May 4, 1992                                     SOCIAL SERVICES ESTIMATES COMMITTEE - HEALTH


Pursuant to Standing Order 87, Mr. Larry Short, M.H.A., (St. George's) substitutes for Mr. Bill Ramsay, M.H.A., (LaPoile); Mr. Melvin Penney, M.H.A., (Lewisporte) substitutes for Mr. John Efford, M.H.A., (Port de Grave); and Mr. Norman Doyle, M.H.A. (Harbour Main) substitutes for Mr. Garfield Warren, M.H.A., (Torngat Mountains).

The Committee met at 7:05 p.m. in the House of Assembly.

MR. W. NOEL: Order, please!

It is now about five past seven, so everybody is all set. I guess we can start.

I am Walter Noel. This is Mr. John Noel, who I think should take over proceedings from here as the Clerk of the House. Should you, Mr. Noel?

MR. J. NOEL: Yes. Our first item of business is the formal election of the Chairperson of the Committee, so do I hear nominations for Chairperson?

MR. WALSH: I nominate Walter Noel.

AN HON. MEMBER: I will second that.

MR. J. NOEL: Mr. Noel?

MR. NOEL: I will accept.

The next order, I believe, is to elect the Vice-Chair of the Committee.

MR. WALSH: I move the Member for Humber East.

MR. CHAIRMAN (W. Noel): Seconder? Mr. Doyle.

Ms. Verge accepts?

MS. VERGE: Yes I do.

MR. CHAIRMAN: Thank you.

Tonight we have the Department of Health with us, and we have a reporter from The Evening Telegram, Mr. Bennett I believe. I have not seen any other reporters around.

The procedure is that normally the minister makes an opening statement of fifteen minutes or so, and the first speaker from the opposition responds for about the same time frame. Then we try and limit questions to about ten minutes per interjector.

Does anybody have any problems with that, or suggestions?

MS. VERGE: No, that sounds good to me.

MR. CHAIRMAN: Any number of interjections, and we go on until everybody is happy.

MR. J. NOEL: So the Department of Health had an expenditure subhead 1.1.01.

MR. CHAIRMAN: Excuse me, if I might, I never did introduce the other members of the committee.

Ms. Verge, who is the Member for Humber East.

MR. HARRIS: You should do it now for the minutes. Last year I know we had debates of great length before the health committee, and primarily before the social services committee, about how the time was allocated and whether the ten minute allocation or the fifteen minute allocation includes questions and answers, or whether the person just has the ten minutes assigned to them.

This minister is very good, in the House I know, of giving very long answers to very short questions. You might have a two minute question and an eight minute answer. I am not suggesting he would do that here, but that could use up the ten minutes of a member. So perhaps we should have a ruling or a consensus amongst the committee as to how that should be treated here.

MR. CHAIRMAN: I would not propose to be too strict on the time, as long as everybody was comfortable. I would think we would consider them ten minute slots, whether it is a question or an answer taking up the time. There is no limit on the number of questions you can ask, and we would just keep going round. We can stay all night if people want to stay; but if we get into trying to keep track of the questioner and the answerer, that makes life more complicated. I do not have a stopwatch, and I do not propose to get one unless we get complicated.

Mr. Walsh?

MR. WALSH: Mr. Chairman, to that point, I tend to agree with you that there is a good chance the committee will flow just fine. I do not think that we are going to be nipping at the bit over a few minutes one way or the other, but I would not want to see a situation where the floor is being dominated. By following the ten minutes through, it gives us all a chance to at least ask some questions rather than just simply sitting and listening.

I know for myself, I will not interject if we should go over into ten or fifteen minutes, just as long as everybody realizes that we are looking and working on ten minute time slots; that we are all cognizant that there are other people in the room tonight. If we go along with that, I think we will be fine.

MR. CHAIRMAN: I would hope we will not have too many difficulties. If we start getting into problems, then we will get stricter, I would suggest.

If I might proceed with the other introductions: Mr. Doyle, who is the Member for Harbour Main; Mr. Harris, second from the left, the Member for St. John's East; Mr. Walsh, the Member for Mount Scio; Mr. Short, the Member for St. George's, who is substituting for Mr. Ramsay tonight, who is unable to be here; and Mr. Efford is missing this evening, so far.

Perhaps if the minister would like to introduce the officials with him, and he is ready to proceed, we can begin.

MR. DECKER: Thank you, Mr. Chairman.

In previous years when I have attended these things, the minister usually had a long drawn out speech and I don't think that is the intent of these committees. We are dealing with $880 million in this particular department and I think it would be a waste of time for me to take up even fifteen minutes, as there are far too many issues which have to be dealt with, so if it is okay with the committee, I would just as soon not give an opening speech.

I will introduce the officials with me. This department we deal with on two levels, there are a lot of policy issues and there are a lot of very technical issues which none of us can answer in-depth I am sure, the depth to which the questions go from this committee, so I would like to have permission with your consent to have the officials deal with technical questions. If it is of a policy nature I will attempt to answer it on behalf of government.

I have with me the deputy minister whom many of you know, Dr. Bob Williams; I have the assistant deputy minister for Planning and Programs, Jerry White who has been here before; I have the new deputy minister who has only been with us for a short time, Joan Dawe and she is assistant deputy minister for Community Health, and we also have another new deputy minister since we last met here, Primrose Bishop. She is the assistant deputy minister for Institutions and Primrose was promoted when Brian Lemon left the department as assistant deputy minister. I should point out that two-thirds of the assistant deputies in the Department of Health are female which is not too bad.

We have the Executive Director of Administrative Services, Mr. Cecil Templeman who is also here tonight, and hopefully to join us a little later, will be the Director of Hospital Services, who is acting, the position is now vacant, Mr. Roy Manuel, and he will be joining us later on. Now, Mr. Chairman, having said that, I won't waste any more of the committee's time but if we can get right into the proceedings of the evening.

MR. CHAIRMAN: Thank you, Mr. Minister.

Mr. Walsh.

MR. WALSH: Reflecting on some of the rules last year - and Jack just jogged my memory on it - as in the House if a question is asked and the officials themselves just do not have the answer off the tops of their heads, they have the right to take questions under advisement and come back to the committee; they are not expected to know all the answers. Is that normally the way?

AN HON. MEMBER: That is normal.

MR. WALSH: Okay, thank you. So the officials with the minister would have the right to take questions under advisement. I just wanted to be sure.

MR. CHAIRMAN: Thank you.

Who wants to begin the questioning? Mr. Doyle.

MR. DOYLE: Thank you, Mr. Chairman.

First of all, let me say I am quite pleased that the minister did not get into a long dissertation on his department and I will pretty well follow suit on that but I cannot resist making a few observations before I go into questioning, because I do have some difficulty as a member of the Opposition and as the health critic as well, in understanding some of the statements that one hears from time to time here in the House of Assembly. On opening day I heard the Premier say that the health care system in Newfoundland is doing very well. You know that is something that I find a little bit difficult to understand when you get down to it, because over the last couple of months we have certainly given the impression, rightly or wrongly, that government seems to be whistling pass the graveyard in a lot of instances with regard to the condition of the health care system in our Province, and it was borne out of course, by statements that we are hearing doctors and nurses and people within the health care system make.

Just recently, we have heard some prominent doctors say that the situation is now so bad in hospitals that doctors are called upon to determine who lives or who dies based on who can get the next hospital bed. These are not my words, they are published in the local media and sound very, very serious to say the least. We can all, I suppose, quote our own individual horror stories that we are hearing from day to day from health care professionals, people who are directly working in the system in the hospitals, on the wards, looking after patients in the operating rooms. They are pretty well saying that the health care system in Newfoundland and Labrador is in a shambles, it is at a breaking point.

Nurses we see over the last number of months have been taking out full page ads in the Evening Telegram. That would indicate to me that something is wrong. So I guess my first observation has to be: are all those people wrong? These are sound, sane, rational human beings who are working in the health care system, and they are qualified health care professionals. Are they all wrong? Are they crying wolf when they shouldn't be? That is the first thing I want to get the minister's opinion on when he answers. You know, I want to know how the minister can square some of the comments that he has been making and the Premier has been making on the condition of the health care system in the Province with some of the comments that we are hearing from doctors and nurses, as I said, who are taking out full page ads in the Evening Telegram to express their concern. The minister, I am sure, has seen all the public statements.

We have a number of hospitals in the Province that have been downgraded. We have brutal cuts in virtually every sector of the health care system. I believe 800 or 900 positions have been eliminated over the last couple of years, 300 nurses gone. Even last year we had a $25 million to a $30 million shortfall in the 91-92 budget. We have hundreds of acute care beds closed. Patients are now being charged in certain instances fees for services. Line ups are horrendous we are hearing, especially in the area of heart surgery and this type of operation. But still, you know, we continue to hear statements from government that the health care system is in fairly good shape. It is in as good a shape as it has ever been. Well probably the minister didn't say that, that it is in as good a shape as it has ever been, but I am just surprised that on opening day I heard the Premier make the statements that he made with regard to the health care system in Newfoundland.

So I guess I will get down to some individual questions that I want to ask the minister. First of all, the changes that have been made to the transplant policy, organ transplants. I would like the minister to give us a rundown on that and to tell us how organ transplants have been affected. What is the formula that the government is using for the transplant patients, especially the people who have to leave the Province to go to the mainland for transplants? What is it going to mean for these people? Obviously they now have to pay. That is the first question. There is no point, I believe, in asking a whole number of questions. Maybe I will just let the minister respond to that question first. I want to find out from him or his officials what changes have been made to the transportation policy with regard to organ transplants and how it is going to in particular affect those people who have to get transplants on the mainland to have to go by air probably taking up two or three seats in an aircraft on a stretcher. How would these people be affected, and what are they going to have to pay now?

MR. CHAIRMAN: Mr. Decker.

MR. DECKER: Thank you, Mr. Chairman. As regards the preamble to the hon. member's questions, I will just have to say I do not particularly share the same observations. But I am sure you will find as many people who disagree as do agree. I suppose it is a matter of perception.

The transplant program - as we announced in the Budget, there is a program in the Department of Health which helps pay the cost of transportation for people who have to go away from where they live in order to receive the services of health care, whether it be from St. Anthony to St. John's or from Goose Bay to Corner Brook, or from St. John's to Ottawa, or wherever. Before the program was changed anyone who had to pay more than $500 in travel, after the person went beyond $500, every dollar from then on was paid in half by the government. So if a person had a $1,000 ticket out of the Province or wherever, he would have to pay $750 out of his own pocket, $250 would be refunded.

Now the exception to that was that people who went out of the Province for heart transplants, or for any transplant, the whole shot was paid. The change which we made was that from now on, whether you pay more than $500 for a heart transplant or for a kidney transplant, or whatever, we treat all the people the same. Instead of treating the disease we treat the patient. So now, if a person has to - for some reason, I do not know how it could ever happen - but supposing someone had to go to Montreal to have a tooth removed. We would pay in excess of, after $500, we would pay half of it back, for whatever the reason is. So that is the only difference.

But there is something which I think hon. members should know. The cost associated with transplants, a very minute part of that cost, is travel. A person, for example, who goes for a heart transplant outside this Province, the average cost is $111,350, which the Province picks up. A heart-lung transplant is $152,320. A liver transplant is $105,730. A bone marrow transplant is $105,895. A paediatric adult kidney transplant is $42,405. Government would love to be able to pay the whole shot, pay everything. We can't do that. Money has to come from somewhere. So you try to make your changes in the places where they do not hurt too much.

We thought that it would be less harmful, cause less hurt to our people, if we could pick-up a savings there of half a million dollars by treating everyone the same. I believe it is really a fair way to treat people. Mind you, we would rather have paid the full shot, treat everybody the way we are treating the people who are receiving transplants, and pay the whole shot. That would be the perfect way to do it.

But living in a real world we thought: if we are going to pick up the savings, this was the equal way to do it, bearing in mind that there is already a tremendous cost to Medicare and to the people of the Province when a person has to leave the Province for a transplant.

MR. CHAIRMAN: Thank you. Mr. Doyle.

MR. DOYLE: I am not absolutely sure that I understand what the minister just told me. So I will get him to approach it from a different angle. What would it cost an individual before this Budget was brought down, say to go to Toronto for a heart transplant? In terms of transportation alone, what would he pay?

MR. CHAIRMAN: Mr. Decker.

MR. DECKER: Before the change, a person who had to go to, say Toronto, for a liver transplant - I think liver transplants, I'm not sure they were done in Toronto. They were done in Halifax, were they?

AN HON. MEMBER: Some were done in Halifax.

MR. DECKER: Yes. It would not have cost the person the fare, the transportation.

MR. DOYLE: It would have cost them -

MR. DECKER: It would not have.

MR. DOYLE: Oh, would not have, okay.

MR. DECKER: Okay? Today it will cost him, first, $500. If the ticket is $1,000 he pays the $500, then every dollar beyond the $500, government refunds half. So if the ticket was $1,000 it will now be $750. But prior to this, the person who received the transplant would not have had to pay anything for transportation. So if the ticket was $1,000 it will now be $750; but prior to this, the person who received the transplant would not have had to pay anything for transportation. Now if there was board and lodging involved and that sort of thing -

MR. DOYLE: What if he takes up three seats on an aircraft?

MR. DECKER: If he takes up ten seats, that does not matter.

MR. DOYLE: It does not matter?

MR. DECKER: It does not really matter. The $500 he pays himself, or herself, whatever the case might be.

MR. DOYLE: And that is the entire cost to him?

MR. DECKER: No, after that he pays half.

MR. DOYLE: After that he will pay half of the cost again? So if it costs another $500 he will pay $250 of it?

MR. DECKER: That is correct.

MR. DOYLE: So it is possible then, if he was on a stretcher, say, and he was taking up three seats on an aircraft -

MR. DECKER: Most likely if it was a stretcher case we would send them up by the King Air, which is the hospital ambulance.

MR. DOYLE: Okay.

Could the minister outline for us what areas have been cut in the children's dental program?

MR. DECKER: We have allocated $5 million in this year's Budget to buy some services from the dentists. That is the way we are putting it. We want to maintain a basic service. Now you might say, what is basic? That is what we are working out between the dental association and the department, the director responsible for that.

So I cannot say to you today, with absolute, total certainty, what we will be delivering and what we will not be delivering. We will be delivering a program for $5 million. Certain basic things we are suggesting will be kept in there - fillings, cleanings and these sorts of things will be kept in there. The details of that are being worked out in close cooperation with The Newfoundland Dental Association and the appropriate director of the Department of Health.

MR. DOYLE: So the department does not really know yet what areas are going to be cut?

MR. DECKER: No, all we do know is that there are certain components we want to keep there; as I say, cleanings, general maintenance, extractions, fillings, and a whole lot of things which we will be keeping there.

MR. DOYLE: What did the minister say was the total cut in that program, two and one-half -

MR. DECKER: It was a $7 million program. Now in this particular year it is going to be $5 million. Then we are hoping to bring the program down to about $4 million in this year's dollars.

AN HON. MEMBER: Is it four?

AN HON. MEMBER: (Inaudible).

MR. DECKER: Okay, my deputy corrected me. It is $5 million. The program, we are hoping, will level off at about $5 million.

MR. DOYLE: I asked the minister some questions about a week or so ago on the cases of meningitis that we have in the Province. I did not get a chance to ask him how many meningitis cases have been reported to the Department of Health this year, and at what point - or is there is a point - at which the department will introduce a Province wide immunization program? Is there some point that you reach where the department would be looking seriously at introducing an immunization program Province wide?

MR. DECKER: Now I have to take my advice on that from the professionals in the field. I can tell you it would be unique, I suppose, to vaccinate the whole Province.

I would like to ask Ms. Dawe to explain this, with your permission Mr. Chairman. I think there were only seven or eight cases this year, but she will explain that, and then the professional reason as to why you would or would not vaccinate a number of people.

MR. CHAIRMAN: Ms. Dawe.

MS. DAWE: Thank you, Mr. Chairman.

If I could, in 1991 there were sixteen cases reported in Newfoundland, and up to the current date there were seven cases reported.

With respect to immunization, there is an advisory committee of appropriate professionals from around the Island who are called into play when there are cases of meningitis, and they provide a considerable amount of advice to the department.

In the most recent case, with the death in Labrador, not only was there professional advice from within the Province, but also across the country, because of the experience that Prince Edward Island and Quebec and Ontario had around Christmas time. So it was based on extensive consultation with professionals that it was decided to vaccinate in Labrador over the past two weeks.

Because of the target group who were affected over the last three months, it was decided to vaccinate individuals from the age of two to twenty-two. That program will conclude this week with about 4,000 vaccinated.

With respect to the overall vaccination program for the Province, it really has to be dealt with over time because it is very difficult unless there are sound medical reasons to vaccinate, and then to vaccinate specific target groups. You don't automatically vaccinate between the ages of two and twenty-two or thirty or whatever. So it is based on a considerable amount of professional advice at the time and then monitored over time.

Again, as you may be aware, the disease is more prevalent in March and May, then October, November and December of the year. But I think suffice it to say that this year the incidents to date are seven whereas the total cases in 1991 were sixteen.

MR. CHAIRMAN: Thank you, Ms. Dawe. Mr. Doyle, your fifteen minutes are up. Do you have something quick or shall I go on to another member.

MR. DOYLE: I was just going to ask a fast question on that. As a matter of curiosity, why would the Province of PEI do a full immunization program? They did do a full province wide immunization didn't they? Why would they do that? I know they are a whole lot smaller to begin with.

MS. DAWE: I don't have all the information at my fingertips, but I guess it is based on their experience and the number of cases at the time the decision was made. I don't have the number of cases ready and available to me on Prince Edward Island at the time of the outbreak around Christmas time.

MR. DOYLE: Okay, I will get back a little bit latter on.

MR. CHAIRMAN: The floor is open. Ms. Verge.

MS. VERGE: I was just going to say the Chair and I had a brief conversation a bit earlier about the order of questioning, and we both agreed it would probably be fair to rotate between Opposition and government members, but since Mr. Harris had his hand up first it would be quite in order to recognize him next.

MR. WALSH: On rare occasions I have granted him leave in the House to speak, so I see no reason not to let him go for a few minutes now.

MR. CHAIRMAN: Mr. Harris.

MR. HARRIS: I speak as a right I hope, and not by leave of my hon. colleague here. I know there are occasions when even the Speaker in the House asks for leave when leave is not required. Nevertheless, Mr. Decker, I have a number of questions. Rather than philosophize about things perhaps I could ask a few questions of a specific nature, jumping around of course from various lines in the budget.

I see in line 4.2.01 on page 206 of the Estimates, some $16 million allocated for services outside the Province. Now that would include some of these transplant operations you were discussing with Mr. Doyle. There seems to be a $500,000 increase allocated over last years estimates and actual. Is there any significant portion of that related to out-of-Province expenses for people who actually reside out of the Province for large portions of the year? I know the Ontario government had a look at what they call their snowbirds issue where large numbers of people spend five or six months wintering in Florida or other places, and asked the Ontario government to pay American style health care costs for them under the medicare budget. I was just wondering if you were aware of what portion of that is the kind of services that would be -- you need an operation in Toronto because of a particular emergency, or transplant, or a particular specialist might be available. What proportion of that is that kind of special service, and what kind would be services for people who are on vacation or extended vacation type of thing?

MR. CHAIRMAN: Mr. Decker.

MR. DECKER: Primrose is going to take that. As regards the snowbirds, as you refer to them, we do have some expense for people who go south or go on vacation, but we made a change to the government policy a couple of years ago whereby we only pay the Newfoundland rate. You would have a procedure done in Newfoundland which would cost you $300 and if you are vacationing south, the same procedure could cost $3,000 and we used to pay the American rate, we do not do that anymore, we only pay -

AN HON. MEMBER: While they were on vacations?

MR. DECKER: That is correct. We only pay the Newfoundland rate now. Within the country we have a different agreement with all the provinces where, we would pay -

AN HON. MEMBER: (Inaudible).

MR. DECKER: Yes, what is it called?

AN HON. MEMBER: Reciprocal billing.

MR. CHAIRMAN: Mrs. Bishop.

MRS. BISHOP: Thank you, Mr. Chairman. With respect to services outside the Province, we have in place what we call a reciprocal billing arrangement between all the provinces and territories, and under the Canada Health Act you are entitled to access health services in Canada and we would pay for the charges that were required for your hospitalization or your care.

Out of that $16 million, just under $4 million has been spent for these transplants, on an average, that are going out. A very small amount is to the US because of the fact that we changed our policy last year, and these would be people who had to access emergency type treatment; if you went down and broke your leg or broke your arm, we only would pay the equivalent as a visit to an out-patients department that we would pay in Canada. The remainder is for people who are in other provinces and take sick; if you are in Ontario and your gall bladder gives you trouble and you have to have it removed, you do not get a bill, you can go in the hospital and we pay for it here on a reciprocal arrangement.

MR. DECKER: I would also point out, Mr. Chairman, that in 1990-1991, outside the country, we paid for 104 people who were treated as inpatients and 434 who were paid as outpatients. Now that was done by Newfoundland rates I understand, wasn't it?

DR. WILLIAMS: 1990-1991, perhaps, not.

MR. DECKER: Okay, 1991 might have been paid at their own rates, we can check back, but in the same year, within Canada under the reciprocal billing Mrs. Bishop talked about, we paid for 1,771 inpatients, some transplants and some other treatments, and we paid for 15,764 outpatients visits outside the Province.

Now I should point out, Mr. Chairman, that, a considerable number of them were down in Blanc Sablon in Labrador, where the borders are so close, quite a few patients go from Eagle River across to Blanc Sablon at Long Point and we have quite a number of billings there. Now what about the other border up in Labrador?

AN HON. MEMBER: I think it flows the other way into the hospital (inaudible).

MR. DECKER: Yes, most of them come from Labrador into Newfoundland.

MR. HARRIS: Thank you very much. The second issue I wanted to question about was the next line in fact in the Budget, 4.2.0.2. - health care centres. How many health care centres are covered under that vote?

MR. DECKER: Which one is that?

MR. HARRIS: Page 206 we are on.

MR. DECKER: Okay, there are ten paid for there.

MR. HARRIS: So ten are covered by that and there is a drop in the Budget for these centres of $1 million, from an actual expenditure of $31.6 million in 1991-1992, to a projected expenditure of $30.4 million, that is a considerable amount of money and looks like approximately a 4 per cent decrease, a million dollars for ten centres. What is the consequence of that $1 million removal of funds for these centres and can you explain what services will be removed?

MR. DECKER: Yes. Mr. Harris will remember that last year we changed the roles of a lot of these institutions. We changed the roles in Bonavista, Bonne Bay, Burgeo, Placentia and Springdale. As a result of changing the role and going more with long-term care in these institutions, that is the explanation for the savings. These were some of the bed closures.

In 1991, for example, in these ten institutions there were 153 acute care beds. In this year's budget, 1991-1992, we were down to sixty-seven. Now in 1991-1992 there was a phase-down. We just could not stop, you had to phase it down. But we are down to sixty-seven acute care beds in this year and that explains the savings.

MR. HARRIS: Can I ask that again? Last year you decreased the number of beds from 153 to ninety-one, yet you spent an additional $600,000 over your budget. Now you are decreasing it to sixty-seven for 1992-1993. You drop a million from what you spent last year?

MR. DECKER: Yes.

MR. HARRIS: Why did it go up?

MR. DECKER: There were severance packages which had to be put in place. You just can't stop and shut your door. You have to phase-down. Were there some other reasons there as to why, Ms. Primrose?

MS. PRIMROSE: No, there was fairly significant severance pay for people who chose to retire.

MR. DECKER: That all had to be factored in. We didn't -

MR. HARRIS: I'm sorry. Is Ms. Bishop responding or just giving you information? Because I did not hear what she said.

MR. DECKER: Okay. Ms. Bishop.

MS. BISHOP: Mr. Chairman, there was a significant number of people who received severance pay who were resigning and retiring.

MR. HARRIS: Do you have any numbers of people? In the ten health care centres, what were the numbers overall? Is that available?

MR. DECKER: Dr. Williams will address that issue.

MR. CHAIRMAN: Dr. Williams.

DR. WILLIAMS: In the original budget there was an increase of $574,200 over what was initially budgeted for. This is due to a new salary contract with the Association of Allied Health Professionals which had some retroactivity to it, increases in employer contribution rates for Workers' Compensation, and the Canada Pension Plan. I understand that these are the three factors that went into that increase.

MR. HARRIS: These are now factored into the cost for this year -

DR. WILLIAMS: These will be factored into the cost for this year.

MR. HARRIS: - less the cost of reducing the number of beds.

DR. WILLIAMS: Yes. Last year as well in our budget, as the minister said, there was provision for severance pay that is not in this year's budget. So that is why there is a reduction.

MR. HARRIS: The figure that I have heard in the medical establishment I guess is terms of cost per day of a hospital bed, acute care bed. The figure that has been thrown around for the past few years is a figure of $400. Is that still a figure that makes sense? Four hundred dollars per day is the cost of having someone in an acute care bed, or having an acute care bed open?

DR. WILLIAMS: I will let Ms. Bishop give you the exact figures that we now use. We have different rates for different types of hospitals. For a community hospital we have one rate, and for our tertiary care centres we use a different rate. Ms. Primrose, do you have those rates?

MS. PRIMROSE: Yes, Mr. Chairman. The inpatient per diem rates, which are effective April 1, 1991, for instance at the Health Sciences, the insured rate is $730 a day. That is a tertiary facility. The James Paton in Gander, $572 per day. These are just examples. Sir Thomas Roddick Hospital, Stephenville, $470 per day. St. Clare's, $428 per day. Burin, $600 per day. Carbonear, $500 per day. These are the per diem rates.

MR. CHAIRMAN: Thank you, Ms. Bishop. That's your time, Mr. Harris.

MR. HARRIS: I will get another chance, no doubt.

MR. CHAIRMAN: Ms. Verge.

MS. VERGE: Thank you.

MR. CHAIRMAN: Were you asking to intervene, Mr. Walsh?

MR. WALSH: I was going to, seeing as how I gave my time to Jack.

MR. CHAIRMAN: Okay, go ahead.

MS. VERGE: You go ahead.

MR. WALSH: Okay, thanks.

MS. VERGE: I just didn't want people to think that I wasn't eager and willing.

MR. WALSH: Actually, I thought you would have gone with the Chair and the Vice-Chair first, but I like the way you are doing it, letting us go first.

Staying with the same particular page actually, 206, there are some very positive things that I see there. I am just wondering if you can elaborate to some degree on them for me.

We were talking about 4.2.01. Services outside province are going up by almost a million dollars, and that is services outside province - well approximately half a million dollars. What would that cover, because you are saying that you trimmed somewhat in terms of what you are looking to do, people going south of the border and so on?

MR. DECKER: Which one are you in now, Mr. Walsh?

MR. WALSH: I am in 4.2.01.

MR. DECKER: Yes, services outside province. You are asking what services -

MR. WALSH: You have gone up by half a million dollars, yet you were saying earlier that there were areas where you are looking to trim and cut. Why would you see an increase there? What would you be looking to look after?

DR. WILLIAMS: These services outside a province could be the same package of service that we provided for in the previous year, but because of cost and inflationary increases in other provinces then the cost of providing those services have gone up. As we bill other provinces, we bill other provinces for service provided.

Say somebody from Ontario is visiting and had to go in hospital, we use our per diem rates in hospital and our cost of outpatient services in this Province to bill them. They in turn, if one of the residents of Newfoundland is in one of their provinces, they use their basic rate structure to bill us. So some of this might be for the same type of package, but it might be inflationary increases that would account for the large portion of this.

MR. WALSH: Under the same heading, Grants to Hospitals, would that also allocate or rationalize why we have gone from $418 million to $423 million? There is about a $7 million increase. Is that just normal increases in operating?

DR. WILLIAMS: Primrose, do you want to go into some detail on that? Do you want some detail, Mr. Walsh?

MR. WALSH: Yes, I would not mind having a little detail there as to what would include that amount - five and a half million.

MR. CHAIRMAN: Mr. Decker.

MR. DECKER: Contrary to the perception, Mr. Walsh, we have not frozen the hospital budget this year. As we have gone over last year's we found there were some budgets we had to increase a bit. So what you see there is the increase to most - I suppose most of the hospitals did receive some level of increase, did they not, this year?

MS. BISHOP: Yes.

MR. DECKER: Ms. Bishop can explain the exact amounts. She has them there.

MR. CHAIRMAN: Ms. Bishop.

MS. BISHOP: Thank you Mr. Chairman and Mr. Minister.

Last year our revised amounts that we gave to the hospitals was in the order of $469 million. This year the amount that has been allocated is in the order of $483 million.

We have given increases to The Cancer Foundation, Western Memorial, St. Clare's, Sir Thomas Roddick, The Janeway, James Paton Memorial, the nursing stations, Melville Hospital, The Miller Centre, The Health Sciences Centre, The Grace, Central Newfoundland -

MR. WALSH: So there has been about $5 million allocated across the Province to those various facilities?

MR. DECKER: Bearing in mind that we have a wage freeze, 75 per cent to 80 per cent of the hospital budget is salaries anyway.

MR. WALSH: How much did you say?

MR. DECKER: Seventy to seventy five per cent of the money that we spend in the hospitals is really salaries. So this $5 million extra is going directly into patient services as you can appreciate.

MR. WALSH: Still, that is quite a number.

One other area that I see increases in, and I am not sure if this ties directly to the changes in terms of chronic care. I know that in my own district there were some major changes made to our hospital on Bell Island. It is something that has been quite accepted. As a matter of fact I think a committee on Bell Island made recommendations as to what they thought the future of that hospital should be. Government agreed with it and went along with it.

I am seeing there in terms of 4.3.01 - long term care facilities. First off, what are those facilities, and before I am corrected again we are looking at about $2.5 million I think in an increase there.

MR. DECKER: Yes.

MR. WALSH: What are we covering in terms of those areas?

MR. DECKER: They are basically the nursing homes throughout the Province. A lot of them are run by interfaith groups. Some of them are government owned, for example, the Harbour Lodge in Carbonear, which we own. I have a list. The Agnes Pratt in St. John's which is church owned, the A.M. Guy Memorial, the Bay St. George, the Blue Crest, the Bonnews Lodge, Carmelite House, Corner Brook, the Hugh Twomey Centre, the O'Connell Centre, the Glenbrook Lodge. These are basically nursing homes throughout the Province, and once again in them we also have to give an increase.

MR. WALSH: Now I understand that you have opened I think some floors at Western Memorial, the sixth floor has been re-opened. Is that being termed chronic care as well, and would some of that approximately $2 million have gone to them for that purpose?

MR. DECKER: Yes. Primrose, would you talk about Corner Brook and the Agnes Pratt and the Twomey Centre in which we are going to open some more beds.

MS. BISHOP: Thank you, Mr. Chairman. In the Western Memorial region the sixth floor is going to be converted now for an additional thirty long-term care beds. We have put in money to open up the remaining twenty-eight beds at the Agnes Pratt Home, and money is in the budget for the remaining sixteen beds at the Dr. Hugh Twomey Centre in Botwood.

MR. DECKER: We also have Baie Verte coming on stream.

MS. BISHOP: Yes, Baie Verte is undergoing renovations for changing the focus more in line with long-term care. It will now have eight short-term acute-care beds and nineteen long-term-care beds. That renovation should be completed by mid-summer.

MR. WALSH: Am I to assume again, based on the minister's previous comments about the amount of funds that are wrapped up in salaries, approximately that entire $2 million has gone into the facilities, and it would not have gone into labour as well in terms of cost?

MR. DECKER: No, not exactly. For example in Baie Verte we never had a long term facility there before, and the Twomey Centre, we have to take on extra people. In Corner Brook we have to take on extra people. As a matter of fact Corner Brook will have nineteen more.

AN HON. MEMBER: Nineteen more employees.

MR. DECKER: Is that now, or when they open?

AN HON. MEMBER: They will when they open up the first of June.

MR. DECKER: Yes, when Corner Brook opens their beds the first of June they will have nineteen more employees than they did last year.

MR. WALSH: So there has been some hiring done because of this change.

MR. DECKER: That is correct.

MR. CHAIRMAN: That is fine for me for now. Ms. Verge.

MS. VERGE: Thank you. I have several questions which I know I won't get through in the first ten minutes. To give you some idea of the major topics I will indicate headings at the outset. I would like to get the minister's views, 1) on the general direction in which he thinks our health care system is headed or should be headed; 2) institutions; 3) MCP; 4) drugs; 5) public health.

In terms of the direction presently and for many years, the health care system in this Province as in most of the western world, has been heavily oriented around institutional care. These estimates provide for total spending by the Department of Health of $848 million, the bulk of that is to be spent on institutions, hospitals, health care centres, long-term care facilities; according to my rough calculations, about $580 million of the $848 million total is to be spent on institutions.

The next single biggest category is MCP, $144 million. That involves of course under our present system, fees, for not all health care professionals but just physicians and to some extent dentists and optometrists. Other health care professionals such as nurses, midwives, chiropractors, nutritionists are not covered by MCP. If they provide services directly to the public, the public have to pay, there is no provision for public funding through MCP.

A third relatively large category is drugs, $30 million for drugs, so while the department is called the Department of Health, actually, most of the effort goes into treating illnesses; a relatively small amount of the Budget goes into preventing illnesses through education or other programs. In fact this year, the same as last year we have the perverted heading on - let me see if I can find the page, the one page of the Budget which is called Health Prevention.

There is a health prevention label on the relatively small amount of effort that involves presumably, not the prevention of health but the prevention of illness, through education programs and counselling. That is what has been called by some academics and analysts, The Western Medical Model. We have reached the point in the western world, as many of us see it, of thinking that this model is not the best model in terms of the results, and regardless of our views on the results, many people are realizing that we cannot afford the model.

The cost of maintaining this model has grown at a faster pace than the economy has grown so we are faced with the inevitability of change, it is just a question of what kind of change; are we going to try to cling to the old model and lop off sections and parts or, are we going to face the challenge of improving the model, of changing the model, of reforming the model? I would like the minister's views on those comments before I move into the next heading which is: Institutions.

MR. CHAIRMAN: Mr. Decker.

MR. DECKER: Mrs. Verge raises some excellent points and I share her views on a lot of the points. If you were to look at the money we are spending on health you could almost call us the Department of Sickness. I would not deny that and I agree that if you look at what has happened to the western world, you would find that we prevent tuberculosis, we prevent polio, we are trying to prevent cancer. You know, if we could ban smoking for example, the impact that would have on cancer would be unbelievable in a few years.

I would suggest that housing has done more to prevent sickness than some of the immunization vaccinations which we give. I would suggest that water and sewer in the western world has done more to stop disease than a lot of things we have done; the western world is trying to clean up our environment, the impact of mining and all this, so I have no problem with saying that we are committed to prevention. I believe that one of the key areas where we are trying to reorganize the Department of Health is in those community health care boards which we are putting place, which will be putting a tremendous amount on prevention. We are trying to work that area.

This is Ms. Dawe's areas, one of the reasons we appointed Ms. Dawe to this particular position within the Department was we knew her expertise in this field. One of her major assignments is to develop those community health care boards. There is a considerable amount of prevention in that. Maybe, Ms. Dawe, if you could address that issue, just to let the Committee know some of the directions that we are heading into.

MS. DAWE: Thank you, Mr. Chairman, Mr. Minister. I would as well encourage support for many of the comments that you have made about the redirection of the system. I think it is fair to say, if you look at what is happening in the country, in many respects Newfoundland is taking the lead in its efforts to redirect health services to the community. Since January part of the major mandate that I have is indeed with the reorganization of community health services and the establishment of community health boards, bringing together many of the community services that are currently provided by a number of organizations.

The first grouping being the public health services, which are provided directly by the health units, administered through the Department of Health. These four units across the Province will, over the next year, become the responsibility of community health boards. In addition there is quite an array of continuing care and home care services that are provided by various organizations, which as well will become the mandate. The process that is in place now to see the realization of the establishment of community health boards is one which involves extensive consultation again with varying departments of government - Health, Social Services, and so on -, quite a number of individuals representing health care providers across the Province, and an individual representing the public at large.

So that we have a provincial task force which is now providing advice and direction through the Department on the reorganization and the need precisely to focus on some of the aspects that you have identified in terms of more time and public attention on health promotion and health protection services, as well as redirecting care, which can be provided safely and appropriately in the home, as opposed to in an institution setting.

So our major focus is really to encourage more independence and to provide care in the most appropriate settings, obviously with quality as a criterion there. I personally, as a newcomer to the Department, am most encouraged with the level of support and commitment that we have not only across the Province but across the country in the initiatives that we are undertaking. It is very much at an early stage. We started this process in January. With the consultation that is required it will take over the next year before we have the boards established. At this stage it appears that our plans are still on schedule to have the first board in place in western Newfoundland in the Fall, before the end of 1992, and as quickly as possible thereafter the boards in central Newfoundland, then St. John's and then eastern.

So if we would, for the moment, consider that northern is under the Grenfell Association, although there has to be some re-organization there as well, on the island part of the Province there will be four community health boards with regional representation on these boards, as well as provider and consumer input. So that the decisions with respect to community services in the whole array of - and I think you may have copies of the conceptual model....

MS. VERGE: No, we don't.

MS. DAWE: Well, these are here to be circulated.

MS. VERGE: Okay, thank you. Where will the four island regional health care boards be headquartered?

MS. DAWE: That decision has not been finalized yet. As far as we are at this stage is that there will be four. One in western, central, eastern, and St. John's.

MS. VERGE: Have you decided where the western board will be based?

MS. DAWE: No.

MR. DECKER: The board itself will have some input into that. We will not be dictating from St. John's that it must be Corner Brook or Port aux Basques. The board itself will make that decision.

MR. CHAIRMAN: Now we have gone through another ten minutes. Does anybody else want to intervene at this point?

Ms. Verge, would you like to continue?

MS. VERGE: Yes, I would, if nobody else does.

MR. CHAIRMAN: Mr. Harris?

MR. HARRIS: (Inaudible).

MR. CHAIRMAN: Okay, well why don't you go now, please?

MR. HARRIS: The next area in which I was interested is basically a follow-up to the question on the per diems. Can the minister tell us how many patients in - well let's just take the three large St. John's hospitals, not counting the Janeway - how many patients do we have in the Health Sciences, St. Clare's and Grace, in each of those hospitals, who have in fact been medically discharged and are still in the hospital because there is nowhere for them to go?

MR. DECKER: A quick answer. We have about 10 per cent of our beds, I think, in the Province occupied by medically discharged. The actual institutions - do we have that figure readily available?

MR. HARRIS: Acute care beds, I guess -

MR. DECKER: I beg your pardon?

AN HON. MEMBER: Seventy-four patients.

MR. DECKER: In where?

AN HON. MEMBER: St. John's.

MR. DECKER: In St. John's we have seventy-four patients who are medically discharged.

MR. DOYLE: And who are still in hospital?

MR. DECKER: Yes, they are in acute care beds in hospitals.

MR. HARRIS: What is the average length of stay of these people after they have been medically discharged?

AN HON. MEMBER: Do you have an average?

MR. HARRIS: Maybe somebody could give us some more information as to what all that means. You could have seventy-four people now; they could be all discharged tomorrow. In order to determine the extent of the problem, I guess, a more realistic question might be: What is the average length of stay of these medically discharged people? Are there people that have been there for six, eight and ten months? Can you give us more information about that problem?

MR. DECKER: Well we are trying. You see, there are a whole lot of problems, and it could take longer than I am sure the committee would be prepared to let me go on.

In this Province, according to The Royal Commission Report which was done, we should have, I think it is 2,896 long-term care beds - chronic care beds?

AN HON. MEMBER: (Inaudible).

MR. DECKER: Well 2,900 we should have for chronically ill, for level two and three. In actual fact we have 3,453 long-term care beds in the Province. So you say we should have lots of room for our medically discharged people; but you will find that a lot of these long-term care beds where, for various reasons, some of them are already occupied by level ones - people who should not be in long-term care institutions, or if they should it should be in a personal care home.

You find in The Agnes Pratt and St. Patrick's and all those institutions there are people who really could in some cases cope at home, with some home care, or certainly in the personal care home. Now there are many reasons for that. One of the most obvious reasons is that when those institutions were built, especially the newer ones, they were built under Canada Mortgage and Housing money, and they were built as hostels. They were built for healthy seniors; but over the years the people have aged, and some of them went in there as level ones and now have become level twos and level threes.

We have made a policy to only admit from hereon level twos and threes, but you obviously cannot put people on the roads. If we had proper placement in our chronic care homes, we would have plenty of beds. It would not be necessary to have those medically discharged people in the hospitals, because we would have about five, six, seven hundred more beds than we are supposed to have, according to The Royal Commission, and we tend to take their advice.

I have said publicly before that in the interim we are going to have to have more beds than we actually need, and we do. We have more beds, but to solve the problem we have to get at admissions to the homes.

Those boards which Ms. Dawe talks about, one of their roles will be dealing with what we call the single point of entry, where government now, or each board, will have some say as to what level of care gets into a particular home.

For example, the interfaith home in Corner Brook has quite a number of level ones in it. It was designed for that in the beginning. We are in the process of bringing that home up to a level two, level three. Then, only levels two and three will be admitted. The home itself will no longer have the right, once this board goes in place, to say: we are going to take this patient and not that one. The home will only say that after this board has determined that Mrs. Doe or Mr. Smith is approved to enter into a facility.

So it is not a simple matter of saying: why don't you build more long-term care beds and take them out? We have enough long-term care beds, but we have a problem with organization. They are inappropriately filled. It is just as wrong to put a level one into a level three facility as it is to put a level three person into an acute care bed.

MR. HARRIS: Did I hear you right when you said 10 per cent of our acute care beds are occupied by medically discharged people?

MR. DECKER: In the Province that is about the number, yes.

MR. HARRIS: Can you tell us what the cost of that is? I am trying to find a way to get a handle on this. We hear seventy-four, and then we hear the other reasons for it. But I would like to know what the cost to the Province is of having - the cost of having these medically discharged people in hospitals. Can anyone answer that question? Whether we are dealing with the seventy-four beds in St. John's, what is the cost to the system of that? Or what is the cost to the system of having 10 per cent of the acute care beds being not used for medical purposes at all?

MR. DECKER: If you are coming at it from cost really there are no savings. If you are just looking at in simple terms of cost really there are no savings. Our concern is not so much with cost as the appropriate care we are delivering. Whether the bed is filled by a chronic care person or an acute care person, the bed in a hospital is going to be filled. But our concern in the Department is that it is inappropriate for a person to be in an acute care facility, a person who is medically discharged. He or she would be much more appropriately cared for in a long-term care institution. That is one of the reasons we are trying, where we did some role changes in the last few years, we are trying to get appropriate placement for people who are medically discharged.

MR. HARRIS: Well, Mr. Minister, it is of great concern to somebody who is trying to get into a hospital and needs a treatment, or is being kept in an emergency situation for longer than they should be, or an emergency ward as opposed to in a bed, as to whether that bed is occupied and whether the health care funding is being essentially wasted. There would be no saving to the system, yes, if you took one person out of an acute care bed and put someone who needed an acute care bed into it. But you would have one person getting the care that they needed. That is important too. But it is important to know how much of our health care budget is being spent to accommodate this problem. I wonder whether you can answer this question.

MR. DECKER: Mr. Chairman, first the member comes at it from a point of view of cost. Well, I explained, the cost does not mean a hill of beans whether that bed is occupied by a chronically ill person or an acutely ill person. The cost is not the factor. But for the person who is waiting to get into an institution, yes, we totally share that, that is a major concern of the Department. That is why when we made some changes last year we tried to free up some chronic care beds so we could take some of those people who were medically discharged out.

There was some criticism this year that we did not open any new acute care beds. The reality is we opened eighty-odd acute care beds this year. By opening up Agnes Pratt and Hugh Twomey, and by opening up Baie Verte and by opening up beds for the chronically ill, we could take the acute care beds that were occupied by medically discharged people and put them into those institutions. We did the same thing the year before with the Springdale situation, where we took people out of Grand Falls and put them in. So we do not directly build new acute care beds, we have plenty. We have ninety-three more than we require. Acute care beds. But the inappropriate use of these beds is our problem.

MR. HARRIS: The same question has to be asked again. My understanding is that one of the roles of an estimates committee is to examine government expenditure and see whether it is being spent properly or whether it is being wasted. Maybe I should put it this way. How much of our health care dollar in terms of millions or hundreds of thousands, and it must be hundreds of thousands even on a weekly basis, is being wasted in maintaining - and what the solution might be is a different question - people in acute care beds who are not required to be there?

MR. DECKER: Mr. Chairman, I hate to use the word "wasted" because these people are sick. They are medically discharged. That means that there is no longer anything that we can do for them in an acute care facility. But I would hardly think that the relatives of those people would consider it a waste to keep those people in hospital beds.

MR. HARRIS: If you had them sitting in operating rooms, Mr. Minister, you would be able to call that a waste, wouldn't you?

MR. DECKER: I would hardly think it is a waste, Mr. Chairman, when you are talking about human beings here who are in a bed. Whether they are old and frail and medically discharged, we still have to care for them.

SOME HON. MEMBERS: (Inaudible).

MR. DECKER: The reality is that when those people are medically discharged, there is nothing else we can do for them, from the point of view of curing their illness.

MR. HARRIS: How much is it costing?

MR. DECKER: They would belong in a long-term care facility. The reality is, as I pointed out earlier, we have some inappropriate placements in our long-term care facilities as well. The Province is trying, as rapidly as it can, to address the problem of the chronically ill. If we can address the problem with the long-term care patient we can free up the beds because the reality is, we only need in this Province about 2,300 acute care beds. About 2,300?

AN HON. MEMBER: Twenty-two.

MR. DECKER: Twenty-two, and we have more than we need. But 10 per centre of them are inappropriately filled. That is the problem. We are trying to deal with that over the term. But we certainly do not look at it as a waste of money. People are sick, they are sick, whether it be a result of old age or what have you.

MR. CHAIRMAN: Okay, Mr. Harris, we're through another ten minutes.

MR. HARRIS: I will want to be back again.

MR. CHAIRMAN: Oh yes, we will all be back again, as long as we want to be.

Mr. Short.

MR. SHORT: Mr. Minister, you are talking about acute care, and chronic care and so on. The Minister of Municipal Affairs last fall, or just I guess before Christmas perhaps, announced a facility for Stephenville Crossing, a pilot project, in congregate housing. Is that the kind of thing that is going to alleviate some of the problems, especially with level one care, which I guess is a real problem for people trying to get into the home? They are not really well enough to be in cottages or whatever, but they are also not sick enough to be in the home itself.

MR. DECKER: The policy of the Department and of government is that the best place for a senior citizen to be is in his or her own home. That is the philosophy. That philosophy is shared by the Senior Citizens Federation, and by most senior citizens themselves. They would rather be in their own home. So wherever possible, with some home care, some home support, we keep people in their own homes.

Now, there are exceptions to every single statement which you come up with. Sometimes for social reasons a person has to have a little extra care. A lot of problems in Newfoundland, both in outports and in the city, is that people do not have adequate housing. So between the nursing home and their own homes, sometimes there are certain levels of care required.

Congregate housing is a concept which is quite common in the States. It is basically an apartment building with about ten to twenty people living in it. The building has one central dining room. Then it will have eight, ten, twenty little apartments. They are more like bed-sitting rooms. There is a kitchenette, there is a private bath, and there is a sleeping area and a living area. One meal a day is prepared and served in the central dining room. The breakfast and the lunch, whether it is midday or evening or whatever, is taken in their own little residence. Services are available. There is snow in this Province, this would be important, snow is shovelled. A little bit of shopping is done.

Visits would be arranged then. The public health nurse would make the appropriate visit the same as if it were a private dwelling. The community health care worker, or whatever the case might be, would go in as is needed.

That is an experiment which we are now trying in St. George's, and we have found a considerable amount of interest throughout the Province for other such similar homes, but we are not rushing it. We want to see just how it is going to work in the St. George's area first. It is very common in the States. I do not know if it is used much in Canada or not. Is it, Dr. Williams? Can you help me on that?

DR. WILLIAMS: I think congregate housing is something that is utilized throughout the system across the country.

MR. DECKER: Across the country. We are the last ones to get in on it.

MR. SHORT: I have a question, or maybe a comment first of all. Last year, I guess, there was a lot of fuss with our budget and so on, and the freezing of budgets and so on. Last Monday I was driving across the Province, myself and Mr. Ramsay, and I happened to pick up The Globe and Mail. There was an article there talking about basically, I guess, the fact that a lot of other provinces wish they were now where we are in terms of, I guess, restructuring the health care system.

I was wondering if you would like to comment on that, because even though there has been a lot of fuss, as I said, when you read the article it seems as though what is happening in Ontario and Saskatchewan and so on, we are probably going to have the best budget in terms of the results, I guess.

MR. DECKER: Yes, Mr. Chairman, I did skim the article. I did not pay much attention to it. I just skimmed the first few lines and threw it in the garbage. I believe I did draw it to the attention of the health critic. Rightly or wrongly - well it has proven to be right - we realized early in the game that in order to save - I think Sister Elizabeth Davis made the best quotation in that article where she talks about where they gave up their obstetrics, where we brought the two obstetrics together into The Grace Hospital. She talks about how their hospital was founded on obstetrics, and it was quite a sacrifice to give it up; but she says it was not that difficult a decision to make when you consider we are trying to save medicare.

This administration is totally, absolutely, committed to universal medicare; but we know that if you pay for everything that people want, then you would end up spending 100 per cent of your budget on health care. Well if you spend 100 per cent of your budget on health care, you have no transportation to get them to hospital; you have nobody working, except in the health care system, so it is totally unrealistic.

We managed to restructure our health care system, and I can tell you that we are getting calls on a weekly basis from other provinces asking for our advice and asking how you can restructure. When the ministers met in Ontario the last time, they had our officials go aside and discuss how we were reorganizing. We try our best to give them some advice.

Naturally all the people in the department are very proud over the article which was done by The Globe and Mail, and I believe it is fair.

I should say for the benefit of Jack Harris that his former leader became aware of this over a year ago, of the steps that we were making in health care in Newfoundland. He did an excellent article which was similar to the one which was done by The Globe and Mail, because in order to save medicare we have to reorganize the system. I would rather pay $500 to go to Toronto to have a heart transplant than to have to pay the $152,000 to do it, which would put me bankrupt.

We have to make sure that this country never gets to the point where you can go bankrupt because you are sick and cannot afford to pay the shot; but if we try to supply every want, every time that an interest group, or every time someone shouts and screams, if we are going to try to run and meet that, for political gains or whatever, we will see the end of medicare. If that happens, I think we are going to be in a lot worse position than we are by doing a little bit of restructuring and making a few role changes.

MR. CHAIRMAN: Ms. Verge.

MS. VERGE: Thank you. I would like to come back to my first topic which is the direction in which our health care system is heading or should be heading. I listened with interest to Miss Dawe's remarks about the proposed community health boards. What I am hearing is that there is some tinkering being done but there really is not, fundamentally, a redirection shaping up. The community health boards, basically involve a shuffling of existing services and personnel.

The proposed organizational chart which I was just handed, indicates that five areas of responsibility which are now carried out by personnel of the department and agencies funded by the department will be combined and run regionally by five community health care boards and that may have merits, it is a bit too early for me to comment on that, but one of the five areas of responsibility indicated is alcohol and drug dependency prevention, treatment, rehabilitation and research, the functions that are now carried out by the Alcohol and Drug Dependency Commission.

The Budget estimates indicate a drastic reduction in provincial government funding for the ADDC, approximating 25 per cent reduction, I am wondering whether under this restructuring the community health boards will have as much wherewithal as the current services that are delivered as I mentioned presumably by the department directly or by department funded agencies.

MR. DECKER: By putting the ADDC under the boards we are going to save, in this year, $400,000.

MS. VERGE: But, how can that be, if I might interject?

MR. DECKER: That is the kind of thing that the Globe and Mail talks about, I believe. It is really amazing. We will be delivering the same service, maybe a better service, as a result of this. It is amazing.

MS. VERGE: I would like to interject.

MR. DECKER: If the hon. member would listen.

MS. VERGE: No. I would like to -

MR. CHAIRMAN: Perhaps you would let the minister finish.

MS. VERGE: No. I would just like to interject to ask the minister to explain that, because we have heard statements, glib statements, to the effect that more is being done with less, but yet the results indicate otherwise. In the case of the Alcohol and Drug Dependency Commission, there have been regional offices. In the case of the Department of Health, there are regional offices of the public health branch. I can speak about the western region, about the services based in Corner Brook. The ADDC, the Humberwood Center operated by the ADDC and the public health branch of the Department of Health seem to work fairly closely together.

Now, how can you expect more to be done if you cut the staff and reduce the funding?

MR. DECKER: Now, Mr. Chairman, is that all the question? So, I can assume I am going to be allowed to answer.

MR. CHAIRMAN: Yes, Sir.

MR. DECKER: We are going to save $400,000 on the ADDC and we are going to deliver the same service or probably a better service. Not a single counsellor will be laid off. None of the hands-on services, none of the people who deal with the people who need it, not a soul, will be laid off. The Humberwood in the member's district will not be downsized one iota. Everything is going to be done better. But by bringing the administration together, we can knock out payroll costs, we can knock out - how many people are we laying off, twelve or fourteen?

MS. DAWE: Eleven.

MR. DECKER: Eleven full-time positions will disappear and one or two part-time positions will disappear, people who had nothing to do whatever with services. It is within the administration. Lots of time you hear the criticism, coming from the unions especially, how some of our institutions have too much top weight on them. In this particular case we are going to do away with the administration, but we are going to keep the personnel under these services.

Ms. Dawe, is there something you can add to that?

MS. DAWE: Mr. Chairman, Mr. Minister, I would like to go back, maybe, to the earlier comment first. The plan that I have distributed, the model, is not intended to just bring together current services, because you are correct, some of these services, if you look at health promotion, health protection, these services are currently offered by the public health units, some of the continuing care services, some home care provided by public health units, and others by other organizations in the community. Mental health is very weak from a community perspective now. So continuing care and mental health are two areas for further development, as well as health promotion. So this is seen as a restructuring of community health services with a longer range plan to put more emphasis on the community for many of these components. So I just needed to clarify, it is not only just bringing together the current and the status quo, it is planning for the future.

With respect to the Alcohol and Drug Dependency services, as the minister has stated, there will be absolutely no impact on the direct services provided across the Province. The provincial office which houses the administration and the accounting personnel functions, will be incorporated into the Department of Health. As we now have a division of mental health, for example, under community health, so will there become a division of drug dependency. So it will have its own entity. That is the only component of the ADDC which will be impacted. The services provided in St. John's directly and across the Province will not, in any way, be reduced.

When the regional boards are appointed, starting in the fall with western, the services in western will then become incorporated under the regional board. At that time, as the minister has indicated, the service will be enhanced, because there will be a greater array of professional support services to assist with drug dependency.

MS. VERGE: That sounds good. Two questions about the details. What eleven people will be taken out of the system...eleven full-time, or part-time? How can this plan, worthy as it sounds, work, with more functions being taken on and better services being provided? Where will the resources and personnel come from to achieve these objectives?

MS. DAWE: The individuals whose positions are being declared redundant are part of the provincial office and they are in accounting, personnel manager and clerical positions. Because these functions will be incorporated into the Department of Health.

MS. VERGE: So when you say provincial office you mean the provincial office of the Alcohol and Drug Dependency Commission.

MS. DAWE: ADDC, yes.

MS. VERGE: So you mean they have eleven administrative people at the head office?

MS. DAWE: No, but there is a claims officer, and various clerks, because they have their own structure. So they have twenty-two people now organizing the provincial services. Because it is independent, it is an entity.

MS. VERGE: Yes, I understand.

MS. DAWE: Okay.

MS. VERGE: But how many staff will be eliminated because of the absorption of the ADDC into the Department?

MS. DAWE: Eleven positions will be declared redundant.

MS. VERGE: So all of those will come out of ADDC.

MS. DAWE: Yes, of the provincial offices.

MS. VERGE: Okay. Now where will the staff and resources come from to provide better mental health services?

MS. DAWE: At the moment, as I said, it is bringing - the plan this year is to get the structure in place. So as is indicated in the estimates, there is $179,000 allocated for restructuring the system and putting the boards in place in western, central and St. John's.

MS. VERGE: But we will have to wait until after the next election to see what happens.

MS. DAWE: No, well I think in fairness, the mandate this year is to get the structure in place and coordinate existing services so as to avoid duplication of effort and provide a broader base of professionals to support one another in the service. As I had indicated, this is really intended to be a longer range plan. It is not a quick fix this year.

MS. VERGE: Okay. Getting back to the question of the need for redirection, a very big portion of the budget now goes to MCP to pay those health care professionals who are covered by MCP. Basically physicians and for some services - dentists and optometrists. Does the minister agree with continuing to restrict public funding through MCP of just those professionals? Does the minister see that the public purse is funding physicians, the most expensive of the health care professionals, to do a great deal of work which can be done quite well - in some instances, better - by lower priced professionals, such as nurse practitioners, nutritionists, midwives, chiropractors?

MR. DECKER: Mr. Chairman, these are topics that we do discuss from time to time. Now you will know the MCP budget has been frozen for two years in a row except for the normal, the increase in utilization. I think last year it was 2.8 per cent, and this year, what is our increase in utilization, Gerry? One point nine per cent we've factored in? So we have practically frozen that budget for a couple of years in a row.

In consultation with the other ministers across the country we are looking at the contribution that other professionals can make. In the whole northern region of course we do have the nursing professional. This year we had planned to go with an experiment with midwives to assist in deliveries. However, that is being done in St. Anthony at this moment. Anyone who goes to St. Anthony to have a delivery most likely a midwife will do it. But I think the way they phrase it, the obstetrician is in sight, is it? There's usually an obstetrician within calling distance.

The Association of Registered Nurses, albeit they are committed to

the midwife playing a bigger role, it is generally accepted that the obstetrician at least be available in the event that something goes wrong and in 15 per cent to 20 per cent of the cases something can go wrong, but we are looking, we have a committee in place with the Newfoundland Medical Association in which these things are being discussed.

MS. VERGE: But the medical association has a vested interest in maintaining doctors monopoly, why wouldn't you broaden that committee to include the other health care professionals who are now shut out of medicare?

MR. DECKER: We have various committees throughout the Province where we discuss with all the people, Mr. Chairman, but I do not think it would be very smart, if we tried to do this without consulting with the Newfoundland Medical Association. I think we would be leaving ourselves open for probably valid criticism if we tried to ride roughshod over the doctors. Even last year when we froze their budget, I know members of the Opposition, I am not sure if the hon. member herself made it, but there was a lot of accusations flying across that doctors are going to leave the Province and all this sort of thing, so you just cannot go ahead and do these things without consultation with the professionals so we have to consult with them.

MS. VERGE: Of course -

MR. CHAIRMAN: We are through another ten minutes. Now I propose that we take about a ten minute coffee break until about 8:45; if people are interested in doing that and nobody has objections ?

MR. DECKER: Only if there is tea.

MR. CHAIRMAN: Pardon?

MR. DECKER: Only if there is tea available?

MR. CHAIRMAN: There is some coffee available in the caucus room of the government just across the hallway there.

 

Recess

 

MR. CHAIRMAN: Are we ready to resume?

MS. VERGE: Okay.

MR. CHAIRMAN: Who would like the floor?

MS. VERGE: I have more questions here.

MR. CHAIRMAN: Pardon me?

AN HON. MEMBER: (Inaudible).

MR. CHAIRMAN: Yes, she did. Yes, I am going to recognize you, if you want.

MS. VERGE: Yes. I think what the Chair is saying is that I had used up ten minutes when we started the break -

MR. HARRIS: You had used them up?

MS. VERGE: Yes. I am ready to go again -

MR. HARRIS: Well so am I -

MS. VERGE: Okay, well you go ahead.

MR. HARRIS: Just like your new questions in the House, I guess eh?

MR. CHAIRMAN: Listen, who is Chairman here? Mr. Harris.

MR. HARRIS: Thank you, Mr. Chairman. I want to go back to the interesting question that I was asking before, which, as of yet I have not had an answer, and I guess the minister does not like the word 'waste', when I talk about the amount of money that the Department of Health spends on services that are not required, so I will have to rephrase it.

Can the minister tell us how much money is spent providing these acute care beds which are filled with people who do not need those beds?

MR. CHAIRMAN: Mr. Decker.

MR. DECKER: Mr. Chairman, to get an exact number, as the hon. member knows, we would have to say there are ten in the General at $790. There are five in St. Clare's at whatever, but the best estimate I could give, and I could take the question under advisement to give the real number, we can put someone on that, but the best estimate is we are spending approximately $600 million in the hospital services, 10 per cent of that is in discharge, so 10 per cent of $600 million is what... $60 million? That is about as close as you would come to it in round figures. Now, it might be $58 million or it might be $62 million, but we would have to break it down per hospital because as Mrs. Bishop pointed out, the General costs more than a bed say in, Labrador West, but we will get the answer to that but it is somewhere in the vicinity of $60 million.

MR. HARRIS: Okay. Thank you. The reason I want the number is because we are looking at a very substantial number, a very substantial amount of dollars spent this year and presumably last year and next year, on this misuse of health facilities and with a substantial amount of money like that, my point is that there could be alternatives devised with that money, and some of that $60 million would obviously be used to look after the people who need the acute care that those beds are unable to provide right now, and maybe more need to be there, I don't know. Obviously some of that money should be used to provide alternative types of care for the individuals who are now there. So what I want to know is: Can the minister tell us what alternatives to keeping on spending that $60 million, and I am assuming that - is that 10 per cent figure something that has been constant for a few years?

MR. DECKER: It is not only constant for a few years; it is constant throughout the country. About 10 per cent of the beds in the whole nation are occupied. That is the reality of the health care system. Yes, it has been constant for what - five or six years?

MS. DAWE: Well for the last ten to twelve years.

MR. DECKER: The last ten to twelve years there has been 10 per cent occupancy.

MR. HARRIS: I regard that as a considerable waste of money. You have told us that we have a problem in the other end of it as well. What other solutions have been considered by the government instead of wasting that kind of money?

MR. DECKER: Mr. Chairman, I agree. I am not sure it is waste. It is inappropriate spending. For the person who is waiting to get into an acute care bed it is a problem. For the person who is in that bed it is a problem. I share the hon. member's opinion. It is really inappropriate to have it.

Now look at some of the things we have been doing and are doing. Last year we changed the role of some acute care facilities in the Province which were underutilized. One was in my own district of St. Anthony, which had 52 per cent occupancy. Fifty-two per cent of the acute beds were being used for acute care. The others were underutilized, so we took a space - we took a whole wing - and we are in the process of putting an extra twenty people, I believe, into chronic - people who are medically discharged, we have redesigned a wing in the hospital for long-term care.

Now for long-term care you have to have bigger rooms. You have to have the access to the bathroom made different. You have to have more lounges. It is a different level of care, as the hon. member knows. That is what we did last year with St. Anthony.

Everywhere we changed the role was to address this particular problem. In Bonavista we did it. In Bonne Bay we did it. In St. Lawrence we are in the process of doing it. Where else did we do it?

AN HON. MEMBER: Burgeo.

AN HON. MEMBER: Port Saunders.

MR. DECKER: In Burgeo and Port Saunders we have institutions which are presently being constructed to deal with this issue. One of the ways we are trying to deal with this issue of the medically discharged is to make available more chronic care space. Another way that we are trying to deal with it is with the home care program. This very day in Newfoundland, I would bet you that there were some people who had as many as five visits from some level of home care. The public health nurse could have gone in. A Red Cross representative could have gone in. Someone from social services could have gone in. That is the reality you will find in certain parts of this Province today.

In other parts of the Province you will find that there has never ever been any home care available. So we are trying to deal with that issue with our community health care boards. One of the components is addressed to home care so that we can have people taken out of the institutions to stay in their own homes.

There are a whole lot of things which we are doing to try to get those beds freed up; but I have to say, Mr. Harris, that history has shown that no matter what we do there will always be some people in the acute care centres who are medically discharged. I think 10 per cent is a figure that we do not want to live with, but it is going to be extremely difficult to have everybody out.

Now people will not be in there for months and months and months on end, but in some cases people who are medically discharged are only there two or three days. In other cases they have to wait two or three months; but we do not have any cases where people are actually medically discharged and staying in hospital for a year at a time. Basically they are there until we can get a placement for them in a long-term care facility.

So we are trying to address it. We are not addressing it as fast as we would like, because when you start changing roles you get an awful lot of opposition. You know what happened in Baie Verte, and you know what happened in Placentia where we tried to deal with the issue. We had people marching on the Confederation Building. So it is not an easy thing to do, but we have to do it.

I do not disagree with you at all. It is inappropriate use to have medically discharged in acute care beds.

MR. HARRIS: Thank you, in terms of home care, perhaps Ms. Dawe can deal with this, what is the best way of measuring the level of service provided in terms of home care? I know you can talk about areas in the Province where it is offered, you can talk about the number of different services that are offered. Is there a way of quantifying what progress we are making in terms of developing home care facilities?

MS. DAWE: In terms of this year there are additional monies going into community based services to improve home care services, but that is certainly not going to be addressing the full need. As I had indicated earlier, the emphasis this year is to get the structure in place and to co-ordinate, bring together appropriate organizations to avoid any duplication of effort, and then build on the delivery of community based services.

MR. HARRIS: So your money is not going into delivery yet.

MS. DAWE: There are some monies, yes, going into the delivery of services this year, some that have been directed around the Province, and some to St. John's home care. Additional funding for home care services are being provided for this fiscal year.

MR. HARRIS: Can you give us, for example, what change has been made in the allocation to St. John's home care?

MS. DAWE: Yes I can. For example last year, 1991-92, our budget for the St. John's home care formed community based services, that is one component, was $900,000. This year it is $1,027,000. That is just out of the community based service vote. There is an increase as well coming from the institutional budget for home care in St. John's. So this is just an indication of what is coming out of one component of the budget for direct services.

MR. HARRIS: This is direct services by St. John's home care. When you say institutional budget, what -

MS. DAWE: That is Ms. Bishop's area.

MR. HARRIS: That is health care services provided through the hospital, and -

MR. DECKER: A nursing home, for example, would have a meals on wheels program.

MR. HARRIS: Here and there.

MR. DECKER: Yes, in the institution in Springdale, for example, they have a meals on wheels, and some have wheels to meals where they bring senior citizens into the institution. So this is what I am talking about when I say it is almost ad hoc what has been going on. That is one of the reasons for trying to bring it together under those central boards where we allocate $10 million or $5 million or whatever we can afford to the board to deliver the service rather than have this ad hoc system which we have now.

MR. CHAIRMAN: Thank you, Mr. Harris, until we go around again.

MR. HARRIS: Thank you.

MR. CHAIRMAN: Mr. Doyle.

MR. DOYLE: Thank you, Mr. Chairman. I have a couple of questions on MCP. Over the last number of weeks the report on MCP has come out and a number of recommendations have been made. I believe twenty-five or thirty recommendations to tighten up security at MCP. Have any of these recommendations been implemented so far? I mean what is government doing with these recommendations? Is there any time frame to have these completed?

MR. DECKER: Most of them I understand have been dealt with. Now obviously we have not moved to a new building. We are looking at whether or not it would be wise. I think the report was that we build a new building, well I doubt very much we will build a building, but we could conceivably rent a new building. So we don't want to go full scale with putting in this electronic security only to discover within six months we move to a new location. So that hasn't been done. But the recommendations about shredding, the recommendations about cleaning after hours, I think the vast majority of them have been dealt with. I don't know, Mr. White, if you could answer.

MR. CHAIRMAN: Mr. White.

MR. DECKER: That is under your area isn't it.

MR. WHITE: It is my understanding that MCP has moved to implement a number of the recommendations. I am not sure exactly of the specific recommendations they have moved to implement, but a number of them they tell me have been implemented already. Some of them are fairly major, as you said with respect to a new building and that sort of thing.

MR. DOYLE: There is a great deal of concern, as the minister knows, about the current method of auditing physicians because of the confidentiality thing that has been going on for the last couple of years, really. Physicians, I think it is fair to say, are quite concerned about it. Will the government be changing in any way, will they be making any adjustments to the current auditing system that they have? For instance, why wouldn't the government, since there is a such a great deal of concern about doctors having to mail in xeroxed copies of their patients files, why wouldn't the government for instance allow the Newfoundland Medical Association, in consultation with MCP or a representative from MCP, to get involved in the auditing process or to have a joint team there who would visit -

MS. VERGE: Require the patient's consent.

MR. DOYLE: Yes. Visit physicians and do the auditing like that in consultation with the Newfoundland Medical Association. Why can't you move somewhere in that direction to get the confidence of the physicians back again? And the patients as well.

MR. DECKER: It is the official position of the Newfoundland Medical Association and the official position of government that there has to be an audit. I do not think there is any disagreement on that. We have had some physicians who have gone public and we have had a court case and so on, and of course the court case made it perfectly clear that the Province does have a right to demand the audit. So I think it is pretty well accepted. I believe the member himself would agree that there should be an audit.

MR. DOYLE: Yes, yes.

MR. DECKER: The process whereby that audit is carried out has caused some problem. Now mind you, the majority of the doctors are not against it. The official position of the Newfoundland Medical Association is that the audit is acceptable. We have put in place a committee made up of representations from Medicare and the Newfoundland Medical Association who at this very minute, for the last six weeks, have been examining the whole audit process. So what you are asking is already being done. We have involved the Newfoundland Medical Association. Now at the end of the day, they might come up and say: there is no better way to do it, or this is the way. But we are waiting for their report. We will not give up our right to audit.

MR. DOYLE: No, and I do not believe government should give up its right to audit. But I mean, there is an awful lot of concern, especially from the patients themselves. I think an awful lot of people would agree, certainly members of the medical profession, and the minister would have to agree, given the statements that have been made by the medical profession publicly, that there have been breaches of confidentiality long before the dumpster type of thing.

MR. DECKER: The accusations have been made and as a result of that I have put this committee in place made up of the doctors and the medical -

MR. DOYLE: So it is possible that the procedure could be changed in some way?

MR. DECKER: Yes, it is possible. Depending on what (Inaudible).

MR. DOYLE: To satisfy both the physician and the patient?

MR. DECKER: Yes. Dr. Williams, have you anything to add to this particular committee on this?

MS. VERGE: Who's representing the patients on the committee?

MR. DOYLE: Yes, that's a good question. Who is representing the patients on the committee?

MR. DECKER: The Medicare Commission is a board which is appointed by government. The majority of the members on that are really representing the consumers. The chairman of that board is Roger Crosbie, who I guess the hon. member would know. He was chairman of the board when we took office and we re-appointed him. There is representation from every region of the Province. There is I believe a Labrador representative on the committee so the Commission itself is basically managed by consumers.

MR. DOYLE: Yes. It just seems to me that it would be very appropriate, if you are going to continue the auditing procedures that you have, it would be more than appropriate to have somebody there from the Newfoundland Medical Association -

MR. DECKER: That's exactly what we have.

MR. DOYLE: - in consultation with MCP, doing these audits. Probably visiting physicians instead of having the patients files coming through the mail, and copies flirting about here -

MR. DECKER: Well these are the matters which this committee is dealing with. I think Dr. Williams might have something to add to that.

DR. WILLIAMS: Yes, there is a committee set up at the minister's request, of the Medicare Commission and the Medical Association to review the practice of audit, how it is conducted, and they are to report to the minister on their recommendations on what modifications might need to be made. So we are waiting for that report to come in.

As well at the Medicare Commission there has been for quite a number of years a consultants committee with representation on it, majority representation from practising physicians in the Province who advise MCP on certain matters relating to physician profiles and the need for audit, and advise, I guess, the Medicare Commission on all matters pertaining to this.

As well the commission has a physician whose only role at the commission is to deal with the audit issue and to provide a medical input to the audit procedure from the Medicare Commission as well. So that person, Dr. Al Mercer, joined the commission perhaps within the last year to make sure that there is a good medical input into the whole process. So there are those sort of checks and balances on the system.

Right now, I guess, the minister is waiting for feedback from the joint committee of medicare and the medical profession to see if there are any adjustments that need to be made to make the process more reasonable if there is a method, or what the recommendations might be. So we are waiting for that.

MR. DOYLE: People say you should know the answer to a question before you ask it, but I certainly don't know this one. Do we have authority under our current Newfoundland Medical Act to be doing these audits the way we are doing them? Because I think there was a controversy recently in Ontario.

MR. DECKER: You will recall that Dr. Delaney took us to court.

MR. DOYLE: Yes, I know that, and the supreme court said yes.

MR. DECKER: Yes, we have the authority to do it.

MR. DOYLE: So under our current medical act, we do?

MR. DECKER: You will recall that the commission went ahead and did the audit, I think they had to have my signature for some things.

DR. WILLIAMS: There is a procedure they have to follow to recover funds.

MR. DECKER: Yes, and there was some question as to whether or not they actually followed the procedure properly. The admonition from the judge was there was a procedure not followed to the letter of the law. But there is no doubt either with our Supreme Court or the Supreme Court of Canada that provinces do indeed have the right to audit. Yes.

MR. DOYLE: Just getting along to another topic here: heart surgery. What is the current situation with respect to the waiting time for heart surgery in our hospitals in Newfoundland. I mean I read the Fraser -

AN HON. MEMBER: That is the one that the Premier misinterpreted.

MR. DOYLE: Yes, the Fraser Report or the Fraser Institute.

And it seems - not seems, it is proved that we are running way behind in that area in regard to waiting time and what have you. What is the current situation in our Newfoundland hospitals with regard to heart surgery? I have gotten two calls since yesterday from two individuals who are in hospital and have been in there now for a month or so and still don't have surgery scheduled. The doctors keep saying they have an adequate number of surgeons to do the operation, but they just don't have the operating rooms. They don't have the facilities to do it. So what is the problem anyway? Could you shed some light on it for us?

MR. DECKER: Yes, the issue came to the forefront in recent weeks, and the Fraser Forum Report was one of the things. The Opposition addressed it in the House, as you are aware. I have had meetings with the General Hospital, who do open heart surgery in the Province, and we have put a procedure in place hopefully that we can deal with. Now Dr. Williams, I am going to ask you because you attended the meeting with me and your memory tends to be better than mine on some of these things. So maybe if you could address the issue.

DR. WILLIAMS: Some years ago we would target it based upon the population in the Province and the needs in the Province to achieve about 300 procedures per year and that includes all open heart surgeries, coronary artery bypass grafting is just one form but that represents the majority of cases. There is also open heart surgery for people with valvular disease that probably represents about forty or fifty cases a year but of a 300 case profile about 250 would be the coronary artery bypass grafting. For a number of years they achieved a number of about 250 or less.

Several years ago, four extra beds were added to the intensive care unit at the hospital to enable them to increase their throughput; they went from ten beds to fourteen beds, all the patients who have open heart surgery have to spend up to forty-eight hours in the intensive care unit after the surgery, given the type of surgery done, so there had been some delays there in the post-op area, the need for more beds in that area as well as there was some additional equipment provided for monitors and that type of thing to accommodate those extra four beds.

Last year, the number of cases done was over 300, I think 313 to be exact. We are targeting this year to achieve a load of at least 300, hopefully a few more. There has been a backlog and it accumulated in the years when we did less cases. We are presently waiting to hear back from the General Hospital about how they might be able to achieve an additional number of cases to try to clear up the backlog. The target we had set had been around 300 cases which we achieved last year but that is the first year we had achieved it.

MR. CHAIRMAN: Mr. Doyle.

MR. DOYLE: So in order to achieve that, to clear up the backlog, how many cases will we have to perform and for how long?

DR. WILLIAMS: Well, we are hoping that with achieving about 300 or just over 300 cases a year, we can start to make some dents in the backlog and maintain the status quo into the future and be able to respond in a reasonable period of time. I read an article recently, and I can get that for you from one of the Canadian Medical Associations Journals or some such journal. This compared the waits in Newfoundland with other areas so it depends on what you read, depending on whether you read the Fraser Journal, the report or this other article, how we compare with other areas of Canada.

Then there is a whole issue that's a very grey area in the health care system and that is the issue of needs versus procedures done. If you look at the US, their rate for coronary artery bypass grafting is probably twice as high as that in Canada; does that represent a different approach to the patient with a cardiac problem or not? These are some of the grey areas that you have to look at in health care.

Each patient is different, physicians have to decide what approach is justified; people with coronary artery disease, obviously some of the surgery that is done has a long-term impact on survival and mortality. Other cases are done for relief of symptoms and are more of an elective nature; you know, we rely on the physicians obviously who are treating the case. One of the areas where we are putting some emphasis on in this Province now is the whole area of continuous quality improvement in health care and is something that is coming to the forefront; it has been I guess, in the business world for some time. It is not a new principle and we are looking at, with the General Hospital, and in fact, I think the committee has approached them Joan, to look at the cardiac program in the Province to supply some of the techniques there to see if there is a way that we can make the whole operation more efficient.

Obviously it deals with the availability of intensive care unit beds, OR time - we actually opened an extra OR I think last year, the seventh OR in the hospital to accommodate this area and it needs to be co-ordinated with the beds available, the ICU time, the anaesthetist availability in the OR, so what I am trying to say it is not a very simple problem and easily solved, and we are working with the General Hospital to improve the situation for patients in the Province.

MR. DECKER: Also, Mr. Chairman, I just want to interject that in addition to the open-heart surgery, they are also doing angioplasty. When angioplasty was introduced - what year did they start that in the Province?

DR. WILLIAMS: It started probably in the early eighties down in Boston - probably about eighty-four or eight-five in the Province.

MR. DECKER: Well the logical assumption was that as you did this procedure then the open-heart surgery should have gone down, but in actual fact that has not happened in this Province. So we are doing 160 or so?

DR. WILLIAMS: We are doing over 200 angioplasties now.

MR. DECKER: Over 200 angioplasties, and we are also doing over 300 open-heart surgery procedures, so it has to be looked at. The angioplasty in effect has become an add-on. It was supposed to replace it, but it is certainly not replacing it.

MR. CHAIRMAN: Are we ready to move along?

Mr. Short?

MR. SHORT: I have a few questions for the minister. It is mentioned in the budget about reducing the number of hospital boards from twenty-five, or whatever the number is now, down to possibly five. How do you plan to go about this? What is the plan? Or is it only in the planning stages?

MR. DECKER: It is pretty well accepted in the Province, Mr. Chairman, that we have too many hospital boards. Now to save money in the hospital system you can lay off people. Alright, do you lay off your nurses? Do you lay off your support people, or what do you do?

Obviously you cannot lay off a whole lot more nurses. You cannot lay off many more support staff. You cannot lay off too many of the specialists. So it seems that the last place we can find some real savings without hurting delivery of the care would be in the administrations. The only way you are going to cut down the cost of administrations is to bring some boards together.

Now if there was an unfortunate figure in the budget, it was five. We are not married to the figure five. We have twenty-five and we are going to bring that number down to a reasonable number. There are some boards in the Province which I do not think anybody would doubt. I am not going to say them, because I am sure - let people interpret it as they will. But what we propose to do is to take on a facilitator, a person who is going to spend the next six, eight, ten months, whatever it takes, meeting with every single hospital board and some of the administrations, some of the users, the consumers of the systems, to try to determine how many boards we should have in the Province and where we should have them.

In addition to that, I am putting in place an advisory committee made up of representation from the general public, from the Association of Registered Nurses, the Newfoundland Hospital Association, the Newfoundland Medical Association, every single group which is involved in delivering health care in the Province. I am going to ask for representation in the form of an advisory committee. Of that advisory committee there will be an executive to work with the facilitator. Over the next number of months we are hoping that the facilitator, after getting all this input and all this advice from the different people in the system, will then bring a recommendation to government as to how many boards we should have, and where they should be - where the headquarters should be and that sort of thing.

The figure five is probably a little bit unfortunate. There is a sort of a bit of a breakdown there, but it might be four; it might be three. I would think it is probably going to be more like eight or ten, but at the end of the next eighteen months or whatever we will know where we are going on that one.

MR. CHAIRMAN: Thank you, Mr. Short.

Ms. Verge.

MS. VERGE: Thank you. It sounds like the minister is going to avoid the consolidation of hospital boards until after the next election. Of course then we will see who is in government.

I have a lot of questions, and I do not think I am going to be able to ask them all before we adjourn tonight. I will move to the heading of Institutions which, as has been pointed out, consume the bulk of the Department of Health budget, some $600 million.

I wonder if the minister would table for the committee, an institution by institution breakdown of the global amount set out in the estimates, for each hospital, for each health care centre, for each long-term care facility. What is the allocation for the current budget year? What was actually spent last year? What was originally estimated for last year? What is the number of beds forecast to be operated in an institution this year? What was the number of beds operated last year? And what was the number of beds in use and funded the year before that?

I don't want to use up the very short amount of time that we have left talking about that, because there are many institutions, but Ms. Bishop seems to have all this on paper and I wonder if copies would be made available to each member of the committee.

Next I would like to move to the subject of AIDS. In our Province -

MR. DECKER: You asked me to table something. I can table it.

MS. VERGE: Good. Thank you.

On the subject of AIDS, relatively little is being done by the provincial Department of Health, but we do have a federally funded community based organization called the Newfoundland and Labrador AIDS Committee. We have all learned through the news media that misfortune has struck that organization recently with a large amount of money having been stolen. The AIDS Committee is providing public education designed to prevent the spread of HIV and AIDS. They have been carrying out education programs for groups of students in schools and for public audiences all around the Province. They have been providing support for people who are infected with the virus and people who have AIDS, and they have been serving as advocates for people who are infected. From what I have seen, they have been doing an extremely good job.

Because of the theft, the AIDS Committee is now unable to continue to pay its staff. As of last Friday, they were taken off the payroll. Most of them have continued to work on a voluntary basis. Some of them qualify for unemployment insurance, some do not and will have no alternative but to resort to social assistance.

I understand that the provincial Department of Health has provided very little financial assistance to the Newfoundland and Labrador AIDS Committee. I would like the minister to tell us exactly what financial assistance and other support the Province has been providing. More to the point, what will the provincial government do for the Newfoundland and Labrador AIDS Committee now in its hour of need?

We all realize the need to restrain spending, but surely the officials here will appreciate that it is much better to spend a small amount on prevention today than to have to spend a small fortune on treatment of people with AIDS in eight or ten years time. Surely today it is better to spend money employing people, through a Department of Employment and Labour Relations employment program or through a Department of Social Services employment program, than it is to pay out more in social assistance.

So will the Department of Health consider interim financing, an emergency allocation, for the Newfoundland and Labrador AIDS Committee. Will the Department of Health recommend to other departments of government that funding be provided to the Newfoundland and Labrador AIDS Committee for an employment project to allow the committee to continue to employ people to do the very worthwhile work of educating and preventing as well as supporting people who are infected? Will the Department of Health immediately take over the cost of the toll free AIDS information and assistance telephone line that the provincial AIDS committee operates? Will the provincial government provide additional support to the Newfoundland and Labrador AIDS committee?

MR. WALSH: I don't mean to interrupt but I counted eighteen questions so far. I wonder if maybe the minister could start answering some and then we can go on with some others. But we could just finish the night on the eighteen questions that were just asked. They are relevant questions and I know they have need to be asked, but can we get some answers? I would like to hear some of the answers before we forget what the questions were.

MS. VERGE: Mr. Walsh, I had just finished, and with respect all my questions were on the same subject. I don't think the minister had any trouble following. Your attention span might be short, but the minister seemed quite able to follow my line of questioning.

MR. WALSH: The reason that I had difficulty understanding is that there were some good questions and I don't want to miss any of the answers. I am up to eighteen questions, and yes I am having difficulty following them. You may have an advantage in that you have them written down. The minister and his staff may have an advantage because they were writing them down, but I didn't write until number seven.

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

MR. DECKER: Mr. Chairman, there are two levels of the number of questions. The details I am going to ask Ms. Dawe to deal with, the policy issue of whether or not we will pay for it I will address afterwards. I will ask Ms. Dawe remembering now that we are dealing with the HIV problem not only through the AIDS committee. Our public health area and the drugs which the Province provides, a whole lot of areas, but Ms. Dawe if you could just walk the committee members through that and then leave the policy issue for the $40,000, I will try to deal with that one afterwards.

MS. DAWE: Thank you, Mr. Chairman, Mr. Minister. There are two individuals in the community health branch of the department whose almost full time is dedicated to AIDS prevention and AIDS education.

MS. VERGE: Who are they?

MS. DAWE: Ethel Heald who is an education consultant, and a considerable amount of her time is working with community groups including the AIDS committee, but a considerable amount of her time as well is working with professional groups across the Province and the public health unit staff in AIDS education and promotion. Joanne McKinnon is the reproductive health consultant. A considerable amount of her time over this past year and currently as well is associated with dealing with AIDS initiatives.

For the record I would be happy to provide you - there are a list of four pages of initiative that are under way dealing with the AIDS question and health promotion.

MS. VERGE: I have been involved extensively as a volunteer in the Corner Brook area in talking to professionals in health and education about efforts under way to educate people about AIDS, to try to prevent the spread of the infection. Every single one of them says without hesitation that they are just not doing nearly enough. These are all well motivated, extremely well qualified people, but they have many responsibilities, and with respect these two people are in St. John's. We have a large Province, and Joanne McKinnon's responsibilities cover the whole area of reproductive health. Another area which we are not doing nearly enough in is preventing unwanted pregnancies. Planned Parenthood for years now has been operating without one cent from the provincial government.

MS. DAWE: I guess if I could, Mr. Chairman, to go back to the AIDS issue, my point was that we have two individuals in the department. A considerable amount of their time is spent in providing consulting services to a number of groups. I agree that there are many other people across the Province who are involved. The role of these individuals is to provide consulting services and try to facilitate AIDS education in a number of different forums. As well to say there are many initiatives currently under way. These two staff members are working with the regional public health offices across the Province currently to develop strategies so that the staff in the areas will be appropriately prepared to work with community groups as well.

MS. VERGE: I would like the minister to answer my questions about the inclination and preparedness of the government to provide assistance to The Newfoundland and Labrador AIDS Committee in what I call their hour of need. Prefacing that, would the minister tell us what the government is doing presently, before this recent crisis, to assist the Newfoundland and Labrador AIDS Committee, and is the government willing to - even on just an emergency interim basis - give additional support to The Newfoundland and Labrador Aids Committee?

MR. CHAIRMAN: Mr. Decker.

MR. DECKER: Mr. Chairman, since I have been minister the department has been working very closely with the AIDS Committee. Doctor Ian Bowmer is Chairman of that committee, and we meet on quite a number of occasions. He advises government on it.

Members will recall the television ads last year which were carried by the AIDS Committee. They were paid for directly by the Department of Health, and they were delivered by the AIDS Committee.

We were involved in the toll free line when it was set up. I think we are paying for a considerable amount of that, are we not?

MS. VERGE: No, I am told that the toll free line operated by The Newfoundland and Labrador AIDS Committee is paid for entirely by the committee with federal funding, and that the Province is not contributing to the cost of operating that toll free telephone service.

MR. DECKER: Well let's get the truth. What is the truth of it, Ms. Dawe?

MS. DAWE: The AIDS Committee has asked this year for funding to provide a second 1-800-line. That is under consideration at the moment.

MS. VERGE: Who is paying for the existing line?

MS. DAWE: My understanding is that is coming from other sources. It is not the department.

MS. VERGE: Yes, that is my understanding.

MS. DAWE: It is a federal grant.

MR. DECKER: It is a federal grant.

MS. DAWE: But they have asked us to provide support for a second 1-800-line.

MR. DECKER: Now, as to whether or not -

MS. VERGE: If I might interject, obviously their ability to continue to pay for the existing line is now in doubt because a large sum of money was stolen from them. They have no money left now.

AN HON. MEMBER: (Inaudible).

MS. VERGE: They took everyone off the payroll last Friday, and they have debt. They have $25,000 debt.

MR. CHAIRMAN: Now that is the conclusion of the time for this period, but perhaps the minister will respond to the rest of that question before we change.

MR. DECKER: Yes, Mr. Chairman, I think this request would be better if it came from the AIDS Committee. At this moment they have not asked government for any assistance on this particular issue. If and when they do, we will sit down and discuss the matter with them. I am not going to commit tonight that we are going to give them $40,000 or $5,000. I am not going to say we will not. If and when the committee comes to us, and we discuss the matter, if there is something we can do, depending on the means within the department and the need and all this sort of thing, we will deal with that matter. It would be inappropriate for me to prejudge what we will say.

MS. VERGE: Yes, I appreciate that.

I wonder -

MR. CHAIRMAN: No, that is the conclusion of that period.

Mr. Penney, the Member for Lewisporte, has joined us as a member of the committee for this evening, replacing Mr. Efford who has not been able to attend.

It is now almost 9:45. Ms. Verge raised the question of time. Does anybody want to say anything about the question of time? You have indicated that you do not expect to conclude say by 10:30 or something like that?

MS. VERGE: Well it depends on the committee as a whole, but I have several more questions that I would like to ask. I do not know about anyone else.

MR. CHAIRMAN: Does anybody want to suggest that we consider a time to conclude for this evening, or that we continue until we exhaust the questions?

Mr. Walsh?

MR. WALSH: I am really curious. I want to come back to a comment that the minister made. I am willing to carry on. Let's go as far as we can to wrap this up tonight. I would just as soon be here until 12:00 tonight as to try to reschedule for another night.

MR. CHAIRMAN: Mr. Doyle.

MR. DOYLE: Not me. It is my understanding we generally go until 10:00 and then it is cut off if it is not finished. I can't stay beyond 10:00.

MR. CHAIRMAN: I don't think there is any rule to govern us. I think we can go all night if the committee chooses to. That is my understanding. There doesn't seem to be much consensus about what to do so I would propose that we continue as we are. If at some point somebody wishes to make a motion we will deal with that.

Mr. Harris.

MR. HARRIS: If my voice could be added to the consensus I don't think we are going to conclude by 10:00, which normally is the time that committees conclude. It would be my suggestion that 10:00 at night is a reasonable time and to set it over for another day. So it would be my suggestion that we go until 10:00 unless we think we can finish by 10:15 or something like that, which I don't think we can, Ms. Verge has a number of questions and there are a number of areas that I haven't gotten into yet as well. So I would propose that we finish at 10:00 and come back another time.

MS. VERGE: Personally I wouldn't mind staying until midnight, but there are other people who have to drive an hour or more to get home for the night, staff who probably made plans to finish at 10:00. I concur with Mr. Harris, I think we should adjourn at 10:00. If we haven't exhausted our questions by then we will have to schedule a second hearing for the Department of Health.

MR. CHAIRMAN: Let's wait until 10:00 to deal with it or when somebody wishes to make a motion. You are not making a motion at this point I take it?

MR. HARRIS: Well I just made a motion that we conclude at 10:00.

MR. CHAIRMAN: You are making that motion.

MR. HARRIS: Yes.

MR. CHAIRMAN: Is there a seconder?

MR. DOYLE: I will second that.

MR. CHAIRMAN: Mr. Doyle seconds. Any debate on the motion? Three in favour, one against, so I guess we conclude at 10:00. It is now 9:47 so I guess that means one more set of questions for this period.

MS. VERGE: If I might interject, would the department officials circulate the breakdown of health care institutions budgets this year, last year, beds this year, last year, so that we can all have a look at it.

AN HON. MEMBER: That is just gone to be photocopied.

MS. VERGE: Oh, okay.

AN HON. MEMBER: (Inaudible).

MR. CHAIRMAN: Who wishes to question next? Mr. Walsh.

MR. WALSH: I would like to pick up on partially the line of questioning that Ms. Verge was on that you didn't finish and that is there is no question that the AIDS committee have run into, I guess, a catastrophe. I understand that, and I am not sure how well they are doing, but there has been quite an outpouring from the public in terms of funds being delivered. I remember seeing Co-op Taxi on television dropping off $1,000 or $1,500 or something that they collected among themselves, and there has been, I understand, quite an outpouring. But am I correct in assuming or did I hear you correctly when you said at this point in time to the best of your knowledge there has been no official request from the committee for funding?

MR. DECKER: That is correct.

MR. WALSH: So there has been none.

MR. DECKER: No.

MR. WALSH: Now we know they have a need and everything, but one might be coming. But at this point in time there has been no request?

MR. DECKER: That is correct.

MR. WALSH: What you are saying then, if I listened to you correctly, is that when a request comes from that committee your department will review it and decide what direction to take from there?

MR. DECKER: I should say that committee has been a very responsible committee, and they don't normally run to government every time they get into a problem - as you pointed out some people took up a collection. You know, some committees would run to government every time they got into a problem, and it is a credit I believe to this particular committee that they have not been on our doorstep before now and I think this shows just how responsible they are. Maybe they won't come, but if and when they do, we will discuss it, but I do not want to give the impression that I am pre-committing funds, I do not have the authority to do that of course, but we will certainly discuss it with anyone who requests a meeting.

MR. WALSH: I know they said themselves, watching an interview on television, that they saw this as an opportunity and they were more than surprised with the outpouring of support from people who are literally coming in off the street, and others who will phone to ask: where do I send the cheque? They thought this would be a great opportunity and a time to go and actually start a fund raiser or a plea to the general public for funds. How much money did we spend on those commercials last year? I know that they were quite involved in it themselves in terms of the direction and -

MR. DECKER: $50,000 or $60,000.

MR. WALSH: $50,000 or $60,000 and, am I correct again in assuming that they were part of the production in terms of working with the department on the style of commercials and -

MR. DECKER: We had hired a consultant -

MR. WALSH: Yes, I realize that but you work with that particular committee -

MR. DECKER: Right.

MR. WALSH: - and that phone number you see on the bottom, was that their phone number?

MR. DECKER: That is correct.

MR. WALSH: Okay.

MR. CHAIRMAN: Are you through, Mr. Walsh?

Mr. Harris.

MR. HARRIS: Yes, if I could go back to the issue of home care and alternatives to the situation with which we are faced, because it is my view that the more home care facilities are improved and alternatives are available, this situation of people staying in hospital because families won't take them home or cannot take them home will improve. The reality is in some cases it is a won't take them home and in many cases it is can't take them home or cannot see their way clear to caring for them at home.

You have indicated that there is about a $100,000 increase in the allocation to the St. John's home care budget, does all of that come from government, do they have other sources of funds other than the government?

MRS. DAWE: Mr. Chairman, may I go back to that previous question? I had indicated that an additional amount of $100,000 was provided from the community based budget, and that there were other dollars allocated from the institution component. In total, let me say that this fiscal year there is a little more than $300,000 which is actually being given to the St. John's Home Care Program to respond to their current workload demands, with an understanding that we will sit with them at the end of December and review the workload and the needs, and then if we are in a position to readdress the situation, we will at mid-year, but the figure is $300,000 which has been given in total. That is direct funding through this department.

MR. DECKER: That is additional though, what is the total budget?

MRS. DAWE: Their total budget is in excess of $3 million to the St. John's Home Care, but it comes from two different components within the department.

MR. HARRIS: So the amount of money that St. John's Home Care spends from government sources, the two elements of your budget is $3 million -

MRS. DAWE: A little over $3 million.

MR. HARRIS: - compared to $2.69 or something last year, is that the figure?

MRS. DAWE: Yes.

MR. HARRIS: Okay, now can you tell us what the number of patients or the number of people who are being cared for as a result of that, what is the change in patient care?

MRS. DAWE: I am sorry, I do not have the correct figures at my fingertips, but I will be happy to get them and have them tabled for you.

MR. HARRIS: This doesn't have to be a cross-examination here. I could ask the right question and figure out what is going on. What I want to know has to do with this whole issue of where we are spending our money and how far we are going, because $3 million sounds like a lot of money and the minister is very proud of that amount of money being allocated. I think it is a lot of money, but when we, on the other hand, are spending more than $1 million a week where it is not being used properly, to say that we are spending $3 million in another area doesn't necessarily point in the right direction.

So what I want to get a handle on - and, I suppose, if you have to look up figures and come back with answers next time, that will be fine - but what I am trying to figure out is, how far we are progressing, at what rate we are progressing in providing home care services, and how many people are being looked after in their homes now that otherwise would end up in chronic care facilities or be required to be in either level 1 or level 2 nursing homes? Does the department have a good idea of what this $3 million is doing? Obviously, as times goes on, you can't just throw money at something. You have to have the ability to deliver those services, you can't just say, we will give an extra $500,000 to St. John's home care if they don't have the people in place and they don't have the system ready to deliver it.

By merely saying there is a $300,000 increase doesn't help me understand how far we are progressing in terms of finding alternatives or how fast we are progressing in terms of finding alternatives. So I would appreciate it if next time we could discuss it a little more fully. I guess there is not much point in responding to what I am saying now.

MR. DECKER: Before you leave that point, Mr. Chairman: As Ms. Dawe pointed out, we will table the details. You can't expect us to carry them around in our heads.

Now, that $3 million is unusual here. The members of the Opposition complain because we are spending too much money in the service. I can assure members that we would like to have another $3 million to spend in home care in the St. John's area. There is a different breakdown which we will provide. For example, a considerable amount of that money, maybe a quarter of it, is spent on people who normally would have been kept in hospital, and not old people necessarily. A person who, maybe five years ago, might have spent a week in hospital can be released after four days and there is a certain amount of home care delivered which is a continuation of the care he received in the hospital, but now it is at their own home. So there is a component in this budget which deals with that, as well as the senior citizens and the other people who have other problems.

We will get an exact breakdown, but I can assure the member that, as proud as I am that we are spending $3 million, I would like to have $6 million to spend.

MR. HARRIS: It may be that this whole $60 million, or maybe half of that, can be devoted to home care, but I just want to find out where we are right now.

My point was that you can't just increase budgets unless you have people in place to deliver the services. That is my only point. I am not complaining about spending money, by any means.

I see that the cost of drug subsidization for what are called here indigents - I don't know if we still use that term - and senior citizens has increased substantially over last year, both in budget revised amounts and now the estimates. We see an increase in excess of 10 per cent, maybe 10 to 12 per cent, for senior citizens, an increase of $2 million over a budget of $13 million in 1991-1992, and about $1.3 million over the other. So about, I suppose, between 10 and 15 per cent increase in one year, which is a considerable increase.

I guess the question really has to do with: Have drug prices gone up from 10 to 15 per cent? Are we having far more prescriptions being filled or prescribed? The question would be, I suppose: To what extent is the government monitoring this kind of increase in cost, because it does seem like a substantial increase in just one year?

MR. DECKER: All of the above, Mr. Chairman.

It is an open-ended program, as the hon. member knows, and we can only judge it from year to year. We have an aging population. The cost of drugs is going higher and higher. We have drugs now which cost as much as $40,000 per year for some people. So all of the suggestions which the hon. members put forward are - what other reasons would there be for the cost of drugs going up?

DR. WILLIAMS: Well to be honest there may be some changes in the people on the plan - who are eligible for the plan. Historically drug costs have gone up 10 to 12 per cent a year, and that not necessarily insists that drug x this year is $10 and next year goes up 12 per cent.

Over time there are a number of new drugs which come on the market with some different indications, and they get into the system. Invariably these newer drugs, as they come on the market, are considerably higher in price than the older drugs that were already on the market for the same condition; but they may offer some benefit, and there is a switch by physicians to these newer drugs, so there is a cost there as well. So it is a factor of maybe utilization, depending on the number of people on the program, and the increase in cost of drugs.

As you know, the Province has a Generic Dispensing Act. I think it was one of the first provinces to implement that. Where possible under that Act we try to use, for all our programs in the Province, even for those who pay themselves, generic substitutes which are the same drug but at a lower cost.

MR. HARRIS: I see that it is ten o'clock. Maybe we can continue that discussion next time.

MR. CHAIRMAN: Thank you, Mr. Harris. I think we should talk a bit about when next time might be, because it is very difficult to organize these meetings. I found that so far, and some other people are finding it.

Does the minister have any problems with when he might be available? Some members of the committee do not like to meet on Monday mornings or Friday afternoons, and there are some holidays.

We have a schedule of the committees before us, so if we could all agree while we are together we might be better off.

I wonder if the minister would indicate if he has a particular time, or anybody else - does anybody else have particular times?

MR. DECKER: Tomorrow evening, Mr. Chairman, would be okay with me.

MR. CHAIRMAN: No. We have somebody else tomorrow evening. I am saying this because members might want to consider going a bit longer tonight, or some other time.

MR. DECKER: Wednesday evening would be okay, Mr. Chairman.

MS. VERGE: I would like to suggest next week, either the evening of Tuesday the 12th or Wednesday the 13th.

MR. WALSH: I will not be here.

MR. CHAIRMAN: I probably will not be available then either.

MS. VERGE: How about Wednesday morning, the 13th?

MR. CHAIRMAN: Then also.

MS. VERGE: How about Thursday morning, the 14th?

MR. CHAIRMAN: Then also.

MS. VERGE: Thursday evening, the 14th?

MR. CHAIRMAN: Thursday - that is possible for me.

MR. DECKER: Mr. Chairman, if there were not too many questions, I feel I am wide awake. I could take another half an hour of this, if we could clue it up.

MR. CHAIRMAN: I really think we are going to have to try to go as long as we can in order to fit everything in over the next couple of weeks, because I have been speaking to the other committee chairmen and we are having a lot of trouble getting people together. There is not a lot of time in the week when you take away the afternoons of Fridays and the Monday mornings.

MS. VERGE: Although Health is the biggest spending government department. I do not remember any year when health was dispensed with in one sitting.

I can remember when I was Minister of Education, coming to four hearings.

MR. CHAIRMAN: We do not have a problem with having another sitting, Ms. Verge, but what we might have to do is call a meeting for a time that is not too accommodating for a number of members of the committee, because we have to get it done by the 21st I believe it is - Thursday, the 21st.

Mr. Harris?

MR. HARRIS: The evening of the 14th has been suggested as being convenient to the Chair. I do not see any problem with that.

MR. CHAIRMAN: I do not think it is convenient to the Chair.

MR. HARRIS: Oh, I thought that was the only one that was. Forgive me.

MR. WALSH: How about that Friday afternoon?

MS. VERGE: Well, you know, we have already had a discussion in the Whole House that Friday afternoons and Monday mornings interfere with members who represent districts outside St. John's. Most of us like to spend the weekends in our homes; you know we only have about three weeks to do the estimates and I just suggested three prime nights right in the middle of it, a Tuesday, Wednesday or a Thursday, 12th, 13th, 14th, failing that, mornings -

MR. WALSH: Unfortunately two of us will be out of town and under the same situation as it would be for people (inaudible) -

MS. VERGE: Well there is provision for substitute members.

MR. WALSH: Well, I think the Chairman should be here at least and he says he can't be or he does not think he can.

MR. CHAIRMAN: We might not be able to settle this tonight but I just thought we might have a go at it. There is a provision for substitute members for all of us of course, and that is what we might have to start looking at it.

MS. VERGE: Well, let us go back. We are talking about sticking to our goal of scheduling meetings on Monday, Tuesday, Wednesday, Thursday evenings or, Tuesday, Wednesday, Thursday mornings; I have just gone through the middle week. Now let us look at the last week, that is the week of the long weekend. We have Tuesday the 19th, morning and evening; we have Wednesday the 20th, morning and evening.

MR. CHAIRMAN: I do not believe I will be available then.

MS. VERGE: Well, with due respect, you are saying that you are not available on more than half the prime days in the short three weeks that we have to do the estimates.

MR. CHAIRMAN: Oh with due respect, I tried to arrange these meetings properly last week you know, and if I am not available it is not going to be something that I would have a choice over, but I am not saying that for sure I will not be available, that's normally for other members to consider. But I think that this indicates that we are going to have problems.

AN HON. MEMBER: (Inaudible).

MR. CHAIRMAN: I cannot come tomorrow morning.

MR. SHORT: I want to find out when the minister is available. Forget about the committee, anybody could serve on a committee, but it is the minister whom you need at the committee meeting. I mean, if you cannot be here for half the time, somebody else can be here, so that is immaterial. It is the group of people who are sitting over there whom you want to finish up proceedings.

MR. CHAIRMAN: Mr. Decker, do you have any preferences?

MR. DECKER: No, Mr. Chairman. I do not see any major problems. I understand it is our role to accommodate this committee. I don't see why we do not finish it off tonight. I do not know how many questions the hon. member has but, we have had some pretty intense questions tonight and I do not see what more is left. I think we could finish this up by twelve o'clock if we stayed.

MS. VERGE: Number one, I would not be satisfied with trying to cram in what I have left tonight. I am getting tired and apart from that, I will get my second wind don't worry, but it is just not fair to people who have made plans to leave at ten o'clock. Mr. Doyle has to drive home to Harbour Main, I would think most of the staff expected to get off at ten o'clock; it is such a bad practice to get into sitting -

MR. CHAIRMAN: Mr. Chair, I am not a member of the committee, so that is up to yourself, sir, but this group is available until twelve or one o'clock, if you so wish.

MR. CHAIRMAN: Well I just wanted the committee to keep in mind that it is pretty simple to cut it tonight but it might not be that simple to get it together at everybody's convenience hereafter.

Mr. Walsh.

MR. WALSH: We lost about ten or fifteen minutes before ten o'clock and we are probably losing more now. If we can't, then the Chair and the Vice-Chair are going to have to try to work out a schedule

and whoever can be here will be here. If not we will have to, as Mr. Short said, appoint substitutes.

I have already said, let's carry it on until midnight, because the other aspect holds true as well, that although people are here and they may have other plans, they may not be planning to come back tomorrow night or the night after either, and they may have plans then. Everybody is going to have something that conflicts with a time. If we cannot go on tonight, the Chair and the Vice-Chair are going to have to work something out.

MS. VERGE: We have already decided by a vote of three to one to cut off at ten o'clock.

MR. WALSH: How many abstentions did we have?

AN HON. MEMBER: We had two abstentions.

MS. VERGE: In the Whole House it was agreed between the House leaders that we would not schedule estimates committee meetings on Friday afternoons, weekends, or the first morning after the weekend. So we are left with -

MR. CHAIRMAN: Was that agreed that we would not, or was it agreed that was the practice?

MS. VERGE: It was my understanding that it was acknowledged that it has been the practice, and it was agreed that we would follow the practice again this year.

MR. WALSH: If we are going to follow the practice -

MS. VERGE: We have Monday night, Tuesday night, Wednesday night and Thursday night.

MR. WALSH: If we are going to follow the practice where we can have substitutes on a Monday night, Tuesday night, Wednesday night or Thursday night, then it would stand that we could have substitutes on a Monday morning and a Friday afternoon as well.

MS. VERGE: Then we are into discriminating against members who represent ridings outside the St. John's area, which is the majority of us.

MR. WALSH: Either way you are discriminating. You are discriminating against me because I have to be somewhere else and you want to go ahead with the meeting on the Tuesday, Wednesday, or Thursday -

MR. DOYLE: Let the Chairperson and the Vice-Chairperson contact the rest of us and tell us when the meeting is, and if we can be here we will be here. It is as simple as that.

MR. CHAIRMAN: That is not a problem. It is just that I thought while everybody was here, if there was something simple we could do we might get it done.

MR. DOYLE: We can talk about this until eleven o'clock.

MR. CHAIRMAN: I agree with you.

MR. DOYLE: Let's leave it to the two people who have the authority to set the schedule, the Chairperson and the Vice-Chairperson.

MR. CHAIRMAN: Let me tell you that those two people have already had a bit of difficulty coming to agreement on what we will do.

MR. DOYLE: Well you will never accommodate us all, so set the schedule and write us a memo.

MR. CHAIRMAN: Okay, well I guess that concludes this evening. There has been a vote that we adjourn, so I rule the committee has adjourned.

On motion, the committee adjourned at 10:15 p.m.