these boards are elected people to a large extent. They are our reeves, our mayors, and our councillors, and I often get the comment, well, they do not know anything about how to run a hospital. Well, you know, when honourable members came here, I suggest they did not know everything there was to know about every facet of government either. We are here to, and elected to be here to use our best judgment based on the best advice that we can obtain.

Sometimes there is a problem in a community with the administration of a hospital. That is in the hands of the board. The administrator is the servant of the board, not the other way around, and that is something I hear allegations about that the mayor and council do not really know what they are doing; they just do whatever the administrator says. Well, if there is something wrong with that and if the community is not happy with that, it is the communities' responsibility, also, to do something about it. That applies in good times as well as more challenging times when we are into reform mode in our communities.

That is the nature of some of the discussions that go on between me and hospital staff when we get to talking. I find it very useful because you get the sense of what is inside the heads of some of the people who work in our institutions. They are people whom we rely on day in and day out, and we have a lot of time for them. I want the boards to have time for them, too.

It does not answer the question the honourable member asked directly because it does not matter, I do not think, at this time, for me, to have an opinion about whether boards are elected or appointed, but it is important to me to know that boards are being sensitive to the concerns of staff especially at a time of change. That is very important to me, and, I think, it must be to the honourable member, too. Whenever I hear there is a board or an administration where it is shown that there is an insensitivity there, I do my best to try to bring the parties together.

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Mr. Jennissen: Regarding the Flin Flon General Hospital, I am sure you are aware that between 30 and 40 percent of the patients in that hospital come from the Peter Ballantyne Cree Nation in northern Saskatchewan, and one of the concerns that I have is that if there are major cutbacks to the hospital, then the Peter Ballantyne Band will no longer use that facility.

They have already made some threatening moves in the sense that they are willing to go much further to Prince Albert to take their people to a hospital there, because they are sort of unsure about quality. I guess what I am really worried about is if there is too much of a cut, that if they were to pull 30 to 40 percent of the patient load out, then we would really be in trouble in Flin Flon. I am just wondering if the honourable minister is aware of this.

Mr. McCrae: I am advised that the hospital traffic or patient load coming in from outside Manitoba was fully taken into account in the development of the staffing guidelines, in the same way that a large percentage of the hospital patients at the Churchill hospital come from the Northwest Territories. That is part of their business.

I think it is very unfortunate if a message goes out to people who normally do business with our hospitals in places like Flin Flon or Churchill that is incorrect, because you are really only doing a disservice to yourself as a community when you say disparaging things about your own hospital. I am not saying the honourable member is, but I am saying if that is the stuff that people are talking about in Flin Flon, they are really doing themselves a disservice, if that is the way it works, because I am advised, also, that the staffing guidelines at Flin Flon are more generous towards staff than the staffing guidelines at Prince Albert.

The people who do their business at Flin Flon maybe should be told that.

Ms. MaryAnn Mihychuk (St. James): I have a few questions and they are quite diverse, but I understand that the minister is providing us with an opportunity, and I am very thankful for that. [interjection] Thank you, I appreciate it, for our critic who arranged for it.

I am going to begin with a hospital, the Misericordia Hospital, and I speak on behalf of many of my constituents who use the Misericordia community hospital and from a personal experience. I recently had my second child who was born at the Misericordia Hospital--[interjection] Yes, she is a beautiful baby. [interjection] Yes, probably the most beautiful baby. That is on the side. [interjection] Oh, the third most beautiful baby?

Anyway, what I wish to ask the minister and the department was, I understand that there is some consideration being given that the maternity department there is scheduled to be closed. Could the minister confirm that?

Mr. McCrae: Mr. Chairman, as one who had the distinct pleasure of meeting personally young Sarah, I can certainly see what the fight is all about over there in the NDP caucus, over who has the most beautiful baby. It was a distinct pleasure for me to meet Sarah and to be told about the circumstances and the location of her birth.

I have heard that before. I have heard people tell me about the positive experience that they have had bringing into the world young lives at Misericordia Hospital as well as Victoria Hospital and Grace Hospital and St. Boniface Hospital and Health Sciences Centre and, I can speak from personal, well, almost personal experience, for the Health Sciences Centre as well. That is a credit not only to the staff at the Misericordia Hospital but also to the long-standing culture that has existed at that particular hospital.

I am coming around to confirming what the honourable member is asking. After long months of discussions with the administration and the board members at Misericordia Hospital, it was decided that they would close their maternity ward at an appropriate time in the future. We discussed the role and mission of Misericordia Hospital and they have a long tradition of looking after women in maternity circumstances.

We also told Misericordia Hospital people of our intention to set up a province-wide breast-screening program for women between the ages of 50 and 70 years of age. It was decided that Misericordia Hospital should be the site of the Winnipeg location for that service in Manitoba, Brandon and Thompson being the other two sites. In addition, Misericordia Hospital will be assuming a role respecting prenatal services and one or two other services as well.

This was not an easy decision to make as the honourable member will understand, having recently been there. We should be proud of the kind of the dedicated service that staff at our maternity wards provide and, indeed, Dr. Frank Manning, the chief obstetrician in Manitoba, put out a report from which this decision flowed. He put out a report that said Winnipeg, Manitoba, statistically speaking, is the safest place in the world to deliver a baby, a child, and that is good news, but on the other hand, his report also told us that we are not quite as efficient as we could be in this whole area, and so Dr. Manning gave us several options, the so-called two-plus-two option, which was Health Sciences Centre and St. Boniface Hospital only, and then--did I say two plus two? I meant two plus zero; then two plus one, which would be those two hospitals plus one other. Two plus two was the final recommendation, which was the two big hospitals plus two others, all of which left Misericordia in a position where it was going to be the one that would have to shut down its maternity ward.

The decision was taken after much agonizing on the part of the members of the board at Misericordia Hospital, who are extremely community-minded and very, very committed to the mission and the goals of Misericordia, and the sisters involved, as well, had to be part of that decision before I was going to be satisfied that we could go with that decision.

That nonetheless was the decision. It is not the most popular one in the world to make, but at the end of the day, it was felt to be an appropriate one.

Ms. Mihychuk: The Misericordia Hospital, as the minister has indicated, is really a community hospital, and there are a great number of inner-city residents, core-area residents, that use the facility, many of them First Nations people, of aboriginal ancestry, new immigrants and people of very low income.

One of the advantages of the Misericordia is that the staff there are familiar with working with the population and are sensitive to those needs. When you compare it to the St. Boniface and the Health Sciences, which are very large institutions, teaching facilities, this personal approach is somewhat, what would I say, compromised or is not as easily facilitated in those sites.

So I am wondering if the ministry has considered that option, and given that it is particularly close to the Health Sciences, so that if a child who went into distress or needed more acute treatment would be in close proximity--I would just like to inquire if, given the closeness of the Misericordia to Health Sciences and the sensitivity that the staff has, do they feel that any other hospital is able to provide an alternative to the Misericordia?

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Mr. McCrae: What the honourable member says is true. I have visited Misericordia Hospital, it must be four or five times now, and seen exactly what the honourable member is talking about, the community type of orientation of the Misericordia staff.

I had the pleasure and honour to be invited to take part in the opening of their Care-a-Van project, which was generated and initiated by the staff people at that hospital. One had to be impressed with that sort of initiative. The Care-a-Van project is a project that demonstrates that Misericordia Hospital is quite willing to be on the leading edge of recognizing the principle of hospitals without walls and reaching out into that community the honourable member talks about.

I have not received a recent report, but their job is to get out there amongst people who may not seek primary care to the extent that they should. They do things like checking your blood pressure and that sort of thing in the community. I am very well aware of the community culture of Misericordia Hospital.

On the other hand--I just throw this out, well, for the sake of having it on the record--I am told that fully 25 percent of so-called normal births become complicated births. That is an important number to remember, in my view.

I would like to see us continue the tradition of being a safe place to deliver babies here in the city of Winnipeg, and I will certainly take what the honourable member says to heart when future decisions are being made about the role of Misericordia Hospital, but I do not think I can revisit the decision that has already been made.

Ms. Mihychuk: To continue, close to the Misericordia Hospital is the Villa Rosa, a facility that provides sanctity and a place for young women who are pregnant and need a facility to stay in.

One of the reasons that it was located there was that it was very accessible to the Misericordia Hospital. Has the department considered the impact on Villa Rosa?

Mr. McCrae: Mr. Chairperson, yes, I am aware of the contribution the Villa Rosa makes and has made, and while it needs to be stressed that prenatal and postnatal services are still available at Misericordia Hospital, that is their specialty, it is the delivery part that we are talking about, and Villa Rosa is a Family Services department funded agency, and we do, indeed, recognize its role.

Ms. Mihychuk: Part of the attraction of the Misericordia Hospital maternity ward is that their rooms are outfitted into birthing rooms or family rooms where, I believe, each room is equipped with the facilities required to have the baby born in the room and can remain there for the whole period of time. That is a very wonderful experience.

That is not the similar situation, I do not believe, in other hospitals. Are those facilities going to be available in other hospitals? To facilitate that type of provision in all those rooms at the Misericordia must have incurred considerable financial investment. Is this going to be a significant loss?

Mr. McCrae: The concept called LDRP--labour, delivery, recovery and postpartum--is a process that starts from zero, and, says, who are we trying to look after here, us or the patient. It is really nice that the patient is becoming the focus of what we are trying to do. I thank the honourable member for the comments she made.

Misericordia Hospital, I understand, was able to make those changes without any extra infusion of funds from the department. If it is done properly, that transformation need not be a hugely expensive sort of thing. It has existed for some time at Victoria General Hospital and is planned to be available to all of our major birthing facilities. What it does is, as I said, put the patient first. It attempts to bring a more pleasant atmosphere to the birthing experience.

I have had occasion to visit the new moms and babies in their rooms, and those who had babies by the traditional hospital method speak very highly of the LDRP. What it does is it confines everything basically to one room rather than having to be shunted and shuffled and pushed around from the time you get into the hospital. It makes it into a more dignified approach to having a child that makes it possible for it to be more of a family experience than previously, so I can certainly support it.

I would not want to overstate the expense to which Misericordia went. I do not know what amounts they spent, but it was done without any assistance from the Department of Health and without, I guess--approval? It was done on their hook, in any event. While we think it is a good thing to do, we will be seeing it happening in other centres as well. It has existed at Victoria for some time too.

Ms. Mihychuk: Is it my understanding then, from the minister, that he will ensure that the families that are used to this type of environment can find it at the Grace Hospital, which I understand will be the alternative for families in the west end and in the core of Winnipeg.

Mr. McCrae: Mr. Chairperson, where a patient is referred is between the patient and the patient's caregiver, the physician. In all of the birthing facilities in Winnipeg in the future, the LDRP concept will be there for the patients. I do not think "patients" is the right word in this circumstance, but that is the plan.

Ms. Mihychuk: One of the things about motherhood or becoming a new parent is that people and families are able to access prenatal services, which I commend the Health Department for doing. We do have healthy babies and we can be proud of that tradition and we would like to lower the number of acute situations even further. It seems to me to be a little strange that we have sometimes up to 10 weeks of prenatal and virtually none after the baby arrives. I think very few families actually have postnatal care, besides maybe one visit from the City of Winnipeg Health Department.

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What are the programs available to ensure that we have healthy children after we leave the hospital?

Mr. McCrae: I thank the honourable member for her comments about prenatal care, and I would love to take all the credit for it, but 25 years ago that was available. I know, because I was involved in it, when our first child was about to arrive. So I wish I could take the credit for that.

With respect to postnatal care, I think we are going to have another discussion about this, too, when we get to the line in the Estimates dealing with public health nurses. Postnatal care is available for people from our public health nurses, and I will be able to give the honourable member more detail at that time, if she either, through her critic or on her own, would like to raise that at a subsequent time when we will have the assistant deputy responsible for that area here with me.

I know also, from personal family experiences as recently as last week, that public health nurses are available and do provide services at home after birth.

Ms. Mihychuk: As the children are going to move up a little bit in age, become a little older, they enter our school system. As a past trustee, it was my experience, unfortunately, to see some children come to school, not fed properly, not experiencing a well-balanced diet, not able to access what we would consider available to most families, such as vegetables, fresh fruits, and so we know what the school system has done. They have resorted to providing food programs, because children require this, to be healthy.

Does the Department of Health have a vision to ensure healthy children, and what are those plans?

Mr. McCrae: Mr. Chair, I sometimes think I need to ask questions in this place too, in Estimates. It will be a question for the honourable member for Kildonan (Mr. Chomiak) to maybe make a note of for discussion at the appropriate time.

We have our Child and Youth Secretariat. The Leader of the Opposition has not spoken in glowing terms about that secretariat, but, it is headed up by a very, very high quality individual who enjoys a lot of support, and that is Reg Toews. That secretariat's job, I think the honourable member would know about this, is to bring together the various departments who deal with child health issues and the nutrition one the honourable member raised is certainly one of them. They have in their hands the child health strategy which we all borrowed lavishly from to prepare ourselves for the election campaign, put out by Dr. Brian Postl's committee on child health.

I am going to be asking the honourable member for Kildonan, at the appropriate time, I am just giving him notice today, how many acute care dollars is he prepared to direct, and does he have any idea where it might come from for this? I am certainly in support of addressing the kind of issue the honourable member has raised.

Surely she knows, very well--it was the Winnipeg School Division that she chaired, and would know very well some of the problems that kids come to school with, which, if they had a proper breakfast or proper nutrition, she knows probably better than I do, the impact that would have on the education system, on the rest of those children's lives. I very firmly believe in what the honourable member is asking.

I want the honourable member for Kildonan, at the appropriate time, to tell me how many dollars he thinks we should use and where we should get them out of the acute care sector. The reason I am asking this is a very important reason. Up until now, every dollar we have taken out of the acute sector, we just got hammered royally by the honourable member for Kildonan. I want to deal with the problem that the honourable member for St. James has raised. I think it is an extremely important one, and I cannot think of a better place to start than at a very, very young age, in dealing with the kids.

My heart just breaks sometimes when I see what the kids--I am talking human terms now, never mind the school division's problems, I know they have them. The kids themselves, have they got a fighting chance like your kids or my kids? The answer is no, they do not. Is the honourable member for Kildonan going to be able to come across, in the sense of saying that he will support removing some dollars from the acute sector so that we can spend it in areas like the honourable member for St. James is suggesting, because I support it. For the honourable member's information, this is probably something we should discuss off the record, but it is the availability of Mr. Toews for discussion in this Chamber and we will talk to the honourable member about that later.

Ms. Mihychuk: I hope to be here when that discussion comes forward in this committee. It would seem to me that it would be highly unfair for the Department of Health to have to look at other very valued services they are providing to look at what I am talking about. Is the minister prepared to look outside of his budget, to look at other areas of revenue? The idea of cutting services to the sick to give to children seems to me to be defeating. Both groups need it. The acute care portion of your department needs the services and needs the resources as much as our children.

I think there may be, in a broader sense, other areas outside of the Department of Health budget that may be accessed through your government's--[interjection] Through the Jets. That is a good idea. On that comment, I am going to lead into another question on children.

My question is that not only are children coming to school undernourished, poorly fed, many children now in schools are severely handicapped, physically or mentally, and to various degrees of handicap, I should say. Many of these children received services through other government agencies and now are receiving services in our local community schools.

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Specifically to the minister, the children who are receiving occupational and physiotherapy services in schools used to receive them in a hospital setting, and I understand even now that if those children went to a medical facility, they would be covered under the Department of Health. Once they receive them in a school, they are not covered. Is the minister willing to address this issue?

Mr. McCrae: Sometimes when there is need for detailed information for me, I am a wee bit at a loss because we are not at the right line in the Estimates and we do not have the appropriate staff for that.

However, just days before the election was called, we released the Postl report on child health which had already been circulated somewhat. We know that. That same day we transferred money either to the secretariat or directly to the Education department to address some of the in-school health issues, perhaps not all yet, but some dealing with nursing. We made money available for that. I am quite willing to go into more detail when we have the appropriate staff with us.

However, what the honourable member said struck me when she said that we should not take from the sick to give to the kids and I agree 100 percent with that. I would not want to do that either. At the acute care end of it you cannot just leave people without acute care services. We are not. I would like to reassure the honourable member about that. The honourable member says we should go outside the department for these dollars, so that means that $1.85 billion dollars on health, the highest percentage of budget anywhere in the country, is not enough.

That is where the honourable member gets herself and her colleagues into some difficulty because, other than the Jets, which comes up with every question and applies to every possible circumstance under the sun and even then some after that--that is fair ball. That is the way you make your point in politics. The point is, at 34 percent of budget, that is the highest rate anywhere in the country. The honourable member is saying, that is not enough. I am saying it is enough. I have said it very publicly and I have said it many, many times. It is enough because it is more than anywhere else in this country.

I am saying that we can do a better job with the dollars that we are spending as opposed to always bringing in more dollars. That is what we always did. That is why we are so deep in debt. We took money we did not have. We took it from those very same kids.

The honourable member and I are wanting to help, and by keeping on doing that, we guarantee there will be no lunch program. There will be no free lunch or free breakfast or anything else in the future if we cannot smarten up with the finances. There is an area where the honourable member and I, with all due respect, are going to have to agree to disagree because I think we are spending enough on health and I think we should be doing a much better job and we need support for doing that better job.

All that being said, I want to get back to this acute care business. We are not taking money from the sick. Anybody who wants to suggest that, just has not been paying any attention. We are putting tremendous amounts of money into our acute care sector and are we asking ourselves are we getting our money's worth? Some people are, some people are not. We are asking ourselves, are we getting our money's worth; are we getting some outcomes that make any sense compared to the dollars that are going in; are we getting some outcome as a result.

We are beginning to show signs that we are knowing what we are doing in the whole area of the delivery of acute services, but I would refuse to accept any comment like that, that we would take from the sick to give to the kids. Goodness sakes, that is not what we are trying to do.

The issues that the honourable member is familiar with in the school system are indeed issues that have to be grappled with, and I think that is why it is important that we put that Child and Youth Secretariat together. We did it with a fair amount of support even though we get disparaging comments from the Leader of the Opposition about a half-time secretariat, or whatever he calls it. It is not designed to be a very nice way to describe it. That is politics, I guess, but we are finding that if we can think in a more corporate way, we can do a better job for the kids. If we can work more closely with the school divisions, we can do a better job for the kids.

When it comes to services like these for children, provided by school divisions themselves, did the school divisions go outside the school division budget to raise the money? What happened? The taxpayer was the one that got hit again, right? Well, the taxpayer, some people accept this and others do not. The taxpayer says, enough. The honourable member knows this, I am sure, from her experience. Going outside the department means cutting somewhere else where we have been doing that for seven years.

You know, we have reduced public expenditures outside the social services departments very significantly. There does come a point where you say, well, you know, how much more of that can we do before the public begins to notice in a big way that we have gone far enough or too far. Yes, we keep an eye on that every single year, on expenditures outside the three major social services departments. Our budgets demonstrate very clearly that we also keep an eye on the inside of those departments because that is where the majority of new spending has gone.

Ninety percent of every newly spent dollar in Manitoba has been spent in health education or family services. That is a significant statistic. I do not know if it is rivalled anywhere else in the country. That may be why, with the exception of the honourable member and a few others, we were not able to overcome the powerful, powerful campaign put on by the member for St. James, but we were able to win in 31 seats, including the constituency of Rossmere which returned the honourable member for Rossmere, our distinguished Minister of Labour (Mr. Toews), and I see that the honourable member for St. Vital (Mrs. Render) is also one of those, and I see a few others around.

But the point I am trying to make is that I think the general public says, enough of the tax-and-spend approach to politics and to public administration. Start learning how to spend the money that we work so hard to earn and that you have confiscated from us, and start spending it better. And that is what we have been trying to do, and it has not been easy. It has not been easy for staff of departments, it has not been easy for staff or administration of our health care institutions, but we have found that partnership. We are getting that partnership.

(Mrs. Shirley Render, Acting Chairperson, in the Chair)

There is a recognition, not only in the institutions, but also in the population, that we should be able to do better with what we have got or less, because less is going to be available. It is a very, very bad sort of thinking that says, we can continue to take from the next generation to pay for what we want to have today. It is wrong, it is wrong-headed. It is certainly not justifiable over the long term, and we have reached the end of our rope as a country in that area, and the people said, we are not going to put up with that anymore.

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So I hope the honourable member, when she says to go outside the department for the dollars for these programs, I want her to tell me where--besides the Jets, we already know about that--but to tell us where else. Because notwithstanding the fact that not a nickel is going to the Jets from this government--I am not going to get into that argument--but I would like the honourable member to tell us other sources, because the issue she raises today is not the only one that calls for another way of spending or additional spending. There are all kinds of them.

If you look back over the gray book, or whatever it is called, there is blue and yellow--no, the gray book. Was it gray?

An Honourable Member: Black and white.

Mr. McCrae: The black and white book, and the campaign commitments of the Leader of the Opposition (Mr. Doer). I do not know how many times he spent that $100 million that does not exist in the first place, to try to buy people's votes. Everybody's arithmetic should bear out that that does not work. You cannot spend $100 million that does not exist, and that is what they were going to do. They were going to cancel the SmartHealth contract, which never has been entered into yet, but they were going to cancel that and spend $100 million here, there and everywhere, and it was $100 million that does not even exist. So I hope it is not that $100 million that the honourable member for St. James (Ms. Mihychuk) wants us to go outside the department for.

So I would like her, because she wants to help out here a lot, because I think she cares about kids like I do, to help us with some suggestions that do not take us outside the department's spending. If the member for Kildonan (Mr. Chomiak) will not answer this--I do not think he will, he does not answer my questions--maybe the honourable member for St. James (Ms. Mihychuk) will.

Where in the acute sector, because there is support for that--removing dollars from the acute sector and placing it in the community--regardless of what the honourable member for Kildonan has been saying for the last two or three years.

Ms. Mihychuk: Madam Chairperson, well, I am not going to get into a philosophical debate about finances, although I can assure this minister that I am a fiscal conservative and having come out of a local government that indeed had balanced budgets, something that maybe this government is attempting in the future to do, I have had personal experience with balanced budgets and dealing with the needs of a community that was getting very short supply in terms of resources. I think that the government does have opportunities. I am sure that we can get into that at some other time, but I do not want to stray too far.

I wanted to ask a more specific question to the minister in terms of the LPNs. I have some knowledge, although I must say not very detailed, in terms of the LPNs. Recently, I believe it was last year that the school for LPNs at the St. Boniface Hospital closed. There was fear amongst many LPNs that that was virtually the end of the licensed practical nurses in Manitoba. I would like to ask, what is the vision of the department for LPNs, for licensed practical nurses, and the health care that they provide?

Mr. McCrae: Madam Chairperson, I would like to congratulate the honourable member on the achievement of balanced budgets. I believe that is a very laudable goal, and if it can be achieved without raising taxes it is just fantastic. Now, the only thing about it is I do not know if the honourable member did it without raising taxes. [interjection] Just a little bit, right? Well, I will tell the honourable member that for the most part here in Manitoba the provincial government, for the most part--because I know the honourable member has a comeback--we did it without raising major taxes. So, touche on that one, I guess.

There are other ways to do it. You could do it like Saskatchewan did, by raising taxes, by cutting out $185 million to the farmers under the GRIP program, or you could do it by closing 52 rural hospitals. That is the way they did it in Saskatchewan. I will compare my government's way of balancing budgets with even Winnipeg school divisions or the Saskatchewan government, any day of the week, including Sundays. [interjection]

The honourable member for Inkster (Mr. Lamoureux) reminds me that we are looking at NDP administrations here, and I was trying to avoid being so blatantly partisan about it, but the honourable member for Inkster brings that sort of thing out of me sometimes. It is a habit that he and I have developed over the years sitting across the aisle from each other.

The honourable member asks an important question about the licensed practical nurse, and I think that in all of my travels in Manitoba visiting nursing professionals, the LPN is the one most often I hear from. Right now in Manitoba enrollment in LPN training is down, at a time when there is a shortage of LPNs in Manitoba. One would think with all those layoffs and everything there would be all this big surplus. What people do not do is follow up what happened, where-are-they-now sort of follow-up. The fact is that I am told that the private sector agencies cannot find LPNs. They are having a problem. I think we are going to have to look at that situation because I am not certain but I do know for a fact that enrollment is down. There are not very many LPN students right now, and that is going to create a problem because we do have a need for LPNs in Manitoba. I think that is what the honourable member's question really is about.

(Mr. Chairperson in the Chair)

When you put into service over 500 new personal care home beds and when you have another 500 or so coming through our capital program you know that you are going to need more LPNs in the future. When you know also that staffing mixes in rural hospitals include LPNs almost everywhere in Manitoba you know that there is going to be a continuing need for the LPN.

We have an ongoing working relationship with the Manitoba Association of Licensed Practical Nurses that deals with issues like education and role of nursing and LPNs. It has been a troublesome issue, as a matter of fact, the whole issue of the role of LPNs because there is a sense among some LPNs that there are people out there trying to get them out of the system. Well, a couple of years ago there was--I guess it is a little more than a couple of years ago now--a labour settlement, I think the one that followed the nursing strike in Manitoba which left LPNs not very competitive. Now that is not just me saying that. I hasten to add that because there have been independent studies done that make the point very clearly that the licensed practical nurse in Manitoba is paid at a rate which makes it difficult for hospital administrators to hire LPNs in the numbers that they used to. The Licensed Practical Nurses Association accepts that fact; the union does not. We have had problems with that.

We have had problems having a civilized discussion about it with the union, but we do not seem to have that problem with the association. So we are asking nursing professionals, LPN professionals and the union itself to look at that issue. They have so far not done it. They have basically said, we are worth every nickel, and I say, you are probably worth every nickel and more, but, in a competitive environment that we have to become, if we are going to run our health system properly, you are going to have to look at that issue with us. I do not mean to dwell unduly on that point. It is one of a number of points that needs to be made, however.

With respect to the role and education issue surrounding LPNs, there is sometimes a little bit of overlap and sometimes friction between issues related to LPNs and issues related to registered nurses and issues related to nurses' aides.

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A year ago I personally had a role in setting up the Manitoba nursing profession's advisory council and it is made up of representatives from registered nursing, from licensed practical nursing, nurses' aides and psychiatric nurses. It was established in May. That is just over a year ago, and this briefing note says that it was at the invitation of the Minister of Health, so that is kind of nice that they have noticed that. I appreciate it.

This council consists, as I said, of the representatives I mentioned, but also the MCHCO, which is the council of health care unions. I am very pleased that we now have representation from that group as well. We are not sure exactly when that happened. It did not happen at the beginning when the MNU was invited to take part and refused, and that was very upsetting, because I think that the MNU does have a role in these matters and certainly, I think, wants to have a voice when it comes to nursing, but they refused to start earlier on, but I was pleased, during the election campaign, to drop in on one of the meetings of the council and there was a representative of the Manitoba Nurses Union. I was delighted to see that was happening. Regardless of the fact that we have our moments, sometimes, with the union, I am still pleased to see that they were taking part.

The first phase of nursing resource planning is completed, and that is a review of the existing supply and demand. We expect by the end of this year to see a completion of a future vision and a nursing resource plan. I think it will have some credibility attached to it, because all of the nursing groups are part of this nursing profession's advisory council.

The trouble was that I was getting different stories from different groups. I should not say different stories, but a different perspective from different groups, and I said, well, you know, I think what we need to do is have all of us around the same table, so we are not talking in the absence of the other party all the time.

I am very hopeful that we can achieve something with this council. I am very happy for the performance, or the role, being played by Carolyn Park who is our Provincial Nursing Advisor, who is taking part in all of those meetings.

Ms. Mihychuk: I have only two more questions, and these relate to specific families that I met in my constituency during the election.

One family, and I mentioned this in my inaugural speech, was an elderly couple. The woman was in her eighties, and her husband had been struck by a stroke or some illness that left him seriously ill. He was at home and she was in desperate fear that their life in their home on Banning Street would soon come to an end, as they could not afford to upkeep their home which they had lived in for many, many years. She said, MaryAnn, what can I do, we have spent $800 in noninsured medical expenses since January.

For a family like that, are there some supports? Is there a cushion that will help this family, this couple, who has put in many years into Manitoba's economy in terms of paying their taxes, doing their fair share. Now that they need our help, is there something that we can provide for them?

Mr. McCrae: Mr. Chairperson, I am always interested in these kinds of cases that honourable members from all sides bring forward. I think in a province like ours, where we have only a little over a million people, that the government can be responsive when these kinds of matters come up.

I did not get all of the words the honourable member said, but it is the kind of case where I need some more details, so we can do more of a review. If the Home Care part of our service is involved, there are things we can do to make sure this family is getting all that we can make available.

When the honourable member refers to $800 worth of noninsured medical services, it would be good if I could know the details of that, so that I can know how much of this is happening and whether maybe this family has not been made aware of everything that is available, or maybe it is otherwise. Maybe there is help from some other sector, i.e., the Social Services department or Family Services department or some such thing. If the honourable member wants to put on the record more information, that is fine. If she wants to share with me in writing a detailed concern or question we would be happy to look into the specifics of the case.

Ms. Mihychuk: I appreciate that. I will be providing more information. I do not want to reveal too much on the public record. I appreciate your co-operation and I will get you the information.

My final question is in regards to new immigrants. In my constituency, we have many new immigrants that have settled, and many of these--and one was highlighted in the paper in fact, I believe it was today--come with a great deal of experience and expertise. In fact, there are some that were medical doctors in their home country. They come here, unfortunately they are not able to practice.

I am familiar with communities in the North. When I was a geologist we worked out of communities that did not have access to any physicians that lived in the community. It seems that something should be done, or perhaps I could ask the government, is there the intent to somehow review the accreditation process? Are there plans to speed up the system so that we can put these people who have all these skills to work--and they are willing to do so--for Manitobans?

Mr. McCrae: Mr. Chairperson, this question is very much like questions raised earlier today by the honourable member for Inkster (Mr. Lamoureux), and I certainly can understand how an immigrant with significant medical training must feel. However, I tell the honourable member what I told the member for Inkster, when these immigrants arrive on Canadian soil, or even before that, they are advised of the unlikeliness--if that is the word--of their being able to practice medicine in Canada based on the training they have received in their country of origin. That is something that is told to them early on in the process.

I have met with a number of these so-called IMGs, they are called. Right? Immigrant medical graduates, IMGs, yes. I have met with them and their organization to talk about their concerns. There is a credentials process whereby right now, if the foreign doctors resident in Manitoba were able to meet the requirements of the federal accreditation process as well as the requirements of the Manitoba College of Physicians and Surgeons--I agree with the honourable member--we have communities that need physician resources.

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The honourable member, as a former professional--I think she said she was a geologist--would know that in order to be a professional person and practise your profession, you have to meet certain requirements. And this is where the difficulty arises. How do you draw a balance between a need that exists in our communities with the need for us as legislators and for regulating authorities to make sure that services provided are being provided by professionals who have the required level of training and skill? That is the issue. I have the same wish that the honourable member has, that here we have a talent pool, notably or mostly in the city of Winnipeg, but for the most part I think those foreign-trained physicians cannot yet meet the requirements of the Manitoba College of Physicians and Surgeons.

So you ask the question--I do, and the honourable member perhaps too--well, should they look at their requirements? Well, that is unfortunately something that--I do not want to have them reduce the standards to a point that my fellow Manitobans might be provided medical services by people who are not yet able or not yet accredited to a high enough level to provide services to Manitobans.

Our standards in Canada might be a little higher than standards in some other country. They happen to coincide well with most of the Commonwealth countries. Doctors from Ireland or Great Britain or Australia or New Zealand or South Africa do not have the same difficulty as doctors from other countries. That is not a negative comment about those other countries. It is simply that the medical schools there do not bring the students or the graduates to the level that we require in the aforementioned Commonwealth countries.

So I was very disturbed when one of those foreign doctors made the allegation that there was a racial sort of bias on the part of the college. I said, well, if there is any evidence of that, I want to know about it, because I would not support that, not for a minute. Neither would the honourable member, I know.

We are, even so, attempting to make some adjustments that will allow people to get the kind of experience, that will allow them to meet the requirements of the college, and that also, at the same time, would benefit communities because of the five-year commitment on our part.

So that little by little I expect--unfortunately, I wish I could wave a wand and fix the problem for the immigrant doctors, fix the problem for our underserviced areas. I wish it was that easy, but nobody seems to make it that simple for us.

Mr. Gord Mackintosh (St. Johns): I have some questions for the minister following correspondence between our offices in January and February of this year. It regarded a quite moving experience for me as a result of work that I had previously been involved with in the Patients Rights Committee in Manitoba.

One of the committee members went on to patient advocacy and discovered the difficult case of a Sister Rolande Dufault, who after serving the Manitoba community all her life and, of course, having taken the vow of poverty--and I believe she worked at Villa Rosa; we talked about that institution earlier tonight--lost her ability to speak as a result of illness, I believe it was Parkinson's.

She, of course, wanted to continue to communicate with the world and went to MTS to find assistance, so that she could obtain a telecommunication device. She was told that such a device was available. It is called a relay system through the Manitoba Telephone System. She then discovered, unfortunately, that there was no financial assistance available to her to obtain the telecommunication device.

Upon further investigation, it was discovered that Manitoba Health, in fact, insured people who were profoundly deaf but not those without speech for such telecommunication devices. As I recall, the insurance was an amount over $75 covering 80 percent of the cost to a maximum of roughly, I think, $425. For someone in Sister Dufault's position, living in poverty, the amount required, although not significant to many Manitobans, was certainly significant to that individual.

The result of our inquiries led to two pieces of correspondence to the minster, one from my former colleague in the Patients Rights Committee and one from myself. The minister took the position that the regulations had strictly limited the insurance to persons who were profoundly deaf, and that given financial considerations, persons in the position of Sister Dufault could not be covered and she would have to pay for the telecommunication device out of her own pocket or seek other private means of payment.

Just as a footnote, there was a television news report on the incident, and the television station which aired that report was apparently flooded with concerns from Manitobans about the unfairness of the application of the government's insurance regulations and ended up in the offer from, I understand, several organizations or individuals to cover the cost of the telecommunication device for Sister Dufault.

The alumni of St. Mary's Academy, I believe, did deliver a telecommunication device or funding for one to Sister Dufault, and I was there at the presentation. I thought it was very commendable on the part of that organization but it left me with a real concern. We had the example, I think, of charity rather than fairness in the system, that yes, Manitobans were moved by the circumstances of Sister Dufault. What if they were not as moved by someone else's circumstances? Is it right that each individual in need of such a device, for example, be put in the position of having to solicit from the general community assistance? I think that is demeaning. I think it is irrational and it is discriminatory, particularly considering that those who are profoundly deaf are entitled to the insurance.

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My question to the minister is, is he aware of the number of persons without speech who would be affected by the government's insurance regulations and are being prevented from obtaining such service as a result of the government's position in this matter?

Mr. McCrae: Mr. Chairperson, I thank the honourable member for his indulgence in waiting while I discussed this matter a little bit with senior departmental officials. The case to which the honourable member refers is one that we have a recollection of, but it is not as clear as it should be.

We are trying to provide in our province as comprehensive a package of insured services as we can afford to provide to our fellow citizens. Unfortunately, at end of the day, I dare say, there might be services that are not covered by our insurance program. In fact, from its beginning I would say the insured services have grown very, very substantially over the years.

Our recollection of the case to which the honourable member refers is something we need to refresh, and we would undertake to do that and report again to the honourable member on the particular case. However, I hear what the honourable member is saying and I have the same sorts of human responses that the honourable member would have.

I always reject any suggestion that somehow there is a different type of sensitivity that exists on one side of the House or the other. I reject that very much. Because of the work that I have been involved in, even before I got to politics, I think I have a relatively well-developed sense of caring for my fellow citizens, and I would reject any suggestion that honourable members opposite might make and have made to the contrary. So if the honourable member would indulge us just a little longer, we would research this particular file and report again to the honourable member.

Mr. Mackintosh: I wonder if the minister could also tell the committee the number of complaints or applications made by people without speech in the last year for this insured service. I wonder if he has such a statistic with him tonight.

Mr. McCrae: Complaints or applications?

Mr. Mackintosh: Applications for insurance coverage for this purpose.

Mr. McCrae: Mr. Chairperson, I do not know if we are able to judge from the number of requests how many out there there might be who, except for not requesting it, still exist, you know. We will gather together all the information that we have in regard to this particular matter for when we make a more complete response to the honourable member.

Mr. Mackintosh: I wonder if the minister has any information as to the number of persons in Manitoba who are without speech and who would benefit from such telecommunication devices.

Mr. McCrae: We do not know that, Mr. Chairperson. I think we could do a lot of searching of our files and still not be able to come up with a number like that.

Mr. Mackintosh: I wonder if the minister has any estimate of the cost of providing an insured service.

Mr. McCrae: Mr. Chairman, not knowing the number of people in Manitoba who might benefit from that if it were an insured service, then we do not know what it would cost to be an insured service.

Mr. Mackintosh: I wonder if the minister can provide the committee with the government's rationale for not insuring telecommunication devices for persons without speech.

Mr. McCrae: I think that really goes with my previous responses. I do not know how long it has been the policy not to insure this service. It may have been the same policy since the beginning, and that is something I need to inform myself about. It may not have been an insured service when the Pawley government was in office and one could ask, well, if it was not, why was it not then too, or you could go back to the government before that or before that or before that, right back to the birth of medicare and ask oneself why was this, that or the other thing not covered. You could say how come home care was not an insured service when medicare got started because it sure would have been a good idea if it had been. We would not have placed so much reliance on the more expensive institutional care that we have done in this country.

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These questions are always valid. I would not want anyone to think that we do not want to know what the needs are out there, but I do not know the answer as to the rationale any more than it would be for any other service that is not an insured service. If it had been addressed, there must be some rationale on file somewhere. If it has not been addressed, then I suspect there would not be that rationale. As I said though, we will be reviewing this file, and maybe we can learn more about the issue by doing that.

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

Ms. Diane McGifford (Osborne): Mr. Chairman, my constituency of Osborne includes Osborne Village. As you may or may not know, Osborne Village has a, relatively speaking, high percentage of people living with HIV or AIDS. Prior to my election to this Chamber, I had the honour to work in the AIDS service community. Over a period of three years, I watched 36 people die--women, men--and although no children died, there are children living in Manitoba with HIV-AIDS.

Mr. Chairman, death from AIDS is painful, miserable. It takes a long time. It is made worse by the fact that there is a stigma attached to this disease. It is made even worse in the province of Manitoba by the fact that the health and social services that would make death easier, would make it easier to die from AIDS--or to live with AIDS, I suppose I should say--are simply not in place. What I am saying is the province of Manitoba has no AIDS strategy, and it is one of the few provinces in Canada that does not have an AIDS strategy.

There was some hope in the AIDS service community last November when Manitoba Health initiated a series of meetings called The AIDS Service Community Together, including people who were living with AIDS and obviously including service providers.

Mr. Chairman, it is now June 1995, and my contacts tell me that nothing is happening, that there is still not an AIDS strategy in Manitoba. Furthermore, I have read, though I must admit I have not thoroughly combed this document, the 1995-96 Departmental Expenditure Estimates, Manitoba Health, and I do not see the word "AIDS" in this document. Actually, I must say, it makes me extremely cross.

My question for the minister, actually I have several, but the first one is, I would just like him to comment on what I have said.

Mr. McCrae: Mr. Chairperson, I appreciate the experience the honourable member has had with this disease and people suffering from it. I cannot say that I have had the same experience, so obviously I am not going to have the same kind of human reaction that the honourable member might have.

I think however looking for words in a document may not be the appropriate measure or yardstick by which to measure one's or a government's concern about a particular issue. I suggest to the honourable member that it might be akin to making something so serious trivial by using those kinds of measurements. I hope we could get a little more serious about this. I speak with great respect to the honourable member when I say that, because I recognize the experience she has had.

Manitoba Health continues to encourage AIDS-related prevention programs and activities at the community level. We realize the community can best identify its needs and offer suggestions on how best to meet these needs.

A little while ago, before supper time, I discussed with this committee the makeup of the Minister's Advisory Committee on AIDS. I think the honourable member is right in that others have expressed a need to get on with the development of another AIDS strategy. We did have a five-year AIDS strategy, and we are embarking soon on another multiyear strategy to deal with this disease.

As one who knows people, myself--as I say, I do not have the same experience as the honourable member, but I know people who have been touched by this disease personally, and to talk about the disease without mentioning the utter loneliness that goes along with it--and that is part of that disease--is not to give the matter its full dimension.

The honourable member mentioned the November round table. There were March and May '95 round table meetings convened by Manitoba Health. We brought together 40 participants with knowledge and experience in the areas of prevention, care and treatment of HIV-AIDS. The purpose of the round table was to identify the needs of HIV-infected people, review the current services and identify the gaps in services. The participants made recommendations on how these needs should be met.

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As a result of the round table, there will be further discussion to ensure the strategy that comes forward properly reflects the proceedings of the round table meetings. The discussion will involve a broad cross section of stakeholders, and that is the process that will result in the development of another provincial AIDS strategy.

I certainly respect the honourable member's view and understand why she would be cross and tell her that through the efforts of the people on this committee and the round tables we expect that we indeed will be part of a network of provinces that have an AIDS strategy.

Ms. McGifford: I think that the minister's suggestion that I am trivializing AIDS is extremely insulting, and I am extremely hurt. I just said earlier that I have lost 36 friends to this disease, and to suggest that I was trivializing it is extremely insulting.

However, to get back to the matter at hand, what my question is really is can the minister tell me when the strategy will be ready and when it will be implemented?

Mr. McCrae: I apologize to the honourable member because I certainly had no intention of insulting the honourable member on the point. I just think that there are better measurements, that is all, to make a point about the lack of an AIDS strategy. It is simply good enough for me to say there is not one, and I accept that.

I have asked people who know better than I do about AIDS to assist our government in developing a strategy to deal with it. So I do sincerely regret any insult; none was intended for the honourable member.

But I do say, when we are dealing with something as serious as this, I guess I am a little oversensitive sometimes because I do not want anybody to think that under my leadership this department is not just as concerned as the honourable member or anybody else about the issues. So again I would apologize to the honourable member.

Ms. McGifford: I certainly accept the apology. I was present at the November 1994 meeting that the minister made reference to. At that meeting the then, I believe, deputy minister of Health promised, or all but promised, the gathered group that the AIDS-strategy would be funded from a 2 percent cut to hospitals, and that it would be ready to go in the fiscal year 1995-96. I would like the minister to comment.

Mr. McCrae: If the honourable member is referring to the previous Deputy Minister of Health, that would be Mr. Frank Maynard, if that is who it was. Many of our community programs are financed out of savings achieved in the acute care sector. That is what health reform is all about. It is not an effort to try to spend more money but to spend it better.

We had this discussion with the honourable member for St. James (Ms. Mihychuk) a little while ago who wanted us to spend more. I have resisted that, and maybe it does not meet with 100 percent agreement, but I think that we have to be able to provide health and health care services from the budget we have been working with. It has grown and grown and grown. It is at very high levels as a percentage of total spending. That is for health only.

When you take into account the discussion we had with the member for Crescentwood (Mr. Sale), and if you look at other expenditures of government that go to the promotion or preservation of health, it is probably a lot more than 34 percent once you take in infrastructure expenditures on clean water and those sorts of things.

So I do not know exactly what Mr. Maynard said on that occasion, but it would not surprise me if he suggested that money for an AIDS strategy would come from money saved from efficiencies brought about in the acute sector. That would not surprise me. In fact, there is unanimous support for that approach to health care reform.

Ms. McGifford: Mr. Chairman, I feel that my question as to when the AIDS strategy will be ready still has not been answered. I wonder if I would be correct tomorrow when I phone AIDS service organizations in the city of Winnipeg to tell them that there will be no AIDS strategy in 1995-96.

Mr. McCrae: I am not sure if I heard everything the honourable member said. It sounded a little intimidating. It was not meant to be. Good. Because you see to operate that way would be to provide knee-jerk sort of responses to issues and I cannot work that way. The reason our health system--if it is in trouble--the reason it is in trouble is because of governments that operated that way in the past.

I go back to my previous response which refers to input from people who know more about this matter than I do--community agencies and representatives of people who advocate in the area of AIDS awareness and so on--and when those consultations are done, then we will have a policy. I hope it is soon. I hope it is very soon because I share the same concerns as the honourable member.

Ms. McGifford: Mr. Chairman, the Village Clinic is changing its service mandate from a clinic specializing in HIV AIDS to a geographically responsive clinic. Does Manitoba Health have a plan for dealing with this change?

Mr. McCrae: I hope that the honourable member can use this information. Right around the time of the federal budget, representatives of the Department of Health here in Manitoba met with the Village Clinic representatives to give them some assurance about federal cutbacks, and that we would fill in where the feds left off. Indeed, the federal government has made life difficult for all of us, but we told the Village Clinic that we would be filling in the funding, that shortfall created by the federal government, until the AIDS strategy is in place. I hope that approach will be of some assistance. We value the services being provided.

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I wonder if this might be an appropriate time to take a small break before we resume questioning, perhaps five minutes?

The Acting Chairperson (Mr. Radcliffe): So be it.

The committee recessed at 10:15 p.m.

________

After Recess

The committee resumed at 10:23 p.m.

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

Mr. Steve Ashton (Thompson): Mr. Chairperson, I would like to ask a number of questions to the minister in regard to a number of health issues, some of which I have raised in previous sittings of this committee and some of which I have actually raised in Question Period, as well.

I would like to begin with a question to the minister further to what I was asking earlier today in terms of the situation at the three northern hospitals. As the minister is no doubt aware, the original guidelines, the rural guidelines, were announced in 1993. The minister was in Thompson at the meeting that was arranged. I appreciate the fact he came to Thompson and met with members of our community and surrounding communities.

What took place was a process afterwards whereby those guidelines were reviewed and subsequent guidelines were brought in. A number of problems have been identified with those guidelines. Incidentally, some of those problems have been identified by participants at both the subcommittee and the committee level of that review process.

For example, in the case of Thompson General Hospital, there are concerns related to the emergency ward, the special-care unit, and one I would like to highlight is in obstetrics, where the College of Physicians and Surgeons in August of 1993, at that time, prior to these guidelines, indicated that there was a potential for a serious mishap because of reduced staffing levels that had already taken place at that time because of the cuts that were brought in because of the deficit that the hospital was faced with.

So, in other words, we are faced with a situation whereby the cuts that have already taken place have had an impact. We have a warning from the College of Physicians and Surgeons. I know this concern has been raised with the consultant from the Department of Health that came to Thompson. It was raised by both hospital administration and by staff at the hospital.

So my question further to what I was asking this morning is to find out when the revised guidelines will be announced, because every indication I have received from the minister and from the Premier (Mr. Filmon) is that where concerns can be documented and where the government accepts that--and we may argue over what is a legitimate concern, but, obviously, the government itself has said if those concerns are accepted, the layoffs will not take place to that degree. Thus far, the cuts are still on hold. I am being asked on a continual basis. I know it is a concern in all three northern communities.

What we want to know is, when are we going to get some final announcement on what cuts are going to proceed, when they are going to proceed, because there is a two-year phase-in and what cuts will not proceed from the revised guidelines because of the concerns expressed by the hospital?

Mr. McCrae: Mr. Chairperson, I believe the honourable member has a pretty good grasp of how the whole matter has unfolded since September of 1993, when I was appointed Minister of Health and the staffing guidelines, as they then were, were put on hold, and the implementation pursuant to those guidelines was put on hold.

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Since that time he is aware, too, that we have spent a good deal of time on the issue which I suggest demonstrates pretty clearly that, where patient care is concerned, the imperative to save money has not been the priority. I think we have demonstrated that amply and demonstrated that, as a government, here in Manitoba, we are quite prepared to place resources at the disposal of hospitals and other health care providers throughout Manitoba at levels which are virtually unmatched anywhere in the country.

That being said, there is no way I can justify to my colleagues or to hospitals in Manitoba which have been able to work within appropriate guidelines, there is no way I can justify an indefinite moratorium on implementation of legitimate staffing guidelines.

I recognize the difficulty faced by some facilities because, for whatever reason, over the years, some facilities have allowed their staffing complement to exceed, and in some cases exceed significantly, levels in other facilities whose job it is to do the same thing, i.e., to provide care to Manitobans wherever they live.

It is true, I did visit the city of Thompson and, thanks to the honourable member and his organization of his community, I was able to take part in a meeting there, with people representing various aspects of the community. It was a positive experience. There were no untoward activities or anything like that. I give the credit for that to the honourable member for Thompson, who, I believe, approached the issue in a way that I felt was reasonable and fair.

Since that time, as the honourable member knows, we have engaged in an extensive review of the guidelines, and the honourable member has set out that there was a committee and several subcommittees, and I remind the honourable member that representatives from the North were on all the committees. The guidelines, it is expected, will be implemented over a two-year period, and consultants from Manitoba Health are having ongoing discussions with facilities. As I said, in answer to the honourable member for Flin Flon (Mr. Jennissen), if there is a legitimate reason why a facility cannot initially meet the guidelines, exceptions will be made until a satisfactory solution can be found.

I think the specific part of the honourable member's question is one I am not able to answer tonight, and that is, when is the next contact with Manitoba Health consultants? I do not expect it will be long. I do not know exactly the date for that. I hope that as soon as we ascertain that we could let the honourable member or other members of the community know about that, especially the hospital administration. I do not wish to, in any way, make insignificant the impact this kind of implementation will have on a community like Thompson or Flin Flon, where, unlike in other communities, the concept of part-time or casual-type staff, you do not see as much of that in northern communities, as you see in some of the others. However, there are a number of rural communities who have the same situation as that. So that when you do reduce positions in a hospital like that, it might be a little more difficult to make the voluntary separation approach work as well as it might work in a place like Brandon or Winnipeg. I recognize that.

I understand that, because during the election campaign, some of the proposals put forward by some of the hospitals were delayed or put off, or whatever happened, because there was an election campaign on, and that is perhaps understandable. Still, we do need to see the proposals coming in from the facilities. Sometimes a proposal for implementation will come in that is not acceptable to the department, and, as the honourable member has pointed out, that may be a subject for disagreement or for negotiation or whatever.

All I can tell the honourable member, if he wants to make a report back to his community at this point, is that we will continue in the time that we have to be as sensitive to the local needs as possible. We will attempt to, of course, be reasonable with the people with whom we are dealing in order to bring about the savings that can be achieved by adherence to guidelines that have credibility built into them.

I realize the honourable member said there are problems still and all after all of the process. Well, that is something I can perhaps understand, and it will be up to the administration at the Thompson General Hospital to put that case to our health consultants. The honourable member says they have. I guess that means they have already put in their plan, and I guess there are aspects of the plan which have not yet received agreement from the Department of Health.

So, I fully acknowledge that the process is going to be difficult no matter how you try to humanize it, no matter how you try to make it sensitive to the labour issues that, of course, are part of this. When you are dealing with a facility that has been staffed at higher levels than other hospitals, there is a period of adjustment, no doubt, for those who are left to run the facility.

I did want to say that the questions being raised should also take account of the fact that in Thompson, as well as everywhere else, there have been new technological advances and surgical advances that have had the effect of reducing lengths of stay in northern hospitals as well as everywhere else. You cannot argue on the one hand, we need more all the time, and accept and acknowledge that, yes, indeed, technological advancements are having the effect of leaving our hospitals with more capacity than they have had in the past.

That is another way of saying that some of the directions in reform are indeed working in the way that it was expected they would. It does not take away the human dimension of change, but it needs to be said that without change we run a very real risk of losing our health system as we have known it and as we might have it in the future. If we do not get our act together in health care, we are going to lose it, and I refuse to subject my fellow citizens to that kind of risk.

(Mr. Chairperson in the Chair)

Mr. Ashton: I appreciate the minister's comments, but even in his comments I think the minister is buying into what has been the problem with this process from the beginning. I will tell the minister that people who are part of the process have described it as a farce. They felt their views were not listened to. They felt, in fact, there was agenda to begin with that went beyond an open process. I hope the minister would look at the fact that the process itself ended up producing very much the same guidelines that had been brought in in the first place, in 1993, with minor revisions. They are marginally better in the case of Thompson.

The second point I want to deal with is the minister talked about other hospitals living up to guidelines. The minister should be aware that it is only rural and northern facilities that face guidelines. The hospital in his constituency, in Brandon, and hospitals in the city of Winnipeg are part of a different process where there are no guidelines in the same way that you are talking about rural and northern facilities.

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The third point to the minister is that the issue in this particular case relates to the specific, unique circumstances of northern Manitoba. I will give the minister some examples of how unique northern Manitoba is in that circumstance. In the Thompson General Hospital, in obstetrics, 37 percent of patients are high risk. In the Thompson obstetrics ward is the highest infant morbidity rate in the province, and it should not come as any surprise, Mr. Chairperson, because when you look at what has been happening in northern Manitoba--this is something that my colleague, the member for Rupertsland (Mr. Eric Robinson) has pointed out many times--is that aboriginal people face specific health circumstances that are leading to much higher rates of illness and morbidity.

People are literally dying in northern Manitoba, aboriginal people. In fact the member for Rupertsland shared some statistics with me. I want to put these on the record because it points out not only the need for recognition of these facts in any hospital guidelines, but for an aboriginal health care strategy. The number one leading cause of death is injury and poison. The suicide rate for aboriginal people in Manitoba for men is twice as high as the rest of Manitoba, for women 2.5 times higher. Violent deaths are three times higher for aboriginal people than the rest of Canada. In 1987, and there is more recent information available, the Thompson region had the highest death rate amongst children aged 28 days to 14 years. A large majority of these children were aboriginal children. Aboriginal children in Manitoba were 4.4. times more likely to have a congenital condition than non-aboriginal children.

You can continue in virtually every other measure of health care. That is very much why, when I talk about northern hospitals, I am talking about not only the communities served by those hospitals, the immediate communities, the surrounding communities as well. I am talking about, in particular, aboriginal health care.

The next thing I want to deal with is, the minister talks about, well, we have to deal with change. The hospitals have dealt with change. The Thompson General Hospital has reduced the number of beds from 100 to 85. By various calculations, these guidelines will result in further decreases anywhere between 68 and 72 beds. There are various estimates, in terms of the impact it will have. I use the bed measure not as even the only, or certainly even an adequate measure in terms of what is provided in terms of health care by a hospital. I want to point to that because that is one easily documented statistic in terms of that.

The reason I documented the circumstances in obstetrics is because the College of Physicians and Surgeons have said because of the reductions that have already taken place there is potential for serious mishap, because of reduced staffing levels. I can provide the information on that to the minister. I can say that the review process, because of the way it was handled, a lot of that information was not available to that review process. That is one of the concerns that took place with the process, and I can tell you that in fact the hospital did send the information and extensive report and that was one of the points that was pointed to.

I want to go one step further and concentrate on the reductions. The minister will know that with the emergency task force and various other reports that have been in place. The minister will know that in terms of the planning of the Thompson General Hospital. The minister will know that when his own former ADM who was in charge of health care reform came to Thompson, all of them point to one thing. That is, as part of any real health care reform some of the significant regional facilities should be used as regional centres which will involve an increase in resources in certain areas. The emergency task force is a good example of that. How can we look at greater regionalization of emergency cases when we are going to reduce the emergency ward in the Thompson General Hospital down to one nurse and cut the special care unit down to one shift a day? It just does not work.

Similarly, in terms of obstetrics, I pointed there to some of the problems where reductions have already taken place. What is happening now increasingly with obstetrics and other areas in terms of northern hospitals is that doctors are referring patients to Winnipeg, both out of Medical Services and doctors in the provincial system. As the minister knows, that adds additional costs in terms of transportation. I really am concerned about that because every study that has been done has pointed to the need for greater regionalization of many areas particularly involving the Thompson General Hospital.

So I look at this whole spectrum. The hospitals have reduced already, warnings have already been given, not just from members of the Legislature or from staff or from administration of the College of Physicians and Surgeons. I point to the significant difference of the profile of populations in northern Manitoba.

There is a real problem out there facing many aboriginal people, in terms of health care. It should not come as any surprise to anyone. There is no sewer and water in a lot of aboriginal communities. There are high rates of unemployment, high rates of poverty. There is a lack of even the most basic facilities, even line power does not exist in many northern communities. There are inadequate or no roads, and there are many people in northern Manitoba who feel they live in third world conditions.

It shows up in our hospital system. To my mind, to deal with that, there are a couple of things that need to be done. The first thing is not to further cut the northern health care system, because the people who will suffer, many of them will be the aboriginal people who just cannot afford to suffer anymore.

What we need to do is go beyond that, not just regionalize to improve some of the specific hospital services, but it is to develop an aboriginal health care strategy. I want to suggest to the minister--I will make a number of what I would consider concrete suggestions here on how to deal with it. When you are dealing with northern Manitoba, in terms of aboriginal health care, you are really dealing with three different types of communities, First Nations communities, Northern Affairs communities, and the urban communities.

First Nations communities, certainly one would have to involve Medical Services, but I think that is one area that definitely needs to be looked at because there needs to be greater co-ordination with Medical Services, the federal government and the increasing role of First Nations communities in terms of health care.

In terms of Northern Affairs communities, we can talk about jurisdiction all we want, those are communities under the jurisdiction of the Department of Northern Affairs, and I can say to you, Mr. Chairperson, that their health care is absolutely inadequate. Many communities, even large communities, do not have doctor visits, they are often isolated, have difficulties in getting to medical treatment, often have difficulty in dispatch of ambulance services. A lot could be done if the province would acknowledge its role in those communities clearly in terms of jurisdiction. We can get into that if the minister wants, but these are under the jurisdiction of the Department of Northern Affairs, in terms of improving the medical care in those communities.

Such a medical strategy would include having some of the services that we take for granted in urban communities, home care, for example. That is something that is not available in many remote communities, but also I think should look at other things such as sewer and water. I mean, this is 1995. We are going to be entering the 21st Century in five years and there are communities in northern Manitoba that have no sewer, no water, no roads in terms of access to outlying communities. The end result, as the minister will know, is an impact on a lot of things in terms of the quality of life but particularly in terms of medical care.

In terms of concrete suggestions, I would start by suggesting that the minister call a meeting with northern communities, with the NACC, the MMF, with MKO, Swampy Cree Tribal Council, other organizations and also the urban municipalities, because I think health care should be put first and foremost on the agenda at this point in time in northern Manitoba. Believe you me, it was a major concern throughout the election. I do not just mean the partisan political aspect, but it was something that was raised in every community that I visited, as a major concern.

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I would suggest it should be a problem-solving meeting, not just dealing with the question of hospitals, but how can we make the medical system work better? How can we deal with the tremendous medical problems that are facing many aboriginal people?

I mentioned some earlier, but I could mention many others, many on the mental health care side. There have been six suicides in Oxford House. Six suicides, young people. Surely, that in itself should call for some bringing together whatever ideas and resources we can put together. I want to suggest that the minister consider doing it, perhaps in conjunction with aboriginal organizations, the urban communities, perhaps in conjunction also with Medical Services in the federal government. But somewhere along the line we have to recognize there is a major problem out there and deal with it.

There are some other things that can be done to improve it as well. In terms of Northern Affairs committees, I believe the Department of Health could look at co-ordinating the provision of medical services. Many of the communities are fairly large communities. I represent the community of Wabowden, for example; it is one hour away from Thompson. It used to have a visit from a doctor a number of years ago; my brother, who is a physician, also was part of the practice in there, which was done by a private clinic. But private clinics often do not have the time or ability to co-ordinate that.

Why can we not co-ordinate physician visits to Northern Affairs communities? Physician visits do occur in many First Nations communities of similar sizes because Medical Services co-ordinates it, deals with it in terms of contract provisions. By doing that, Mr. Minister, you not only improve access to health care, but you also can cut down on transportation costs. If you bring one doctor to a northern community, it stops the 10 and 15 and 20 patients from having to go to visit that doctor. I believe over time you can establish preventative health care. That is one suggestion.

I have some other suggestions as well in terms of the operation of nursing stations. Right now, there is a whole series of gaps between how we operate nursing stations and how we educate nurses. For example, we have a Northern Nursing Program through KCC in Thompson. Last year, many of the graduates were unemployed, could not find employment. I will give you an example of how unfair that was. In one case, when a woman applied for a job at a local health facility, there were two positions. One of them was a person who was hired locally; another was person who was hired from outside. This is the same woman who told me she has contacted virtually every hospital and every health care facility across the country to be told in each and every case that they hire local residents first.

Even when the jobs fit the qualifications of graduates, they do not get the employment necessarily. Some Northern Nursing graduates are working in Wal-Mart in Thompson. That is how difficult it has been for them. I want to go one step further because we have various requirements for the nursing stations in terms of Northern Affairs communities and the nursing stations in the First Nations communities. I do not know if you are aware of this, Mr. Chairperson, but to practise in many of those communities, it is not sufficient to graduate from the Northern Nursing Program, or even a bachelor's program. In fact, there are two remote nursing programs in Canada. One is at Dalhousie University in Nova Scotia, the second one is at McMaster University in Hamilton. So, to get this, I think, sort of straight for a second--to get the additional training for the remote nursing, you have to go to Halifax or to Hamilton. Somehow, that does not quite make logical sense to me.

To my mind, to have the appropriate training, why can we not do it in Manitoba. We have got remote communities. We have got remote nursing stations. We have got hospitals. I want to take this opportunity to lobby. Certainly, I know the minister is involved in discussions with the proposal for the bachelor of nursing program that is being put forward by the MKO because I think that would be the first major step toward achieving that.

We took one step with the provision of the R.N. program, the Northern Nursing Program in Thompson, through KCC, originally with Red River. That is another step that could be taken.

But there are a lot of concrete things that could be done in northern communities, and I would suggest that it is not just a question of service. I already believe, in many cases, if those kinds of provisions are taken, we can improve the long-term health of people in the communities. I can talk about a lot of other things, too, in terms of preventative health care. I think there is a lot of potential in northern communities.

I will give you a quick example of something that should be replicated in community after community, and it is in the constituency for the member for Rupertsland (Mr. Robinson)--Berens River, the Berens River Ikwewak food co-op which produces food in that community.

You know, many northern communities, and I am sure the member for Rupertsland can provide much more information on this than I can--20, 30 years ago many northern communities did have significant production of local food. I know, talking to the elders in the communities I represent, they still reference the fact that there was significant food production in terms of vegetables, berries, et cetera. We do not do enough to promote that, and that is probably another area of preventative health that could be dealt with.

I could continue--I mentioned about home care. There is a need for home care, and the minister talks about some of the changes in hospital policies. We turn people out of the hospital quicker, and in northern Manitoba we send them back to their communities where we have no home care. There have been numerous problems of people ending up with severe difficulty when they have gone back to their community, including infection.

In some cases, people at risk of infection were being sent back to their communities which do not have sewer and water, so they are more susceptible to infection, and ending up back in the hospital for much more difficult infections and much more difficult situations to treat.

I realize that I could continue in terms of a number of other items. I will be providing this in documentation to the minister because I think a lot of these issues that we are dealing with here require that sense of bringing things together. I mentioned this when I referenced some of these issues in the throne speech, and I have written to the Premier on this.

There is a big gap that is developing in this province. Some of it is political, but some of it is also just in terms of what we receive in terms of basic services. I think there are many people in urban communities, in this city, and many other communities in Manitoba that have no idea what it is like for people living in northern Manitoba. But, you know, it does not always have to be that way. There are things that can be done, and in some cases what we need to do is not spend a lot more money; in some cases, we do not have to spend any more money. In some cases, we have to be more focused, more creative, and we have to bring people together to solve the problems. Because, you know, a lot of times we will spend money out of one budget, transportation to send people to Winnipeg for treatment, instead of spending that same money and providing better services in northern Manitoba. It is wrong not only in the sense the way the system operates, it is wrong for the people themselves.

So I realize, Mr. Chairperson, that there are many issues I have raised. I do not expect the minister to respond to all of them at this point in time. I would certainly welcome the response to the letter I will be writing to him, because I will be documenting these. By the way, many of these suggestions are not my own suggestions. They are coming from many of the organizations, administrations of hospitals, staff at hospitals, patients. I think pretty well everything I have listed falls in that category.

But I would particularly hope one thing, quite apart from the specifics of the hospitals which I will continue to raise with the minister, and that is some sort of a commitment to an aboriginal health care strategy. The member for Rupertsland (Mr. Robinson) raised in Question Period, I believe, the fact that we were the only province that did not send a person to a Canada-wide meeting that took place in terms of aboriginal health, and I realize the minister said that the aboriginal health consultant was not in place at that time, that is why that took place.

Presumably, now that we have the consultant in place that no longer applies. What I would like to suggest to the minister is that maybe that Manitoba should take a lead role. We have the highest aboriginal population in the country. We have got a lot of significant health care problems. We also have a lot of expertise. So perhaps we can take the role, bring that expertise to Manitoba and get some constructive solutions to many of the real challenges we face in terms of aboriginal northern health care.

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Mr. McCrae: The honourable member did indeed cover the proverbial waterfront with his comments this evening, and I know that my response will pale in comparison to what the honourable member has had to say. I felt that he came well prepared to make his comments tonight and covered issues that, to a large extent--I can certainly see the thoughtful homework he must have done in order to bring forward the comments tonight, so I commend him for that.

Of course, there are a few areas I would take issue with, but for a good part of what he had to say, I appreciate and identify with--and indeed many of the things he said fall well into line with the basic reform policies we have been trying to encourage here in the province of Manitoba.

I do not know quite where to start, so I hope my response will not be seen to be insufficient, but I fear it may be insufficient, so therefore I look forward to the honourable member's correspondence so that I can be given an opportunity to respond fully to each and every matter that he raises with me.

He takes issue with the process with respect to the northern and rural staffing guidelines, and that is alright. That is his right to do. To say, though, that--I mean, I have heard this so many times before. To say that, yes, I was involved on a committee, and there was a foregone conclusion, there was a hidden agenda, and the deal was done before the committee ever got started, I think does a disservice to those who worked very hard on the staffing guidelines review to do a good job.

I do not think I have said often enough that I genuinely appreciate the work that was done and the efforts that were made by those involved in that process. I should say that more often, because I think it was a very important process.

To say what the honourable member said also may do a disservice to the--[interjection] Yes, the honourable member was reflecting what some members of the committee had to say. I do not lay this at the honourable member's feet. He is repeating what he has heard said by some others. So I say to those people, anonymous though they may be to me--[interjection] The honourable member will provide me with names, and they will provide me with this information straight to my face, and I hope that happens. When it does, I will say to those people who feel that way that they do not speak very highly of their professional colleagues who are professionals serving on these committees. [interjection] Some members of this committee claim they did not like the process, and I accept that.

All I say, if the honourable member will hear me out, is that if somebody wants to allege that the process was flawed should tell that also to their colleagues who also took part in the process. I am talking about colleagues representing professional organizations whose mandate, by law of our province, is to protect the patients, i.e. the Manitoba Association of Registered Nurses, who had representation on these committees, the Manitoba Association of Licensed Practical Nurses, who had representation on these committees, and the Manitoba College of Physicians and Surgeons.

The representatives of those agencies, if we believe what the honourable member's correspondents are saying, threw aside their lawful mandate in order to participate in this process. I accept that somebody might feel that way, Mr. Chairperson, but I also have to stand by what I have said. We, in our province, have a job to do in our facilities. We have people who are willing and prepared to go the extra mile to take part in this sort of process and then at the end of a year, year-and-a-half process to be told that the process was the same as other processes that are not right, Mr. Chairperson, it just seems all too convenient for me to participate for a year and a half on a process and maybe not be able to face one's colleagues at work with the report, and then at that point to say, well, the whole process was not very good anyway.

Mr. Ashton: They did not agree with the report, period.

Mr. Chairperson: Order, please. Could I ask the honourable member to allow the minister to finish and then he can come back with another question.

Mr. McCrae: My honourable colleague says there are people who do not agree with the report. I would like to hear their response to my question about the fact that we had professionals involved on those committees, people whose legal mandate is to protect patients. That is all I am saying. I am not saying that it was a pleasant process or that politically anybody agreed with anything. I am not saying any of that sort of thing. I am saying that for the honourable member, at this point, long after the reports are done and we are into the implementation phase, to say, oh, but it was all wrong. [interjection] He said it at the time, my honourable colleague is helping, Mr. Chairperson. All I am saying is that if we listen to the honourable member, I suggest we would never do anything, and never to do anything is to signal the destruction of our health care system.

I hear and appreciate what the honourable member is reporting to me. I also am one who has to take some responsibility. On this side of the House that is what has to be done, and I think it is wise for us to operate on advice-giving. I met with some groups, notably union bosses, associated with the APM project at the big Winnipeg hospitals.

They said to me that even though they were participating in the process, they felt that they were being outmaneuvered or whatever in that process, and so therefore no recommendations really, or some major ones certainly, ought not to be followed because they were flawed, because they did not agree.

The thing of working in a consultative process is there has to be, we hope, consensus arrived at. In order to arrive at consensus on a committee--any committee I have ever been on has involved some give and take, has involved some compromises. I might walk into a room with a very clearly set agenda because I worked for a union or I am a union rep. I was a member of a union once; I paid the dues. The point is, it has become clearer and clearer to me with each and every public message purchased by unions in our province that there is more than one agenda out there besides pure concern for one's fellow citizens.

There is more of a vested interest involved. That is where, in an environment where we no longer have the luxury of just saying yes to those people who have vested interests all the time, we now have to say, we respect your views, but will you please join with us in putting the patient first. That is the kind of point that we are at in Manitoba. We can no longer say, well, its all right, we can just go and tax the people some more or we can just go and borrow some more money.

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Those days are over and the honourable member, in his heart of hearts, in his private moments, I know agrees with that. But I am not with the honourable member in his private moments, so we cannot have the kind of discussion I would like to have. I sincerely believe the honourable member knows what I am talking about and knows that if he were in my place, he would have to grapple with the issues that I have to grapple with, but I sat on that side of the House for a couple of years and I know how it works over there.

I think those two years of my life were good experience because I can understand what the honourable member is attempting to do. As the honourable member points out, I even got kicked out of the House once for my beliefs. Not one of my stellar moments, I can now say with delicious hindsight, it is true, but I still believe in the things that I got kicked out for.

I believe in an end to hooliganism on picket lines. I believe in an end to the kind of intimidation practised by some union bosses and their supporters, but I digress, and I get into the thing that got me kicked out in the first place, so I better stay away from that.

I know the honourable member for Thompson (Mr. Ashton) remembers that, and I know that the chairman of this committee agrees that I ought to get away from that particular discussion, in case I run the risk of getting kicked out again, and I do not want to do that. Like I said, that was not one of my stellar moments.

Mr. Chairperson, I think that it would be wise if I could be relevant to the topic here. [interjection] Come into my house said the spider to the fly, and I believe the honourable member for Thompson is portraying the role of the spider tonight. But, oh, what a tangled web we weave when we practise to deceive. I do not think the honourable member is doing that. That would not be relevant.

I think the later the hour, Mr. Chairperson, the sillier the discussion seems to become, so I will try to get myself back to the point at hand, but it is amazing that at a little after 11 in the evening, when the members of the Legislature might not be counted as legions, how much distraction there can still be in the Legislature.

I think I have tried to deal as best I can with the process of the staffing guidelines review, and I think maybe the member and I will have to agree to disagree on the point.

However, he has invited me to go eyeball to eyeball with the people he has been talking with, and that is something I am up for. I can tell you that, Mr. Chairperson, because I have done it before. I am prepared to do it again because I want to ask detractors what it is about the process that has been so flawed, from their point of view, because it seems only in the honourable member's case that I hear that, unless the honourable member for The Pas (Mr. Lathlin) wants to echo the same point of view.

But, you see, the member for The Pas represents an area where an aboriginal leader put out an emergency press release to allege that the cutbacks at The Pas General Hospital have resulted in an incident in the emergency room, even though there had been no cutbacks to the emergency room, and demanding an emergency meeting with the minister, even though there had been no cutbacks in the emergency room of The Pas.

So one has to begin to try to ascertain what may be behind such a press release, the timing of it being what it was and so on, and what was it that was being attempted to achieve.

I am quite prepared to stand in my place, Mr. Chairperson, and address reductions in funding where reductions occur and talk about the responsibility that I have, and my colleagues on this side of the House have, to spend the largest budget, as a percentage of budget, on health anywhere in the country. I am quite prepared to do that, but it is so much more meaningful when it is based on facts and not on something somebody made up.

So, in response to that emergency press release, I expressed some frustration with people who would, in the name of health care, put on the public record incorrect information in order to try to achieve some end or motive or objective that seems to have nothing whatever to do with quality health care but something to do with something else altogether.

The honourable member asked about Winnipeg and Brandon not being part of the rural and northern staffing guidelines, and it is a legitimate point, and I accept that.

We have embarked upon a secondary care review for all the community and tertiary hospitals providing community or secondary care, and I dare say a review of use that is made of these facilities and the staff who is there to deal with that use would be relevant to a review like that.

I know, coming from Brandon, that I hear--because I know so many people there and many of them in the health care field, people talk to me about how busy the staff at the Brandon General Hospital can sometimes be. I hear from patients from time to time who make the same claim, and I like to be very responsive and sensitive to those things when they come up because it is my job, I feel, to be concerned about the health of the patients that are in our care when they are in our facilities. So each and every time an allegation comes forward, I follow it up and I satisfy myself that in real terms either the concern was not justified or if it was justified that appropriate measures are taken by facilities to deal with the issues.

However, concerted attempts by unions to outspend governments and everybody else combined when it comes to advocacy during an election campaign--there are times when you use actors to portray things on public messages to people about something so important as health care. That, for me as a Manitoban, detracts from the message that they are trying to get across. [interjection] Yes, sometimes canoes get used, and I really do not know what that has to do with using actors to portray the concerns of a health care worker. I fail to see the comparison.

In any event, I hope that that secondary review will reveal for us a number of improvements that are possible for us, as we try to develop a network in a big city like the city of Winnipeg, or a small city, depending on how you look at it. But I think of Winnipeg as a small city when it comes to the issue of health because I know that we have seven acute care facilities that, if they were more appropriately co-ordinated, I think there is room for lots of improvements for patients in the Winnipeg area. I would like very much to have the support of honourable members in moving forward to bring about improvements in our system here in Winnipeg and in Brandon too.

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The honourable member came around later in his comments when dealing with aboriginal health. He started out to try to make a case for hospitals when really what he was talking about was conditions in communities that really need to be addressed as much as or more than the focus of his comments. He is still working in the world where the acute care facility is still the focus of everything having to do with health care. Right?

An Honourable Member: No.

Mr. McCrae: No, hear me out, because I am not trying to put words in the honourable member's mouth, but he started out with all of this focus on hospitals. Well, that does draw people's attention. I grant you that. That is a fact, and that is a way to do it. If you want to make political points, point to the acute sector where reductions are happening. Go ahead, that will work.

An Honourable Member: If you are having a baby, or you need emergency care, where do you go?

Mr. McCrae: You go to a hospital when you are having a baby or needing emergency care. As a rule, that is where you go, and no one wants to stop that because that is what we need to do.

But, if the honourable member will let me complete my thinking process here--granted, mine might be a little slower than his--I would like to develop my theme here, which rounds out what the honourable member was saying, because he did get to the point of communities and the developing of communities. I think it was appropriate for him to do so.

I would like him to put more emphasis on that because we are not going to develop communities in addition to adding and adding and adding to the acute care centre because, at 34 percent of government spending on health, there is no province that does better than we do.

His government certainly did not do as well as we are. His government was not committed to health care. Is that a fair statement for me to make? Of course not. His government was committed to health care, but just not as committed as this government is, that is all.

What he says about the development of communities is absolutely true. Absolutely true. But why does he not give it some real meaning by working with us, to say, well, at the levels of spending that we are doing on the community development and social services, we are going to make some improvements? We are going to make a real difference to health care for the future by working together to bring about the changes.

How are we going to get Northern Affairs communities and reserve communities to respond to the call in the action plan which talks about the development of communities? How are we going to do it if all we are ever going to do is attempt to score political points in the debate? I know there is room for a reasoned debate and lots of legitimate disagreement. I know there is, but to what end? Is it to help win elections or is it to help us build a better society?

Well, I have been working for seven years on this side of the House to try to build a better society, and I have found that much of the time in this place, rather than being encouraged or assisted by constructive criticism, I am hounded, I am badgered, I am faced with an onslaught of unfair, artificial, fake, made-up accusations and allegations and criticism. That is not helpful.

An Honourable Member: Which one of my comments was not real?

Mr. McCrae: Okay, the honourable member wants to know which ones of his comments are a concern. I was not accusing the honourable member individually, because I started out my comments by saying I thought a lot of the things the member was saying were right on the mark. I guess my comments are directed perhaps a little more to the official critic for the NDP party, sometimes the Leader of the New Democratic Party, who are most often the spokespersons for the party on matters of health care.

This is one of the few times I have been able to hear the honourable member's comments. I know that he speaks often in his community on these issues. I know he writes in his community on these issues, and I know he does his job. All I am trying to do is appeal for some reason. The election is over now. We have got an opportunity in Manitoba to be a model to the rest of this country. In some ways we already are, but in some ways we could be. We could do so much better by working together on health care issues.

I get it from the Liberal Party. I get my fair share of criticism from the Liberal Party--[interjection] Very funny, very funny. The honourable member says, not as much any more, a reference to the reduction in the strength of the Liberal forces here in the House. Well, out in the rural, maybe not even in the rural areas, we have an expression. It is called rubbing one's nose in it, and I really do not know that it is going to achieve anything more for honourable members in the New Democratic Party to continue to rub the three Liberal noses in it, because it is pretty clear what happened in the election campaign. The Liberal Party did not come out the big winner. It is a fact, it is recognized. How much longer are we going to keep rehashing that aspect of things? [interjection] I guess it is never going to go away, Mr. Chairperson.

We know, too, what happened to the federal Conservatives, and one could include in that list the federal New Democrats, I suppose, too. [interjection] I guess those federal New Democrats just did a wonderful job, did they not, Mr. Chairperson? They got six seats, or seven or eight or whatever it was. [interjection] Maybe it is the hour. I do not know how long we are going to be going at this here tonight. In my own inadequate kind of a way I am trying to respond to some of the points that the honourable member raised.

By the way, when he spoke about obstetrics at Thompson General Hospital and the 37 percent risk rate, that is high, and that is acknowledged. The guidelines for obstetrics were increased in Thompson as a result. The point I make with the honourable member is that Thompson is the only normal northern hospital recognized Level 2.

Anyway, I do not want to belabour my comments unduly, but just on the vein that I was on a little bit about constructive approaches and so on, why did the honourable member not make reference in his comments to the very, very significant efforts by this particular government in the area of claims in northern Manitoba? Why did he not make some reference, while he was talking about physician visits, to the concept of nurse resource centres that we are planning in Manitoba? We have got the first one under way in St. Vital, and there are plans for Thompson and northern Manitoba, two other locations.

Physician visits, I take what the honourable member said, but why did he not say that I think this nurse resource concept and an integration of the health professionals in delivering services in communities is a good idea? Why did he not say that? Is it beyond his ability?

The honourable member talked about conditions amongst the aboriginal population. It is the closest I have heard--[interjection] Oh dear, maybe the honourable member will grant leave for me to carry on. We will see you in two minutes. The closest he came--[interjection] Yes, right. The honourable member was talking about the circumstances of aboriginal people and compared those circumstances with other people. He comes closest in the caucus of the New Democrats to addressing the real issues, and I will give the member credit for that.

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I have found that all you do is end up getting in trouble if it is me doing it, calling attention to the high suicide rate, the high levels of alcohol and drug abuse amongst aboriginal people, the high levels of abuse of women and children on reserve and other aboriginal communities. Those are real problems, and they require something that goes well beyond the traditional health system that we talk about day in and day out in this place in terms of solutions. It requires a much different working relationship with the aboriginal leaders than the kind that you see when they put out emergency press releases complaining about something that is not a fact. That is a problem.

The aboriginal people are suffering because they do not get good representation from their aboriginal leadership, and they do not get representation from the other leadership either. That good representation would bring them together. I think that the kind of thing that the honourable member wants to see is exactly the kind of thing I want to see.

Why is it that aboriginal women, and children especially, have to suffer for more generations because their leadership and the other political leadership in this country cannot seem to come together and solve problems and work together. I was not able to respond to all of the comments made by the honourable member simply because his comments were so well put together and mine are a little bit on the fractured side, but that is because he obviously was well-prepared for this discussion tonight. He talked about food production being commonplace 30 years ago. How come it is not commonplace now? I do not know the answer, but I would like to know the answer to that.

The honourable member also did not make any reference to the major advances in mental health care delivery services being provided. He points out he has done it before. I appreciate that. He is right; we could do more of that too. No matter what good you do, Mr. Chairperson, I will never question that you could always do more, but to simply use that as a criticism is not good enough. There are things we are doing today that we have never done before and we are doing it in northern Manitoba and we would like the honourable member to remind his constituents about that, too.

Mr. Ashton: I want to indicate to the minister, and I think he knows me well enough and I know him well enough, that when he talks about not giving credit for areas that I feel are positive--I have done it before, and I will do it again. I have said this many times. I did it on the mental health care. I did it as Health critic for the New Democratic Party. At the time there were some major initiatives taken by the then-minister Don Orchard. I, quite frankly, did not agree with him on many things. I agreed with him on the mental health care. I certainly supported that.

He made reference to the nurse health care centres. I have spoken for many years in favour of that concept a number of years ago as Health critic for our party. In fact, I believe that, if anything, some of the proposals we had put forward, some proposals that we put forth in the election, are far more the model that should be followed in terms of establishing complete community health centres. I think that is the route to go.

By the way, in the case of my own community, one way that would take some pressure off the emergency ward that has been pointed to, and I have pointed to it myself many times, is by having a community health centre where people who perhaps do not require the most severe emergency care can be diverted to go there because a lot of the cases that are dealt with in Thompson are in that category, a significant number. There is no other place for people to go. This is not the city of Winnipeg. We do not have walk-in clinics, for example. So it is a matter of being restricted by the hours of operation.

I have been very clear in that and, quite frankly, I make no apologies for being critical of the government in terms of what is happening with the hospital care. We have gone from 185 beds at Thompson General Hospital. We have done our bit; we have reduced. Quite frankly, I think in some areas it has probably affected patient care. But, you know, that is the point. That is what frustrates people in the facility. It is the fact that the reductions have already taken place internally and now further reductions are being pushed forward.

The concern about the process again was not any of the credibility of any of the individuals in the process, but I am sure the minister knows, it depends on how you set up the process. If the minister sets up a committee with a certain mandate, it produces one result. If he sets it up with another kind of mandate, it is going to do totally different work.

The fact is I do not believe, and I documented it earlier, that the kinds of cuts that were proposed and the guidelines can be put into place without affecting patient care. Period. Not just my words, the College of Physicians and Surgeons has referenced that in obstetrics. I can run through the whole list again.

I want to mention again too, because I think the Department of Health is playing games with words here, because I received a letter from the Premier (Mr. Filmon) talking about this reference to the guidelines having been affected.

Let us compare apples and oranges. The fact is, in the case of obstetrics, the case of the special care unit and the case of the emergency ward and other areas of the Thompson General Hospital, and in a similar way in Flin Flon and The Pas, what you will see is reductions in staffing. For years, the so-called rural guidelines have not been followed because in many cases, I believe, Mr. Chairperson, they are not practicable, to use a term that has been used in this House in other ways. You cannot follow them. You cannot follow them without affecting patient care.

So what has happened in the case of the obstetrics ward is the final round of guidelines as compared to the previous guidelines that were in place, the ones we were dealing with in '93, are marginally better. They still result in reduction, and they still result in reduction when the College of Physicians and Surgeons has said that will lead to a potential for serious mishap. If the minister wants that quote, I can provide it to him--August of 1993 prior to any of these cuts.

So, that is what I am pointing to. That is a concern that was expressed. You know, that is why I phrased my initial question in terms of the health care consultants, because I disagree with some of the process that took place, fair enough. I do appreciate the fact the minister came to Thompson. The end result is, I believe that the process ignored a number of the concerns that were expressed. The minister himself, the Premier (Mr. Filmon) has said that those concerns will be listened to and if the hospital can make the case, the cuts will not proceed.

I am saying that the hospital has made its case in a number of areas. In fact, if the minister wishes to see the analysis by the Thompson General Hospital of the impact of the original guidelines in 1993, a document that was produced when this process was ongoing, a document which I have been told by a number of people who were part of the process who felt it was not considered because of some various aspects of the process, I can show the minister. I really get frustrated because, and I am not saying this so much even with the minister, but the fact is that when the college of physicians says, very clearly--this is the College of Physicians and Surgeons--how far do we go down the line before this process picks it up and says you cannot do it? How far do we have to go before we get out of this mental trap of saying, well, the guideline is slightly better than the previous guideline.

The actual is what the college looked at, the actual staffing. It said there is a problem. In 1993 it said there was a problem because of cuts that had already taken place. Now we are proposing further cuts. It does not take too much to flag that as a concern.

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The same thing with the intensive care unit and the emergency ward. You cannot handle the number of emergency cases in Thompson with one nurse's shift. That is what the guidelines propose. You cannot operate a special care unit in a facility that serves the population that Thompson does on one shift a day. That is what is being proposed by the guidelines.

Repeatedly the hospital has made the argument, and the staff has made the argument, and all of the hospitals have made the argument, that one of the difficulties we are dealing with is balancing the fact that you do not have a constant flow of patients. There are ebbs and flows, and the problem is when you hit that crunch. When you hit the crunch at emergency, what do you do? With one nurse you have a major problem. And also, by the way, the guidelines take out the float which provided some flexibility. The supervisors' positions, the two positions, are still being reviewed. They may or may not be cut.

I mean, I can get into details. I can provide the documentation, and that is the way I wanted to start this discussion because I am not getting up here and slamming the minister for cutting and not backing it up with the evidence. That is not my point. We can get into broader debates about health care policy. My point is, there is clear documentation this goes too far and that is where I am hoping that somewhere along the line it will get picked up.

I appreciate when the minister came to Thompson in 1993. I think it was a dramatic change in style. I do not think that it would have happened before. I do not mean that as a shot at the previous minister, but I think the minister knows, and anybody in this House knows, that the previous minister would not have taken that approach. I think it was very constructive he came.

I am asking him now, at sort of the back end of this process, to take one more look at it. His consultants have met with the hospital, and I can sit down, and I can document it. I have got the documentation from the hospital. I can put him in touch with people who can explain it to him directly. I have met with people in The Pas and Flin Flon, as well.

You know, the sad part that has come out of this constantly is many of the grassroots people involved in the health care system have said, involve us and we can show you how to save money. It may not be the way that you are bringing in the guidelines, and I have heard that from people in Thompson, I have heard it from people in Flin Flon, and I have heard it from people in The Pas. So that is the approach I am taking.

I also want to make one more comment on the minister's comments because I was quite disappointed in the comments on the aboriginal leadership. I do not know what the minister has against the aboriginal issue. I know he had some fights with the Minister of Justice, with some of the chiefs, and I know there was some hard ball both ways.

Mr. Chairperson, I represent eight communities. I represent three communities of First Nations and a fourth that has attained First Nations status. I represent four Northern Affairs communities, in fact five if you include the one which is in transition and I represent an urban community. I will say to you, I have the utmost respect for the leadership in those communities. They are in touch with their communities. They are elected. When they speak, they speak for their communities. When they speak on health care, they speak for their communities.

I realize the minister may be sensitive about one particular press release that took place, but I think he has to understand the concern of people in The Pas. People in The Pas were very concerned about the cuts that have been announced under the guidelines, which have yet to be implemented. We are very concerned about that. Some of the cuts have already taken place. We can talk about whether they were necessary cuts or whether patient services have been affected or not by those cuts. There have been cuts. I mention Thompson. We have gone from 185 beds in the space of two years because of the deficit situation.

Mr. Chairperson, I hope the minister will put that aside. I recognize we just went through an election campaign and maybe some of this may have some reflection on that result. I think the minister would be the first to acknowledge that there was not much support of First Nations communities for the government. I hope that the minister is not referencing that in terms of his comments. I do not believe he is, because I am sure that he agrees with me that when he is elected member for Brandon West he does not check someone's party membership or how they voted when they walk into his constituency office. In fact, I know the good people of Brandon well enough to know they would not have re-elected the member three times, now being on his fourth term, nor would they in Thompson. If I had said to anybody who walked in my door, I am not going to work for you, you did not vote for me. I do not do that. I do not ask for party cards. I do not care how people voted. I have even had people say to me, "I did not vote for you," and they are almost surprised when you go to bat for them. I say that is not the point, I represent everyone.

I think that has got to be the spirit how we approach this because, quite frankly Mr. Chairperson, I will say to the Minister of Health that if he thinks the aboriginal leadership is not going to play hard ball with him, you bet they are, and so they should. When we were in government, the aboriginal leadership asked us a lot of tough questions. He kept us on our toes. I think he maybe even asked a few questions, certainly, at the request of some aboriginal leaders, many groups in society. I think it is unfortunate that we get into suggesting that people do not represent their communities, because they do. The people are always right. Even if we do not like it, the people are always right. I must admit, I was a little bit disappointed in the 1995 election result, but the people are always right. You accept that and you respect that.

I think that has got to be the first step with the health care situation for aboriginal people. You know, it is hard to say what is the No. 1 priority when there are so many priorities. What is it? Poverty? Unemployment? Self-government? Education? Health?

But I can say that one of the most significant ones is clearly health, because people are literally dying. That is how serious it is. You know, I will say this to the minister before asking a number of other related questions, apart from all the politics of anything. Every minister has the opportunity to--we all do as members of the Legislature, but ministers of departments have an opportunity to leave something of a legacy. I did not agree with much that the previous minister did. I agreed with him on mental health, and I am sure if you would ask for his legacy, it would be seen as some of the mental health reforms that took place.

I would suggest to this minister, if he is looking for an area that needs some work that he will be remembered for, it is aboriginal and northern health generally, because that is where the greatest challenge is in this province. I just say that as a comment, not as a criticism or a critique.

I have some further questions, and I would like to get into the $50 user fee for northern patient transportation. I am not going to get into a debate over it. The minister knows my position. I believe it is wrong. I know his position. He supports it.

I can tell him that it was a major concern that was expressed in my constituency. It certainly was raised many times in the election. I think the results in northern Manitoba reflect that to a large degree, but, you know, I do not want to get into the overall issue. I think we have a resolution on the Order Paper where we can deal with the overall issue.

What I want to deal with are some of the specific incidences that have happened with the application of the fee, because the minister knows when the fee was first announced--and he did not announce it, it was the previous minister--there was an indication that it would certainly not apply to what was called elective surgery, but in terms of other medical procedures, the fee would be waived.

What I found, Mr. Chairperson, is there is a review process, an appeal process, put in place, but I want to give you some examples of people who have been hit by the $50 user fee.

I received some correspondence from an individual who has cancer. He has been told by the Department of Health that the severity of illness has nothing to do with whether he pays the $50 fee or not. I feel, Mr. Chairperson, that borders on the inhumane. He was very frustrated by this--very, very frustrated. He has had to go repeatedly for cancer treatment, and the ironic part is, if you go for chemotherapy, you are covered; if you go for follow-up treatments you are not.

Another example--a women who had breast cancer. Fortunately, her health has been fine after five years. That is the most important thing. Each and every time she goes for a visit, she pays that particular fee, and it is not easy with the kind of pressures that people go through to have that additional burden.

I will give you another example, Mr. Chairperson. A young couple in my constituency, they have a child that has a condition that only 300 kids across the world have. Every time they go, they have to pay the $50 fee, every time, and they have had to visit up to nine times. By the way, other facilities are not available in Thompson which creates additional pressures on them. If she lived in Winnipeg, there would be child care facilities available for her child so she could continue working. She has been told, basically, for her to be able to give proper care to her child in Thompson, unless she moves to Winnipeg, she has to quit her job, so she is already faced with those kinds of financial pressures.

I had another example of a person who was borderline dialysis. Once again, if he was on dialysis, he would have had the $50 fee, and it was not until some questions were raised that the $50 fee was waived. You know, I think his comments summed it up, Mr. Chairperson. He said to me, I am unemployed right now. I have to pay the $50 fee. I am on UIC. He said, eventually it will not matter. When I am on welfare, I will not have to worry about the $50 fee. But it frustrated him, nonetheless, that that was the case.

So what I would like to ask the minister on that particular question is if there is going to be some review of the $50 fee, to look at cases like that.

* (2350)

As a supplementary to that, I will give him another example. It is appropriate I should ask this today because this is a family who has a son who had treatment at the Mayo Clinic, and it is the same condition that we were referring to earlier today when we were talking about Lorenzo's Oil. They ran into all sorts of problems because--and a very similar problem came up, as well, with another constituent of mine who had to have a treatment that was only available in Ontario, and basically was told that she could not get northern patient transportation to come to Winnipeg to have her blood banked, even though the doctor said he would not operate unless that was the case.

So it deals with the real pressure that people often find themselves in, having to go to other jurisdictions for treatment that is not available here. One of the difficulties is often they have to go through a whole fight just to get the northern patient transportation to get to Winnipeg, because, technically, the northern patient transportation covers you to get to Winnipeg for treatment in Winnipeg, but if you have to go further afield to the Mayo Clinic, for example, what it ends up doing is putting pressure on the physicians to have to arrange an appointment with a specialist before they are seen further by somebody else.

I am saying this in full knowledge that I can mention another case where this occurred. In this case, it was mental health care, where this was the specific proposal put forward at the time by the deputy minister. We met with the deputy minister, the constituent and myself. The minister may be aware of some of this, may have received some profile, but, you know, that is the kind of situation that is developing.

People are often having to have secondary medical appointments to get coverage, so that they can then access the primary reason why they are going. I am not saying it is an abuse, because perhaps they do need to see the specialist at some time, but I am wondering if we cannot improve the handling of the situation in terms of dealing with people in those kinds of circumstances.

I just want to ask one more question on an unrelated issue. I realize it is getting late, and perhaps it might be easier to bring some of the answers back tomorrow on some of these. It is related to the blood contamination question. With the Krever commission meeting--in fact, there is further media coverage today on the Krever commission indicating there are more questions being raised about contaminated blood.

I met with a constituent this past weekend who had an operation in 1983, had severe bleeding. It was for a hernia operation. He ended up nearly dying and had to receive a significant amount of blood. Now, fortunately, he survived, probably in large part because of his good physical conditioning. This person is very active, King Miner, he has won various King Miner events. Anyway, in 1991 he was diagnosed as having contracted hepatitis from contaminated blood.

Now he is fortunate in one way--this is what he told me--in the sense that some of his medical needs, the pharmaceutical drugs that he requires are covered by his employer, INCO. He has a fairly good benefits package. Also, because it was related to the hernia, which was work-related, there were prospects of continuing workers compensation coverage, certainly in terms of a pension. But he has a family to be concerned about, and he is not alone. There are other people that contracted severe medical conditions--we have heard a lot about AIDS but also in terms of hepatitis C--a number of things that have happened because of contaminated blood.

What I would like to ask the minister--and I do not expect that tonight, I realize it is late--would be if he could give some update on federal-provincial discussions on the contaminated blood situation and particularly if there has been any discussion in terms of some form of compensation for such individuals to help them deal with the very real concerns they have. In the case of my constituent, he is concerned that he is not going to be around to the same extent he would have been. His life span has been shortened by this, and, you know, it is tough enough to deal with that on a personal basis, but his concern is with his family, to make sure that they have some adequate care. His concern is also for the many other people, as he said, who do not have the employer drug programs that he has available to him.

So pretty well any information that the minister could provide on that issue would be appreciated. I do not expect that tonight, and if the minister wants to answer even some of the questions on the $50 user fee, I am quite prepared to listen now. If the minister would like to adjourn and come back tomorrow, I would certainly be agreeable on that.

Mr. McCrae: Mr. Chairperson, I wonder if honourable members will be in a position to advise their colleague the member for Kildonan (Mr. Chomiak) that if they want to raise issues related to children and aboriginal health issues, Mr. Reg Toews we expect would be available in the afternoon of Thursday. That might be of interest to the honourable member for Kildonan in planning his approach for these Estimates. If the honourable member would pass that on, I would appreciate that.

I think many times the honourable members opposite have put their position on the record very clearly with respect to the northern transportation $50 fee. I think each time we look at the preparation of our Estimates as a department, we look again at the concerns raised by honourable members and the examples they have raised and put on the record. I do not doubt but that would happen as we head toward our next year's Estimates as well. I will not venture to give a response tonight on the issue raised by the honourable member about the latest revelations regarding the Krever inquiry. Perhaps my staff could do some work on that point and give me some advice that we could bring forward to the Estimates review.

I would like to explain myself just a little bit. I did not mean to single out a particular group of leaders. Each time I raise this frustration, I do not do it to condemn everybody. There are some that I am highly critical of, not only in aboriginal governments but also in our own governments, the rest of them as well. It is not meant as a general criticism and I hope it is not taken that way unduly. Maybe I am just not as good at being politically correct sometime as I ought to be. Even this explanation, I am attempting to give now, does not give the comfort that I would like to see given to the rank and file aboriginal population in this country.

I feel a deep and abiding and lifelong frustration on that issue, and I just think it is so avoidable. There are so many circumstances which do not have to be the way they are. I guess I am expressing some outrage and frustration because I, acting by myself, or even part of one provincial government, have not made the kind of progress that was one of the reasons for my getting involved in public affairs as I felt strongly about that issue. I remain of that view, that somewhere along the line, somebody does not have the priorities straight.

I remember as Justice minister, getting involved in a major tussle with aboriginal leadership on the issue of abuse of children and the interference of aboriginal politicians in child welfare issues. I was asked to resign by a noted Manitoba chief over that particular comment. I guess my skin is as thick as anybody else's around here, but there are times it gets a little on the thin side. On an issue like that, I get a little bit thin-skinned because I do not even approach this as a partisan. I approach it as a Canadian who has a genuine concern about the first peoples of this country and what their future might be. I have to agree with the honourable member; it does not look very good from where I sit.

Here I am in a position of government, reputedly in a position to be able to do something about it, and all my efforts thus far have been stymied. As a Justice and Constitutional Affairs minister, I worked very hard, thinking, well, now, here that I am in a position, I can maybe hopefully make a difference for some aboriginal women and children especially. We made some progress in areas of abuse and areas of family violence and things like that, but not enough in reserve communities to suit me.

There is a point at which I cannot go further as an individual player in the piece. I do feel frustration from time to time, so I share that with the honourable member. It is not directed at any one individual. It is a systemic problem we have in our country. I think in some ways the treaties do positive things for aboriginal people and in some ways the treaties hold them back from the kind of progress that could prevent the kind of abuse that occurs in some of those communities.

Maybe it is not fair to make this an aboriginal issue, because where you see the poverty you see some of these horrible cases of abuse going on, and it is not always in the aboriginal community.

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Mr. Chairperson: Order, please. The hour being after 10 p.m. committee rise. Call in the Speaker.

IN SESSION

Mr. Deputy Speaker (Marcel Laurendeau): Order, please. This House is adjourned and stands adjourned until 1:30 p.m. tomorrow (Tuesday).