The House met at 9:00 a.m. in the House of Assembly.

CHAIR (Wiseman): Good morning ladies and gentlemen. This morning we are in the Budget Estimates Committee. The Social Services Committee will be doing the Estimates of the Department of Health and Community Services.

Before we start today's Estimates, members of the committee, you have copies of the minutes of the meeting of April 20 when the committee reviewed the Estimates of the Department of Municipal and Provincial Affairs. Could I have a motion to accept them as circulated?

Approved by Mr. French, seconded by Mr. Parsons.

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

On motion, minutes adopted as circulated.

CHAIR: Thank you.

Now, as I said, this morning we are doing the Estimates of the Department of Health and Community Services. Welcome minister to you and your staff. To help us get started, maybe I will ask the members of the committee, for the benefit of your staff, to introduce themselves, starting with Mr. Butler.

MR. BUTLER: Roland Butler, the Member for Port de Grave District.

MR. PARSONS: Kelvin Parsons, MHA for Burgeo & LaPoile District.

MR. REID: Gerry Reid, Twillingate & Fogo.

MR. JACKMAN: Clyde Jackman, Burin-Placentia West.

MR. FRENCH: Terry French, Conception Bay South and Holyrood.

MR. YOUNG: Wally Young, St. Barbe.

CHAIR: Minister, if you would not mind, if you would introduce your staff to the members of the committee. Then, when you are through that, if you want to make some opening comments before we start the discussion the floor is yours.

MR. SULLIVAN: Thank you, Mr. Chair.

To my left is the Deputy Minister, John Abbott; to my right - was up until Friday - the Assistant Deputy Minister of Financial Support Services, Donna Brewer; behind, to my right, Jim Strong, Director of Financial Services; immediately behind me is Moira Hennessey, Assistant Deputy Minister of Board Services; and to my left behind is Carolyn Chaplin, Director of Communications with the department.

CHAIR: Thank you.

Did you have some opening comments that you wanted to make?

MR. SULLIVAN: I just have a few brief - on the thrust of where we are this year with health. This year we budgeted, I guess, a record $1.776 billion in health care; a $113 million increase over last year. Some initiatives have come down in the past year, in particular.

The First Ministers' Meeting; over the next six years we will receive $284 million extra in health care. That is an average of a little over $47 million a year. We have looked at a plan - just now committed to over $52 million a year over that period. That is $5 million above and beyond for specific initiatives talked about at the First Ministers' Meeting. Also, we have added on top of that, really, above the five year average, about another $60 million into health care this year. We have made significant investments in health care, in mental health and wellness strategies. We made our single, biggest investment in the public health initiative, into the promotion of that aspect, in our Province's history. We are looking at aspects of - a prevention and promotion aspect is very important. It is probably the most cost efficient in the long term.

We are expanding community mental health services. We have increased the funding in that area. We have looked at enhancement for gambling and OxyContin addiction treatment. We have taken initiatives to put extra money in there, in those endeavours. In personal care homes, for example, $4 million to assist with putting sprinkler systems in. They are really fire and life safety measures; significant numbers, especially to reduce waiting times. This year we are putting $23.2 million to reduce waiting times. There are five initiatives identified at the First Ministers' Meeting to reduce waiting times. These five areas are in, basically: cancer, joint replacements, efforts in diagnostic imaging, sight restoration, and one other, cardiac surgery. These procedures alone will result in 43,344 more procedures this year to reduce waiting times in line with the FMM meeting. We went beyond our allocated amount that would be directed in these specific areas.

We have looked at medical transportation arrangements in Labrador, to put it on a level playing field in Western Labrador, $40 they would pay and the rest would be covered. Labrador West did not have that option. We have changed that. We have also put a program in place where the first $500 now is paid and 50 per cent thereafter, instead of paying the first $500 and 50 per cent thereafter. So, that is another $567,000 in these initiatives, in residents there. We looked at adding twenty-five new drugs to the program this year. We have increased - over a 10 per cent increase from last year - in our drug program.

We have looked at long-term care investments in three specific areas, between Corner Brook, Clarenville and Happy Valley-Goose Bay. Investments into technology and so on, especially in PACS - that is the Picture Archiving Communication System - to allow people, especially in more remote areas, and especially western and Labrador areas, to be able to come on stream with new technologies in transmission of diagnostic imaging. So that has been significant.

The pharmacy network, along with moving in that direction, to put extra money there. We have a twenty-four hour seven-day line that is open; a help line, basically. It is a toll-free system that will come on stream, in line with New Brunswick, and Nova Scotia is pursuing that endeavour. I guess P.E.I. is not establishing one on site but they are looking at buying into that system, too.

Also, we provided significant money this year to assist the boards in balancing their budgets. We put $20 million extra in there this year, over and above, and another $11 million to cover inflationary costs. Also, to assist them in balancing their budgets in this year, particularly during a transition year. So, there are significant investments made into health care, not only acute but in other aspects of health care this year.

So, with that, Mr. Chair, I will conclude my opening comments.

CHAIR: Thank you very much.

Just a couple of housekeeping things. I would ask each person, as they are about to speak, if they would identify themselves to help the people operating the microphones to be able to turn them on.

The other thing, minister, in terms of facilitating the discussion, rather than deal with each head at a time we will just call the first head. Then we will deal with all of the subheads and vote on one motion at the end, as we have done in the past. I will ask the Clerk if she would call the first head.

CLERK (Murphy): 1.1.01.

CHAIR: Shall 1.1.01 carry?

Gentlemen? Whenever you are ready, sir.

MR. REID: Minister, I am going to take you through some of the headings. We will start with 1.1.01 and 1.2.01. Did you hire additional staff in the minister's office? There is apparently a $50,000 salary increase.

MR. SULLIVAN: Which one is that you said, 1.1.01?

MR. REID: I think it is 1.1.01, Minister's Office.

MR. SULLIVAN: Okay. That is because there was failure to include the Parliamentary Secretary. That was not included initially in the Budget, which is included now.

MR. REID: Who is that?

MR. SULLIVAN: Who is the Parliamentary Secretary? The Chair of the Committee.

MR. REID: You said the second.

MR. SULLIVAN: The secretary was normally under the House of Assembly -

MR. REID: I thought you said second.

MR. SULLIVAN: - and it should have been under the department. When parliamentary secretaries are appointed, their allocation comes from the department rather than from the Legislature, and that change had to be made.

MR. REID: That is not a bad salary.

MR. SULLIVAN: Pardon?

MR. REID: That is not a bad salary. What is that, salaries and benefits, is it?

MR. SULLIVAN: No, it would not have been entirely on that basis. Salaries are done on the same scale as they are done for - a PS03, they would become a PS04 when they are a parliamentary secretary, I am understanding, as opposed to a PS03. Wherever their experience on that line is, that is where it would be. The actual salary for that position, for that individual, is $34,000.

MR. REID: So, it is the secretary to the Parliamentary Secretary, is that what you are saying?

MR. SULLIVAN: That is correct. The Parliamentary Secretary, which is a Member of the Legislature - the secretary to the Parliamentary Secretary, if he wasn't a parliamentary secretary he would be just a regular Member of the House of Assembly and you would have your constituency assistant. When you move to a department as a parliamentary secretary, that is taken from the House of Assembly budget and it is put into the department budget. That was not done initially, so that had to be allowed for that. That was $34,000 for that item.

MR. REID: So, what you are saying is that right now we are taking the Parliamentary Secretary's secretary position from upstairs here, putting him over with you and we are moving the money from the House of Assembly and into the department, is that right?

MR. SULLIVAN: No. The reason I am saying last year, your estimate on last year - in the 2004-05 fiscal year ended, when the budget was brought down there wasn't provision in the budget to allow for the secretary to the Parliamentary Secretary to be included. That allocation was in the House of Assembly. So when a parliamentary secretary - it should have been included in the departmental, not in the House of Assembly. That has been the procedure, I am aware of, since I came here.

MR. REID: So, right now, the member from Clarenville -

MR. SULLIVAN: Trinity North.

MR. REID: - his assistant is not being paid by the House of Assembly. Is that what you are saying?

MR. SULLIVAN: That is the same. The same as -

MR. REID: Or does he have two?

MR. SULLIVAN: No, all ministers and parliamentary secretaries are paid out of the department rather than out of the Legislature. Traditionally, there are forty-eight members who are entitled to a constituency assistant, or whatever name you want to call it. If you are appointed to Cabinet, that allocation - for instance, when you were minister your constituency assistant or secretary, whatever you want to call it, was paid from your department, not from the House of Assembly. That is the same in parliamentary secretaries and that. I think the House Leader would be probably very much aware of that, in that instance. That is how it has always been done. It was not included in the budget. It is the same amount of money, but it should have been budgeted in the department as opposed to under the Legislature.

MR. PARSONS: I also understand, albeit there were parliamentary secretaries in the previous Administration, there were no secretaries to the parliamentary secretaries. For example, as a member of Cabinet I had a constituency assistant as an MHA. It was a departmental secretary, but the parliamentary secretaries appointed in the former Administration did not have secretaries in addition to their constituency assistants. So what you are telling me now is that parliamentary secretaries have both, a constituency assistant and a secretary?

MR. SULLIVAN: No, it is called the same - the same person. I said whatever you want to call it. It is still the same person.

MR. PARSONS: Just one person, but they are being paid for by the department now rather than the House of Assembly?

MR. SULLIVAN: Yes.

MR. PARSONS: Okay.

CHAIR: However, if you would like to suggest that they should have one, I would entertain such a motion.

MR. SULLIVAN: I referred to it as the secretary to the Parliamentary Secretary. I could have said it is the constituency assistant to the Parliamentary Secretary. I used them synonymously there in my statement earlier.

MR. REID: So you are telling me that when I was a parliamentary secretary at one time, my secretary was not being paid by the House of Assembly?

MR. SULLIVAN: That is correct.

MR. REID: I do not think you are right.

MR. SULLIVAN: Well, I have sat on the IEC every year probably since the early 1990s. That has come up in the IEC. It is recorded in the minutes of the IEC, except for two years. We have dealt with that. When looking at the IEC budget, we have indicated that when you have - and one of the reason we had a lighter burden when there were nineteen or twenty Cabinet ministers and parliamentary secretaries, we had a much lower budget in the House of Assembly then and the appropriate amount was shifted. That has been traditional. I have sat on the IEC on that, and your colleagues there who sat on the IEC would be aware of that.

MR. REID: Executive Support, an additional $100,000. It might be under 1.2.01.

MR. SULLIVAN: 1.2.01?

MR. REID: Salaries for Executive Support.

MR. SULLIVAN: Yes.

MR. REID: An increase of $100,000, is that right?

MR. SULLIVAN: That is correct.

MR. REID: Who did you hire?

MR. SULLIVAN: Pardon?

MR. REID: Who was hired?

MR. SULLIVAN: Roughly, $150,000 increase. That is primarily to severance and vacation pay costs for the former deputy minister.

MR. REID: What was the total?

MR. SULLIVAN: The total amount, you can see there - $152,000 is the difference there on that line item.

MR. REID: One hundred and fifty-two was to severance and vacation?

MR. SULLIVAN: No, I did not indicate that. I said the difference between the two lines here is $152,000.

Overall, a person is entitled to severance based on the grid of their years of service and their age. There is a grade that is standard in the public service, and vacation pay is what someone has built up and they are entitled to. Severance could be taken as a continuation of salary. Vacation pay or annual leave, as we call it, you are entitled to take that when you so desire, so that option is there.

MR. REID: How much did you pay the previous deputy minister when you told her to go home?

MR. SULLIVAN: We paid what they were entitled to under the grid, based on age and years of service.

MR. REID: Minister, you know all the numbers. How much?

MR. SULLIVAN: I do not think it is appropriate to talk about somebody's income. It is based on what they were -

MR. REID: You told me there was a calculation, and how to calculate it. Why don't you just tell us how much? You are supposed to answer questions on the budget. That is the reason we are here today.

MR. SULLIVAN: I am answering questions. I am saying they received what they were entitled to, based on the grid. I am not sure if I want to give publicly that this person worked so many years, their age and so on, and those factors. That is the amount. The estimates are about $150,000, roughly $800 there of which is primarily due to severance and vacation pay for the deputy minister. That is what the person is entitled to on the grid, and what vacation pay they had accumulated.

MR. REID: Open and accountable government, no doubt.

We are going to force independent plant owners in the Province to open their books on the table and you will not answer a question about the books you are responsible for, when we are spending public money.

MR. SULLIVAN: I will give you the total amount on the item, but I do not want to talk about someone's personal income, what they have received. They received according to the grid of their entitlements. If anybody wants to check on the age, and how many years they were in government, they can find that from the table. The Salary Details has the salaries of these people, in the Departmental Salary Details that are published, and someone can work at that and determine them.

MR. REID: That might be all fine and dandy, what the formula says, but was she given any extra?

MR. SULLIVAN: Pardon?

MR. REID: We can talk about the formula for severance when somebody leaves. Was she given any extra?

MR. SULLIVAN: I do not want to talk about someone's age and years of service. I do not think I should do that, because there is only one individual involved.

MR. REID: You missed the question, though. I said you are talking about a formula that you calculated her severance on when she left, based on years of experience and the position that she had, and all of that. Was she given any money over and above that which was calculated by the formula?

MR. SULLIVAN: None to my knowledge. She received salary continuation. If you are entitled to forty weeks, fifty weeks, sixty weeks, seventy weeks, you can draw that in salary and there is a salary continuation for that individual.

MR. REID: I know how all of that works, but the question I asked - I know what I am entitled to when I retire, in severance and stuff like that. I am asking, was she given additional money?

MR. SULLIVAN: Not to my knowledge.

MR. REID: Do you have a Director of Finance there behind you anywhere?

MR. SULLIVAN: Yes, I do.

MR. REID: Maybe that individual can tell me.

MR. STRONG: Not to my knowledge, no.

MR. REID: So you are saying she did not. If you, the Director of Finance, and the minister, if neither one of you are saying to your knowledge, she did not, I guess. Is that right?

MR. SULLIVAN: That is correct. I said I am not aware of anything other than the grade, the salary and the vacation pay she was entitled to, annual leave. I am not aware of any others. My Director of Finance is not aware of any others.

MR. REID: Under 1.2.03. there is an increase in Professional Services under the Medical Services heading. I think it is $117,000.

MR. SULLIVAN: Which one is that? Which number?

MR. REID: I think it is 1.2.03.

MR. SULLIVAN: Yes, but which one under that?

MR. REID: Professional Services, under the Medical Services heading.

MR. SULLIVAN: The breakdown for this year, I can tell you what each of them are for this year, the $445,000.

MR. REID: One hundred and seventeen thousand. That resembles an increase of $117,000 under Professional Services.

MR. SULLIVAN: Why has it increased?

MR. REID: Yes.

MR. SULLIVAN: Overall, the funding for the Canadian Co-ordinating Office of Health Technology was $75,000. Newfoundland and Labrador is currently the board chair. The liaison to the deputy minister is on this conference. There is also drug utilization research funding of $46,300 on that. There is $75,000 for the Co-ordinating Office of the Council of Health Technology, and the balance is drug utilization research funding. The two of them add up to -

MR. REID: Both of those headings you never had last year: the $75,000 and the $45,000?

MR. SULLIVAN: No.

My understanding is this emanated from the FMM and this is a new co-ordinating role. I do believe there is some revenue - do we have revenue offsetting any of that? I do believe. We get offsetting revenue, too, by the Chair, I think, for operating the office, in my understanding. Even though there is a cost, we get offsetting revenue.

MR. REID: Under subhead 1.2.04., apparently there is $40,000 less there this year under cuts to board services, is there?

MR. SULLIVAN: Item number?

MR. REID: I think it is under heading 1.2.04.

MR. SULLIVAN: Supplies?

MR. REID: I think there are cuts to board services. Are there any people gone as a result of that, or is it just a $40,000 decrease?

MR. SULLIVAN: Which item overall here? You mean in salaries?

MR. REID: Yes.

MR. SULLIVAN: On the salary issue?

There is one-time funding we received for a smallpox activation response program. That was a one-time funding for that issue in that area. That is why there is a difference there of $40,600. It was for that position. That was one time. That is why it would be down in salary.

MR. REID: Under 1.2.05., last year there was $40,000 more spent on Professional Services under the heading of Community Programs and Wellness.

MR. SULLIVAN: Okay, Professional Services from $27,000 to $64,500?

MR. REID: Yes. What happened there, and what did you do with the money?

MR. SULLIVAN: That was additional funding we got for the Province's Wellness Strategy under that specific area.

MR. REID: Yes, I know it is there. I asked the question: What did you do with it?

MR. SULLIVAN: At $37,500.

MR. REID: Yes, what did you do with it?

MR. SULLIVAN: Well, how is it directed? Into the Province's Wellness Strategy program. That is an ongoing program.

MR. REID: I think it is under 1.2.07., under the heading of Policy and Planning.

MR. SULLIVAN: Okay, just give me a second to catch up to you there. Under 1.2.07., okay.

MR. REID: There is $50,000 less there, or was.

MR. SULLIVAN: In Salaries?

MR. REID: Yes.

MR. SULLIVAN: Primarily to position vacancies in last year from the past year in Policy and Planning.

MR. REID: So there is a job gone there, you are saying?

MR. SULLIVAN: There is a vacancy there that was not filled.

MR. REID: So, it is not filled?

MR. SULLIVAN: It has not been budgeted to be filled this year.

MR. REID: At the same time, though, that position was not filled, there was an increase of $100,000 in Professional Services. Is that to take care of the job that the person you let go or did not fill that position was doing?

MR. SULLIVAN: No, the $100,000 was for reporting and accountability under the FMM. That was -

MR. REID: Could you use the -

MR. SULLIVAN: That was miscellaneous -

MR. REID: Minister, the acronyms you are using, I am not familiar with. Could you tell me -

MR. SULLIVAN: That is the First Ministers' Meeting on health care. There were certain initiatives at the First Ministers' Meeting on health care. In light of getting federal funding, there are certain basic things that the Province agreed to follow to implement that. If you are getting money, there are certain structures in place for accountability and reporting and expenditures of these monies. That flowed from the FMM, and that was held in September, 2004.

MR. REID: You spent $100,000, you say, to get ready for that meeting?

MR. SULLIVAN: That is where the $100,000 - as to how it got spent overall, I will have to refer that to one of my officials; but, yes, the money got allocated here and spent, or it is budgeted for this year, the amount. It is not spent this year, yet, but the amount of money is allocated to be spent this year.

MR. REID: On what?

MS BREWER: One hundred thousand dollars was an allotment provided to that division. When you read the First Ministers' Meeting, the Ten-Year Plan To Strengthen Health Care in Canada, there is expectation from the provinces of a whole bunch of having to measure, like, for example, wait times, having to report back over a five or six year period. One hundred thousand dollars was planned money for that division. It has not yet been decided whether or not they will hire staff to do that in-house, whether they will contract, for example, to the Newfoundland and Labrador Centre for Health Information, or whether it will be contractual people from time to time.

Basically, that was a plan to allow them to begin planning as to how the Province was going to meet its reporting and accountability requirements that were within the funding.

MR. REID: So there is $100,000 there in Professional Services and what you just said is that you do not know if that is going to be done in-house by hiring extra employees or contracting it out. Is that right?

MS BREWER: Or using this Newfoundland and Labrador Centre for Health Information, which is an agency that reports to the ministry.

MR. REID: Down in 3.1.01., what type of supplies are purchased? I guess it is under Purchased Services or Supplies or something. It looks like there is an increase of $2.9 million in allocation for the Regional Integrated Health Authorities and Related Services heading. Do you see that there?

MR. SULLIVAN: What line item under 3.1.01.?

MR. REID: It is under Regional Integrated Health Authorities and Related Services.

MR. SULLIVAN: Under Supplies?

MR. REID: There was a $2.9 million increase.

MR. SULLIVAN: There was a public health immunization trust fund, in addition, to add certain costs. There were three particular vaccines for pneumococcal, meningococcal and varicella, three initiatives that were added, the costs that were announced. That was a $2.854 million extra cost, in addition to the current ongoing ones of over $2 million.

MR. REID: Under Grants and Subsidies, there is $60 million to $80 million allocated.

MR. SULLIVAN: That went from $1,220,000,000 up to $1,283,000,000.

Overall, that is the money we provide out to the Regional Integrated Health Authorities, which means they are getting $63 million more dollars this year to operate than they did last year. That is used for a whole variety of all of the services that are operated under all of the Regional Integrated Health Authorities. That is a combination of health boards, a combination of community boards, from the cancer rehabilitation treatment foundation overall.

Just to give some examples of some of the new areas that have gone in there, the new costs, if you want some of them, some of the big items are: We gave $20 million in one-time stabilization funding. We put $11 million in for an inflationary factor; that was $31 million. We gave $4 million, personal care home sprinkler systems; $5 million for the fifty cent wage parity with home support workers. We put $1 million OxyContin task force; $1 million in mental health; $2.4 million into wellness; $2.1 million into home care; $8.5 million into various wait times initiatives, operating; another $1.3 million Self-care Telecare, I made reference to at the beginning about the phone line system; medical transportation in Labrador, all these initiatives; all the initiatives that we have talked about overall for dialysis and a whole host of early learning in childhood. These initiatives are delivered through Regional Integrated Health Authorities. There is $60-some million on top of last year for some of these. They are just some of the major items in the list there.

MR. REID: Under 3.2.01. Property, Furnishings and Equipment.

MR. SULLIVAN: Okay, it is up by -

MR. REID: Twenty million dollars.

MR. SULLIVAN: - $20 million. The total amount this year is being spent on - there are new initiatives particularly with wait times. Out of that $24.42 million this year, we are putting $2.5 million announced toward an MRI in St. Johns; $2 million for CT scanners; provincial pharmacy network, $2 million; nuclear medicine gamma, $3 million; $3.72 million, that is equipment to reduce wait times for PACS - that is the Picture Archiving Communication System, $4 million there. There is an unallocated block that goes out to boards for different initiatives in this area of equipment that would be allocated out there of $7 million, so that adds up to $24.42 million.

MR. REID: When your deputy minister was let go last year you had Ross Reid, who is the deputy minister to the Premier, fill in for that position for a period of time. Where did he get his salary at that time, when he moved into the department of health, or was he getting paid twice?

MR. SULLIVAN: It is my understanding that he was getting paid once, the same as I get paid once for two portfolios at the moment. That is customary within government. You do not pay someone twice for extra responsibilities. It was not paid out of Department of Health, to my knowledge, it was continued to be paid from the area under the headings where it was budgeted for. If any of my officials have anything further they want to add on whether it is paid out of health - to my knowledge it was not paid out of health. They continued his salary where it is to. I have been informed that is correct.

MR. REID: Minister, there is a brand new twenty-bed facility on Fogo Island. It was built for ten acute care and ten chronic care patients. In fact, I think in the contract that was signed with government for purchase of equipment, there were actually twenty new beds delivered to that facility and set up in the twenty rooms, and that under the cloak of darkness one night, just prior to the opening of the facility, there was a van or a truck arrived on the Island, under the cloak of darkness, from the health board in Central East and took ten of these twenty beds and slunk out the next morning on the first ferry. Right now we only have ten beds open in that facility. I am hearing horror stories, and if you do not want to believe me you can check with the people of Fogo Island.

I had one incident earlier this winter where a female senior citizen went to the hospital, thought she was having a stroke, and was sent home because they did not have room in the building for her. She later turned up at the hospital that night and was airlifted to Gander where she died.

This week I have been dealing with the children of an eighty-two year old woman who is terminally ill, and because she has lived a short period of time longer than they first anticipated in the hospital - and I am talking weeks, not months - she is being told now that they are going to discharge her and send her home because they need the bed.

Now, in light of the fact that in consultations you had last week with the Minister Responsible for the Status of Women, and that the position of this government now is not to do things that negatively impact women, your colleague, the Minister Responsible for the Status of Women, even went so far yesterday - or last Wednesday or Thursday - as to saying that they would not be closing the kitchen in the hospital in Stephenville because the majority of people working therein are female and she would not negatively impact employment of women in that facility.

I say to the minister, in your discussions with your colleague, the Minister Responsible for the Status of Women, don't you think, and she should also think, that the health of our elderly female portion of the population on Fogo Island deserves the attention that those in the Stephenville area are receiving from you and your government and the Minister Responsible for the Status of Women? Because I think, minister, that it is absolutely ridiculous to be using the people, especially women on the West Coast, as a pawn in the political game, when you consider that there are people dying on Fogo Island and you will not open the ten beds that are needed out there.

I ask the minister: When will you reverse the decision and put the ten beds back on Fogo Island where they are much in need today?

MR. SULLIVAN: We look at the availability of beds in line with need. If we wanted to look at and compare the ten beds unopen on Fogo Island, there are ten beds in a facility built in 1992 down in St. Lawrence that have never opened to this day. There were 3,200 beds in the Province in 1989. There are 1,500 today. There were in excess of almost 1,700 to 1,800 beds closed during a former government in office.

One of the movements today is to try to move people out of acute care institutions and move them home. There is a post follow-up care. In fact, $2.1 million is budgeted this year to deal with people who are released from hospitals - dealing with acute care who have been released. They are also to deal with end of life care. Also, some of that would go toward dealing with mental illness aspects. So, the philosophy, overall, is to look at accommodating people in acute care but also to try to get them into a home setting and provide the necessary supports there. That is the trend that things have been moving.

We have half the beds we had in 1989. We have had beds when there were opportunities to open beds. The same rationale prevails, whether it is in any part of our Province. We are going to look at the needs of any people, whether they are male or female, and look at their needs and deal with it appropriately. We are going to take medical advice and allow medical people to make decisions on whether someone is discharged or someone is retained. That is not one that, as a minister, I should be making or staff in my department should be making.

MR. REID: I find your comments hypocritical, minister, when you say that people are treated everywhere in the Province, when last week, on the spur of the moment, the minister not even responsible for health stood here and talked about leaving three units open in Stephenville, including a kitchen, when we have people who are being sent home, basically, to die in another area of our Province. When you talk about moving people out of a hospital and trying to get them home with the proper care, I think you said something similar to that a few minutes ago, well, I tell the minister that the eighty-two year old women I am talking about on Fogo Island was told that she was going to be discharged last week and they did not even have home care provided for that individual when she was about to be discharged - and to say that people are being treated fairly.

You can talk about the past all you want, and go back to 1989 and everything else. The problem is, today, that right now health care is not what it should be on Fogo Island, with a brand new facility with ten empty rooms out there and elderly people who are being sent home without even having home care available to them. I think it is criminal.

MR. SULLIVAN: The total cost, approximately $380,000 for both. That would be the Western and Grenfell.

MR. PARSONS: Three hundred and eighty thousand.

MR. SULLIVAN: Roughly $380,000, give or take a little; roughly there, yes.

MR. SULLIVAN: I guess we are focused on outcomes more so than processes, even though you might consider processes important. Overall, it is not uncommon. I have been around here for some time. I have seen ministers in regions makes announcements - informally in governments and traditionally. How you want to do it is entirely a decision of government, who they want to answer to it, anybody in Cabinet or anybody who is directed, if it has affected their area. I have seem announcements made by your Administration in regions where the minister did not make them, the minister in that region made them, so that is not uncommon at all. A decision was made. A decision was articulated there, and -

MR. PARSONS: It seems to be, Minister, that the decision, however, was totally couched in the words and justification that it was being done because it was a women's issue.

MR. SULLIVAN: If the minister made a statement, you will have to take the statement up with the minister, not with me. Any statement that I made, you can take it up with me. That is a decision that was made, and it has moved forward on a decision -

MR. PARSONS: Minister, we did take it up with the Minister of Health in Question Period, but you are the minister here today and the purpose of your being here, I would think, is not to defer to other ministers. I asked you a question: What was your involvement? What are your thoughts on the fact that this is being done as a women's issue and not as a justifiable health care issue, public issue?

MR. SULLIVAN: I am not here to give thoughts, to be honest with you. I am here to give responses, not thoughts. It went through a process. You have been in government. You know what processes are in place. We will articulate the results of process. We are not going to get in and discuss details in processes. That has not happened, and I do not intent to discuss it here, but I will tell you that a decision was made. A decision was articulated, and who articulates on behalf of government is a choice of government to do that, the same as anyone who stands in the House to answer questions. That is a prerogative of government, who wishes to answer.

MR. PARSONS: I am not talking about the prerogatives of government, Minister, and I appreciate your responses. I would just like to think that there is some thought put into your responses, and that is what I am trying to get at. Whether you want to have thoughts or not, I am just concerned and would like to see that there is some thought put into your responses. That is why I ask the question again: Is this done with the full concurrence of the Department of Health because it is an unsupportable recommendation of the Hay report, or was this done because it was necessary to do in the interests of women? Now, that is a pretty straightforward question.

MR. SULLIVAN: There are numerous factors involved in decision making, and this was a decision by government and articulated by government, answered by a minister of government here in the House. That was made quite clear, and you can ask it ten times. A decision got made, it got articulated there, and the result is out there. I think it is a result that probably the people in the region should be -

MR. PARSONS: Was it a Cabinet decision, Minister?

MR. SULLIVAN: It is a decision of government, yes. All decisions articulated there are decisions of government.

MR. PARSONS: Was it a Cabinet decision?

MR. SULLIVAN: I am not going to reveal was goes on in Cabinet.

MR. PARSONS: I am not asking you to reveal what goes on in Cabinet. I asked you, was this a decision of Cabinet or was this a decision of the Minister of -

MR. SULLIVAN: I am not going to comment on decisions in Cabinet. I am not going to speak on any decisions in Cabinet. They will get articulated appropriately by a minister from Cabinet.

MR. PARSONS: Back for a second, Minister, to the issue of the previous deputy minister's severance package, for which you refused to answer.

I asked the Deputy Minister of Health, was there a confidentiality agreement between government and the former Deputy Minister of Health which would prevent you from making that information public?

MR. ABBOTT: Sir, I can answer that. I have not seen any of the documentation around that particular matter, but what I have been advised in terms of the financial aspects is that the severance arrangements were clearly to be budgeted in our department and, as I understand them, they are based on current policy within government, but it was certainly before my time so that is as far as I can go with that.

MR. PARSONS: Well, maybe the minister can inform us.

MR. SULLIVAN: I am not aware of - you mean any confidentiality agreements?

MR. PARSONS: Was there a confidentiality agreement, to your knowledge, between government and the former deputy minister regarding the terms and conditions of her settlement?

MR. SULLIVAN: Not that I am aware of. I am not aware of any confidentiality. I am aware that the former deputy was paid in line with her years of service and her age based on a grid, and that grid, anybody could go to the salary departmental details and look at her salary and see what amount and what it equates overall.

She was paid based on her earned credits, based on that grid, plus any annual leave she had entitled to come to her. The severance portion is being paid out. That area on the grid is being paid out as a salary continuation. It is the prerogative of the individual to choose when they would like to receive their annual leave: lump sum, (inaudible) during the course of that salary continuation, or while technically they are still an employee, they are entitled to draw down on that when they so desire, the same as anyone can do it on their annual leave. I am not aware of anything other than that.

MR. PARSONS: Minister, the settlement of the VON matter in Corner Brook last year, how much did that cost government to resolve that issue?

MR. SULLIVAN: Well, overall, the VON number - was it $20,000 or $50,000 on the VON?

OFFICIAL: (Inaudible).

MR. SULLIVAN: Close to $50,000, I think, was the amount. I am sure we can find the number there, but it was in the tens of thousands based on - I guess it equated to the salary increase. It worked out to around fifty cents based on the number of hours that were provided for the project overall.

MR. PARSONS: You would agree that could be variable numbers, in the tens of thousands. It might be $150,000 too.

MR. SULLIVAN: No, a specific number would have been recorded there. I might be able to find that for you during the course of the morning. If I can, or one of my officials can get that number, we will give you that number.

MR. PARSONS: In the event, Minister, that you do not find it this morning, I take it you undertake to provide us with that figure?

MR. SULLIVAN: Sure.

MR. PARSONS: Usually, Mr. Chairman, the process is that the undertakings are recorded as part of the minutes -

CHAIR: They are, yes.

MR. PARSONS: - so they are easier to track that way.

CHAIR: For the benefit of the Clerk recording that, could you repeat the actual -

MR. PARSONS: How much did it cost government to resolve the VON issue in Corner Brook?

CHAIR: Thank you.

MR. PARSONS: My second question related to that, Minister, would be: Where did those funds come from? Where would we look in this budget, or in the Budget, or in government, to find out where the funds actually came from?

MR. SULLIVAN: Funds are allocated to the Western Regional Community Health Board. That is where they would be administered through, is my understanding. If any of my officials want to add to that, those services are delivered through the community health boards. In this case it would be delivered through the Western Board, the same as other home support or elsewhere would channel through other respective community boards in other regions, and that is where it would be within the budget of those boards.

MR. PARSONS: I understand that the Western Integrated Board or whatever would be the funnel through which the money flowed. My question relates to, if this is new money, obviously it was not there; or, if it is old money, I would just like to know, where was it found? Did you have to give Western the money, whatever that x figure was? If so, where did it come from, if it was new money? If it was not new money, where would Western have found it in their budget? Because we understand that they already run a fairly big deficit.

MR. SULLIVAN: Funds are allocated to the boards. There wasn't new money channeled for that under the current appropriations, is my understanding. If Donna wants to add to that she certainly can after. The money that was appropriated out to those boards at the time, as they were called, was found within their money that was appropriated and passed in the Legislature. There was no new expenditure required of funding in terms of any special warrants or any Supplementary Supply or anything to deal with that issue. That was within the appropriation that was already approved.

MR. PARSONS: Okay, so -

MR. SULLIVAN: If there is anything -

MS BREWER: There was a one-time budget adjustment that was provided to Western Health and Community Services. The department, while it allocates the majority of its funding up front to the boards, there is a small amount of money that is there on reserve that is used for contingencies for unexpected initiatives that may come up through the year, so we would have dipped into our reserves on a one-time basis.

MR. PARSONS: Is that how the money came about? Was it in the Western Board pot already or, as a result of this VON issue, did government have to dip into this contingency and give Western the money to resolve it?

MS BREWER: The department dipped into its reserves and provided a one-time budget adjustment to Western.

MR. PARSONS: Okay, so where in the Budget would one look to find out where your contingency fund is?

MR. SULLIVAN: I probably can answer, and Donna can add to that.

In the past, a lot of boards never got their budgets until the fall. The year was half over and they did not even know what they were getting. For example, traditionally, money flowed in the past at different intervals during the year. They did not know what their final budget was going to be. What we did this year, I think on April 1, every board this year got an estimate of what they were going to get this year. They know what they are going to get in this fiscal year. There were times when they did not know that until November. I know I raised an issue here before that a board - it was in November and they did not know how much they were going to get to operate, and the fiscal year was ending in a few months' time. This year we put out front the amounts they are getting and they know what they are dealing with now. They can plan accordingly.

So there was always a holdback by departments, voted for and approved in the Legislature under the Estimates appropriations, and it could be channeled out. There could be an epidemic in one particular region that might require extra funds, whatever the case may be, and you might have to channel extra monies there. So that was done sort of to, I guess, meet certain occasions as they arose. That is traditionally, I know, from my experience, what has happened. If Donna or any of my officials want to add to that, that is my understanding of how it has worked.

MR. PARSONS: Maybe the lady could go back now and answer my question, now that we have your explanation: Where would I find it in the Budget?

MR. SULLIVAN: You would find it under the Regional Integrated Health Authorities, under the line item Grants that go out to all of these agencies. It would be under 3.1.01.10.

MR. PARSONS: Okay, that $1,283,064,200.

MR. SULLIVAN: Under 3.1.01.10.

MR. PARSONS: Minister, I believe there was a Supplementary Supply request filed some time before the end of the year, I guess, regarding - there was a shortage in the doctors' money for payment for doctors, I do believe.

MR. SULLIVAN: That is correct.

I will just give you the generalities. If you want to get into more specifics, I can gather specifics.

Overall, there was an increase in the last fiscal year. In the previous fiscal year, when this MOA was signed, there were about thirty-two new doctors who came on steam, previous. This past year there were seventeen more salaried physicians came on stream, last year. In addition to seventeen salaried physicians coming on stream, there was an increased utilization also of over $3 million within the current utilization of doctors there, so there was extra money spent. That had to be delivered in line with the MOA that was signed in 2002; the end of September, I think, it took effect. We had an obligation to channel money in line with the agreement to fund those particular areas because a lot of the vacancies and so on got filled. Therefore, there was a greater uptake from current and there was an increase in the number of physicians in our Province and we had to honour our agreement that was signed.

MR. PARSONS: I take it, notwithstanding the existence of the agreement since when did you say, 2002?

MR. SULLIVAN: Yes, that was the three-year agreement that was signed, if you remember, with the doctors back in -

MR. PARSONS: Yes.

MR. SULLIVAN: It runs from October 1, 2002 to September 30, 2005.

MR. PARSONS: So, notwithstanding the existence of the agreement, it had not been budgeted.

MR. SULLIVAN: That is correct.

MR. PARSONS: I am assuming if it was in the agreement you would have anticipated it and therefore budgeted for it, and not find yourself in a situation where we did not budget for it, there was an uptake on it, and now we have to go back and honour the agreement by way of Supplementary Supply.

MR. SULLIVAN: You see, the uptake proceeded the previous year on current, plus there were seventeen new, so we did not anticipate that. Technically the overall, I think, would have been $7.5 million, I believe, but there were certain savings found within the salaried physicians and so on to be able to offset. I think we had to go to a special warrant on that amount of about $4.5 million because of that, but we found some savings to allow for some of that overrun within the salaried physicians ones but we could not find sufficient savings and that is why we had to bring a special warrant to the House. We had to fulfill the agreement. If we did not bring it when we did, we would not have been able to advance the money to pay them. I think, if I remember correctly, if we had not had it done by March 10 we would not have been able to pay the doctors.

The suggestion was made: Look, if we are starting everything from square one, what is the likelihood of - you have a new board with new directions with a new government. Why wouldn't you start them off from square one? Because if you leave them with this $35 million deficit to start with, maybe these good things that we are seeing like the Hay report being scrapped might not be able to happen anyway. If they are still told, for example, you have to live within your budget, and part of your budget includes a $35 million deficit, it seems like there were not answers there.

I am wondering if you or your officials can enlighten us a bit, because that seemed to be the lost question that was there. Nobody had any kind of answer to that.

MR. SULLIVAN: I will give a response to that.

Even when you went back historically, and I will just touch on that before I move to the present and where we are headed on that issue, every year, back when there was some board consolidation, the government lifted a good chunk of its debt - not all of it - and they went forward and they still incurred more debt on top of that debt. So what we looked at this year, we said: Look, we are going to allow you - there were overruns last year of about, the bottom line, they ended up about $18 million overruns, and to use some of the strike savings, about $10 million, to assist, that we are allowed to retain to help. It would have been higher expect for that. So we said, starting this year, we have four Regional Integrated Health Authorities; we will give you a budget on day one, April 1. We are going to put $20 million more dollars into your budget and we are going to give you, to allow dealing with getting a balanced budget, we are going to put $11 million on top for inflationary of $31 million. Here is your budget on April 1 now. They are not finding out in November when their budget is and it is too short in the year to budget. They know twelve months in advance. Here is your budget now. There is $31 million in there, $20 million plus $11 million. Go out and deal and balance your budget. We give you a year of transition to get in place and balance it.

On the long term there is $125 million accumulated in their accumulated deficit, you could say, or debt that had been carried on the books now of those Regional Integrated Health Authorities which (inaudible) the next ten years now, let's build in to be able to eliminate that debt over a ten year period.

Over a ten year period, if you look at eliminating that debt in a ten year period, based on the current budget of boards, and that has been going up and will go up over the next number of years, that would be equivalent, just on today's budget, it would be less than 1 per cent. They would have to get 99.1 per cent approximately, so less than 1 per cent they would have to find to balance it, assuming they have no more money based on today's current. So that is saying: Look, we are enabling you to get it in order this year in transition. Here is $31 million, $20 million plus the $11 million for inflationary increases that would probably be there anyway, but at least $20 million directly to assist in that process. Then, deal with a plan over the next ten years to deal with. That is where we are. That is what we have indicated, and that is our expectation.

MR. PARSONS: Just if I might clarify a couple of those points, the overall board deficits, we will say, in the Province, was one hundred and -

MR. SULLIVAN: The accumulated deficit is about $125 million, the accumulated deficit over the past number of years.

MR. PARSONS: Okay, so the twenty -

MR. SULLIVAN: Some had balanced theirs and some did not and so on, but that is the accumulation of all the boards that were outstanding that were rolled into the four Regional Integrated Health Authorities.

MR. PARSONS: The $31 million that you put in, the $20 million plus that $11 million for the inflationary piece, that was again towards all of the boards?

MR. SULLIVAN: That is going into the general pot overall.

MR. PARSONS: Over ten years, by doing that kind of strategy, you are saying, you ought to be able to keep up with inflation and at the same time eliminate the $125 million accumulated deficit.

MR. SULLIVAN: Well, this year we put in $113 million net when you factor out revenues against it, net more gone in this year, so we are saying over the next ten years they will come back with a plan to show over the next ten years that they would have to eliminate a little over $12.5 million a year, average, based on a budget of $1.25 billion.

We know that health care funding over the next six years, the ten year plan federally, the money we are getting federally is going to allow a 6 per cent increase after the six year period thereafter as an inflationary amount that we are going to get from the federal government on the portion that we got under the FMM.

MR. PARSONS: So you are not saying this $20 million this year was a one-shot deal. You are saying you are going to put money in every year for ten years to allow to erase the $125 million accumulated deficit.

MR. SULLIVAN: No, I did not say that, no. I said we put $20 million in this year to assist in balancing it, and this is a transition year, and what we will do in the future, we want a ten year plan. We will look at things on an annual basis, on what service the board is providing, what is happening, what initiatives. It depends. Certain boards may be advancing certain initiatives; other areas might be in other initiatives. The funding they get will be a product of the service they deliver.

MR. PARSONS: Okay, let me go back. I am not a mathematician, and I am not very good at figures. I would just like to understand stuff, and Joe Chesterfield, as I say, likes to understand it as well. It saves a lot of trouble if people can understand where you are going.

The $31 million that you put in this year, which is the transition year, where is that going to be, or expected to be used, and by what boards? How do you see that working?

MR. SULLIVAN: Well, that is something that I will refer to an official, how it is going to be broken down. What the boards get, including that $20 million and the $11 million, is a product of services they provide, how much will go into one. If one board - the $20 million, and I will let officials expand on it - if a board is in a situation whereby they need to have more pressures on dealing with that deficit than others, there would be an appropriate allocation of that amount to be able to deal with that. How it is divvied and how it is broken out and how it fits into the other $1.25 billion, I would defer that to -

MR. PARSONS: Do it in a context, if you would, of the Western. I was told at the meeting the other night by Dr. Genge, the Chairman of the Board, that there is about a $35 million or $36 million deficit in Western and Grenfell. That is what I took it to be, Western and Grenfell.

OFFICIAL: No, just Western.

MR. PARSONS: Maybe it is just the Western Board. You can clarify that for me as well.

What does he do? You gave him a budget on April 1, which was great. He has some idea of what his budget is going to be on a go-forward basis for this year for 2005 and 2006.

MR. SULLIVAN: That is right.

MR. PARSONS: He knows he has this $35 million deficit for his board.

MR. SULLIVAN: That is not on an annual basis, now. That is a debt, not deficit. His deficit is not $35 million.

MR. PARSONS: No, that is a debt.

MR. SULLIVAN: Yes, that is debt.

MR. PARSONS: So, what happens? That is the whole point. If government is saying to Western, get rid of your debt - how are they going to get rid of their debt if what you are giving them for the year is being fully spent without even putting anything towards the debt? That is what we are trying to figure out, out there.

MR. SULLIVAN: I will refer to my deputy in a second, but we are looking at a whole new structure now that has several rolled into one. There are certain efficiencies in operating one organization as opposed to several also, but maybe the deputy or somebody could comment on the structure of where there are greater pressures in achieving that level in some boards than others there. If there is anything, John, on that?

MR. ABBOTT: Mr. Parsons, in terms of taking Western, right now they approximately have accumulated deficits in and around $28 million. They will continue to have that accumulated deficit.

This year what we did, so that deficit does not increase, is to allocate them a portion of the $20 million so that they basically stay flat. We provided another $11 million across the system to deal with inflationary increases as well as some program increases to respond to their pressures. That allocation was done based on their submissions to the department. We looked at each of the boards, looked at what they requested, had some discussions, and then did an allocation. So the sum of that is that, when we provide them with their budgets by the end of March, they knew then for the coming year that they would have "balanced budgets" and that, all things being equal, the accumulated deficit will not increase.

The expectation now this year is to have a discussion with each of the boards to say: How can you develop a plan to address that accumulated deficit? As the minister said, there would be a pay back, as it were, to bring down that deficit over the next ten years.

If you take the total of the $125 million, divide it by ten, that means that the system is to define and achieve efficiencies in around $12.5 million over the boards, and that is where the minister's 1 per cent number comes in.

MR. PARSONS: Okay.

Therein lies the crux of the problem, I guess. The question that was asked at the forum was, if we are currently spending all that we are given for the level of services that we have, and the thought was that was why the HayGroup came in, to tell us and help us where we could find these efficiencies - that is why I understood that Western brought them in, to tell us where we can find some efficiencies - and they made a whole bunch of recommendations, so now if these recommendations of clinic closures and obstetrics at Stephenville and obstetrics at Port aux Basques and food services and all of that, if those recommendations which Hay said should be done to save you money are not going to be done, the question asked of Mr. Genge was: How are you ever going to pay back this $28 million?

MR. ABBOTT: Well, if I may, just on the Hay recommendations, there are still obviously quite a significant number of recommendations in the report that we will be expecting the board to look at, address, to see if, from their perspective, they are doable and they wish to recommend implementation, which would see significant saving in those that are, shall we say, still to be addressed by the board.

MR. SULLIVAN: I might add, Mr. Chair, there are numerous recommendations and numerous initiatives not only with the consolidation efficiencies but also in best practices, utilization rates, admissions by people discharged earlier and not the length of stay. In some of the areas it is longer than the norm, it is longer than in some parts of the Province, by having a follow-up in community health and so on, and initiatives to work hand in hand. There are numerous thrusts that should give more efficient delivery and be generated while they could be in the envelope of moving the pressures from the acute care. There could be longer term savings if a person is in hospital two days less and the follow-up care in the home would not necessarily be as expensive as a follow-up from where they has surgery, by putting resources into the community health line. There is a whole area of things now.

They have an opportunity now. By having a separate entity before, as an institutional board and a community health board, and whether it is a nursing home board and a separate one here in this area, there are efficiencies and so on that could be achieved; because, instead of pushing off from one budget onto another your are dealing with it all under the one budget now. Therefore, those issues will take a transition of this year to be able to look at areas of their operation and then to be able to come back with a plan. So at least they are getting funded to meet that this year and then it will give them an opportunity during the course of the year to come up with a plan to see how they can deal with this in the long term.

MR. PARSONS: Minister, my next question - and I do not want to get into specifics but I have written to you and it has been very recent. I am not even sure if you have even seen the letter. I do not like to bring up personal specific circumstances, but it relates to a bigger picture problem and that is, what does a person do...? - I will give you the circumstances.

An individual who has cancer of the kidney was booked for surgery on Wednesday of this week. I have had lots of cases where people come to you, for example, and say: Can you do anything to get me pushed up the line on a heart surgery rotation or wherever? My stance on that is, everybody's life is worth the same. If you are on a list, somebody put you on a list for good reason, and I leave that stuff to the medics. That is one issue, but we are talking here about a situation where a person was on this list, has a life-threatening surgery booked, cancer of the kidney, and the urologist is leaving Corner Brook. The surgery that he was due to have on Wednesday - and this is a person who, by the way, is not a complainer. This is a person who stoically sits back and just says: Any suggestions as to what I might do?

I, quite frankly, do not know what to tell the person to do. What does someone do in that situation? What do they do?

MR. SULLIVAN: I would not want to get into specifics, but you mentioned that someone had surgery booked on a Wednesday, for example?

MR. PARSONS: This Wednesday. It was booked for tomorrow.

MR. SULLIVAN: Booked for tomorrow, and the surgeon is leaving?

MR. PARSONS: They were told on Thursday past that: Your surgery is cancelled. You will have to get the next rotation, which is going to be some time in May. They have been told as well: By the way, you are not on the May list.

MR. SULLIVAN: Why would it be cancelled?

MR. PARSONS: Because the urologist, apparently, is leaving Corner Brook. The person who was going to do this surgery tomorrow on this individual, for whatever reasons, is not going to be there to do it.

MR. SULLIVAN: So is there a shortage, or somebody else would have to pick up that patient and do it?

MR. PARSONS: Nobody is prepared to pick him up. He has just been told: You have to wait like everyone else, and right now - it is not a case of getting your toenail off. This is a person who has cancer of the kidney. I just do not know, quite frankly, who to tell him to consult with. Who does he call? Obviously he is not getting a lot of help from the doctor who was supposed to do it, because he is in the process of moving, and obviously he cannot get another doctor because he does not know one.

I do not know what to tell the person. I agree that there are wait lists and I agree that we all have problems, but when you meet these urgent - I call them urgent - life-threatening situations, is there any kind of person in your department you can contact with these emergency type situations to get some explanations on?

MR. SULLIVAN: Yes.

MR. PARSONS: It just happened that I was coming here today and I said, I have to ask because I would not be doing my job if I never even asked to find out for the person.

MR. SULLIVAN: I guess on that one, what I would indicate, we can follow up and see by virtue of a doctor leaving that somebody has put in an inordinate wait for something that was medically determined to be more urgent in nature. We can follow up. I have no seen the letter but it must have just come in very recently.

MR. PARSONS: Yes, it was very recent to you. I only found out late Thursday. The letter came to you on Friday.

MR. SULLIVAN: Overall, in reference to dealing with cancers and that, this year we made a significant investment in funding that is going to reduce cancer surgeries by 30 per cent this year, in this year's budget, that we will have a 30 per cent reduction in wait times for cancer surgeries.

That, I know, is a significant investment. It may not help this individual, but we will follow up on that specific thing, but it will benefit the general lines of dealing. We are looking at even in cancer lines people working extra hours on weekends to be able to accommodate people who need, whether it is radiation or chemo, to be able to access that by extending hours. There is extra money in the Budget to deal with that, too, in addition to a 30 per cent reduction in wait times for surgery for cancer.

That is part of the bigger picture, but that specific one we will follow up on.

MR. PARSONS: Thank you, Minister.

CHAIR: Mr. Butler.

MR. BUTLER: Thank you very much.

Minister, just a few questions. I want to go back to the heading 3.1.01. under 10., where you mentioned Grants and Subsidies. I know you mentioned earlier the different boards get their budgets, they know what money they have as of April 1.

I am wondering, for 2005-2006, this $1,283,000,000, once those budgets are done, is all this money allocated? What would be kept or in the reserve we heard reference to a little earlier?

MR. SULLIVAN: Well, all the money is earmarked. I will have to refer that to an official to see if there is a certain amount of reserve for any unusual circumstances that do arise; if there is anything or whether it is all allocated out to the boards. There is $300,000 on reserve out of the $1,283 million.

MR. BUTLER: Three hundred thousand?

MR. SULLIVAN: Three hundred thousand.

MR. BUTLER: Okay. So that leads to my next question, and do not get me wrong, I am not against what happened there a while back because I am so pleased to see - I think it was $1.2 million or $1.4 million allocated for the cancer clinic in Central. Where would that money be in this 2005-2006 budget, seeing there is only $300,000 left there under that heading? Is this new money that is going in or is it money that will be put into the budget coming up for 2006-2007? Can you outline where that $1.2 million or $1.4 million is?

MR. SULLIVAN: That is going to come under our - there were certain capital announcements we announced for capital expenditures this year. Under capital, there are numerous initiatives announced for capital expenditure.

When this request came up, the Premier asked the minister to go out and look at the site with the deputy minister and other officials. When he came back there was a report done, and I discussed with the department on coming back from that with the deputy, and we discussed this issue in government as to - first of all we said, what is needed? For instance, in 2002-2003, there were 1,298 people in Grand Falls-Windsor receiving treatment for cancer. It is projected this year to be 1,400, and we said, are there other needs? While you are looking at it, are there other needs for that area?

We looked at Gander from that same period, it went from 1,129 people to 1,850 now projected who will need it. Is there a solution under the Central Regional Integrated Health Board to deal with that within this year's budget? They went back and looked at the capital projects that were announced for this year, where they are, what stage they are, how fast they can advance these projects. How much would be needed to complete this project in Central Newfoundland is $1.55 million; $1.2 million for Grand Falls-Windsor site and $350,000 for the Gander site. They indicated that you cannot spend all of that this year. Maybe you might only get to spend $600,000 or $700,000; $800,000, whatever the number may be. There are other projects ongoing, too.

It was felt, in looking at our expenditure for this year, that there is sufficient monies in our cash flow. If anyone needs an explanation in how that works, I can give an explanation on that. That is more a financial process, but I will answer that. There are sufficient numbers within the cash flow to be able to do this within the cash flow, but at the final analysis, when the projects we announced this year and the cancer ones in Central, at the end of the day, we are still going to need $1.55 million but it will not need to be drawn because all these projects are ongoing. They will not get all finished this year, but we will need $1.55 million in next year's budget, not this year, to be able to complete all those capital projects then out of what is allocated. So, it is really - cash flows are sufficient without new monies to do it but next year we are going to need to come up with $1.55 million. If they all get finished in 2005-2006 or 2006-2007, technically, we would need another $1.55 million, but the cash flow is sufficient to be able to carry these projects what we announced earlier and this project without needing a new appropriation of money.

MR. BUTLER: So, will the cancer clinic or the facility be finished this year?

MR. SULLIVAN: In any event, it would not have gotten finished this year. Under the previous proposal that came in, you know, to this past - actually, four years. The proposal that came in for the past four budgets, came into government, it was a scenario of over $4 million to build on and to house other areas under this proposal; like, the pharmacy and the labs. There is a variety - I think the dialysis. There is a whole area. We looked at a bigger proposal that could have cost $9 million to $10 million. We moved on an initiative to build on. You have to get a plan now, a design. You have to get the construction, get it built, covered in. It is an addition to a facility. The practicalities of seeing that finished by the end of March, that would not have been practical under any scenario but a good bit of the work could end up being finished and completed but the intent, this should be finished in the 2006 year. It would not get finished this year anyway, but the cash flows are sufficient. We do have to allocate some extra money in next year's budget to be able to complete the ongoing ones, but there is no new requirement of money needed to be able to do it.

MR. BUTLER: Minister, with regard to the long-term health care facility, was there a ranking for Conception Bay North or Carbonear area? What is the status of that facility?

MR. SULLIVAN: Overall, the rankings of the three in long-term care are: Corner Brook, number one; Clarenville, number two; Happy Valley-Goose Bay, number three. I can say that other facilities out there, the one that is in Carbonear or the Conception Bay North region, is a strong priority. We know what it is like. St. John's has serious problems, and Carbonear. We are aware of that. If you want to look at this region as an example, we are very much aware of them but the top three priorities got funded this year and Carbonear is beyond these as a high priority. I have seen this. I have visited. I went from one end of it to the other. I am personally very familiar with it. People in my department are aware that it is a concern that needs to get addressed in the future; as things get looked at in the future and to what extent. I guess when you come to a budget table you look at how much we can get into Capital and so on, but it is a concern and it is something that is targeted. As to when, I guess at this time we cannot tell you.

MR. BUTLER: Minister, the facility for Conception Bay North area was not ranked number one or number two in the past by officials in your department?

MR. SULLIVAN: The top three are the ones that we moved on this year. Actually, the Corner Brook one was moved on last year, and Clarenville and Happy Valley-Goose Bay.

MR. BUTLER: No, the question I asked: Was there at a point in time - I am not saying this year - where Carbonear ranked higher than some of those that are listed here today?

MR. SULLIVAN: I, personally, cannot answer that, where past rankings are. I can tell you on current rankings. If there are things that have changed over the past number of year, there could be a variety of factors that could change rankings. If an official wants to pass judgement - there are numerous things that can change rankings, demographics of an area, increased population. I know from reading background areas that the Clarenville area has the highest elderly population in that region in our Province, unless things have changed in the last years. I have read that. I have looked at things right back from Nycum studies on that. One particular area, the area down in Happy Valley-Goose Bay, is in bad need of it. Carbonear too, of course, is one, but there is nothing, that I am aware of, based on the numbers and the needs and so on, that theses were the top three.

MR. BUTLER: Can any of your officials answer the question that I just asked?

MR. SULLIVAN: I am not sure if they can, but I will certainly ask if they are aware. I can do that.

MR. ABBOTT: Mr. Butler, in terms of our priority setting, basically, the process we went through is to look at, as the minister said, population-based issues, as well as the facility issues, and to present to the minister and then to Cabinet a listing of the specific projects that we think, as a department, need to be addressed, and then that list was presented to Cabinet during the budget process. The selection was then made there, but in terms of the minister identifying the three, they were the ones that we identified on that list as well.

MR. BUTLER: Was there a time - my understanding is that Carbonear ranked number one through - I do not know if it was studies, reports or analysis, whatever was done, that Carbonear was number one when it came to long-term health care. I was just wondering, what happened to that or is that correct?

MR. ABBOTT: Just - if you can give me a second. I will ask Ms Hennessey to answer.

MS. HENNESSEY: Mr. Butler, there are quite a number of priorities within the department for long-term care. I have been with the department a long time, and as I go around the Province there are very many long-term care facilities that need a lot of work. Right now the government has ranked the ones in Corner Brook, Clarenville and Happy Valley-Goose Bay as the highest priorities for redevelopment. But, as our minister has said, there are other pressing needs out there that we need to address all the time.

MR. BUTLER: So, there was never a time that, within your department, Carbonear was ranked number one? That is the question I would like to have answered.

If it was number one I am wondering why it was downgraded, because it is my understanding that it was within the department, within the system, that Carbonear - internal - was ranked number one. I am not saying the other ones do not need it just as much as we did but I am wondering, what happened? If Carbonear was ranked number one, how come all of a sudden you are down in fourth or fifth place? I mean, something had to change there. I can tell you, the need out there - there is nothing happened out there to take care of the problem.

MR. SULLIVAN: Mr. Chair, overall, I guess, if you look at - I guess you can look at the condition of facilities. You could look at the future needs to meet the wait lists. I guess if you looked at wait list and the condition in some, you might say that St. John's probably, I would think - if some of the officials - has the highest wait list of anybody to get in. Therefore, if you consider the longest wait list, it might be determined as being the greatest need; along with the condition of facility is another factor that weighs into a need.

I think the wait list here in the St. John's region is probably the longest in the Province, I would think. Yes, I have been informed. So, we might say that is the greatest need, but you have to look at a variety of factors. I guess when you look at - there is no doubt that the three are certainly distinct needs, along with St. John's and Carbonear are strong needs too. Maybe if you had to do it on rankings alone, the longest wait list, it should be in St. John's; if you look at that basis alone, but there are conditions and other factors of facilities and so on that have to be taken into play.

MR. BUTLER: No, my question, minister, and I am not going to belabour it any longer -

MR. SULLIVAN: I am not aware if it was ranked first.

MR. BUTLER: I understand those three and I agree they are ranked the way they are, for whatever reasons. My understand is, and I cannot get an answer from anyone to confirm to me that Carbonear was not ranked as number one.

MR. SULLIVAN: I am not aware that it was ranked number one.

MR. BUTLER: Okay. So, your department is saying, basically through you, that Carbonear was never ranked as number one?

MR. SULLIVAN: Well, my understanding of the indicators, there are a whole list of priorities there but -

MR. BUTLER: It is only a simple question, minister.

Is there anyone over there who can confirm for me that Carbonear, yes, was ranked number one at a point in time not too long ago?

MR. SULLIVAN: I said I am not aware that it was. No, I am not aware that it was. I am not aware.

MR. BUTLER: And there is nobody - none of your officials are aware of it?

MR. SULLIVAN: Well, I think they have spoken to that issue.

MR. BUTLER: We will leave that one, Sir.

The other thing I want to ask a question on is with regards to emergencies. If someone goes to an emergency, what is the practice? I guess we all know what the practice is. There is a doctor there who sizes up the situation and is wondering if you should stay in the hospital or not. Is that solely the way it is looked at? - because I can give you an example that happened out our way. This individual who was dying with cancer was taken to the hospital. The doctor in emergency sent him home. The family returned with him again. He was sent home the second time and they said: You are going to have to go to St. John's to see your cancer specialist.

We had to call that specialist here in St. John's and I had to call emergency in Carbonear for them to admit that man because he could not travel to St. John's. They had to get a doctor at his residence to call them. Is that a practice? To me it was a terrible thing, and what the family went through. To have to get hold to a cancer specialist here in St. John's and get word to the doctor in emergency in another hospital to say: Look, you have to take this guy in. He is too weak. He cannot travel to St. John's.

Is there anything we can do about that? Like you said, is there anyone in your department we should be calling rather than trying to track down some specialist here when he is off duty?

MR. SULLIVAN: I will give my general comment and knowledge of situations like it, and if someone wishes to comment on it then, they can certainly feel free to do so.

Usually when people - especially people who have cancer, sometimes they may take ill. It could be 1:00 or 2:00 o'clock in the night. I know people I have spoken with at the emergency department 2:00 o'clock in the morning. Sometimes their cell counts are up and there are major problems with people receiving treatment, whether their platelets are down or their white cell count varies. Some people take ill and have gone to emergency. They would be examined, I guess, by a doctor at emergency who would not be acutely aware of the medical condition of anybody coming into emergency, not always.

I know specialists have indicated to their cancer patients, when they come to emergency: If you go there and you are ill, and you are going to be discharged, for example - some have indicated - Look, contact me. Because they have told them, if you get into a situation do not stay at home, immediately get in. People are not always routinely aware of that. So there are circumstances that can vary from individual to individual, and doctors there on duty make decisions based on their medical expertise and sometimes decisions get made. It is not done by political or administrative. Decisions are made, and should be made on admission, based on medical information. If a doctor did not admit somebody, a department cannot dictate - or anybody - to a doctor, who is the medical professional, to interfere in the carrying out of their responsibilities. We are not experts in that area but if there are concerns there, I think it would not hurt, as a suggestion, that communication with the doctor, with their specialist - it would not hurt if they are in an area and a region where they may have to receive it. I think it would not hurt to have communications with that emergency if a patient comes in, or they are to be monitored. I think that would make them more acutely aware of their condition. That may be the case.

I have dealt with - numerous people I have talked to have gone to the emergency with cancer and have contacted me. I have suggested they speak to the doctor and make them aware of it, or contact their specialist if they have to, if there is something that the emergency doctor may not be aware of. When someone comes into an emergency, in most cases if they are busy there is a certain triage they go through. Usually a nurse will look at somebody and the more higher priority ones get on the line. I have sat there for eight hours with people with me saying, the wait time is now eight hours. I know at the emergency it was seven hours and gone through that process that other people more important - more urgent ones have moved through the system. So, as to the admission part, I think that is a medical opinion that - other than raise that attention to the appropriate people to follow-up, that would be, I think, a medical follow-up process.

If there is something John or Moira on how (inaudible). I did work at the emergency for a year.

MR. BUTLER: In that particular case, and I do not want you to respond to this, but I know in this case that individual had to be taken twice by ambulance operators, that is how weak the individual was, and then for a doctor at emergency to say: no, we are sending you back home - and his specialist, whatever.

The other thing - I know this question was asked to you in the House of Assembly the other day and I am after forgetting the exact title of the individual, like a doctor who would be operating in emergency. Apparently when the ambulances go pick up a patient, before they can perform any medical procedure or do anything, they have to get a clearance from this individual, I guess, back in emergency at the hospital. I just forget the title. Out our way last week - and I think the Member for Carbonear-Harbour Grace asked you the question -

MR. SULLIVAN: Medical control?

MR. BUTLER: Medical control officer, that is it, sir.

I was just wondering, have you had the opportunity to check into that to see if it has been resolved? My understanding at that time, as of 12:00 o'clock - a lot of people were concerned and the people on the ambulances were even concerned about what the outcome could be.

MR. SULLIVAN: Well, it has not been raised since, and I have been out there. The issue has never come back. I do not know if - Moira, if you could comment on that, please.

MS HENNESSEY: That issue was resolved, Mr. Butler. There was a physician leaving the area who was responsible for medical control, but the medical control was transferred to another physician as of midnight that night, so there was no break.

MR. BUTLER: So, it is resolved?

MS HENNESSEY: Yes.

MR. BUTLER: Wonderful.

MR. SULLIVAN: My understanding is that for the operation of your ambulance service and your certain level of services, there must be a medical control officer designated in this operation, I understand.

Before midnight came there was somebody other than that physician, then, had been designated and took up those responsibilities, I think Ms Hennessey said.

MR. BUTLER: Because what we were told, and what the ambulance operators understood that day, they were told that before the paperwork could be done, before the new individual was taking over, it would be a week or a week and a half. That is what caused the concern. If it is resolved, that is wonderful.

MR. SULLIVAN: Well, Mr. Sweeney probably panicked. It did get done before midnight.

MR. BUTLER: The other question with regard to Carbonear again, and we are talking about budgets and balancing their budgets and so on, I was just wondering, I do not know if you can elaborate a bit on the situation with that facility out there. Where do they stand? I know we are talking about $28 million with the Western Health Care Board. I was just wondering, what is the situation with our board out there when it comes to - do they have a balanced budget? Are they in the same position as other areas and so on?

MR. SULLIVAN: I will just ask to see if they have the breakdown of the budget for those areas. I think the Avalon Institutions Board is running a deficit of - about $14 million rings a bell with me

OFFICIAL: You have all the deficits integrated now, right?

MR. SULLIVAN: Yes, they are all integrated now but, I think, from my memory, they had their line of credit of $7 million and we approved to pick that up to a maximum of $14 million, anything above $7 million and up to $14 million, so they were probably running about $10 million it was currently when they closed out, I have been informed. Because, I remember, they had exceeded the $7 million and, of course, the banks wanted assurances on a line of credit and we approved to pick up the surplus over $7 million as a guarantee for them. That is why I said not to exceed $14 million. It is in that range. I think it closed out at $10 million.

MR. BUTLER: Minister, could you or your officials give me a figure on what it would cost to assist an individual or senior staying in their own home versus, if twenty-four-hour care cannot be provided, what it would if they were put in an institution or a home?

MR. SULLIVAN: In their own home? Do you mean twenty-four-hour care?

MR. BUTLER: Yes, say twenty-four-hour care in their own home.

MR. SULLIVAN: I would say, off the top of my head, in the vicinity of $70,000 a year. If you look at twenty-four hours multiplied by the wage, multiplied by - if it is self-managed, there is a certain cost. It would be higher if you are managed through a home support agency; there is a higher figure. So, take the number at twenty-four times seven and multiply by 365 and then by $7.28 an hour; plus, there is a fee if someone - I would say in the $70,000 range to be in our own home.

MR. BUTLER: So, what would that be versus if that individual -

MR. SULLIVAN: Institutional care has been estimated to be - some of the buildings are sort of owned and the cost of capital, if you factor in - roughly, to get nursing home care, it is in a similar range. That is nursing home care.

Personal care homes, Level I and Level II, cost the government in the vicinity of probably as little - some very minimal, and some $2,000 or $3,000 a year. It is in the range of more like $3,000 a year in a personal care home. Personal care homes charge a fee of about $1,208 or $1,210, somewhere around there, and most of that is recovered through their old age security and so on. There is an average of about $3,000 a year, roughly, per person in a personal care home.

Maybe they have more accurate figures there, but I have looked at the figures up to two or three years ago, and looked at the total cost of the budget by the number of the beds. So, let's say $3,000 a year is a ballpark in a personal care home, and roughly about $60,000 or $70,000 range to be in your own home, maybe more. I could run it up quickly there. It would take a minute, based on the price. Maybe someone can run it up there based on - currently, it was $7.28. There is going to be an increase, so you are close to $8.00; plus, you get some of the processes. So, in the run of a day, at twenty-four hours, that is $200. If you look at 200 times 365, that is $73,000 that it would cost in a year. That is to give twenty-four-hour care in your home, and about $3,000 in a personal care home. There is about a $70,000 difference.

MR. BUTLER: I have been advised not to ask you any more questions with numbers.

The other thing -

MR. SULLIVAN: And in managed care it would be that much higher again. You could probably add another twenty-four hours through home support agencies, and you could look at close to $100,000 through a home support agency, about $100,000 a year to give care in your home.

MR. BUTLER: Why I asked that question, I have a couple of cases like that and we hear so much about trying to assist people to stay in their homes as long as possible.

MR. SULLIVAN: There is a big price beyond a certain limit, huge.

MR. BUTLER: Okay.

MR. SULLIVAN: In a city usually done through home support agencies it could cost you $100,000 a year for twenty-four hours and it could cost you $70,000-some a year out in an area where it is done by self-managed care.

MR. BUTLER: At the Carbonear Hospital, like I just mentioned, there is one doctor who left and caused this concern there a little while ago. I believe the individual who is taking over that position, or about to take it over - but you tell me it is taken over now - he is leaving in June. I was wondering, has the board expressed any concern to the department about doctors leaving the Carbonear area? I know that is two who will be gone from the Carbonear General Hospital by, I do not know if it is the first or the last of June of this year.

On the same line, I guess, when it comes to staffing, I know from visiting people in the hospitals that nurses, no doubt about it, are just run ragged, in my terminology. I have seen people in the Pentecostal Home up in Clarke's Beach, with sixty-five to seventy residents, in the night there are two nurses on, and two assistants, two people looking after thirty-five. I am just wondering, is the department, through the boards, looking at additional staffing?

We have so many young nurses who are being trained, and ever so many from my area are working down in the States. I know they are making big money but I was just wondering, is there any major concern there where we are losing more doctors? We heard Mr. Parsons say just now there is another doctor leaving the Corner Brook area. I do not know where he is going, but the two who are leaving Carbonear are gone out of this Province. I was just wondering what is being done to have a look at not only the doctors but the nurses and the full health care system when it comes to staffing?

MR. SULLIVAN: Well, overall, when you have close to 1,000 doctors in the Province you are going to get a certain turnover. There are reasons they may leave. Some are personal and some may be work related reasons. I guess that is the prerogative of the individuals there.

We have had an increase of about fifty-some physicians in the last two to three years in our Province. We have a ratio now that, while some areas you might consider to be under serviced and in other areas the ratio is different, we now have a ratio of about one point one specialists to one for general practitioners, when most jurisdictions are roughly a one to one ratio, I think, it is generally over. We may have some imbalance in some areas, and in some others we could be short. We are always cognizant of maintaining full complements, and we made significant progress since the MOA was signed, an increase in the number of doctors.

On the nursing issue overall we have had, back several years ago, back six or seven years ago, we did get into a situation with nurses where we had a shortage of nurses in our Province. We went out and advertised outside the Province, and even outside the country, to get people to come back home here. Over the last number of years only a small percentage of those graduating from the School of Nursing have landed with permanent jobs. There are some who have gotten casual. Some have gone outside of the Province. We are not at the point right now, but we are monitoring it to ensure that in the future we are not going to get into the situation we got into five or six years ago, where we had to spend inordinate amounts of money to try to fill that void. The number of people, I think, is 225, I believe, the nursing intake per year, and the majority are not getting permanent jobs, which means there is not a shortage of nurses at this time; but we are aware, with the aging population, with a lot of seniors - the average age being, I think, forty-eight for a nurse - that there is point where we are going to need them. We are monitoring that, and we are not going to get into a situation where we have a hole to get out of. That is important, to keep the finger on the button.

There is a concern. A lot of decisions get made, too, in line with their need, in line with the number of beds that are utilized. Another important thing that we need to move to is that people get trained in numerous different areas: personal care attendants and LPNs and nurse practitioners. It is important, too, that people be able to perform along the line of - the scope of their practice should be in line with their training. If people trained at these particular levels, it would alleviate those shortages.

That will give you the spectrum of, I guess, health care in that area.

MR. BUTLER: Back some time ago, Minister, I received a letter - a copy of a letter, I should say. It wasn't just sent to me; it was sent to others - from the social workers at the Janeway expressing concern about the time frame it took working with another department, Human Resources, Labour and Employment. I was just wondering, has that situation been taken care of? Because when they were trying to contact the, I guess, CSOs, are they, with the Human Resources -

MR. SULLIVAN: Yes, Client Service Officers.

MR. BUTLER: - the social workers in the health care system, there were breakdowns in communication when the social workers were trying to get some assistance for someone to transport or travel out of the Province and so on. I haven't heard anything on it and I was just wondering, can anyone relate to that, that the social workers at the Janeway are satisfied now that the co-operation between both departments has, I guess -

MR. SULLIVAN: In my short while here I haven't been aware of it. There hasn't been an issue that has come to the surface in that. I would assume it got dealt with in the process, but if somebody is aware of it here, who wanted to comment on it, certainly feel free to do so.

MR. ABBOTT: Mr. Butler, I am not aware of that particular issue, although similar issues have arisen, certainly, during my tenure.

I guess one of the things that we are expecting to see through the integration is that those kinds of issues, then, should be, will be, addressed internally within the larger board. That is one of the things the department found, certainly in recent times, is that we had several organizations out working with similar clients, or the same client, and those delays in service were happening, and right now we are working on a weekly basis with the CEOs to address those kinds of issues to make sure, in fact, that they do not arise. Not to say they will not, but that is certainly what we are attempting to do through the integration.

MR. BUTLER: I have one question just for my colleagues over here, just one other question, but I will make a comment before I ask the last question. It was referenced, Minister, when you mentioned earlier - and I agree with you to a certain degree - about the length of stay in the hospitals. It is more efficient now, and people get out earlier, and I am sure everyone wants that to happen, but I think also we have to be very cautious. I am sure some officials in your department must know of the incident that happened here in St. John's, I would say within the last three weeks, where an individual was being discharged from St. Clare's after having a procedure done. A taxi came to pick them up and, whatever happened, the story that I got was, they were asked to be discharged too early for the procedure that was done. An emergency took place, and I think they only got the individual back in the OR in time to save that person's life.

I understand where you are coming from. I agree with you if it is a minor thing, but I am wondering now if we are not pushing it too far, for some procedures, to leave the hospital sooner then they should.

MR. SULLIVAN: My comment on that is that a discharge is done under, I guess, medical consent, and not necessarily would it have to be designated to a certain procedure. I think a lot depends not just on the procedure but on the individual's condition prior to surgery, the condition that he had going into surgery, the severity of that condition, his ability to respond and get back. They are decisions that, I guess, medical professionals, doctors, make in contact with the individual himself in light of the procedure carried out. So they can be fairly reasonably subjective to certain degrees based on the doctor's knowledge of the particular patient and so on. That is something that I am not in a position - nor would I dare attempt - to render judgement on that, but there are a lot of factors that go into making that decision.

We all hope that when someone is discharged they are ready to go home and the follow-up is provided. There is evidence out there that early discharge can be a positive factor to individuals in recovery, too, as well as moving out of an acute setting and so on. There are certain disadvantages by being in the setting too long. There are advantages, and that is based on best practices and procedures there. That is a medical decision, and they are a lot more qualified to make that than any of us.

MR. BUTLER: My last question, Minister, has to do with a situation where individuals have a home setting for some individuals who are mentally challenged, and they are placed in the homes. It is not a home where there are fifteen or twenty. They may have one or two come in there. I am just wondering. I know they have to go, I guess, through all the procedures and that before they are advised of which home they can go and stay in and so on. I am wondering, once an individual takes a resident into their home, what follow-up is there, or is there any other guidance for that person? Because there is a situation, there is a letter to your department that I sent on behalf of a response that I received from health care workers in the Bay Roberts office when I was told that - because the person who called me just wanted some guidance on what they could do, what their rights were and so on. I was told by a health care official that they could not talk to me about it. I said: Look, I do not want to find out the facts of it, it is none of my business, but I am just calling for you to call this individual. She was concerned of what she could or could not do.

An incident happened, the RCMP had to be called on several occasions, but I was just wondering, once someone takes - I will just use myself. If I took someone in who is mentally challenged and once I have them there and everything is passed and the guidelines are all adhered to, and something goes wrong, is there any system in place within the department where I, as the individual who took this client in, have something to fall back on or supports to carry an issue through? This lady felt that this did not happen. She was left on her own, more or less, and could not get the support of people to help her with that incident. She was told that she should call the ambulance operator; she should call the RCMP, which was done. But after a serious situation took place, it finally got resolved. She felt that after taking them in the system let her down to a certain degree. I tried to get some answers for her but I was told that I could not be responded to. I was just wondering, are there any supports in place for situations like that?

MR. SULLIVAN: You are referring to people who may be mentally challenged that are taken into your home to live there on a full-time basis. Is that who you would be referring to?

MR. BUTLER: I do not know if they would have been there for a full-time basis.

MR. SULLIVAN: Or would it be respite? Because there are people who have people in their homes and they there are on a full-time basis. They may get some respite for that. There are other people who may just take them during that respite period and provide it. Either way, I guess, your question might be applicable. There are two scenarios, I am not sure which one you are referring to.

MR. BUTLER: I did not think it mattered, but, sir, to be honest and fair with you, I cannot answer you that. I do not think it is there for the long-term in the meantime; probably a respite type thing for awhile. I am not quite sure.

MR. SULLIVAN: Okay. John, do you have a comment on that one?

MR. ABBOTT: Mr. Butler, the services that you are referring to would be managed and funded by the community health board at the time. Their responsibility does not rest once the individual is placed in a home, whether it is in an individual setting or a co-op apartment, depending on the arrangement. So, the staff at the board office are responsible for continuing to monitor and work with the families. If that did not happen, then there was a breakdown obviously in the services that were required. Our job then in the department, if that is brought to our attention, would obviously be to follow up with the community health board and now the Regional Integrated Authority to make sure that those services continue to be provided.

MR. BUTLER: I think what happened here, they got through to the officials but I do not think it went through the way she thought it would to help her out of the situation she was placed in.

Thank you.

CHAIR: It was requested that we take a five minute break from the minister for a few moments. Can we take a five or ten minute break and then come back and resume hearing at that point? It is 10:55 a.m. now, let's come back at 11:05 a.m. and resume and finish up then.

Thank you.

CHAIR: Okay, we are ready to reconvene. Mr. Collins, the floor is yours.

MR. JOYCE: (Inaudible).

CHAIR: He is a member of the Committee. We will go through the Committee first.

MR. COLLINS: One of you can go first if you want to, but I will go third and watch the clock.

CHAIR: Mr. Joyce.

MR. JOYCE: Thank you, Randy, for your consideration. At least there is someone here considerate.

I will get back to a few questions that were asked earlier about the VON in Corner Brook. It was stated publicly - by the Premier, by the way - that the money used was because of the new health care accord funding that they signed in Ottawa. It was said here earlier this morning that the funding was found in existing funds. Is that correct, that it was found in existing funds?

MR. SULLIVAN: That is correct.

MR. JOYCE: So, the strike went on for sixty days because there were no funds - the former minister. Now here in the Estimates it is being stated that the funds were found in existing funds.

MR. SULLIVAN: That is correct. There was no new appropriation of monies in the Legislature. That was money that was budgeted but -

MR. JOYCE: None of these funds came out of the new health care funds?

MR. SULLIVAN: Money for health care initiatives that were identified - one was in palliative care initiatives. Government felt it was important to move forward in that specific area. VON, even nationally, has a fair amount of expertise in palliative care and by moving on a project - and that project certainly would be assessed. There are allocations also in this year's money to continue one of the directives that came from the First Ministers' Meeting on the health accord to be able to move toward that. So there is designation in a pot of money this year, overall - palliative care is one of three intended uses of $2.1 million.

MR. JOYCE: I will make it very specific. Last year the funds were taken out of existing funds after sixty days straight.

MR. SULLIVAN: How long the strike lasted, I cannot tell you that and what it was, but I can tell you the money that was used last year was money that was appropriated and approved here in the House of Assembly and it came from the budget that was approved. There was no special warrant or new supplementary supply bills to pay for that. It came from money that was approved and appropriated for here in the House.

MR. JOYCE: I asked one of the officials: Would they confirm that in Corner Brook already there is what they call an End-of-Life Program and a Palliative Care Program existing in Corner Brook before this study was done?

MR. SULLIVAN: Yes, one of the reasons in that area was because they already had initiatives in that area. I do believe, and my officials can comment, they were more advanced in this area, in the Western region and other parts of the Province. That was a logical area if you are going to look at dealing with palliative care or end of life care, that would be the appropriate area to do a pilot.

MR. JOYCE: No, my question is: Would they confirm that there were already two programs existing in the Corner Brook region?

MR. SULLIVAN: That there are two prior to that?

MR. JOYCE: Prior to that.

MR. SULLIVAN: I will have to -

MR. JOYCE: End-of-Life Program and a Palliative Care Program.

MR. SULLIVAN: Well, I will have to refer that to an official to see if there were two existing. I think VON provided some palliative care service, to some extent, under home care.

MR. JOYCE: The two programs, one is the End-of-Life that was being offered by the community health Western and the other one was a Palliative Care Program with an extension to the homes offered by the Western Health Care Board.

MR. SULLIVAN: My understanding is the Western Health - and I will ask, to get confirmation of that. The Western Health Care Corporation, to my understanding, was in- hospital palliative care. That is similar to palliative care in here, the corporation one.

MR. JOYCE: No, there is also an extension to the home under a doctor's recommendation. There was an extension already in place. I know the officials are just checking back there on the books, so I will just wait.

MR. SULLIVAN: Under the Institutional Boards, you mean?

MR. JOYCE: Yes.

MR. SULLIVAN: Under the Western region, the Grenfell Institutional Board?

MR. JOYCE: No, under the Western Health Care Board.

MR. SULLIVAN: Yes, there are two boards. There was the Western Community and there was the Institutional Board.

MR. JOYCE: There were two. There was one under the community health Western, which was called the End-of-Life Program, and there was one under the Institutional Board called the Palliative Care Program. The Palliative Care Program also had an extension to the home, where they offered services in the home, if someone wanted to spend their last weeks or month at home. I am sure the officials know it.

MR. SULLIVAN: Yes, I will ask the officials. What I am aware of was that - I was not aware that the Institutional Board had one in the home. I was aware of the Institutional Board because one of the concerns in space requirements came up is getting a palliative care unit within the institution. That occurred over the last, I think, two years roughly, that they had accommodation there. Whether the Institutional administered one in the home, I am not aware of that kind. I will certainly ask my officials if that is the case.

MR. JOYCE: Well, it definitely is. Go ahead, sorry.

MS HENNESSEY: In January, 2002, there was a Palliative Care Program established at Western Memorial Regional Hospital. So, there is an in-patient service there and they do provide some support to the community.

MR. JOYCE: And to the homes?

MS HENNESSEY: Yes, support.

MR. JOYCE: They do, yes. That is the documentation that I have also.

So, my question is: Who made the decision to do a study in Corner Brook when there are already two programs? I can see why the minister resigned. Who made the decision? Was it a Department of Health decision? Obviously, it was not a Department of Health decision. Who made the decision to do it when there are already two existing programs in Corner Brook, confirmed here this morning?

MR. SULLIVAN: Well, there was an initiative with VON. They have expertise in the area of palliative care, and even the organization on a national level, to initiative a pilot project to look at that because it was one of the initiatives of the First Ministers' Meeting in a designated area for expenditure. We followed through on that in this year's budget and made allocations to continue to put some money into the end-of-life care.

MR. JOYCE: My question is: Why are you putting $150,000 into a pilot project when your own departmental officials confirmed this morning that there are already two existing programs? Who made the decision? Did the Department of Health make that decision? That is my question. Who made the decision?

MR. SULLIVAN: Any decision we make are made in government, and the Department of Health is a department of government. It is to look at a program that could, hopefully, encompass and be expanded on a provincial basis in that area. So that is the initiative behind that program.

MR. JOYCE: Okay. A pilot project, with two existing.

My next question is, there is $150,000 allocated in the budget. In a statement that was made in Corner Brook, by the Premier at the time, is that the VON could take off $50,000 for wages and settle the strike. Can your department here now - and I am sure you have it - supply me with a breakdown of what the funds were used for? What that $150,000 was used for in Corner Brook?

MR. SULLIVAN: You cannot run any program without human resources. Obviously, you have to allow for a salary component if you are doing a pilot project. That has to be built into it. There is money that have to go in to pay individuals who participate in that. So, you cannot run a project in the absence of any allocation for the human resource element.

MR. JOYCE: I agree with the human resource element. I have no problem with it, but my question is: Will your department now - if there is nothing to hide on this palliative care, if it is such a great pilot project, even though there are two already existing in Corner Brook - can you supply me with a breakdown of the $150,000? Because if someone is out giving home care, they are definitely not going to be involved in doing a pilot project study for palliative care. That is a given; that is already a given.

Will your department undertake here today to give me a breakdown of what the $150,000 was used for? How much of that $150,000 was taken and used to pay wages for home care workers to settle a strike because they did not want a golf tournament interrupted? Will your department undertake that here today?

MR. SULLIVAN: When things are completed - things are in the process of being completed. Within the next few weeks we will get a final report on that and we will look at the assessment then and respond when -

MR. JOYCE: Can I get the information? This is my idea of the estimates. If there is money in this budget, which your department confirmed this morning that it was taken out of this existing budget, the budget for last year carried over, that if there were funds used out of that budget - and here is the estimates and it is in there for general - that we should have access to what is in that budget and this is what the estimates are for.

MR. SULLIVAN: We did not have the number there, the exact amount for that. We said we would check on that.

MR. JOYCE: Well, I am telling you what it is, it is $150,000.

MR. SULLIVAN: Whether that is the amount that was expended is the next question. In the next few weeks we will have the report and the details and then we will be able to have specifics upon conclusion of that.

MR. JOYCE: Will the minister undertake here now to supply me with a copy of the breakdown of what the funds were used for? The appropriation of funds: what was used for wages; what section of the VON wages was for; the complete breakdown of the $150,000 that was committed to, give or take money - whatever, $5,000 or $10,000 - the $150,000. Would you take that undertaking, as part of the Estimates Committee, to give me the breakdown of that $150,000?

MR. SULLIVAN: We will follow up with - the Western Community Health Care Board is the one that delivers that money to VON. We can check with the former board and look at their expenditure, and they would have to depend on VON to provide a breakdown to them on how it was utilized. So, we will follow up on that.

MR. JOYCE: Can I get that or not?

MR. SULLIVAN: I cannot give you what we do not have. The Western board will have to get that. We will follow up to pursue that and see if we can get the answer to that from the Western board and the Western from the VON.

MR. JOYCE: With all due respect, you are here this morning saying that government made a decision on the HAY report under the Western board. So you do have control of the Western Board. You are telling me here now that the officials that are with you here this morning do not get a breakdown on how funds are spent in the Western region?

MR. SULLIVAN: I did not tell you that, no. I did not say that.

MR. JOYCE: Well, that is what you are saying. You have to check with them to see if they got a report. So, obviously, the report is going to be given to the Department of Health. Sure it is.

MR. SULLIVAN: When we get the report I said, in the next few weeks.

MR. JOYCE: Will I get a copy of the breakdown of how the money was spent? Yes or no?

MR. SULLIVAN: I said I will follow up with Western for them to get a copy from VON and follow up on that.

MR. JOYCE: Will I get a copy? Yes or no?

MR. SULLIVAN: I cannot give a commitment. I do not know if I am going to get it from them. If I get it from them, yes. We will follow up and we will pursue it and we will try to get these figures.

MR. JOYCE: So you are saying if the Western -

MR. SULLIVAN: I am not going to tell you something that I do not know if I can deliver on. I will endeavour to do that. That is what I will say.

MR. JOYCE: But with all due respect - and I do not want to belabour this. With all due respect, here you have just made a decision. Your government made a decision. You notified the board that morning - the chairman of the board found out that morning the decision was made, that Wednesday morning. Here you are saying that you have complete control of the decision because government makes the decision. Here you are saying that -

MR. SULLIVAN: What decision on Wednesday morning on VON?

MR. JOYCE: Not VON, on the -

MR. SULLIVAN: I thought it was VON you wanted the response on.

MR. JOYCE: No, the Chairman of the Board found out about the Hay report decision on a Wednesday morning out in Corner Brook.

MR. SULLIVAN: That has nothing to do with VON.

MR. JOYCE: It definitely has, because if you are in control, if you can make the decisions, obviously if you are spending $150,000, your department - I asked the officials: Will you get a report of that, or is that just $150,000 (inaudible)?

MR. SULLIVAN: I will answer that.

First of all, you are confusing two issues. The VON report is not connected to the Hay report, number one. Secondly, I will endeavor to get that through the Western Board that is now a part of the Regional Integrated Board from VON on their expenditure. We will endeavor to get that. That is what I have said.

MR. JOYCE: Will I be given a copy?

MR. SULLIVAN: If I get it.

MR. JOYCE: Okay, when you get it, perfect. I just want to be on record that the minister did confirm that I will get a copy.

MR. SULLIVAN: I cannot confirm that I am going to give something that I do not know if I can get it. If I get it, I do not have a problem with it. I have to get it first.

MR. JOYCE: The second thing, Minister, you were head of the Public Accounts for a number of years and you were very adamant about the expenditures. Will the department release to me today the tender process that it went through to give out this $150,000?

MR. SULLIVAN: Reveal the process?

MR. JOYCE: I am sure it had to go through a tender process.

MR. SULLIVAN: I said this morning that we are focused on outcomes, not processes. You have been in government. I am not going to talk about government processes and what decisions get made in Cabinet along the way. The money was made. It was a government decision. It got articulated out there, and that is all I will add on that. It was a government decision.

MR. JOYCE: Okay, it was a government decision, but I am sure, with accountability, as when you were sitting over here for years, the accountability is that it has to go through a process of public - why did the VON get it?

MR. SULLIVAN: I have answered that. I said one of the initiatives of the First Ministers' Meeting was to move in the End-of-Life Care, the palliative care. The VON has expertise in the area, both locally and nationally in this particular area. It was directed as one of the aims of the First Ministers' Meeting on health. That is why it went there.

MR. JOYCE: So there was no tendering done whatsoever for this $150,000 for VON?

MR. SULLIVAN: I am not sure of the amount, first of all. I will take your word if you say it is $150,000. We said earlier this morning, the officials could not tell you the exact amount and we would endeavor to get that number. Whatever that number is there, a decision was made to move into a -

MR. JOYCE: Was there any tender process done? A simple question, yes or no?

MR. SULLIVAN: Home support services are delivered under the community health boards, whether it is in self-managed, through agencies. The money channels out to those community health boards to deliver those services. They go out to these boards. If an individual wants care, they go to -

MR. JOYCE: Mr. Minister, this is not home care. This is the palliative care study that was done. It has nothing to do with home care. You just said it has nothing to do with home care.

MR. SULLIVAN: You are still providing the care at home for palliative care.

MR. JOYCE: My question is: Was it put out on tender, yes or no? It is a simple question.

MR. SULLIVAN: It is provided the same way as your government provided it previously, and our government has provided since, that any services given to home supports are channelled through the community boards in budgets for community boards. If someone wants to get care at home, whether it is End-of-Life Care because someone is dying of cancer, whether it is because they have some other ailment, we do not distinguish a specific one. If someone needs care at home, and it is determined by the people who do the assessment that they need care, they will go through a self-managed process or they go through a home support agency to get that care, and we do not question the medical ailment they have in getting that care. That is open there, whether it is people who need palliative care or whatever the reason may be. If the care is needed, it is done on that basis and we do not discriminate on the particular type of care, if the medical assessment shows that it is needed.

MR. JOYCE: A great bunch of garbage, but my question is, once more: The pilot project that was given out to VON, $150,000 to complete a study on palliative care for the Western region, or all of Newfoundland, however you want to put it, was it put out on tender? Yes or no?

MR. SULLIVAN: It was delivered in the same manner as all other programs are delivered in care by government, the same as your previous government and our government delivered them. It went through the community health boards, that is channelled through, and those community health boards, when the need is there, they deal with those initiatives.

MR. JOYCE: So the answer is no. So you have no tenders on file for this here?

MR. SULLIVAN: Home care is not tendered.

MR. JOYCE: It is not home care. It is a pilot project for palliative care.

MR. SULLIVAN: It is care at home. You might choose to determine it that way. It goes through the same process that was provided to us prior to us taking office and since taking office. There is a process.

MR. JOYCE: You did not tender it. Thank you, Minister. Thank you.

MR. SULLIVAN: You are quite welcome.

MR. JOYCE: The next question is on the Hay report.

Of course, the former Health critic when the Hay report was done in St. John's said, if you do not follow the recommendations it is a waste of money. I was just wondering, does the minister still agree with that statement that was made by the former health care critic, that if you do not follow the recommendations it is a waste of money?

MR. SULLIVAN: I am not going to conjecture on someone's statements. I will respond to my statements and what I say on my department.

MR. JOYCE: Okay.

Recommendation 172 in the Hay report is a recommendation that is causing a lot of concern for a lot of seniors in Corner Brook. Recommendation 172 is where long-term care patients are in acute care beds and they are waiting for placements in a long-term care facility. The Hay report recommended that they move to Stephenville, but, because of the recent and abrupt decisions made by the Minister Responsible for the Status of Women, this recommendation cannot go through because there is no physical space in Stephenville, because the recommendation by the Hay report was to move obstetrics and gynecology out.

Just for the sake of decency for the thirty-two or thirty three people, can the minister ask someone to do an evaluation? Because physically this cannot be done, but for some reason they still have to go through the process of embarrassing themselves, explaining why spouses can be separated, one put in Stephenville, how they can be separated from their children and whomever - because it physically cannot be done. Can the minister ask someone to do a quick assessment - because it is very easy to do - because there is no physical space to put them now in Stephenville, to have this recommendation taken off the table.

MR. SULLIVAN: The department will move in conjunction with the boards in achieving objectives that are reasonable and practical, and we will move forward in conjunction with that.

MR. JOYCE: That is nice and compassionate, Minister of Health, I must say.

The long-term care facility in Corner Brook, there is $2.7 million put aside. Where in the Budget is that, in the Estimates, for the long-term care facility?

MR. SULLIVAN: That is in a capital expenditure area. There are two areas there. One is $1.7 million under one type of service, I think, site operations, and $1 million is under Professional Services, I think, there.

Under 3.2.02.06. Purchased Services, that $1.7 million - I will check, just to make sure, but from my recollection - all that $1.7 million is related to long-term care in Corner Brook, and there is also $1 million grouped in with the $2.6 million up above that also relates to it.

MR. JOYCE: What number is that, Minister?

MR. SULLIVAN: Under 3.2.02.05., Professional Services, there is an amount there, $2.6 million. There is $1 million in that amount that covers the one in Corner Brook, and under Purchased Services, 06., all that $1.7 million is allocated to the Corner Brook facility. Both of these add up to $2.7 million. The $1 million is for design and site work, long-term care, and then the other one, Purchased Services, is for the site work at the facility, the other $1.7 million.

MR. JOYCE: Has there been a consultant hired for this yet?

MR. SULLIVAN: A consultant hired? I will refer that to my official. My understanding is that they are currently at the point now where the site selection is just about complete. Whether it is the consultant, you mean, on the design and so on? I will just refer that to the department. I am not aware if there is, or who it is.

MS HENNESSEY: As the minister said, the site selection is in its final stages and once the government makes that decision we will move forward to appoint a design consultant for that project.

MR. JOYCE: Okay, thank you.

Who did the site work evaluation? Who was selected for that?

MR. SULLIVAN: I cannot answer who did it. I do not know who did the site selection, if Ms Hennessey is aware, or -

MR. JOYCE: She is, yes.

MS HENNESSEY: SGE Acres Limited was the site consultant.

MR. JOYCE: Where is SGE Acres? In Corner Brook?

MS HENNESSEY: It is a firm out of Clarenville, but it has an office in Corner Brook.

MR. JOYCE: In Clarenville, oh yes. SGE Acres is out of Clarenville?

MS HENNESSEY: SGE Acres, their main office is in Clarenville.

MR. JOYCE: Interesting.

MR. SULLIVAN: I think Ms Hennessey indicated that the firm's main office is located in Clarenville and it has an office in Corner Brook.

MR. JOYCE: Interesting.

The site selection was supposed to be, and it was announced publicly that it was going to be, done by the end of February. Will that be done soon?

MR. SULLIVAN: Well, it will not be done by the end of February, but it will be done soon. We just said, both myself and Ms Hennessey indicated, it is in its final stages and it should be very soon. We have already said that just a couple of minutes ago.

MR. JOYCE: I know it was not done the end of February because it was announced twice that it would be (inaudible) and it was not done.

MR. SULLIVAN: It was. We would like to get it done as soon as possible, and that is progressing.

MR. JOYCE: Okay.

I guess I will ask the officials: How long will the design work take for a facility of this size? Is it $1 million? Will that do all of the design work?

MR. SULLIVAN: The $2.7 million is allotted this year. The $1 million and $1.7 million will not only get the design work done; it will also get some actual on-site preparation done.

MR. JOYCE: The $1 million, will that do all of the design work or just preliminary design work?

MR. SULLIVAN: I can refer that to an official, but my knowledge of it - and I will state that first and preface it, if they have more detail - is that it will complete all of that design, to my knowledge, and it will allow some on-ground site preparation. If somebody has more specifics than that, they can certainly relay them.

MS HENNESSEY: The minister's comments are accurate.

MR. JOYCE: That the $1 million will do the design work. How long would it take to design such a facility?

MS HENNESSEY: Design on these major long-term care facilities can take up to nine months.

MR. JOYCE: How much?

MS HENNESSEY: Up to nine months. Generally speaking, they can run around nine months.

MR. JOYCE: Once the actual construction starts, will there be extra money there for professional services for the actual construction, or is that built into the construction cost?

MR. SULLIVAN: There is sufficient money allotted this year to get to where we can get this year, to get this planning done and get the site and advance it. The $2.7 million was as much as could be expended, and we will deal with next year's budget then, the allocation to advance that. It is the number one priority, and we want to treat it as a number one priority.

MR. JOYCE: I am not an engineer, so I would not know - I am assuming not - can this go ahead with site preparation and with water and sewer unless the design is done, completed, or can it go hand in hand?

MR. SULLIVAN: Well, I am not an engineer and I am not going to venture to answer on a technical question, but I would assume some preliminary areas can. It depends on identification of the site, the service at the site, how far the location would be from the services. There are a number of factors that could play into that. A site hasn't been finalized yet, so it might be a little conjecture to be able to say that when we do not know about the site.

Can they go hand in hand? I would think in cases yes and maybe in some cases no. If someone has more technical information on that, they are free to answer.

MR. JOYCE: One more question.

MS HENNESSEY: Site work can go ahead at the same time that the detail design is being done.

MR. JOYCE: Okay, excellent.

My next question, and my last question, because I know everybody was so accommodating this morning, as usual: When do you expect to have the actual construction of this facility built? Is there any projection within the department itself?

MR. SULLIVAN: When it would be completed?

MR. JOYCE: When it would be completed.

MR. SULLIVAN: Well, our plan is to expedite it and move it as quickly as possible on that. How fast that takes, I am not an expert in that area but if one of my officials wanted to indicate what we could realistically get this completed in, based on what is allocated this year, if they wanted to pass an opinion on that - our goal is for government to provide sufficient funding to move this as quickly as possible. As to the logistics and details on a professional basis to get it to that, I am not qualified to answer that part of it.

MR. JOYCE: Okay.

MS HENNESSEY: Generally, once the detailed design work is done and site work is done, we are usually about two years from the time we commence construction to being able to commission and occupy the building.

MR. JOYCE: Okay, thank you.

CHAIR: Mr. Collins.

MR. COLLINS: Thank you.

Good morning. I apologize for being late. I will start off by saying, not to the acting minister but to the minister, I guess he had everybody concerned for awhile there, but I certainly would like to say that we hope he will be back at work soon and that he is doing all right.

MR. SULLIVAN: Thank you. I am hoping he will get back soon, too.

MR. COLLINS: I just have a few questions. I would like to make a couple of comments first. I would like to say that during this Budget and during the Budget Debate, on behalf of the people that I represent, I was certainly pleased to see a number of initiatives taken that benefitted people in Labrador, Labrador West in particular.

Number one, of course, was the medical subsidy to Goose Bay from Labrador West return. Something that we have been struggling for, for many years and we are very happy to see that that is in place. Also, the change that was made to the provincial non-emergency medical transportation, when people in Labrador have to come to the Island. Where the fundamental change is at now the first $500 is absorbed by the Province, rather than being the responsibility of the patient and the cost sharing taking place after.

In addition to that, I want to touch on the $200,000 study for the Captain William Jackman Memorial Hospital. I think everybody in Labrador West understands that there is probably no need of a study. However, we also understand that very few things get done these days without a study taking place. We are convinced, and we want to impress upon government that a new facility is needed. There have been many attempts over the years to try and band-aid the one that is there but it is gradually getting worse and worse all the time. So, we are looking forward to that study being completed and I think that - and other people in the area agree with me. I think we would be hard pressed to find an engineering firm that would go through that hospital and at the end of their study conclude that it is worth spending money on rather than building a facility that meets the current needs, present day needs of the people who live in the area.

I think the other good news in this Budget under the health care was the addition of a third MRI unit which will benefit everybody in the Province, no matter where we live, because the line ups for that and the wait lists are long. By adding the third MRI, it will certainly go a few steps towards eliminating, or at least reducing the wait times that people presently experience when trying to obtain an MRI for their health.

So, there are a few things I want to point out first before I get into anything else. A few initiatives that were taken in this Budget are things that I was very pleased with. From my own personal district, it probably contains more for health care than any other Budget in the past, that I am aware of in my thirty-three years in Labrador. But, we do have some concerns.

One of the questions I want to ask, Minister: What is the provincial plan for nurse practitioners in the Province?

MR. SULLIVAN: I will make a preliminary comment and then I will refer it to someone who has more expertise than I in that area. Overall, nurse practitioners - I guess the program arose and the Centre of Nursing Studies delivered through. In fact, I attended the first graduating class there.

There were areas in our Province where it was difficult to obtain doctors to go to, and by having someone train to another level could fill a certain void. Even in areas where there are doctors, nurse practitioners can work in other settings also with a higher level of training to assist in other procedures. In other words, to allow people to be able to practice - the scope of their practice should be in line with their level of training. As to deploying these people in areas where it is difficult to get a general practitioner; initially, there were a lot of concerns raised. People who have had the experience of having these there, I think have had very pleasant experiences and responses.

So, I guess in line with our ability to deliver services and that, we would certainly like to see the role move along quickly, but there are tremendous funding pressures overall everywhere on the system. We found, this year, opportunity. We did get about half of that from the federal government that channels through. We did put double that amount into health care needs this year and a lot in very important areas. So, we are trying to advance the agenda on that line, along with other areas, too; people to be able to practice to their levels of training overall. If there is something more specific on where we are heading, that we have on this issue, certainly, I will invite my official to comment on that, but that is in the general context of where we are going.

MR. ABBOTT: Mr. Collins, what we are doing right now is working with the four integrated health boards to get them to identify areas where the nurse practitioners can and should be working. What we are seeing more and more, the positions are being recognized as fulfilling the role in which they are certainly intended, whether it is in the emergency room, in the long-term care service, and in the various clinics around the Province. So our - really more of an approach than a plan, is to continue to work with the Integrated Health Authorities to make sure that those professionals are used, as the minister said, to their full scope of practice. It is taking more time than I guess many of us would like, but there is certainly a great acknowledgment across the Province that, in fact, is where the nursing profession is moving and we are encouraging it.

MR. COLLINS: Thank you.

I think one of the things that the minister said too, is worthy of note, in the sense that this has to be promoted. People have to be educated as to the abilities that nurse practitioners have and the high degree of training that they have developed to make it easier for the public to come on side as well and accept the fact that nurse practitioners can exercise certain responsibilities in certain areas. I think that would be an important part of any plan, to get the public educated and knowledgeable about what the nurse practitioners are really all about.

A couple of months ago the minister announced that a study would take place on gambling addiction in the Province. Can someone tell me what the status of that study is?

MR. SULLIVAN: I will just open by saying that there was $100,000 made available for that. I do believe it is in the process of moving - or where it is exactly. I will ask one of my officials where it is, but the intention is to have it completed, I think, by this fall is my understanding. It should be completed by this fall, but if there are more specifics, I will refer the specifics to one of my officials.

MR. ABBOTT: Mr. Collins, what we are doing right now is finalizing the terms of reference for the study; consulting with some people at the university. We will be going out with a proposal call in the near future to undertake that study.

MR. COLLINS: So, it has not started yet?

MR. ABBOTT: No, it has not.

MR. SULLIVAN: The funding for that is in this budget we are debating right now and which is before the Legislature. In the Interim Supply Bill - whether the Interim Supply Bill had funding, I cannot say specifically. I did not -

MR. COLLINS: Was that in this budget or was that announced by the minister? I thought that study was supposed to start prior to -

MR. SULLIVAN: Yes, we were going to do it but the money to carry it out - because it could not be carried out that quick, so the money for it has to be approved there. The decision to get it done was announced but the money to approve the funding of it is in this budget because it was not announced last - it would have to appropriated from last year's budget or a supply bill if the funding was not there and so on to advance it. But the money is in this budget for it.

MR. COLLINS: Did you say the Terms of Reference were already developed?

MR. ABBOTT: We are just finalizing those now, this month.

MR. COLLINS: Okay.

The Provincial Drug Plan. I have been asking you a few questions about that in recent days but, I mean, most other provinces in Canada have a provincial drug plan that their residents are able to take advantage of, particularly when they are faced with having to purchase catastrophic drugs, like those used for MS and Alzheimer's and other forms of illnesses. Why is it that our Province, over the years and now, still haven't developed a plan that would allow residents to avail of these drugs without forcing themselves - I mean we have people with decent jobs in this Province who get up and go to work every morning and they have to reduce themselves to income support levels. They have to spend any RRSPs they may have saved for their retirement. They have to spend any money that may have accumulated in an educational plan, registered plan for their children's education. They have to do all these things to themselves, then government will step in and help. I say to the minister, it is not a matter of whether or not the Province will help someone or not. It is a matter of what the Province requires people to do to themselves before they will help. Because once you have everything you worked for all of your entire life gone, then government will step in and help. Why do we continue to have that -

MR. SULLIVAN: Well, I guess one of the reasons is limited resources overall. Every province is not the same in what they provide and what they do. For instance, in our Province there have been two specific areas. One are people on income support who get the cost covered and the dispensing fee. Then there are the seniors, of course, who get the drug covered but they pay the dispensing fee. Then there are people who may be of low income that may - because of their expenses in other words - qualify but that is done on a needs assessment basis. It is my understanding -

MR. COLLINS: But they have to reduce themselves to income support levels.

MR. SULLIVAN: Yes, I was just going to make a comment. If there are specifics there or any further there - if my numbers are not exactly correct on it, my officials, I am sure, can correct me. My understanding is that under the current program, too, there was an income level to qualify of $13,800, and I believe that has increased to $20,280 now. I think we have moved about a 50 per cent increase in the level to allow some other lower income people to get in there. Would that be correct on that?

MS HENNESSEY: That is for child care subsidies.

MR. SULLIVAN: Oh, that is child care. Okay. No, I am sorry, that is child care subsidies. I am off on that one. That is right. If you meet the need as a senior, you must have the supplementary income - the old age supplement it is called. You would have to have that, and then if you are on income support you would qualify.

Well, it does vary for province. If we increase the base for higher income people, the amount we have will probably go from $114 million, who knows, up to let's say $130 million or $140 million, which means: Are we able to keep adding these other drugs on if you have limited resources? Our ability to finance them overall and you look at where we are fiscally, it is worse than any other province in the country. Nearly every other jurisdiction have balanced budget legislation, or balancing theirs, or drawing on a stabilization fund, or balancing within. If you lose one year you have to make up that difference the next year. We are the only jurisdiction that is running $500,000 deficit without balanced legislation, with one exception this year that got into a situation two or three years ago.

Apart from that, we do not have the means to carte blanche to do that because if we did, someone might have to pay the price on adding twenty-five new drugs we added this year and we might not be able to do that. Do we keep adding and try to make available ones that could advance the life of people and their lifestyle and free from pain, or do we lift the ceiling on people with certain income levels? When there is a limited amount to put in -

MR. COLLINS: If I, as an individual - say I have MS and I make $40,000 a year and my drugs cost me $2,000 a month. I have $25,000 saved up in RRSPs and I have $10,000 in a children's educational fund. This is the part that puzzles me. It is not a question of whether or not the government of the Province will help me with buying my drugs, it is a question of what I have to do to myself before they will. Because if I spend all of that money that I have saved up and reduce myself to income support level, then government will help. Then you will find the money, you will have to, but I have to inflict all that hardship on myself and my family from a disease that I did not inflict on myself. I mean, we have people leaving this Province. We have a person working in Wabush Mines, which is a damn good-paying job in this Province or in this country, who is looking at moving to New Brunswick for half the wages and be financially better off. I say that is sad, when a person has to make that big a sacrifice in their life. So, if I spend all that money that I have worked hard all my life to save, then you will help me. I am saying, why put that hardship on me? Because I will spend that money in a year or two. Why put that hardship on me and my family and then you will help me?

MR. SULLIVAN: I know. You know, it is a good point you raise. It does raise the issue should we fund, regardless of income, and fund all these? There are inordinate costs, and to be able to do it within our means. If we fund it unlimitedly in one area, are there certain other areas that are just not going to get it?

MR. COLLINS: Let me ask you this.

MR. SULLIVAN: I just want to make one comparison, if I could. I mean, if you look at other areas, let's look at long-term care as an example. You know, should we fund and pay for people in a long-term care facility, let's say, if they have $500,000 in the bank or if they have monies? Should we draw on their resources until they get down to a certain level, which is the case now, and then fund them, or should we apply care in a facility the same way, or should we look at drugs separately? I mean, there are legitimate questions that you ask, but there are decisions that get made, and if you do you cannot spend the same money twice. If you do that - it would probably be a positive thing to do - it has to be funded, and it has to be funded in the context of what you are able to pay.

MR. COLLINS: Well, two things there. If I am in long term and I am - it is not always the case, there are exceptions, of course, but by and large there are people who are at, sort of, the end of their lives, you know, towards the end. They are not going through the process of raising a family and having the responsibility of trying their best to educate their children, and all these sorts of things, so it is a bit different, but the long-term example that you use is a good point, because without the drugs that many people are going without, for MS in particular, and Alzheimer's, because contrary to what you answered last week, there are studies that prove - and the MUN study that was done, by the way, is looked at as a deficient study because they had a huge number of people.

MR. SULLIVAN: They analyzed another study, I think, that does analysis on the AD2000 study.

MR. COLLINS: Yes. They ended up with very few to base it on, but a lot of people with MS and Alzheimer's who are going without the drugs they need will probably end up institutionalized years before they would have to, or probably never have to if they had the drugs that would help them. So, I mean, there are added costs there down the road.

What I want to ask you, because we can argue about that all day, is: Would the Province consider looking at - I think there may be other provinces that have it - introducing a plan whereby residents of the Province can cost-share, co-pay, and the plan would be available? I mean, even people who have private plans would probably still - because private plans, we have some Cadillac plans in this Province, some damn good plans that still do not cover some of these drugs, so even people who are members of one plan may opt to join a provincial plan if it is broader based coverage and the cost of becoming a member of the plan is not astronomical. Could the Province look at a system whereby they can introduce a plan?

How many people get up in this Province each morning and go to work, work hard, and do not have a plan? How many small employers cannot afford a plan? Maybe they could buy into a provincial plan that could be developed along that line. What would be your thoughts on that?

MR. SULLIVAN: I guess there are a few points you mentioned there, like the co-pay thing, and then you have also - there are avenues, though, available where people are in a situation where they may have a certain income but it could deplete their resources. There are special authorizations of people to do it on that basis. They are assessed, and that is one of the other groups. While they may not be Income Support, they do have low income they could access.

When you look at co-pay, on a co-pay basis, if you look at specific areas, are you referring generally on co-pay basis? Because if you do it on a general basis and get into co-pay, what you do is, you take more middle and higher income people that are now doing it through other insurance and they are paying for it, and probably paying $1,200 and $1,500 and $1,800 a year and maybe more in cases, then they might gravitate to a public system whereby it would be less costly on them and a bigger overall cost on the whole system also, so we have to be careful. If we move to a universal access to it regardless of incomes, on a co-pay basis, we have opened up the doors for those 32 per cent roughly now, I think, of services now paid through private as opposed to public insurance and otherwise, you would start to see that in our Province come down dramatically and the public system accessed that would bring a whole new group of people into the system if it is done generally.

If you are referring on a more specific basis, there has been a fair amount of discussion on certain drugs, catastrophic drugs. I attended the Health Ministers' Meeting the weekend before last and when we looked at - the federal government is looking at bringing in a vote for catastrophic drugs. Now they call them - I think they have another name. They have not defined catastrophic, number one. I think they are called expensive drugs for rare diseases. The last terminology, I think, I saw them called -

MR. COLLINS: Catastrophic drugs are defined as (inaudible).

MR. SULLIVAN: It has not been defined. We are working under a National Pharmaceutical Strategy with all the other provinces to look at that. That was one of the discussions at the meetings of Health Ministers in the past while. That is an evolving process under that, and where it will get to I cannot predict, but there is an ongoing discussion and a National Pharmaceutical Strategy underway to look at it. Where it will end up, I cannot tell you exactly, but it is ongoing.

MR. COLLINS: On page 198, article 2.2.03.

MR. SULLIVAN: Under 2.2.03? Okay, just give me a second to get that. Page 198, Estimates?

MR. COLLINS: Yes, page 198.

It talks about Special Drug Programs: Appropriations provided for the display of drugs and accessories to residents with CF and other medical conditions.

MR. SULLIVAN: Yes.

MR. COLLINS: What does that -

MR. SULLIVAN: Well there are certain people who do not have to do an income test for CF and others; they get their full coverage for these, and cystic fibrosis is covered under that. I am getting the page now, first of all, to see the amount there. Under 2.2.01?

MR. COLLINS: On page 198, under 2.2.03.

MR. SULLIVAN: Under 2.2.03. Just a second now. Okay, under Allowances and Assistance there?

MR. COLLINS: Special Drug Programs.

MR. SULLIVAN: Cystic fibrosis is mentioned there. That is one of the conditions in which you are automatically covered on that. It is not done on assessment. Growth hormones is another one that is covered.

MR. COLLINS: Is that a new one?

MR. SULLIVAN: Would that be HGH, or some aspect -

MR. COLLINS: Growth hormones, would that be new?

MR. SULLIVAN: No, cystic fibrosis, to my knowledge, has been covered. There are areas covered in that for some time. Cystic fibrosis, as I can remember, I do not know when it came on the provincial program, but I am aware of it for a number of years to my knowledge.

OFFICIAL: The Smallwood days, I think.

MR. SULLIVAN: How many?

OFFICIAL: The Smallwood days, I think.

MR. SULLIVAN: The Smallwood days, I am told, but that is a long while ago. The reason I know that is that we were involved very heavily in some of my past volunteer experiences, the chief contributor to the Cystic Fibrosis Foundation in fundraising with service organizations I was with, so I was aware of the cystic fibrosis one, but growth hormone is covered too. I am not sure what other condition -

MR. COLLINS: Would that be the same as hormone replace drugs?

MR. SULLIVAN: No, it is growth hormone. I am not sure if it is the human growth hormone related to malfunction in the pituitary gland or one of the glands stimulated by the pituitary that affects the growth. They need injections, I understand, to be able to maintain normal growth because the growth hormone regulates the growth of the body, the growth of bone structure and so on in areas where the condition may exist. I would assume that is done at an early intervention stage, I would assume. I am not sure if it is continued to a certain age, I would think. If anybody has anything further - I just know from my bit of background experience on it. I do not know all of the specifics or what else is under that category.

MR. COLLINS: Could I get a copy of the other medical conditions that would be covered under the Special Drug Programs?

MR. SULLIVAN: Yes. I am not sure what other ones specifically. Neupogen is another one. Congenital neutropenia is a third one under that program. That is a condition of the neutrophils which is one of the types of white blood cells. They are the three that I am aware of. cystic fibrosis, growth hormone, and congenital neutropenia. Apart from these three, I am not aware of any others. Are there any others? I will ask my official if there are, but they are the three that I am aware of.

OFFICIAL: We will double check.

MR. SULLIVAN: We will check to see if there are any others.

MR. COLLINS: If there are no others, that is fine.

MR. SULLIVAN: If there are any others, we will get back to you. If not, you will take it as being the only ones.

The cost is like $850,000 in total. If there are, it probably would be to a very minor extent, I would think.

CHAIR: I would just like to remind the Committee of the time. We initially scheduled it from 9:00 a.m. to 12:00, and people have made some commitments around that time allocation.

MR. COLLINS: That is fine.

CHAIR: Any further questions from the Committee?

Yes, Ms Jones.

MS JONES: I would like to ask, Mr. Chairman, that we reschedule so we can come back. I have other question and I will need probably about an hour for my questions. I would like to do that at the minister's convenience.

CHAIR: Okay. I will ask the Committee, then, to leave it with the Chair to set up an alternate time to conclude the discussions.

Thank you.

MR. SULLIVAN: Thank you.

MR. COLLINS: Thank you.

CHAIR: Thank you, Minister.

I will have a discussion with the Committee members, the minister and his staff, to set up an appropriate time.

On motion, the Committee adjourned.

May 3, 2005 SOCIAL SERVICES COMMITTEE

Pursuant to Standing Order 68, Wallace Young, MHA for St. Barbe, replaces Kathy Goudie, MHA for Humber Valley.

The Committee met at 11:00 a.m. in the House of Assembly.

CHAIR (Wiseman): Order, please!

Good morning, Minister, to you and your staff. Welcome for the second time. You had so much knowledge to impart the last time, we had to come back a second time.

The Member for Cartwright-L'Anse au Clair reminded us this morning that if you had not had such a wealth of knowledge that you wanted to share with everybody we could have wrapped it up the last time, so a compliment to you and your insights.

MS JONES: (Inaudible).

CHAIR: I paraphrased a little bit.

As a Committee, we have circulated a copy of the minutes from the meeting of the Social Services Committee of April 26, where we had the first discussions around the Budget Estimates for the Department of Health and Community Services. Could I have a motion to accept the minutes as circulated?

Mr. French, seconded by Mr. Young.

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

On motion, minutes adopted as circulated.

CHAIR: We will start the second session on the Budget Estimates for Health and Community Services.

I think when we left off, the Member for Cartwright-L'Anse au Clair, and the critic for Health and Community Services, was about to start a line of questioning.

Ms Jones, with that, the floor is yours.

MS JONES: Thank you, Mr. Chairman.

Good morning, Minister, and good morning to your staff.

I have a few questions and I think I will start off with those around the health boards themselves. First of all, how much money is expected to be saved by the merging of the health boards, a decision that you made in the last year?

MR. SULLIVAN: With what aspect? Government structure?

MS JONES: Yes.

MR. SULLIVAN: Or the whole gamut over the -

MS JONES: If there are two figures, I would like to have both of them, one with regard to the structure and one with regard to overall.

MR. SULLIVAN: The only one we would have would be structure.

This year we budgeted approximately $7 million overall to the government structure in this budget.

MS JONES: How much is that in terms of savings by merging the boards?

MR. SULLIVAN: On this year's basis?

MS JONES: Yes.

MR. SULLIVAN: Seven million.

MS JONES: The savings is $7 million?

MR. SULLIVAN: Yes, on the projections for this year's budget. That is based on, I guess, transition on April 1, the fiscal year. There might be some erosion on that, if the process is slower coming together, but that was the amount that was put into the budget at budget time for this fiscal year.

MS JONES: You would not know what the transitory costs are yet, then, would you?

MR. SULLIVAN: No. At this point it all depends on when it happens. If it had to happen April 1, it would be different than May 1 or June 1 or July 1. It depends when it happens, and how fast the transition occurs.

MS JONES: Okay.

In our last meeting you indicated that the total deficit, I think, for the boards right now is around $125 million.

MR. SULLIVAN: That is correct. That is what I stated the last day.

MS JONES: Do you have a breakdown of the deficits by boards?

MR. SULLIVAN: Yes, there is a deficit breakdown. I do not have them at my fingertips. Is there any particular one that -

MS JONES: No, I would like to have a copy of all of them, please.

MR. SULLIVAN: Yes, we can provide a copy of that breakdown. I think I mentioned the last day that Western - the question was, it was $28 million total with the Western, and the total was $125 million overall. So I guess the other boards would be the balance of that, which would be about $97 million overall. It is there in the detail. If you want to take the time we can go into the details and find it and give it back to you before we finish here, but at the top of my fingers I would not want to give the numbers without making sure they are entirely accurate.

MS JONES: Okay.

This year, you guys approved $20 million to be paid towards board debt in your current budget. Can you tell me how that money is going to be distributed to the boards, in what proportion?

MR. SULLIVAN: That will be broken down in terms of the ones identified, I guess, having the greatest difficulty in balancing their budget. I would assume that would be the rationale that is used, if any of my officials want to comment further, but that $20 million was included to assist during the transition process until they can get together and be able to get their hand on the whole situation with the new boards. We put another $11 million of inflationary funding on top of that, too, to give the boards in this transition year so they can balance their budgets.

On a collective basis last year, the budgets, when they considered their strike savings, they were about $18 million short of balancing it when they took that into consideration, so this $20 million plus inflationary funding, too, which, I guess, was provided also of $11 million.

We feel that these numbers should enable the boards this year to balance their budget. If it has not been specifically earmarked at this point, I will have to defer that to an official to see what the breakdown on that actually is.

MS BREWER: On Budget day, we did give the boards a draft budget schedule and we did have that $20 million allocated by the four health authorities, so that information is available and was provided to the boards.

MS JONES: Okay, but you have not decided yet how that money is going to be paid out, have you, to what boards?

MS BREWER: Yes, we have actually used the $20 million. We have allocated it, and it is now part of the bottom line budget for each of the four health authorities.

MS JONES: Okay, so they have already been informed.

MR. SULLIVAN: Yes, we mentioned the last day, I think - I am not sure whether you were there at the time so I will just mention it again in case, I think, maybe one of your colleagues might have asked it. I indicated the last day that, for the first time ever, on April 1, all the boards had their budget. It has been sometimes into November when they have not had their final budget. This year they got a draft budget, including all the monies, and we did make reference to only areas that were under consideration. The rest of them, they got their draft budgets on April 1. At least they know, starting their year, exactly where they are and what monies they have at their disposal.

MS JONES: Now, I am assuming that the $11 million that was allocated for inflation was paid out on percentage to each board, was it, as a percentage of their budgets already? Is that how that was distributed?

MS BREWER: Basically, we looked at the history for each board in terms of what their inflationary experience has been on like medical (inaudible) supplies, and based on that, along with the $20 million, we did allocate the $11 million to the four authorities.

MS JONES: Can I get a list of what the overall budgets are, then, for each board this year?

MR. SULLIVAN: On that point, before we move to that, to further comment on your last point, when you look at what are the historic inflations, they may vary from board to board depending on the service and the equipment that is available; like, a tertiary facility may have a certain inflationary. It depends on the equipment and what your normal costs are. That is usually set through historic, which really reflects the equipment and the service that you are providing too. They are considerations that set that history.

You asked how much was put to each board? What was your question?

MS JONES: Yes, what I requested, and just for the Clerk to make another -

MR. SULLIVAN: How much does each board receive?

MS JONES: Yes, I wanted the list of what the budgets were for each board this year. The other thing I requested was the total deficits for each board in the Province.

MR. SULLIVAN: They may want to give the specifics there. I will just give the ballparks. If you want specifics, I think Eastern is around $800 million. They may want to give the figures. I think Western is a shade over $200 million. Central is just a shade under $200 million. I think the board for Labrador-Grenfell is about $82 million.

If you want the specifics, that is within just a few million of each one. If you have more specifics there I can -

MS BREWER: Eastern was $743 million.

MR. SULLIVAN: It was $743 million with Eastern.

MS BREWER: It was $191 million for Central.

MR. SULLIVAN: Yes, $191 million would be Central. Western would be a little over -

MS BREWER: The total was $184 for Western.

MR. SULLIVAN: Western, $184 million total, and $83 million, or $82 million-something.

MS BREWER: Almost eighty-three

MR. SULLIVAN: Eighty-two something.

Now, there are small amounts of money, too, to be allocated that could fill some of these areas, right?

MS BREWER: Yes.

MR. SULLIVAN: We mentioned that the last day, but that would just move them up proportionately depending on where that particular service need is.

MS JONES: Okay.

Also, in the last Estimates you said that you were working with the boards to look at a ten year strategy to pay down their debt that they have?

MR. SULLIVAN: Yes.

MS JONES: How far along are you in that process?

MR. SULLIVAN: The officials can comment specifically, but this year - at this point, early in the year - we have not asked them at this point because we provided money that we feel will give them a balanced budget. Over the course of this year, if they want to come back with a plan as to the details of that, or the specifics of that, I will refer that to one of the officials, but at this point, from my understanding, it has not advanced yet because they have, I guess, close to a year to be able to do that. If there are any specifics -

MR. ABBOTT: (Inaudible).

MR. SULLIVAN: My deputy informs me that is correct. It is not one of the most pressing concerns they have at the moment, because they have ample time to be able to work on that. I guess getting this year's budget up and getting it clearly identified, the distribution is the more immediate concern at the moment.

MS JONES: There was a consultant's report done on health care service and delivery in the St. John's region back a few years ago through the HayGroup, right? There was one done in the last year for Western Newfoundland and for the Northern Peninsula Board, the Grenfell Board. It is my understanding that two years ago there was one done for the Labrador Health Board. Have there been any studies done for any of the other boards, like for the Central Board, for example, in the Province?

MR. SULLIVAN: No, there have been no studies done on others. I will ask my officials. I am not aware of any other studies. They are the only ones to my knowledge.

MS BREWER: There has been no comprehensive study, to my knowledge, but I think within the Central region they may have contracted looking at, I do not know, say dietary services, a particular service. There might have been a particular review done, but no comprehensive operational review as was done in those areas that you mentioned.

MS JONES: With the report that was just done for the West Coast, the HayGroup report, government has already said there are a number of recommendations in that report that you will not move forward with. What about the other recommendations? Has the report in itself now been squashed all together, or are there still components of the report that government is reviewing?

MR. SULLIVAN: No, the board is going to move forward, and the department, and consult. They are going to look at best practices. In these types of areas there are always ongoing things. They are things that I think should be ongoing processes, more effective delivery of health care.

The department will work with the Western Board, as you referenced there, to look at these, to assess these and to see what is practical and what is not practical over the next number of months. That is the plan. That has not changed. They will do that. Certainly, the department will work in consultation with the board, and the board will go through their processes to identify if there are areas where there can be more effective use of services and they can deliver more services within the scope of delivering the ones that are there more efficiently. Those options will always get consideration. So the board will move forward in looking at these and carrying out their consultation process to see what is most effective in the delivery of these services.

MS JONES: You said that this Budget, this year, was offering up $63 million more revenue in health care for the Province.

MR. SULLIVAN: More revenue?

MS JONES: More investment, sorry; $63 million more this year being invested in health care. Was that what I understood?

MR. SULLIVAN: One-hundred-and-thirteen million more from last year; an extra $113 million. If you look at the last Estimates, the total is there. What it was last year, the amount on the last page of the Estimates, would be page - just a second now.

MS JONES: I have no idea why I have $63 million recorded in my notes. That is fine, I can look it up.

MR. SULLIVAN: It is in the Estimates book, it is 1.2.01. You will see it in the last page of the Estimates there.

MS JONES: So, of the $113 million, what portion of that would have been in new federal transfers?

MR. SULLIVAN: Federal transfers, out of that this year there is direct money - do you mean in federal transfers or money to meet federal objectives? Or federal priorities established?

MS JONES: Well, there was money under the Health Accord, new money that flowed to the Province I am aware of.

MR. SULLIVAN: Yes.

MS JONES: I thought there was some other health care funds as well under separate deals that were done.

MR. SULLIVAN: Totally, my understanding - and officials can add in. My understanding, the money that is specifically earmarked, out of that $113 million new dollars, $59.5 million of that is direct money that we got money federally to flow to programs - $59.5 million would be the amount - and the balance of up to the $113 million would be extra money that we just use from our own source revenues.

MS JONES: So, the other $40 million, $50 million or whatever, would have been put (inaudible)?

MR. SULLIVAN: That is right, that is additional.

The early learning and child care, there was an $11 million commitment overall, if I remember the number on that, of which $6 million would flow through this year in early learning and child care. I think that is one of the things that is in the media now. They are signing some agreements with provinces. We have not, as of yet, signed an agreement, to my understanding, on that. It did not occur, to my knowledge, prior to my taking over as acting - was signed. That is the one, I think, we are probably seeing in the media. There was one signed in Manitoba, I think, just recently. There would be $6 million in early learning and child care that would be delivered under a different federal department.

MS JONES: Okay. So, the other $48 million would have been provincial investments?

MR. SULLIVAN: That is correct. That is new monies that we just generated from our general revenues.

MS JONES: A couple of questions with regard to the Labrador -

OFFICIAL: (Inaudible).

MR. SULLIVAN: The $63 million you referred to there, I think that is just an increase in the Regional Integrated Health Authorities line, but if you look at the total budget on the last page of your Budget Estimates and look at the difference of what was expended last year, in the last Estimates page here in our Estimates book -

MS JONES: Yes, 201, is it?

MR. SULLIVAN: You go to the very end - I will just get that now, give me a second.

MS JONES: Yes, I have it there. I can see it right there. I have it right in front of me.

MR. SULLIVAN: Page 201. You can see $1.641 billion last year, $1.754 billion this year. That will be $113 million.

MS JONES: Some questions with regard to the Labrador medical travel program. This year you signed a new agreement with the federal government for investment dollars for medical travel in the North. Can you tell me how much that contract was or how much money you got from the federal government for that program?

MR. SULLIVAN: We did not get anything specifically from the federal government, other than what any province got based on their population for health accord. There is no specific agreement that we signed. Certainly, if any department wanted to add - but my understanding, I attended the First Ministers' Meeting on health care and the money we got for health care was based on per capita, 1.622 per cent of the population. We are just taking that from our regular health money to use for Labrador initiatives. That is not an in-and-out item. That is out of our pot of money. That is not over and above what we got for health care.

MS JONES: Okay, because that was not the way that it was perceived to me.

MR. SULLIVAN: That was our intention. In fact, at the First Ministers' Meeting I attended, that was an initiative which seemed to have the support at that meeting, to do a separate thing like would be done with the three Northern Territories, but nothing got transacted to give us extra money to cover that. In fact, we went so far as to look at potential costs in all of these areas there. So, that is just money that is taken out of our regular health operation. There is no new money for that. That is money that we just felt we should utilize it to level the playing field for some other people in Labrador where costs are higher, to take that initiative. That is not money coming in directly. If anyone in the department has information - I attended a First Ministers' Meeting on these issues there and that was the impression, that we were going to get that money from the federal government, but we did not get it. The deputy has informed me that nothing has happened since. We thought that we were given some understanding federally and we were going to get that money. In fact, that did not materialize. So -

MS JONES: What you are telling me is that the new money which was announced for the Labrador medical travel program is provincial money?

MR. SULLIVAN: Yes, correct.

OFFICIAL: That is part of the $59.5 million (inaudible).

MR. SULLIVAN: No, it is part of the $59.5 million we are using, sorry. It is not new money, but it is in the envelope of money that we announced. The six years for health care - the $284 million we are getting over the next six years, it is taken out of that money. It is no more over and above - when they struck a pot for health care and they took the population of our Province, it is 1.622 of the Canadian population, and we got our chunk of money out of that pot of health money, we did not get any add-on to cover transportation in Labrador and northern areas. We thought we would but we did not get it, and we have not gotten it to this point. We are hoping to be able to access some money for that. We do not have any commitments, and what we have we have. That is as far as we are.

So, that is money which we are utilizing out of our revenues really, but if you want to say it came from the federal government and utilize that, it is not over and above. It is exactly in our health money on a per capita basis that all other provinces received.

MS JONES: Now, the Territories do have a separate program for medical travel in the North.

MR. SULLIVAN: They do. The Territories have a different plan on all aspects on equalization too. They have a territorial financing formula. They have a different formula for financing areas in the North. I guess where they are unique areas - they have always had a different funding formula from the rest of the provinces and the country.

One of the cases we wanted to make on this was that: Look, our geography in Labrador is unique. It is way out beyond other provinces. When you look at the three Northern Territories and look at their population per area and their location and their transportation, they have to fly to just about all the areas in the North. Look at Labrador, it is way out there in terms of beyond other provinces, but not close to the Territories. So the Premier had made a case, that: Look, we should be looking at the cost of delivering services in northern areas. It should get consideration over and above what we would get, and we had hoped we would get that. We got some indication there but it was not delivered.

MS JONES: Yes. I am really surprised to hear this because I heard the Premier's interviews - in fact, I have transcripts of his interviews when he came out of the health summit in Ottawa. I believe it was in Niagara was it, or somewhere? I am not sure now.

MR. SULLIVAN: Yes, at the end of August it was Niagara on the Lake; in August of 2004.

MS JONES: Basically, what he said at that time was that they had become incorporated as part of the medical transportation program for the North and that there would be specific dollars that would flow for this program in Labrador. Of course, until now, I have never known the difference.

MR. SULLIVAN: Niagara on the Lake was a meeting of the Premiers and so on. It was not a meeting with the federal government. He got agreement there, among the other provinces, that this should be included. So, the other provinces of the country agree that Newfoundland and Labrador should get consideration for travel in Labrador. That got endorsed by the provinces. That was brought to the federal table, but the federal government have not provided that. Niagara on the Lake got provincial support for that, but, obviously, we did not get federal money for that.

MS JONES: That certainly was not the message that the Premier brought back home, I can tell you that.

MR. SULLIVAN: No, we had hoped, too. In fact, we received indications from the federal government that - we felt that would be included. We received it verbally but we have not received anything to that effect. We are waiting. There was a follow up. I know the Premier had done a follow up on that, since that First Ministers', to try to get this extra money and some commitment in some form. It is still an ongoing thing but we have not received anything on that other than - we got sort of a verbal commitment, but we are following up on that. We are hoping to get it, but we have no insurances they are going to give us anything on it.

MS JONES: Okay. Well, I guess we are -

MR. SULLIVAN: We would like to receive it.

MS JONES: My part in it, the program that is there is - don't get me wrong, it is much better than having nothing at all. That is absolutely true, but it is still causing a great deal of hardship for people simply because they have to pay all the cost upfront. The problem that we always had is them coming up with the money to pay the cost upfront. We will monitor it for the next year and see if there are more people meeting their appointments instead of cancelling them and things like that, and see if it has improved it, but I am really disappointed to know that there was not a specific program earmarked for medical travel in Labrador.

MR. SULLIVAN: I am very disappointed too, because we were led to believe we were going to get that from the federal government. We are disappointed we did not. One thing on that program overall - what we looked at. This program, what we did this year, we went - a couple of things, in particular, for Labrador residents. One was including Labrador West with that $40.

The second thing we did - anybody else in our Province, if they are going to travel outside the Province for medical services or in Labrador having to travel for medical services, everybody else in the Province, from the most isolated region of the Island, have to pay the first $500 upfront and they will get 50-50 thereafter. Anybody on the Northern Peninsula, down on the South Coast, isolation, or in any other area, but for the people of Labrador we put it in, because of the uniqueness of the area, that government pays the first $500 and then they split the next fifty. Anybody else will have to pay the first $500. We have a program that we put in, recognizing the uniqueness, the geography and the cost - that the people in Labrador have a program, because of their geography and that, which is superior to the program offered on the Island portion of the Province. That is a step that we took this year on that.

Your colleague from Labrador West said it was the best Budget he has seen for this area of Labrador in some time since he has known.

MS JONES: Yes. Well, he is certainly entitled to his opinion. I do not share it, but what I will say is that on the medical transportation program, I am pleased with the improvements that were made. But, I expected far more, simply because I thought it was being funded under the national program as part of the medical travel program for Northern regions. I had looked at what was being offered in the Territories and, I guess, our expectation was that we would expect a program that was very similar to that. This program does not reflect that at all, of course, and you would know that.

MR. SULLIVAN: No. I want to add, even though the federal government did not deliver on that we still put a program in that was superior to the rest of the Province, in spite of not getting the extra funding to do that.

MS JONES: I understand now.

MR. SULLIVAN: Any money we got on the northern program we would have channelled every single penny, just like we are doing on the First Ministers' money, into the intended purposes of that money. We went beyond by using money that was not dedicated to northern travel. We dedicated extra money to it that was not specific money that we necessarily received for that specific purpose.

MS JONES: I am surprised that government did not make any public announcement with the fact that the feds have withdrawn their commitment on that program.

MR. SULLIVAN: The federal government will have to indicate they have withdrawn their commitment. We are pursuing it. We do not know if they have withdrawn it. We do not know if they are going to deliver on it. That is an issue that we certainly hope the federal government will provide funding for. If they do, we will channel it to its intended use for that program, every single penny of it. But, when you don't have a commitment it is hard to channel money for a purpose when you do not have a commitment from the source on that. If that does materialize we will make sure that everything gets channelled for that purpose.

MS JONES: Has government given any consideration to paying out reimbursement under that program for people who drive to the hospital?

I had a situation last year where I had a cancer patient who lived in the Labrador Straits. They had to come in here every six weeks because of the nature of the condition. For a while, during the winter they rented an apartment here and they stayed here, but from May until the end of November they used to drive back and forth every six weeks because it was cheaper than flying, and she needed to have someone with her when she came here. They could not claim any of that expense because they had driven every six weeks as opposed to flying.

MR. SULLIVAN: Well, that program - in fact, friends of mine, two years ago, had to come in and rent an apartment, which they really could not afford. One of the family members had to pick up the cost. They submitted it and they did not qualify either. I know a lot of people, whether you drive from Port aux Basques or The Straits, or anywhere in the Province, it has not been provided under the program. If you expand the scope of that and increase it, I guess there are so many dollars you put into it; it has to come from somewhere else. Maybe there are other important areas, too, that it could get challenged.

If we had unlimited resources and revenues, we could do a lot of things like that, and numerous other pressing areas also, but within the scope of what we had in our budget this year, and to be able to put $113 million extra in, even though half of that, or around half came from the federal government, still we have pushed the health care budget this year immensely well beyond any other areas, if you do a comparison of budgets.

We have extended a lot of things in health care this year from twenty-five new drugs and in a ton of areas. I will not go into naming all of them, but tremendous not only in capital but also in service. The five main areas identified we put significant resources into - identified at the First Ministers' Meeting. In those five specific areas we put a significant amount of resources. The continuation of these resources beyond the commitments, too, of course, builds our extra base of expenditure that is going to go on forever.

MS JONES: Okay.

You have mentioned the drugs. I have some questions on that, so I will move into them now. Why was there no funding for the drugs for Alzheimer patients in the budget, although you added a number of new drugs to the formula this year?

MR. SULLIVAN: The expert advisory committee brings recommendations on the effect of what would be the priorities that we should focus on. There are a lot of priorities. To somebody needing Aricept, that might be their biggest priority. We acknowledge it just was not as high a priority as other particular ones.

Just to give some background on it, why it was not a priority, well, that is not a decision made at a political level. That gets made at a professional level. Some of the questions asked to me in the House, too, well other provinces have all come on stream with it. Well, I know there are provinces looking at now whether they made the right decision and they are reviewing it. Ontario is one, for example. It was recommended by the expert committee that Aricept be added to the list, and there was an AD2000 study that was published in Lancet in 2004, I think, probably in February, that indicated that looking at the study that occurred after this recommendation by the expert medical committee, that it does not delay institutionalization, and there is minimal, basically, if any, benefit. There is an epidemiological group at MUN that looked at the results of that and came to the same conclusion.

The provinces that brought it in, I would say, someone brought it in under public pressure. They were all done around election time, and now they are reassessing whether what they did was right or whether it is the best use of those dollars in there. They are decisions that I think are best left to medical professionals and so on. I think that gives a little background. We do not question expert advice as to what are the priorities. We are not saying it is not on a priority list. There are so many get on a list. You try to fund the highest priorities to effect the greatest result and get the best outcome, and they are some of the decisions made by adding these new twenty-five to the list.

MS JONES: Who is your expert committee? Is it internal, in the department, or external, in the Province?

MR. SULLIVAN: That has been ongoing. Who is on it? I cannot tell you who is on it. I can refer that to an official. I know there is an Atlantic Provinces advisory committee that looks at ones to add to the program and to the formulary. There is an Atlantic Provinces group, I understand, and we are part of that group. Advice comes, and I guess our own individual Province makes their decisions based on recommendations and based on what the priorities are and, I guess, based on how much funding you want to put into it overall.

Any specifics, I will certainly refer that, how the committee itself functions, if there are any other more specific questions. Did you want more specifics on the committee?

MS JONES: Well, I want to know who the expert committee is because, if it is the Atlantic Provinces group, all the other Atlantic Provinces have already added those drugs to their formula.

MR. SULLIVAN: They have, and I indicated why (inaudible).

MS JONES: They must have done it against the expert advice, or we did not heed the expert advice.

MR. SULLIVAN: No, the expert advice was also prior to - the expert advice did come, actually, I understand - the expert advice committee was recommended, I do believe, in 2003, with the former government, I understand. It was recommended to the former government and they did not put it on the list. We reviewed that, and information has come since, of a clinical nature, and studies, that did not place it and recommend it on a priority list because the result is there is known delay in institutionalization, and there is minimal benefit derived from it. This came subsequent to the Atlantic Provinces recommendation back about two years ago. That is when that came, so I can speak why we did not add it to the list. I cannot speak why a former government did not add it to the formulary. I know you were a minister at the time and you might know about that than I would, but I can speak in our view. We did not add it based on it was not on the recommended priority list.

MS JONES: I can only remember the last time we looked at it, and that was at that time before the Atlantic Review Committee. They had not finished the work that they were doing and we were awaiting a recommendation. I think the recommendation came late in 2003, if I can recall correctly.

MR. SULLIVAN: Last year, in the 2004 Budget - if an official wants to comment - we looked at a restraint budget last year in 2004. There was only one added to the list last year, and that was Gleevac, to my knowledge. That was the only one added, a cancer drug, in our 2004 Budget. We said we would restrain, we would put a halt from capital structure to a whole host of array of things. Then we came back and looked at, this year, adding twenty-five more to the list.

The only ones added in the last two years since we were there were the twenty-five just added, and Gleevac last year. As to what happened prior to that, I will say that in the 2004 Budget there were none added to the list. It was basically because of our fiscal situation; we could not afford to increase budgets. We put the brakes on, and then we looked at it this year and added twenty-five.

Prior to that, I was not there, we were not in government, and I would not be able to comment on that, unless my deputy or somebody would have more of a history of that than I would.

MS JONES: Can you tell me if there was a drug called Plavix added this year?

MR. SULLIVAN: Yes.

MS JONES: There was?

MR. SULLIVAN: Yes.

MS JONES: I had calls from a patient who was on that drug - actually, in the last two weeks - when they went to get the drug, they still were not covered. What is the situation with that? They still had to go through a special authorization process through the Department of Health in order to obtain the drug.

MR. SULLIVAN: Well, it is not uncommon to have certain drugs under special authorization.

MS JONES: I realize that, but I thought that once they were added to the formula they would be accessible to the patient like any other drug that they would have been prescribed.

MR. SULLIVAN: Yes, this one was added. Some, obviously, were added under open access, but there are certain ones added - just because they are added does not mean they are added under open access. Some are added under special authorization. This one was added under special authorization.

In fact, we have had drugs that were added - one, in particular - to the list that was added to open access just a couple of years ago in one of the medications, subject to a review by a committee. When that committee reported on one specific one, it was recommended special authorization, so that reverted to special authorization then. There is an ongoing, I guess, assessment, but this was added on a special authorization basis.

MS JONES: Why is it, when drugs are added, they are not all open access? Once they become covered through the provincial government, under your program, why is it still required for special authorization?

MR. SULLIVAN: I will give my opinion and then if an official of the department wants to give theirs, the reason is because a lot of drugs that are added sometimes are more expensive drugs. If another drug, or some other generic, can get the same response for that patient, why use the more expensive when you can get the same medical outcome based on one that is not as expensive?

If other drugs could be used that are not effective and are not getting the outcome that you desire, the doctor may then sign for a special authorization because this drug, based on your chemistry and your system, is the only one that could be effective in getting that particular outcome or treating a medical condition.

Every system does not react the same to drugs. A cheaper drug or generic might be more effective. Why pay a higher price? Because somebody else is going to be deprived somewhere along the way of certain access because of limited dollars if we do not use the most effective use of particular drugs that are available.

MR. ABBOTT: In the case of Plavix, the conditions on that are very, very specific. It is intended for a short period of time and not to be used on extended treatment. You would have some of those issues that the physician will work either with our pharmacy group or with our medical consultant to ensure that we have the right approvals. It is a precautionary measure more than a cost measure in terms of how we administer the program.

MS JONES: Okay.

I have a situation in my district that has become more of an issue in the last year. I do not know, it has probably been a problem for a couple of years, but it has really only been brought to my attention within the last year.

Right now, in my area of Labrador, any specialized drugs for cancer patients, MS patients, that are very expensive drugs, as we say it, have to be done by mail order. They cannot pick them up at the local clinics any more. There are no drugstores in my district at all, so that is not an option. They have to do mail-order drugs through a pharmacy somewhere in the Province.

Up until apparently a couple of years ago the drugs were provided through the clinics in the region, and, for some reason, they are not being provided any more. They are saying it is because of the cost of carrying the medication or whatever.

I ran into two cases this year, one from a patient who had prostate cancer and the drug that they were taking was, I think, like $1,000 a month or more cost for the medication that were on. They could only order it in small supplies because they could not afford to buy it at a full month's supply. The other case that I had was a young girl who was a MS patient, a young mother, actually, of two children, and the drug that she was taking, I think, was $1,500 or $1,600 a month. She could only buy her medication in a one week supply. We kept running into problems where she was doing a mail-order drug and the weather was down for, like, almost a week, she could not get the medication in, and she started having to go without the medication, which caused her more complications and ended her up back in the hospital and all the rest of it.

I am wondering, is this a decision of the Department of Health or would it be a decision of the board? How do we fix it so that if there is a patient - and, believe me, there is not going to be a lot but, you know, you might have fix or six at any given time in my whole district who are on a specialized drug. Is there a way that we can have the medication provided to them through the local clinics whereby when they pick it up they pay for it and they do not have to have it ordered by mail and run the risk of not having the airplane get in, or the mail get in, and all this kind of stuff? I do not know if there is a way that we can work that out. I know it would involve carrying medication at the clinics that would be very expensive medication, at least a month's supply at a time.

MR. SULLIVAN: Just to make sure I understand what you are indicating, normally the clinics would carry that inventory of that particular drug? Is that what you are saying? Or, would it be forwarded to the clinic for that designated individual?

MS JONES: It would be forwarded for that designated individual.

MR. SULLIVAN: To the clinic?

MS JONES: No.

A few years ago, what used to happen - say if I was on a MS drug and I lived in Mary's Harbour, okay?

MR. SULLIVAN: Yes.

MS JONES: What would happen was, once I was diagnosed and the drug was prescribed to me, then the clinic would always have that drug -

MR. SULLIVAN: An inventory of that drug there.

MS JONES: - in inventory, for when I needed it, so I could pick it up every week, my prescription. I would still have to pay the same amount of money for it, and I would pick it up every week.

What happened was, apparently - now, the only understanding and explanation I got was from the actual clinics themselves. They told me that they were informed because the drugs were so expensive that the decision had been made that they would no longer carry them in their inventory for a patient. So it was now the patient's responsibility to get that drug. That is fine if you are living in an area where you have a six-day week air service. We are in an area where last year we were down to two flights a week. If the weather was bad on either of those days, we did not get any air service. That could happen again this year. I do not know. We have it sorted out now for the next few months, but it is really up in the air and you are dealing with a private company.

In the meantime, this woman ran into all kinds of problems trying to get her medications. She did not have the money to order in a two week supply or a months supply because they just did not have the income to do that. She had to buy it on a week-to-week basis. In order to buy it on a week-to-week basis, if she did not get it every single Friday or Monday, whatever that day was, she had to go without the drug.

MR. SULLIVAN: Yes, okay. I would assume that those programs are delivered through the boards. I would think they are not a direct department. I mean, that would not change her situation of course, but in areas like that - I was not aware of that. It has not been raised before, that I was aware of, but it is something that we could follow.

If someone is not able to get their medication because of, whether it is inclement weather conditions or availability, it is certainly an area I can take back to the department for follow up to the boards. If any of the officials have been aware of situations like that, from backgrounds that they want to comment on, or if they are aware of instances like that, I would certainly like to hear their comments on it also, to see if there is an avenue to be able to ensure medication is available.

MS JONES: Yes, and if you want, I can just forward it to you in writing to have it for more detail.

MR. SULLIVAN: Yes, we would not want to get into personal ones, but on a general basis, if an official has a comment - if not, you could forward it and we could do a follow up on that specific one.

On that too, that would not be something that our department necessarily would be aware of because boards operate out there and sometimes their certain practices change. We are not always aware unless an issue was raised that there are certain practice changes out there. Boards deal with numerous things under their jurisdiction. They have the autonomy to do that without coming to the department.

MS JONES: So, I really should be addressing this to the board, is what you are saying?

MR. SULLIVAN: We can follow up on that if you want to get the particulars, but I am not sure if any officials are aware of that from my department. There are none aware of the situation. So there will be a lot of operational things, procedures and practices that would occur at boards that the department would not, I guess, ever be able to know what is happening on a day-by-day or week-by-week basis in all these instances. So it would be, yes, an issue that would be dealt with by the board, but if you want the department to follow, we will get the information in and we will have someone forward it to the appropriate board for follow-up.

MS JONES: Okay. There is a request that has been into the department for kidney dialysis equipment for Goose Bay. As you know, there is no kidney dialysis in the Grenfell Labrador Authority area. Is that something that is being considered by government?

MR. SULLIVAN: Yes, there is a provincial expert committee - nephrologists, who are kidney specialists - who look at areas where prior needs would be. When setting up the stations, I guess, there are some main units in our Province. For example, in Corner Brook, Grand Falls-Windsor, here in St. John's at the Waterford and at the Health Sciences. I think there are two sites here. There still are, I think, to my knowledge, and then there is satellite.

Setting up satellite stations is important. It is not only a matter - it is done based on medical advice and what is safe and best for the individual. It is not based on a number, if you hit a magic number you will get one. It is based on the availability of medical people to be able to administer a satellite in a safe environment with the best interest of the individual, the patient or the person getting those services. So, that is an important consideration. That comes from an expert committee. Usually, in those satellite stations, they are in locations where they do not have a nephrologist, or probably an internist, who would oversee this particular program in line with a regular one where they would be in contact with, and so can be administrated safely under a program. Usually when the needs are met and there is an available team and available resources there - it has been indicated and said that we have ten or twelve. Well, I guess, looking at numbers to be set up for a safe environment and best interest, it is done on a medical basis. It is not done on a numerical basis. Even though it is utilized and have available people around, I guess there are certain dynamics that may come into consideration, but the consideration on whether it is done has to be based on medical need and what is best and safe for that particular individual. So, they are considerations.

If Labrador, for example, moves into that, where that is recommended by the committee that it should be, that is one that would be given the consideration, the same as other areas in the Province. Also, the Burin Peninsula was a case. They are the two areas where it has been raised. Maybe in the future if it gets to that level and the recommendation is there, government will consider that advice and deal with it, but it has not been on the list for that at the current time because it has not come as a recommendation on that basis.

MS JONES: From whom? The board or from the kidney specialist?

MR. SULLIVAN: No, there is an expert advisory committee who sits on the committee. There is a provincial - I guess it is called a provincial kidney or dialysis program committee. A provincial -

OFFICIAL: A coordinator.

MR. SULLIVAN: A coordinator for the Province, and they look at the whole region. Because, I think, back about two or three years ago - I am just taking this from my knowledge now. I guess prior to us coming into government there was a committee established, about - I am not sure how many years ago. Maybe three years ago? Approximately, I would think, just from my knowledge of it, because we were in Opposition, I know, and I was aware that a committee was established, a coordination.

So, decisions can be made based on medical advice and what is best rather than doing geographical areas and using it as political means to put equipment out there. It was done with the intent of putting it in areas where the best service - and that is one, certainly, that predated us but we followed that, and the committee. We take seriously the recommendations of the committee and medical basis upon which decisions are made. So, that is (inaudible).

MS JONES: Who is the coordinator? Can you tell me that?

MS SULLIVAN: The coordinator is Cheryl Harding.

MS JONES: Cheryl Harding?

MR. SULLIVAN: Harding, H a r d i n g.

MS JONES: Where does she work? Where does she work, out of the department, the Health Sciences?

MS HENNESSEY: She is actually employed by Eastern Health but she provides provincial advice through the department.

MS JONES: So, she works over in your department over here?

MS HENNESSEY: Yes, she is physically located in the department.

MS JONES: One thing I am going to mention to you, and I do not know if there is a way - like, I know the Department of Health, I am sure, talks to the boards all the time about how they can be a little bit more effective in some of their services. One of the things I find that I run into a lot in the Northern area, meaning like the Goose Bay-St. Anthony area, is that now they use this - I think it is called the PAC System for CT scans.

MR. SULLIVAN: Yes.

MS JONES: They do all the scans and they send them out through this system to the Health Sciences to be read because there is no radiologists or whatever in those hospitals - or most times there isn't because they are vacant positions and they have trouble recruiting people - but it seems like there is a long time delay in getting the results read and back. That is a complaint I often get from patients, especially in the St. Anthony hospital. I do not know if there is a way that there could be a little bit more efficiency in the service, whereby the ones that are coming in over that system from the rural hospitals, if they could be looked at a little bit quicker than three days or something like that. Especially when it is situations that you do not know what the cause of certain sicknesses or illnesses might be and things like that.

MR. SULLIVAN: It is a matter of dealing with, I guess, coordinating and what the workload is at any particular time, I would think. I guess they would have to be examined by a radiologist.

Yes, the PACS, Picture Archiving Communication System, I think it is not just a transmission - also for reading purposes. I think it is transmission for retrieval too, to examine in a specific area. The system can be communicated digitally.

With the specific thing that you are mentioning, I would assume if they are directed to a coordination in an area - I guess what you are saying is that if they get in at a certain point to speed up the process, we could follow up on that because I am not sure what the backlog is, regardless of where you live - if you are in the City of St. John's, or you are living in Carbonear, or whether you are in any rural area of the Province - what the wait is here. If the wait in here might be five days, or two or three, I would hope that circumstances would dictate similar responses, regardless of where you live, that there would not be a delay from where it originated. We can certainly follow up on that point. I don't know if any members - but that is something, I think, would be coordinated through the Regional Integrated Health Authorities. I would assume there is more than one site where these are done. I would assume a major hospital, like the Western region, might be channelled into Corner Brook, would they, with the radiologists there and central? Probably most would get channelled into the Eastern region here because of, I guess, the larger availability of radiologists and the larger area, and the availability to be able to deal with more patients.

MS JONES: Well, I just wanted to make that suggestion. I do not know how many rural hospitals have to do this, but I know two that I am familiar with. I get calls from family members of patients all the time saying: Well, such and such, he has been there now three or four days. He had a CAT scan. We have not heard anything back. Is there a way that this could be a better process?

MR. SULLIVAN: Yes, in our budget this year, my understanding - and officials can correct me if I am wrong - is that the Western, I think, and the Grenfell and Labrador areas did not have a PAC System that was fully functional. It was not complete. We provided money in the Budget this year - I believe it was $4 million, if I remember the amount correctly - to be able to expand the services to bring them on stream and to be able to advance the system in areas that do not have it. So, that is probably because the system was not previously available there and we met a budgetary amount of money - I will have an official check the amount while I am speaking, but the number $4 million came to mind.

OFFICIAL: Four million dollars.

MR. SULLIVAN: Yes, I have been informed that $4 million new investment in the PACS to move it into those areas and, hopefully, that should be able to solve that when that system is fully operational.

MS JONES: Okay. I was not aware that it was not fully operational, to be honest with you, because they have been using it for two years.

MR. SULLIVAN: My knowledge is that Western, Grenfell and Labrador were not fully operational. Would that be correct?

OFFICIAL: Grenfell had a minor solution, so that is being enhanced, and Labrador did not have a system.

MR. SULLIVAN: Grenfell had a minor one that is going to be enhanced, I have been informed, and Labrador did not have one at all. The $4 million, hopefully, will bring all the Province up to a standard and advance that so we will have a much better system of communications with picture archiving.

MS JONES: Okay. Just a couple of more questions before I finish.

In the last Estimates one of my colleagues was questioning about the money for VON. You guys were not sure, at that time, how much money was allocated to settle the strike with VON. Can you tell me now?

MR. SULLIVAN: Yes. Your colleague mentioned $150,000. We checked that since and the amount that VON received - there was $120,000 put in the program. There was a coordinator who went with the Western Health Community Services, and that was roughly $40,000, and there was $80,000 actually ended up going to VON to do this pilot project on palliative care. It was not $150,000. It was $80,000 that went to VON. Maybe you can pass that to your colleague because he asked that question.

MS JONES: Yes, I will.

MR. SULLIVAN: That is the number I think I used. I thought it was in the $70,000 to $80,000 range initially, and he informed me it was $150,000.

MS JONES: Okay. The other question that he asked was: How much then of that $80,000 would have been used for wages or salary increases?

MR. SULLIVAN: Well, that is something you should ask the VON, that question. We would not be able to answer that because their project was done dealing with palliative care. They were going to do a report and come back with a report - that is due in a number of weeks now - and, hopefully, prepare a model for palliative care for the Province.

This year we did budget as one of the emanating, I think, from the 2003 First Ministers' Meeting, I believe. One of the areas was End-of-Life Care and palliative care. We looked at budgeting this year, in our Budget, to deal with End-of-Life Care, $2.1 million, and that would go towards, overall, home services of which End-of-Life Care was one of those three specific areas that were targeted under that umbrella. So, that is ongoing. We are expecting a report and, hopefully, see if there is some model for the Province in palliative care that could emanate from the conclusion of this pilot project.

MS JONES: Minister, I have been informed that there are three doctors who are leaving the Carbonear hospital; one who has left the Corner Brook hospital and two who have left the St. Anthony hospital. Do you foresee another problem with recruitment of physicians? It seems like we have been doing alright for a little while but it seems like there is more of a turnover again now. Is this an issue for the department at this stage?

MR. SULLIVAN: Well, we have, just last year alone, seventeen new physicians. Before that, I think we have added, it must be, about fifty to sixty new physicians in the last two years, and the numbers of people. That is why we had to come to the House with a special warrant. We had to issue a special warrant the department had. We tabled it in the House for discussion because the number of physicians had increased immensely since the MOA was signed at the end of September, 2002. We had a significant increase in the number of physicians in our Province. That is why, of course, our budget in those areas went up.

We are very much aware of physician ages and stats and monitoring. I am not aware of anything out of the ordinary. We have seen an increase over the past two years; a significant increase. So, hopefully, the numbers we have are being maintained. There might be some need that the ratios might be a little different of physicians to general family physicians. The specialist ratios might be a point one away from national standards but, in some areas, you might look at specific areas where we are adequate. Other areas we may not, but I guess it is hard to recruit specialities and sub-specialities sometimes. There is always some difficulty, but I think it is probably better than it has been in some time, to my knowledge. If any of the officials wanted to add further specifics to that, feel free to do so.

MR. ABBOTT: Ms Jones, the challenge for us here in the Province, interestingly enough, is not recruitment. Now, there are some issues but we are able to attract new doctors in either out of the medical school or from outside the Province, and the minister referred to the additional doctors who came on stream this year.

The perennial challenge is around retention in the areas you identified and others in the Province. They are the issues that we are working with the Medical Association on. In terms of the quality of life issues, call issues, those kinds of things, that is where our emphasis has been for some time. What you referred to is actually people leaving, either moving within the Province or moving outside. But, in terms of our overall complement, it is up. Our number of specialists are up considerably, which it tends to be in many jurisdictions are having more trouble attracting specialists than we are. There is recognition that the medical school here is a basis of attracting a lot of the specialists to the Province. So we have a good basis of growing that medical doctor population. As I said, the challenge is to make sure that they stay and they want to stay.

MS JONES: When you said fifty to sixty new physicians in the past few years, does that mean recruited or new positions that is made that may not be filled?

MR. ABBOTT: That would be some new positions, but would be new doctors in positions we have already had in place.

MS JONES: Okay.

MR. SULLIVAN: That would be a net increase number. Just to give you some insight, the net increase in fee-for-service, went - in the last couple of years - from 569 to 609. So we had forty new, we will say, fee-for-service physicians in that period, and salary physicians went from 314 to 338. That is a twenty-four increase there. So, when you look at both of these, that adds up to sixty-four since 2002 in those specific areas.

MS JONES: Okay. What plans does the government have with respect to the replacement facility in Grand Bank?

MR. SULLIVAN: The replacement of the Grand Bank facility?

MS JONES: Well, you have the cottage hospital that is seventy years old. You have the seniors' home that is thirty years old. Are there any plans by the government to replace that facility at all?

MR. SULLIVAN: First of all, there is no plan to have another acute care - basically, as we call it, a hospital in Grand Bank. That is not a plan of government. Government will look at and sit down, and over the next while look at the priorities of the Burin Peninsula in general, and look at what the needs are for that region, in conjunction with the community regional integrated health board in that area. In fact, certainly over the next while, we would like to hear their concerns. There are efforts being made to be able to move in that direction, but any decision would have to come to the table and look at the whole area.

What does Grand Bank need to meet the needs of that area there? What can be serviced from the Burin area or the region? What cannot be serviced from that area? No decisions have been made, other than that it will not be a hospital, as such, because there is one that serves the region. It is most practical to be able to pool resources to get the best service. I am not saying that there will not be certain needs that might need to be met there. They will be done in due course, in consultation between the department and the boards. Any decisions that will be made will be future decisions when the proper identification of what it needs.

With the transition in boards overall now, not only in the Grand Bank area but all over the Province, I guess the new Regional Integrated Health Authorities will be certainly looking at the best service delivery and what is needed to deliver the best service; the most effective. They are certain things we hope would be always looked at on an ongoing basis anyway, not just because they are new boards. So, hopefully, that answers -

MS JONES: What about the CT scanner for the Bruin Peninsula?

MR. SULLIVAN: Pardon?

MS JONES: The CT scanner for the Burin Peninsula, is there anything happening with that?

MR. SULLIVAN: There is a CT scanner in Clarenville. The expert committee which reported on diagnostic services indicated that under the former Peninsula's board, which would take in Bonavista, Clarenville and the Burin Peninsula, that one was certainly sufficient to meet the needs. The current wait time in that region now - you can get a CT scan within two weeks. That has considerably improved over certain areas of the Province. I know that people have waited eight weeks in other areas of the Province to get one. Personally, I know people in the last while who have waited eight weeks to receive them. So, the period there was adequate and there is sufficient capacity to be able to accommodate people within that time frame. It was not on the recommended list that came in. That was probably in, maybe 2003 or 2004. I am not sure of the exact time but it was - that does not mean depending on things in the future, but that was not on the recommended list.

MS JONES: Okay. I am just getting to my last question now. Page 201 of the Budget Estimates, section 3.2.02.

MR. SULLIVAN: Okay, just give us a second now to get the page. Section 3.2.02?

MS JONES: Page 201.

MR. SULLIVAN: Section 3.2.01?

MS JONES: Section 3.2.02.

MR. SULLIVAN: Section 3.2.02?

MS JONES: Yes.

MR. SULLIVAN: Okay.

MS JONES: Under 3.2.02, the Professional Services, $2.6 million and the Purchased Services, $1.7 million. It is my understanding that the totals of that amount of money will be used for the long-term care facilities in Clarenville, Corner Brook and Happy Valley-Goose Bay.

MR. SULLIVAN: That is correct. I did mention when we met last week on the Estimates, that $2.6 million was for Professional Services. Designing site work at Corner Brook out of that $2.6 million was $1 million; designing site work for Clarenville was $1.4 million, and the commenced planning for the nursing home in Happy Valley-Goose Bay was $200,000. That adds up to $2.6 million.

I did mention that in response to a question by one of your colleagues last week.

MS JONES: That brings me to my question. Where is the money for the study in Labrador West coming from?

MR. SULLIVAN: In Labrador West? Just one second to see where in the item it is.

MS JONES: What line is the money coming out of?

MR. SULLIVAN: I will check on the breakdown, and where specifically it is. That is under Grants and Subsidies.

MS JONES: Number 10?

MR. SULLIVAN: That is the $7.5 million, in that category.

MS JONES: Okay.

You also said that out of that $7.5 million would come the money for Grand Falls, for the cancer clinic in Grand Falls and Gander.

MR. SULLIVAN: Grants and Subsidies?

MS JONES: Yes.

MR. SULLIVAN: In the $7.5 million? I did not say that, at that time.

MS JONES: Where is the money for Grand Falls and Gander coming from?

MR. SULLIVAN: In our Capital Budget. The Capital would be shown -

MS JONES: That is the Capital.

MR. SULLIVAN: The Grants and Subsidies. I am just looking here now.

OFFICIAL: (Inaudible) where it is coming from.

MR. SULLIVAN: Yes, I will explain where it is coming from and then if she wants to give the specifics on it.

What we have indicated is that the projects that have been approved in the 2005-2006 fiscal year, upon assessing those projects, how they would advance, the department followed up and looked at sufficient cash flow available to be able to advance those projects in the normal fashion and not require a new appropriation this year, looking at where these other Capital projects were.

Obviously, when the ones we announced, and the Central Newfoundland ones in Gander and Grand Falls-Windsor, when they get to completion we are obviously going to need $1.55 million more if the amount budgeted is accurate in what actually gets done. Any project that you have out there, some might come under, some might come over, but assuming they are on target we would need to make an allowance in next year's budget for $1.55 million. There is sufficient cash flow in the one that is announced this year to be able to do that.

MS JONES: What line is it coming out of?

MR. SULLIVAN: That is coming out of the $7.5 million.

MS JONES: Okay.

Can you give me the -

MR. SULLIVAN: In this year, for example, the $1.55 million would not all get expended this year. For instance, there might be the planning, the site work and starting construction, by the time it is completed, because within Grand Falls-Windsor it is $1.2 million. That has to be in addition, so there is obviously work that has to be done on that, design and site work.

The one in Gander, it is internal space that is being done that should be able to move quicker than going through plans for expansions or extensions, so the cash flow should be sufficient. How much of that $1.55 million will get used this year? A certain portion of that would, and within the $7.5 million they feel we can advance all of these at the pace that is there, upon looking closer at them, that no more money will be required in this particular budget.

MS JONES: Can I get a list of the breakdown for the $7.5 million under Grants and Subsidies, please?

MR. SULLIVAN: The $7.5 million this year?

MS JONES: Yes.

MR. SULLIVAN: Okay, I will just see if I do have it here.

OFFICIAL: It goes on for pages.

MR. SULLIVAN: Okay, there is a whole list of things there. It is a really lengthy list. Do you want some of the high points there?

MS JONES: Can I ask to have a copy forwarded to me, please?

MR. SULLIVAN: Sure, we will give you a copy. All of the breakdown is done on each item, every single one there. It is a long list of all the specific areas.

MS JONES: Those are just two things that I have requested. One is the breakdown of the total board deficits, by board, and also the expenditures under section 3.2.02.10. Grants and Subsidies.

I do not have any further questions. I would just like to thank the minister and his officials for the opportunity to meet again this morning to finish the Estimates. I appreciate it.

Thank you, Mr. Chairman.

CHAIR: Thank you.

There being no other questions and no other issues to discuss with the minister, I will ask the Clerk if she will call now - apparently we are doing all of the heads together, so I guess we will call all the heads from 1.1.01. to 3.2.02.

CLERK (Murphy): Subheads 1.1.01. to 3.2.02. inclusive.

CHAIR: Shall 1.1.01 to 3.2.02. carry, all-inclusive?

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

On motion, subheads 1.1.01. through 3.2.02. carried.

CHAIR: Shall I now report the heads under the Department of Health and Community Services carried without amendment?

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

On motion, Department of Health and Community Services, total heads, carried.

CHAIR: I want to thank you very much.

Thank you, Minister, for your second appearance. To the Committee, thank you for your work. We have now concluded all of the Budget Estimates that have been referred to us. I thank you for your time and patience.

On motion, the Committee adjourned.