Mr. Chairperson (Marcel Laurendeau): Would 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. Would the minister's staff please enter the Chamber at this time?

Hon. Eric Stefanson (Minister of Health): Mr. Chairman, as we are getting ready here, I have not had much of a chance this morning to run through it, but for starters, one thing I would like to table is Supplementary Information for our review. Just a very minor aspect that was missing from the original Supplementary Information, basically, two pages long. It is just on the Capital Investment, just the quantity there. So if one could be provided to the member for Kildonan (Mr. Chomiak) right away.

On May 26, the member for Kildonan requested information on the Health Information Systems branch organization and the breakdown of the FTEs by the various areas and sort of what was done in those areas, so I am tabling that information, Mr. Chairman.

The member had also asked just for some information on the VON contract status and service coverage on weekends, I believe, so I will table that.

I will just read one response into the record very briefly. On May 20, the honourable member for Osborne (Ms. McGifford) asked if any consideration has or will be given to holding an inquiry into the death of Mr. Wesley Kent. Manitoba Health staff have been in contact with senior staff at Health Sciences Centre and St. Boniface General Hospital. I have been advised that neither the availability of staff and palliative care nor the use of proper protocols was at issue in Wesley Kent's care. After reviewing all aspects of the case, the office of the Chief Medical Examiner has not called for an inquest into Wesley Kent's death. I might have some more as we go along, but that is it for now.

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Mr. Dave Chomiak (Kildonan): I thank the minister. For clarification, is the minister saying that we are adding this year to capital investments $20.7 million on behalf of the SmartHealth initiative? Do I read this correctly?

Mr. Stefanson: That is correct. That is the discussion we did have previously. Really what the supplement does is it matches, I think, what I pointed to, and we discussed it before. If you look at page 153 of the detailed Estimates of Expenditure, you can see the overall Estimates of Capital Investment for all of the departments. If you look there, it is Health at $20,700,000. That is just the supplemental information backing it up in the Health supplement. So the member is correct, Mr. Chairman.

Mr. Chomiak: So where does this particular expenditure fit within the capital supplementary estimates?

Mr. Stefanson: If you were to look at the detailed supplementary information for the Department of Health, and if you go to page 119, we have discussed this previously, but this is where we show the amortization of the health capital assets. This addendum now would be 119A and 119B, so it would follow right behind that section, because this is the capital investments side that ultimately becomes amortized on an annual basis so it really–we did discuss this but all that happened is in the preparation of the detailed supplement these two pages should have been inserted behind page 119, so that is what this is correcting.

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Mr. Chomiak: So the minister is saying the amortization of the capital expenditures for '99-2000 is $1.3 million, and in addition there is a capital investment of $20.7 million that will be commenced to be amortized next year. Is that correct?

Mr. Stefanson: The member is basically correct. What happens now with capital assets is the capital investment is made, and then those capital assets are amortized over a period of time again, like we discussed before, and the $1.3 million is basically the amortization expense of the capital assets that have been invested in. From '99-2000 there is going to be the $20.7 million invested basically in the SmartHealth health information initiative.

Mr. Chomiak: I will return to that issue when we get to the capitalization, as I have a little bit of clarification, and I want also to compare it with one of the other documents I have.

The minister said he would get back and we would discuss Victoria Park Lodge. Has the minister been able to come up with that information at this point?

Mr. Stefanson: No, Mr. Chairman, we still are awaiting some additional information on that, so really other than what we discussed the other day about the RHA prioritizing the need for new personal care home beds which have been committed to in Souris, and then the impact on the beds at Victoria Park Lodge not being funded as personal care home beds, is really obviously the root issue that we talked about, and then the member has asked specific questions about the future of that facility, and we are still awaiting some information.

Mr. Chomiak: Just for the record, I am of the view similar to the situation that we had recommended with the Odd Fellows that at the very least, the very least, the whole facility should be grandfathered to permit individuals to stay in there as well as for the community to function. I seriously question, and I have a lot of concerns about the whole concept of supportive housing, frankly. I think the move from Levels 1 and 2 care to supportive housing is a problem. I have yet to be convinced from the information I have seen that supportive housing is the way to go, which brings me to a point that I had mentioned I was going to refer to today, that I made mention on Thursday, and that is with respect to Ten Ten Sinclair.

I was not going to ask a lot of questions about Ten Ten Sinclair. Ten Ten is located in my constituency. I have been a big supporter of Ten Ten Sinclair for years. Every June, when Ten Ten has its annual meeting and the regular minister comes through, the ministers generally come away very impressed, extremely impressed with the work that is happening at Ten Ten Sinclair. I think that Ten Ten Sinclair ought to be always prioritized in terms of the government's view of dealing with various aspects in the health care system and that one should recognize the role and function of Ten Ten. Let me give you an example, since we are talking about supportive housing.

I think that what Ten Ten does with respect to focus housing and the various group arrangements that Ten Ten makes is a model that ought to be looked at and expanded upon. I think that I would prefer to see a move towards that kind of development as opposed to–and I am not ruling out supportive housing development, I want to make that clear, but that I think some of the initiatives undertaken by Ten Ten ought to be given more emphasis and there ought to be more direction and heed paid to that type of housing.

The other issue with respect to Ten Ten is it has fluctuated back and forth with respect to the kind of facility and the kind of function and role it provides. I think we are probably in an era in health care where to totally isolate a facility perhaps to one function is probably no longer necessary, but you are looking at stroke programs, for example, and you are looking at programs where individuals have to adapt. Ten Ten, for example, has just upgraded a number of suites which the government, through Manitoba Housing, has supported, and I have met with the Minister of Housing (Mr. Reimer) and discussed this on many occasions. I mean, there are certainly options for a role and function of Ten Ten in a variety of areas that I think ought to be looked at.

So that is the situation with respect to Ten Ten that I wanted to refer to. I do this every year generally, not just because Ten Ten is in my constituency but because in my view Ten Ten Sinclair was a very innovative and shining light in health care in the 1970s and has continued to be in a whole series of areas. I think we can build upon some of the strengths of Ten Ten and ought to do so.

That is a long way of getting around Victoria Park Lodge and Ten Ten Sinclair and a variety of other issues, as well as putting on the record my concerns about supportive housing.

Mr. Stefanson: Mr. Chairman, I am certainly somewhat familiar with Ten Ten Sinclair, although I have to admit I have not been to the facility but would obviously like to get there at some point in time, and the member for Kildonan has added to my interest in doing that. Everything I know about the organization and the facility is they do provide excellent services. I gather they do continue to have discussions with, as the member himself indicated, either Manitoba Housing or, of course, the WCA, about their ongoing role and other initiatives and so on. So, other than those general comments, if the member has specific issues to be followed up on behalf of Ten Ten Sinclair, obviously I would be more than prepared to do just that. I am glad to hear he is at least keeping an open mind on supportive housing.

My initial impression is, first of all, that it is needed. Secondly, the limited introduction of it so far in terms of the feedback I have been receiving is positive. It just becomes one more means of meeting the needs for people at certain stages of their lives, so I think it is a part of the whole continuum of care that we want to provide to Manitobans, but I am glad the member at least is still open-minded on that issue.

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Mr. Chomiak: Mr. Chairperson, I wanted to pursue two strains of questions, and I wonder what is the most appropriate at this juncture: questions related to various professions, remuneration and the like; and the second strain I wanted to go down was the bit about some of the programs being offered at hospitals, WHA and the related. So which would the minister prefer I do first?

Mr. Stefanson: Mr. Chairman, I think dealing with the professionals would be the most appropriate, first of all, initially.

Mr. Chomiak: Can the minister indicate whether or not, under the arrangements with the Chiropractors' Association, there was an overfunding last year, this year, and in fact what that was?

Mr. Stefanson: First of all, the member is correct. The cap for funding to chiropractors has been exceeded in '97-98 and '98-99. We have had some ongoing discussions with them, whether or not there is some overlap here between at least two Crowns that have also required chiropractor services, the Workers Compensation Board and Manitoba Public Insurance Corporation.

I recently met the chiropractors in the last 10 days or so, and they presented basically some information to me and an overview of that. I would not want to necessarily call it a position paper, but just some of the issues that they would like to see addressed as part of this review that we are gong through right now. The member is correct. The cap was exceeded in those two years, and we are in discussion with them.

Mr. Chomiak: What review has the government undertaken with the chiropractors right now? I know there is a five-year agreement that is in effect, but the minister talked about a review. Is there consideration of a review of the entire arrangement? What is the review the minister just referred to?

Mr. Stefanson: At this stage the review really covers '97-98 and '98-99. As I indicated, it has been suggested to us that there might well be some overlap or some shifting of costs that might more appropriately have been the responsibility of one or both of the Crowns that I referred to, so we are in the process of doing that review.

Mr. Chomiak: Is the government considering increasing the number of visits permitted annually by Manitoba residents under the agreement? Although we are part of that five-year agreement, I was not in favour of the reduction of visits from 15 to 12, and I wonder what the government position is in that regard.

Mr. Stefanson: As the member knows, we do have two more years to run on the agreement with chiropractors, 1999-2000 and 2000-2001. It includes the number of visits presently at 12 per year that the member refers to. Even in my recent discussion with the chiropractors, the concern or the focus was more on the issue of the overall cap, the 9.6 million, and the fact that it is has been exceeded slightly now in two years and our willingness to look at the entire issue, particularly in light of the possibility of any shifting of those costs from Crowns to government. So the agreement is in place that provides for the ongoing number of treatments at 12, which is currently in the agreement.

Mr. Chomiak: Can the minister table for us the breakdown of payments under the various categories so that we know how much is for physician, how much is for optometrist, chiropractic and oral dental, if we can get breakdown of that?

Mr. Stefanson: If the member were to look on page 88 of the expenditures under Medical, which is really the program we are talking about right now, the first line is Physician Services, so that is the total amount paid for physician services, $388,789,000. Under Other Professionals, that has two components: chiropractic at $9.6 million as per the agreement, and optometric at the difference, $3,344,000. So those two combined equal the $12,944,600, and then Out-of-Province Physicians is exactly what it suggests it is.

Mr. Chomiak: Under the Physician Services, do we have a breakdown of how much is fee for service versus salaried, and what the government's plans and expectations are in that area this year?

Mr. Stefanson: The breakdown under Physician Services is medical fee for service $271,362,000, alternative funding $117,427,000, and those two together equal the $388,789,000. As we discussed the other day, it really is not an either/ or based on how we end up providing the funding, whether it is fee for service or whether it is through salary or contract. It is really based on what we and the employers would deem the most appropriate from an employment perspective, but also in consultation and discussion with either individuals or the individual governing body, so it is not as though there is an either/or that automatically applies in every situation.

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Mr. Chomiak: Can the minister perhaps table that specific breakdown so we have an idea of where that–I mean, if the minister wants an opportunity to take out information that may not be relevant, but I would not mind seeing where the breakdowns are with respect to the fee for service versus the salary.

Mr. Stefanson: Just for clarification, is the member talking of breakdown by specialty or by region, or what further breakdown is the member looking for?

Mr. Chomiak: I am more looking for function. I am trying to get a sense of, for example, we talked about it earlier, the Assiniboine Clinic. How much is going to family physicians in terms of remuneration, how much to the northern program in terms of salary, that kind of thing? I do not want to cause a lot of work to be done, but whatever is available that we can get access to–I do not generally, I think, whatever we can get access to. If I am wrong, I stand to be corrected.

Mr. Stefanson: He brought a smile to the face of staff when he said he is not looking for lots of work, so that is encouraging. Mr. Chairman, I am told it is fairly readily available and that we can produce it on a functional kind of a basis.

Mr. Chomiak: I know what the briefing books look like. I have been on both sides of those. I have prepared them myself, so I know often what is available and what is not available. I do not really like to cause additional–but usually the staff is so efficient that generally it is all there. The question is: can the minister reveal what is all there? We could expedite the whole matter by just exchanging briefing books, but that probably would not work.

I understand that Manitoba Association of Optometrists fees are well below national average, in fact, 25 percent lower than the national average, and there obviously are ongoing negotiations in this area. I wonder if the minister can outline what the government plans or strategies are in this regard. It is fairly clear that there is a significantly lower fee that is paid.

Mr. Stefanson: I am beginning to think, Mr. Chairman, that the member is following me around or watching what delegations came into my office.

I recently met as well with the optometrists. Of course, the member is right that we are in discussions with them about the fees. They have shared a great deal of information with staff and recently with myself along the lines of what the member just touched on–national comparisons and the last time the fee was adjusted and so on. We are right in the process of looking at that entire issue, having discussions with them about what would be a reasonable fee adjustment and whether or not we can obviously get agreement on that. I think, again, as the member knows, I believe I am correct, under our current system, the fee is established through Order-in-Council by government, but obviously we are going through a process of sharing information, having a discussion and seeing if we can reach some agreement on a fee adjustment.

Mr. Chomiak: The minister had cited earlier a projection this year of 3.3, roughly, I am going from memory, in terms of fees available to optometrists in Manitoba. My question to the minister is: is that 3.3 status quo, or does that include a proposed portion of an increased optometrist? If it does not, would I presume that the additional fees, if a settlement is reached with the optometrists, would come out of the pool that we had discussed earlier?

Mr. Stefanson: Again, the member is absolutely correct. We discussed this approach and this principle before. I do not think it is something unique to us or previous governments in Manitoba or governments elsewhere; whenever you are in negotiations, you set aside an amount in a separate account. Again, the member is exactly correct that that is how things have been provided.

Mr. Chomiak: The minister is getting back to me with information with respect to the Assiniboine Clinic and the like. I understand we discussed that earlier, and the minister was going to provide me with–am I correct in that understanding?

Mr. Stefanson: I was just checking. I do not think until just a couple minutes ago we discussed Assiniboine Clinic, unless my memory is failing me.

Mr. Chomiak: This time I think I am right.

Mr. Stefanson: We did discuss it as an example when we were talking about the primary care model that has been introduced in the city of Winnipeg. We had talked about the need for correlating all of the activities in the primary care centres with physicians. We used Assiniboine as an example. So certainly we did have some discussion about Assiniboine then. I think the request that the member was asking for in terms of the breakdown of our medical services was on a functional basis. I do not know that we can or should or have the ability to get into breaking down all the individual clinics. I am not sure what that would serve, unless there is a specific question about Assiniboine because Assiniboine right now is back on the fee for service. That pilot project was terminated, has been assessed, and, as of now, they are on a fee-for-service basis.

Mr. Chomiak: Do you think we could see the assessment of the project?

Mr. Stefanson: I think all I can do on that, Mr. Chairman, is take it as notice and undertake to provide as much information as I can on that issue.

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Mr. Chomiak: I am just not quite clear, and perhaps the minister can just clear this up. The increase from $333 million to $388 million, can the minister give us a rough idea, a breakdown, of where those increases are taking place?

Mr. Stefanson: Mr. Chairman, as the member can appreciate, with a $55-million increase, there are various elements in there. Some of it is volume related. Some of it relates to some of the increases in the medical fee-for-service program that were announced last year that the member would be familiar with for basic and intermediate visits, comprehensive visits, after-hour premiums, palliative care, obstetrics. So this now becomes the annualized cost of those additional services as well as the incremental costs of the relative value guide. We talked about the relative value guide with anesthetists as included in here.

Also the cost of some of the initiatives introduced as a result of the WHA, initiatives announced during 1998-99. Some additional items have to do with, again, some of the priority initiatives for the RHAs, for Brandon and the rural RHAs, again which were announced with funding increases several months ago for the RHAs, funding for the bone density testing in Brandon, funding for a few additional physicians in some rural communities, and so on. I think those would be some of the more significant areas leading to the increase in this line, Mr. Chairman.

Mr. Chomiak: Would those figures roughly add up to the $55-million difference?

Mr. Stefanson: Those would be the majority. There are some other lesser amounts in a few other areas, but those would certainly be the majority of the increases.

Mr. Chomiak: Is there a chance to have a copy, albeit a politically correct copy, of it tabled at some point just for general understanding?

Mr. Stefanson: We could certainly provide a summary of a number of the key elements that I have already outlined for the member but most likely without dollar amounts for various reasons.

Mr. Chomiak: Just out of curiosity, would the MMA be negotiating on the basis of the 333 or the 388 figure?

Mr. Stefanson: It is really not on either, and it is certainly not on the 388 million. It really is, as the member knows, through the arbitration process on a tariff code by tariff-code basis. I believe the position of the MMA has been using some variations of national averages as their benchmarks. So, again, you really could not go from either one of those dollars amounts and certainly not the 388.

Mr. Chomiak: Mr. Chair, I will be pursuing some questions along the line 4 for a little while, and then we will be moving onto the balance of the Estimates book for hopeful completion today. That is where I anticipate going, just so the minister is aware of where we are going on this.

I wanted to spend a little bit of time on some of the specific programs as they relate to the WHA. Before I do that, if I have not asked for a list of the board of directors of the WHA and the like, as well as the various positions, is it possible to obtain that?

Mr. Stefanson: I am told, and I believe it is correct, I recall tabling it, that I have tabled the board chairs, the board listings and the CEOs for all of the RHAs. I think the only outstanding entity is I indicated I would provide the board members for Urban Shared Services Corporation, which I have not done yet. But I think the member should have the other listings. Obviously if not, that information is readily available, and we can certainly provide a copy.

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Mr. Chomiak: Mr. Chairperson, certainly if the minister says he has tabled it, then I will assume it has been tabled. I asked for an update of all the tabled information and reviewed it this morning and did not see it, but if the minister says he has tabled it then I will accept that and proceed.

In 1998, the WHA put out a listing of programs that were going to be offered at city of Winnipeg hospitals, and it broke down the hospitals by area outlining programs. I am very interested if it is possible to get an update as to what the program status is for all of the city hospitals, based on the criteria that were provided at that time. Now, if the minister wants to respond by saying that the original plan is still on as per the plan, that is fine. Then I will assume that the changes announced in the plan are still on. But what I am trying to get is an update and a status as to what programs are being offered, where within the urban hospitals in the city of Winnipeg.

Mr. Stefanson: Mr. Chairman, I will return with an update for the member. But certainly to the extent of everything I am aware of, that program outline is basically still the one that is in place. But I would not want to say absolutely unequivocally in case there has been some minor adjustments, so I will return with an update for the member.

Mr. Chomiak: Mr. Chairperson, we did request a bed map from the minister, and I know it is forthcoming. One of the issues that I wanted to determine that generally is not in the bed map that I think is quite relevant is the whole issue of the ICU beds, the number of ICU beds available.

Is it possible within the context of that to give us a number in terms of ICU beds within the confines of that bed map?

Mr. Stefanson: I think what we will do is return with that separately. The bed map is more or less being done I think on the same basis as before, but we can certainly provide information on the ICU beds.

Mr. Chomiak: Mr. Chairperson, one of the areas that has been incredibly studied is the whole area of emergency services. Now I recognize that there is a provincial review going on of some of the related emergency services. What I would like to know is what the present system is for the city of Winnipeg, what the protocols are and the practices in the city of Winnipeg with respect to emergency situations. In other words, is the Health Sciences Centre now the trauma centre and major trauma is automatically transferred to Health Sciences Centre?

Are there any longer situations where–the word escapes me, as usual–we are offsetting transfer of vehicles from community hospital, et cetera? I am trying to get what the sense is in terms of diversions–that is the word I was looking for–whether diversions are still on, what the protocols are. Just let me take a step back to show that it is not just a fallacious question or a probing question because I have been contacted by many individuals who are told, for example, when they phone or when they attend at an emergency centre, say, Seven Oaks or Grace, that they are told actually they should attend at the urgent care centre first. I am trying to get a sense of what the protocols are and what is in effect in terms of emergency conditions in the city of Winnipeg.

Mr. Stefanson: Mr. Chairman, I take it what the member is after is when it comes to emergency medical services, the Winnipeg ambulance service, what are the protocols in terms of accessing which facilities, and we can certainly provide those protocols. As the member also knows from previous questions and discussions, the City of Winnipeg and the WHA are in discussions on the whole issue of interfacility transfers, and I think they have set a timeline of 90 days to try and resolve that issue.

Mr. Chomiak: I would appreciate copies of that. When the WHA put out its proposals approximately a year to a year and a half ago, one of the next steps was the development of a critical path to support the major changes under WHA as well as the development of a multiyear funding plan. I am wondering if the minister can update us as to the status of the critical path and the multiyear funding plan and, if they are available, to table them.

Mr. Stefanson: Mr. Chairman, I will provide the member with a status report with as much information as I can on both those issues.

Mr. Chomiak: Does the minister, or can the minister, provide us with information as to the future and the plans for the ophthalmology program presently located at Misericordia?

Mr. Stefanson: Mr. Chairman, it is certainly the intent to maintain the ophthalmology program at Misericordia. Beyond that, I can return again with any status of that service. If there is any specific question the member has, again I would certainly respond and determine information on that.

Mr. Chomiak: I would be interested in the minister tabling information with respect to the status, as well as the issue of the beds that are available for use by the ophthalmology program at Misericordia, and the status of those beds and the continuation of those beds and their function.

Mr. Stefanson: Mr. Chairman, no problem. We will provide that information.

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Mr. Chomiak: One of the interesting programs that was offered under the WHA announcement of the major programs was the Criti-call program. I am wondering if the minister can outline–Criti-call program was a 24-hour referral services for physicians to have access to specialists. I am wondering if that program is in operation and if we can have an update on that.

Mr. Stefanson: Probably best I return with an accurate status report for the member.

Mr. Chomiak: Mr. Chairperson, this is not specifically related to this area; it is indirectly related to this area. Do we have any information with respect to the timetable for the construction and the functioning of the various components of the cancer treatment facility? Can we have information on that?

Mr. Stefanson: I am told that it is going to open in stages, so I will return with that information for the member. The final completed facility, 100 percent operational, I am told will be January 2002, but various aspects are going to open prior to that. I can give the member a summary of basically the functions and the estimated opening times.

Mr. Chomiak: I thank the minister for that response. I would also, if possible, like if the minister could provide as well a similar summary for the redevelopment of the Health Sciences Centre and the William Avenue projects and related.

Mr. Stefanson: I will return with that information as well. It is somewhat different, I am told, that the entire new facility will open all at once, but it is going to be done in stages in terms of some of the relocation requirements, renovations and improvements. So, again, I could provide that information to the member.

Mr. Chomiak: Can the minister give us an update as to the status of the process in the city of Winnipeg for providing accreditation to doctors to function at various facilities? Can the minister update us as to where that is in terms of permitting doctors to be accredited and to have access to facilities as a result of shifting programs?

Mr. Stefanson: Mr. Chairman, maybe if the member could clarify whether he is talking accreditation of doctors at certain facilities for certain functional areas like ICU, or whether he is talking admitting privileges at hospitals in the city of Winnipeg.

Mr. Chomiak: Both, if it is at all possible, because they do affect each other.

Mr. Stefanson: Again, I will return with details on both of those issues. I am certainly told that the issue of admitting privileges has not been a problem in terms of the shift of programs to different facilities and doctors having admitting privileges, but I will return with a status of both of those issues for the member.

Mr. Chomiak: I note, as I go through the information provided, the fact that the minister had tabled the listing of all of the members of the various regional health authorities, as he had indicated.

In the Supplementary Estimates book on page 86, it is indicated under the Provincial Health Services line, subappropriation 21-4B, that, and I am quoting, under Expected Results: "Financial assistance is provided to Manitobans requiring assistive devices."

Can the minister outline what the extent of that financial assistance is, what programs they are and what is offered?

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Mr. Stefanson: Mr. Chairman, I think we did touch on this briefly before, and we are providing a list of the various devices that are covered. It is the prosthetic, as it says on page 87, the prosthetic and orthotic devices, the hearing aid support for children and so on, so I think we did undertake to provide a summary of everything that is covered under those programs.

Mr. Chomiak: I agree the minister did undertake to do that, but financial assistance implies some kind of program or something else. That is what I am basically trying to determine, but if that is not the case, then I will await receipt of the other information.

Mr. Stefanson: Well, again, I think, as the member probably knows, there are quite varied approaches here from deductibles to reimbursements for expenses and so on, so really financial assistance is meant to cover the various ways that it is done, and when we return with a summary of the programs, we will also show whether it is reimbursement, direct support, buying the devices or how the programs function, Mr. Chairman.

Mr. Chomiak: Again, by way of clarification, whether or not we are waiving private members' hour is a bit of a factor, but I intend to proceed through Section 4, a complete Section 4 in the very near future, then pose questions under Section 5, which is the Addictions Foundation for a little bit. The questions will not be particularly difficult or specific and finally probably closing out on Capital Grants and the like. Having said that, I do have a question on one of the pieces of information that was tabled by the minister and that was the grants and transfer payments from Manitoba Health.

There was a grant of $33,000 to the Canadian Institute for Health Information. It is indicated the agency's goal is delivery, maintenance and enhancement of MIS. Can the minister give me more information as to who the Canadian Institute for Health Information is?

Mr. Stefanson: Again, Mr. Chairman, the Canadian Institute for Health Information, the chair, the CEO, is Mr. Michael Decter, a familiar name to most of us in this building. This is our share of the funding or the support for that organization, ours being the Province of Manitoba. I am told that they in theory report to the conference of ministers of Health. They do a number of national analyses, health data. They recently were the source for that health publication in Maclean's magazine. They have recently put out some additional health information on comparisons across Canada, so they really are a health information and research body done on a national basis for national comparisons of health indicators, health statistics, health financial information, and so on.

Mr. Chomiak: The minister also provided us with information on the Victorian Order of Nurses backup service information. I wonder if the minister can provide us with a little bit more detailed information as to the kinds of services that are available both from VON as well as from WCA in terms of services that are provided on the weekends, backup and emergency-related services. I know that there are initiatives in that area. That may come with some of the other information that is coming, but I wanted to specifically highlight those particular areas.

Mr. Stefanson: Yes, Mr. Chairman, we could provide that information.

Mr. Chomiak: Under the Pharmacare item, just a general question. At one time there was a monitoring from the Department of Health as to the costs and fees charged for dispensing fees and drugs that are offered under the program. Is there any kind of a system in place now to deal with that?

Mr. Stefanson: We do continue to monitor the issue of the dispensing fee on an ongoing basis. I think, as in the past, that fee is really driven by market conditions. There is no cap, no fixed amount, but we do continue to monitor it to ensure the reasonableness of those fees charged.

Mr. Chomiak: Mr. Chairperson, I do not like dancing around in terms of going back and forth in questions, but the time structures are such that I am doing that. So I apologize.

There are needs assessments being done in rural Manitoba with respect to services to be offered. What is the ongoing process that is going on now outside of Winnipeg to determine what programs are going to be offered where?

Mr. Stefanson: Well, Mr. Chairman, I am told that the RHAs will continue to update their needs assessment. It is not as though it is just a one-time document and then nothing happens with it after that.

As the member for Kildonan knows, there are core levels of services that are to be provided in our health care system. What we do each year is we get a health care plan from each of the regions, and that is an opportunity to obviously assess the recommendations and decisions the regions are making in terms of the provision of those services, their requirements in different communities, and so on. So again, it is likely discussed with a few other issues, that it is very collaborative between the RHAs and the Department of Health in terms of reviewing their plans for the services they are providing.

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Mr. Chomiak: Mr. Chairperson, so essentially the process is that the annual needs are budget-based or needs-based assessment that is done with each RHA. There are the core services that are mandated by the provincial Department of Health, and that is assessed on a yearly basis.

Is there any kind of a five-year or rolling plan in terms of a future direction and/or needs?

Mr. Stefanson: I think, like some issues, that is where we will end up, with longer-term plans of three to five years. We are not there yet, for obvious reasons, in terms of the transitions that the system has gone through and in terms of the RHAs doing their needs assessment and doing their annual business plan. So I certainly see us ending up where the member has asked, with five-year plans, but right now it is done on an annual basis.

Mr. Chomiak: Mr. Chairperson, perhaps we should take a break at this point. Generally, I think I am going to move on to Section 5, followed by Section 6. We will also have some determinations as to whether or not private members' hour is waived, which could affect the–but maybe we should take a five- or 10-minute break at this point, if that is acceptable. We could pass or we could wait. We might want to wait for Marcel, because he has got it all in his head maybe, but I do not know.

Mr. Stefanson: We will then just take a five-minute break.

The Acting Chairperson (Mr. Helwer): We will take a five-minute break. We have the agreement of the committee to take a five-minute break, I believe. Good. Okay.

________

Mr. Chairperson: The committee will come to order.

Mr. Chomiak: We certainly could pass the items under Section 21.4., or would it be more advisable just to go through and pass it all? Whatever is most expedient.

Mr. Chairperson: I will just pass that Section 21.4. now, and then we will move on to the next one, make it easier.

Section 21.4. Health Services Insurance Fund (a) Funding to Health Authorities, Acute Care Services $870,311,300–pass; Long Term Care Services $300,477,700–pass; Home Care Services $147,220,900–pass; Community and Mental Health Services $97,688,500–pass; Emergency Response and Transport Services $11,581,600–pass; Less: Third Party Recoveries ($5,295,600)–pass; Less: Reciprocal Recoveries ($29,878,000)–pass.

Section 21.4.(b) Provincial Health Services, Out of Province $18,658,800–pass; Blood Transfusion Services $25,273,900–pass; Federal Hospitals $1,859,700–pass; Prosthetic and Orthotic Devices $4,093,100–pass; Healthy Communities Development $10,000,000–pass; Nursing Education $5,748,200–pass; Other $82,900–pass.

Section 21.4.(c) Medical, Physician Services $388,789,900–pass; Other Professionals $12,944,600–pass; Out-of-Province Physicians $13,384,600–pass; Other $1,225,200–pass; Less: Third Party Recoveries ($2,433,400)–pass; Less: Reciprocal Recoveries ($6,365,400)–pass.

Section 21.4.(d) Pharmacare $72,338,400–pass.

Resolution 21.4: RESOLVED that there be granted to Her Majesty a sum not exceeding $1,937,706,900 for Health, Health Services Insurance Fund, for the fiscal year ending the 31st day of March, 2000.

We will now move on to Resolution 21.5. Addictions Foundation of Manitoba, Board of Governors and Executive $185,200.

Mr. Chomiak: Mr. Chairperson, I have only some general questions in this area, and I do not know if the minister has the personnel available. Certainly, like most other information, we look forward to the subsequent follow-up responses.

Mr. David Faurschou, Acting Chairperson, in the Chair

Mr. Stefanson: Mr. Chairman, I am sure the member for Kildonan (Mr. Chomiak) knows, but joining me is the executive director of the AFM, Mr. Herb Thompson. I did not introduce Linda Bakken, who is the director of Capital Planning who joined us earlier.

Mr. Chomiak: This is just for perusal and information purposes. I wonder if we can have a description of the methadone management program that is offered in Manitoba in terms of an outline of how the program works, the number of participants and general information respecting its effectiveness, as well as whether there are any plans to continue and/or expand the program.

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Mr. Stefanson: I am certainly prepared to return with some more details, but as the member would know, it is a program that was taken over from St. Boniface Hospital. I am told there are three staff and now some 78 persons on the program. It is certainly being described to me as a very successful and obviously worthwhile program. I can certainly provide further information on the status of the program, again confirming the numbers of people and the staffing and the resources directed towards it and the overall objectives and results.

Mr. Chomiak: Without resulting in a lot of additional work, I would appreciate it if the minister could return with just that written information. As well, I wonder if it is possible to have a listing of all of the programs available. I am thinking of residential programs for young and adolescents for drug dependency treatment, if that would be possible.

Mr. Stefanson: I will return with those details. I think, as the member knows, there are really two adolescent programs funded by the Manitoba government, St. Norbert Foundation and then the AFM program that now is going to be opening at the facility opening at Southport in Portage la Prairie in the next few months. There are two programs, I am also told, running through the federal government, one at Sagkeeng First Nation and one at Thompson. So that is just an overview, and I will return with more information for the member.

Mr. Chomiak: I thank the minister for that response. I look forward to the information. Unfortunately, more often than not, we as MLAs experience the difficulty and the problem of parents approaching us as MLAs or others saying they suspect their child may be involved with drugs and the like.

Is there a primer or is there any kind that we all typically follow courses of action with respect to that? Is there a primer or is there information sheet or a flow chart or a description that can be provided to ourselves that can outline the steps that can be taken by the parent in terms of dealing with the–I mean I know this happens all the time. Is there a primer or a sheet or information available for us as MLAs?

Mr. Stefanson: The short answer is, yes, I will make that available to the member. It might be timely. I will certainly look at whether or not the time has come to circulate that to all members of the Legislature.

Mr. Chomiak: Can I have a description of the community-based dual diagnosis program in Winnipeg?

Mr. Stefanson: I will provide greater detail, but it is run by the same staff that run the methadone program. I gather one is running in the morning, the methadone, and the dual diagnosis in the afternoon. It is run out of Misericordia. Once patients are stabilized, they are provided this service. Again, I will provide greater detail on that program for the member.

Mr. Chomiak: Would it be possible to get a listing, again, if it is available, of all of the programs offered by AFM?

Mr. Stefanson: Yes, there is an annual that is published, and we can make a copy available to the member.

Mr. Chomiak: Can we get a sense or an understanding as to the number of staff and the extent of the AFM's involvement with EAP programs?

Mr. Stefanson: Again, I think that would be another program I could return with greater detail. Generally the Addictions Foundation goes into an employer, develops a program, provides information, education, and so on. They do counselling if there is a need for an intervention, but the intervention is really done through the human resources of that particular employer. But if there is a need for further follow-up or further treatment, again the AFM is involved. So that is an overview of the program, and I will return with more details for the member.

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Mr. Chomiak: Mr. Chairperson, every year I make a determination in Estimates that we will spend more time in this area, and every year the same thing happens; so I apologize. There are some significant issues that need to be addressed.

Can we get an update as to what is happening in terms of the sniff and nonpotable alcohol abuse process in the province; in other words, where programs are available and what programs are available both residential and nonresidential?

Mr. Stefanson: Again, the same as other questions, I will provide greater details. But St. Norbert Foundation provides support for individuals up to, I believe, 24 years of age; I think 20 beds provided at St. Norbert. AFM has basically an outpatient kind of a service to individuals. They also go into a number of schools, 19 or 20 of the schools. Again, the federal program through the two sites we talked about, Sagkeeng First Nation and Thompson, provide support in these areas. So that is again a snapshot of the program, and I will provide greater details.

Mr. Chomiak: Mr. Chairperson, I think because I want to ask a few questions in terms of capital that I think we can probably pass this area. I am curious though, and I will just throw this out. Has there been any examination or review in Manitoba of the medicinal use of a particular substance that shall go unnamed and what the status of that is?

Mr. Stefanson: Mr. Chairman, a timely question. AFM is doing a review of that very issue, and I expect a report within the next couple of months.

Mr. Chomiak: Mr. Chairperson, will that report be a public document? Of course, I recognize the whole issue of timing; the minister did say a couple of months. I suspect there is a timing factor it involves, but I still pose the question.

Mr. Stefanson: I would expect that at the appropriate time that would become a public document.

Mr. Chairperson: 21.5. Addictions Foundation of Manitoba, Board of Governors and Executive $185,200–pass; Finance and Personnel $352,900 –pass; Drug and Alcohol Awareness and Information $532,000–pass; Program Delivery $11,115,000–pass; Gambling Addictions Program $1,652,100–pass; Less: Recoveries from the Manitoba Lotteries Corporation, Third Party Recoveries $1,652,100 and $1,817,300–pass.

Resolution 21.5: RESOLVED that there be granted to Her Majesty a sum not exceeding $10,367,800 for Health, Addictions Foundation of Manitoba, for the fiscal year ending the 31st day of March, 2000.

21.6. Capital Grants (a) Acute Care (1) Principal Repayments $28,674,400.

Mr. Chomiak: I actually wanted to jump up when you were going through that and just ask, if it is at all possible–it does indicate that there is a gambling program that is being aimed at the at-risk populations, seniors, aboriginals, and young people. I am wondering if it is possible to get an allocation of the government's determination of the at-risk populations, if that is at all possible, if the minister can undertake perhaps to provide us with that.

Mr. Stefanson: I believe that information is available. I will certainly make available whatever is on that issue for the member.

Mr. Chomiak: Returning to capital, I do not think I will get through my briefing book on the capital issues, but I did want to determine and establish again the issue. The minister tabled the document that indicated $20.7 million in terms of capital. Does the minister's provision of this addition to the Supplementary Estimates indicate that our capital allocations for this year have increased by $20.7 million or was the $20.7 million already included in the budgetary Estimates? If it was included, where is it?

Mr. Stefanson: Yes, it has been included all along. All that happened is that in the rush to have the detailed supplement of Health ready, knowing we would be the first department up, there was an oversight in not including those two pages in the Supplementary document. In the Detailed Expenditures, you can see on page 153 and then carry forward to 154, on 153 is the summary, 154 the details of Health. So it has all along been included. It was just an oversight in the preparation of the supplement document.

Mr. Chomiak: What would be correct to state what the capital expenditures in terms of Health are in total for this budgetary year for the province? Clearly, it is $72 million under Capital Grants. There is amortization of $1.3 million and then again of $1.3 million and then we would add the $20.7 million. Would that be a fair and accurate compilation of what the capital is for the province for this year?

Mr. Stefanson: I am told this is always a confusing issue for members, and I am certainly prepared to take the time with the member. That is not correct what he indicated. Our capital program is $123 million on the building capital that we discussed before, the personal care homes, the hospitals and so on. Where that ultimately shows up as an expenditure will be under the Principal Repayments line, 21.6.(a)(1), so you do not see the $123 million here at all. All you ultimately see is the paying back of the debt on the $123 million.

On the equipment we discussed previously, $10 million of the equipment is also financed as a capital investment, so, again, you only see that as a payment of the debt. On the information technology, the capital investment, all we are seeing as an expense here is the amortization of those investments, so the $20 million is separate.

So, if you really wanted to look at the capital investment this year, you would have to take the $123-million capital for buildings. You would have to take the $27.5 million roughly for equipment on a combined basis with the debt and what it is in here, and you would have to take the $20 million for investment in the IT project. So, in terms of total capital investment in Health, you would be up at about $170 million. So that differs from what you see as the expense portion, which is the amortization and the principal repayment of the debt.

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Mr. Chomiak: Has the department been approached by the Refit Centre with respect to a need for a capital infusion, and can the minister indicate what the position of the government is in that regard?

Mr. Stefanson: The short answer is we have had a request from Refit for an expansion and upgrade of their services. Certainly, we are generally supportive of the facility itself, the services they provide and so on, and I expect to be able to provide further details on that shortly.

Mr. Chomiak: That sounds like a fairly positive response. Would that mean an additional capital appropriation that would be required in order to meet those needs, or could those be found within the existing capital funds?

Mr. Stefanson: Mr. Chairman, we are looking at it from both a health perspective and also from a community perspective. So if we end up supporting it, it might not necessarily be from one of these accounts. There are some other accounts that we could potentially support the Refit fund, but you are right, we are generally positive in terms of the overall service it does provide.

Mr. Chomiak: It seems to me that rehabilitation programs have been transferred from St. Boniface Hospital to Refit in order to undertake that, so that only lends credence to the argument about the particular provisions.

Mr. Stefanson: That is correct. We provide some ongoing support for that program that was transferred through the WCA, so the member is correct. That is one element of the service they provide that is important to the community.

Mr. Lamoureux: Mr. Chairman, being very much aware of the time, I am posing a question quick and concise. I understand the minister has the chiropractor's legislation as proposed amendments. I have had conversations with a couple of physios. They wanted to find out in terms of what the government's intentions are with proposed legislation. Is the government looking at bringing in legislation this session with regard to physios?

Mr. Stefanson: The earlier legislation we are actually looking at is for physiotheraptists. It has been on the order paper. I intend to be bringing forward first reading very shortly. There is some interrelationship with chiropractors. I have met with both groups, had discussions about those issues, but we do intend to bring forward certain amendments to, I think it is called, The Physiotherapists Act.

Mr. Chairperson: Shall I pass that capital stuff?

An Honourable Member: Yes, pass.

Mr. Chairperson: Okay. Staff can leave now.

Item 21.6. Capital Grants (a) Acute Care (1) Principal Repayments $28,674,400–pass; (2) Equipment Purchases and Replacements $16,202,000–pass; (3) Other $20,201,200–pass; (4) Less: Recoverable from Capital Initiatives ($5,000,000)–pass.

21.6.(b) Long Term Care (1) Principal Repayments $6,506,200–pass; (2) Equipment Purchases and Replacements $1,282,200–pass; (3) Other $4,850,500–pass.

Resolution 21.6: RESOLVED that there be granted to Her Majesty a sum not exceeding $72,716,500 for Health, Capital Grants for the fiscal year ending the 31st day of March, 2000.

21.7. Amortization of Capital Assets - Provides for the amortization of capital assets $1,326,300–pass.

Resolution 21.7: RESOLVED that there be granted to Her Majesty a sum not exceeding $1,326,300 for Health, Amortization of Capital Assets for the fiscal year ending the 31st day of March, 2000.

We will now return back to the first resolution: 21.1. Administration and Finance (a) Minister's Salary $27,000.

Mr. Chomiak: Mr. Chairperson, just two brief comments.

Firstly, I anticipate that there will be more discussion concerning the physiotherapy bill. I am not sure if the minister is aware of some interesting developments in that area, and disagreements. I think that we will be saying more about discussing that in more detail.

Secondly, I just want to indicate at this point I appreciated very much the minister's co-operation. I think it built on a tradition that was started by the previous minister of perhaps less rhetoric and more information exchange. I wanted to thank the minister, and his staff through him, for the co-operation.

Finally, while certainly we voted in favour of this budget, one of the reasons we voted in favour of this budget was because, from our view, for the first time in 11 years a lot of what we have asked for has actually been announced. We certainly do not agree with everything that the government is doing in the area of health care and have made our position known, but the reason for support in most areas is that it is better to accept some of these programs and initiatives that we have long sought after at this point rather than reject them when in fact we had called for a lot of them for a number of years.

Having said that, Mr. Chairperson, I can indicate that I am not even bringing in an amendment–at this point.

Mr. Chairperson: Shall the item pass? The item is accordingly passed.

Resolution 21.1: RESOLVED that there be granted to Her Majesty a sum not exceeding $7,760,200 for Health, Administration and Finance, for the fiscal year ending the 31st day of March, 2000.

That concludes the Estimates of the Department of Health. The next department up will be Executive Council.

Is it the will of the committee to call it five o'clock? [agreed]

Five o'clock. Committee rise. Call in the Speaker. Time for private members' hour.