The Committee met at 9:30 a.m.

MR. CHAIRMAN: Order, please!

Ladies and gentlemen, welcome to the Estimates Committee for the Department of Health. As you can see, we are in the process of getting some coffee. So during the session, if you feel you would like to get a coffee by all means do so.

I would like to welcome to the Committee, the Minister and his officials. I would, first of all, introduce to you the Members of the Committee who are here this morning. To my immediate left is the Vice-Chairperson, Ms. Lynn Verge, the Member for Humber East; Mr. Aubrey Gover, the Member for Bonavista South; Mr. Doug Oldford, the Member for Trinity North; Mr. Charlie Power, the Member for Ferryland, who is also the Health critic; and our Secretary, Miss Elizabeth Murphy, who is the Deputy Clerk in the House of Assembly. I welcome the media and other observers.

The format we will take this morning is: I would want to give the Minister an opportunity to have an opening statement and introduce his staff, and then I would give Mr. Power an opportunity of approximately fifteen minutes. We are not going to be totally on the second as someone suggested the other night.

Mr. Gover.

MR. GOVER: Will the Vice-Chairperson allocate her fifteen minutes to Mr. Power?

MR. CHAIRMAN: No, I think it has been the normal practice that the critic have an equal opportunity with the Minister and, of course, the Vice-Chair would take the same role as other Committee Members. That is loaded up with fairness and balance and I think that is the way this Committee should operate.

Without any further ado I would give it to the Minister.

Mr. Minister.

MR. DECKER: Thank you, Mr. Chairman.

I would like to introduce the officials from my Department: Dr. Williams is the Deputy Minister of Health; Dr. Hogan is the Assistant Deputy Minister; Mr. Lemon, Assistant Deputy Minister; Mr. White, Assistant Deputy; and Mr. Templeman handles a lot of finances in the Department; we also have Mr. Downton of the Drug Programme sitting back in the gallery and he is available if there is some detail we should want to have on the drug programmes.

In my opening statement I want to say that sometime last fall the Department of Health was notified there was a good possibility that our budget for this fiscal year would be frozen at the same rate as last year. Of course, as you can imagine, this came as quite a shock to the whole system and we realized that we were going to have to try and reorganize the whole Department of Health and the hospital system throughout the Province. Now, we had already started a reorganization programme before we were aware of any fiscal problems. You will recall, just after we took office, we changed the roles of two hospitals on the Burin Peninsula and we phased down some acute care beds in these hospitals which allowed us to make enough savings to open up thirty-five beds in that hospital and made it a seventy-five bed hospital. This was in keeping with the Royal Commission of 1985 which recommended that very thing be done.

When we found ourselves with this fiscal problem we decided we would speed up the rationalization that we had started. We decided we would do it in one fell swoop. The Department went under an intensive internal review of itself. We asked the Newfoundland Hospital and Nursing Home Association for some representation. We asked the Newfoundland Medical Association, the Association of Registered Nurses, the Medical School, and between October and January we had intensive reviews and we had every single director in the Department involved. We had presentations made to us, the St. John's Hospital Council made presentations to us. We had concerned individuals make presentations to us. Some hospital boards made presentations to us. We did a total review of the health care system.

We knew we would have somewhere in the vicinity of about $800 million with which to deliver health care to the Province. We looked at Newfoundland and Labrador as if there was nothing there, a blank map with no health care, no hospitals, no nursing homes, no clinics, no anything, and we asked: what would we put there if we were starting out? I suppose it would be the same concept as zero based budgeting. What would we put there? We looked at the needs of the Province and we looked at the needs of an individual, and basically what does an individual need? For most of us we need some primary care sometime during our lives. For some of us you need a second level of care which would involve surgery or dealing with a specialist. And for a few of us we need tertiary care, and then as we get older some of us will need chronic care and some of us will not need chronic care. So, we said let's start from the assumption that everyone in this Province will at some time need some level of care. We are all going to be born, we are all going to die, so we are going to need some care out of the system.

Primary care is basically a visit to your GP. In some cases in the Province it is a visit to a nurse. It is a prescription, it is an x-ray, it is lab work, it is the gateway into the health care system. So we looked at the rest of the nation and tried to arrive at a reasonable distance that primary care should be available to all of our people. And we came up with the figure between a half an hour and an hour by vehicle. We thought that no matter where you lived in this Province it would be desirable to have your primary care available within half an hour or an hour of where you live, and that is pretty well in keeping with the standard across the nation.

The system that we inherited, generally speaking, had primary care available to people within a half an hour or an hour of where they lived, but it was not total. In the Port Saunders area there was one case where they were trying to be all things to all people and the primary care was suffering, so we have made provisions to build a new community health care centre there where we can deliver our primary care. Burgeo was another case in point. We changed the two hospitals on the Burin Peninsula totally to primary care and in one case we are going to add some chronic care beds to it.

So it is pretty well accepted throughout the Province now, in most cases primary care is available within a half an hour or an hour. There are cases on the Labrador Coast where the primary care which is available is, I suppose, not quite up to standard. Patients are still being seen by nurses as opposed to being seen by doctors. There was some criticism raised in the House of Assembly by the Member for Labrador that non-qualified people were actually dispensing drugs and there is some element of truth in that. The people who are doing it are supervised, of course, by a doctor, but the fact of the matter is that the system is such that the primary care which is available is inadequate. So we are working toward making this primary care system available to all our people.

The next thing we went through when we were reviewing the department was referred to as secondary care. We concluded that we should make secondary care available to our people in all the regions within two or three hours, at the maximum, of where people live. In some cases that would be by ambulance, in other cases it would be by an air ambulance. In the northern parts of the Province you have to use an air ambulance to get there. Thus you see Corner Brook, Gander, Grand Falls, St. Anthony, and Clarenville where they have specialists on staff, and they can perform surgery.

In the case of Grand Falls, and in the case of all the secondary hospitals, they do have an area which is primary care as well, but they are the regional centres. We realized that if we wasted too much money on our primary care we would not be able to meet our secondary care. We realized that if we wasted money on secondary care we would not be able to deliver our primary care. The two are interrelated. So we ended up stopping doing some of the things in the secondary care hospitals that we had been doing, and we ended up regionalizing things which attempts were being made at doing in the primary care hospitals.

The next conclusion we came to, which was obvious, was that this Province can only afford one tertiary care centre. I have said publicly that if the map had truly been vacant and there was no Health Sciences Centre, and there was no School of Medicine, then I would have liked to have seen it in Gander. I would like to have seen it in a central location, available for people from all over the Province. However, as you know, the Health Sciences Centre was there, so we decided to put more emphasis on making that centre a centre of excellence for the Province as a whole. Almost fifty per cent of the people who are taking advantage of that centre now are from outside the St. John's area, and I would think, if you were to knock out the primary care stuff, you would find that the majority of people who go there are from outside the city.

We are trying to put in place, primary within half an hour, secondary within two or three hours of where you live, and have at least one centre for tertiary care within the Province. The nature of tertiary care is such that if we had all the money on earth we would not be able to attract the specialists to put three or four centres in this Province. Saudi Arabia, which has no problem with funding these facilities, cannot get enough staff to operate any more than one or two of those tertiary centres. It is money, yes, but it is not only money, the people are just not available. It is generally accepted that specialists now in the tertiary care hospitals want to have access to research, so one of the main justifications for keeping the medical school available is the fact that there can be some research done. We divided the acute care centre into three levels, primary, secondary, and tertiary, and they are all interrelated. What is done in Burgeo is just as important to the system as what is done in the hospital in St. John's, but Burgeo does what Burgeo is equipped to do and hopefully will have the good sense to forward on what they are not able to handle.

The other matter we dealt with was chronic care. By the year 2000 68,000 of our people will be sixty-five and over, so the need for chronic care is growing continually. When we began to do some of our rationalization we discovered, by coincidence, that some of the primary care facilities, the old cottage hospitals, some of them, not all of them, could be changed into chronic care facilities. Springdale was one where the building was in reasonable repair so we took out the acute care beds and changed them to chronic care. This allowed us to move some people out of the Grand Falls hospital who were holding up acute care beds and move them into Springdale. The Baie Verte Peninsula: here the acute care beds were utilized 42 per cent and even some of them were long-term patients, so we decided that we would change that hospital into, basically, a chronic care facility. A lot of the nursing homes throughout the Province were built as hostels. They were build for healthy people who just happened to be old. Over the years, and the previous administration started this, some of those buildings had to be upgraded so that they were capable of attending to the level three patient. That is the trend we have been following. Early in the review we came to the conclusion that if the Budget were indeed frozen, and in actual fact, Mr. Chairman, it was not, we realized it would wreak tremendous damage to the system had we totally frozen the Budget.

We took out the equivalent of $35 million on an annualized basis. In this fiscal year it will be $23 million. The Newfoundland Hospital and Nursing Home Association have been arguing with us all along that we did not make enough allowance for slippage, that we really will not save $23 million in this years budget. Maybe they are right, maybe they are not. We disagree with them; we believe we will. Notwithstanding the fact that they disagree with the amount they are pretty well in agreement with the principle in what we are trying to do. So if there is an argument it is whether or not we can really save that much money.

In the system we said we would be laying off up to 900 people. To date there have only been 450 actual warm bodies laid off in the system. There are several explanations for this; one is that some of the hospitals back in January, anticipated that there would be problems so when people resigned they did not replace them, so that is one explanation. So when the actual lay offs came, the positions were vacant, normally they would have filled them. In other cases hospitals have picked up some savings elsewhere in their budget and they have kept some of those people on because they anticipate vacations coming up in July and August. So I would not be surprised if before the year is over the figure would go higher than 450. I am not sure if it is going to go to the full 900 or not, but there are 900 positions which have been taken out of the system. I believe that what we have done will not seriously damage the delivery of health care. I think next year we are going to need more money in the system to enlarge on what we have started.

In closing I want to give a quotation which was given by Dr. Harry Watts at a meeting in Burgeo when we met with the people and explained what we were doing. Dr. Watts said that to run his institution, the Corner Brook Hospital, cost about $40 million. He said it cost $2 million to run a cottage hospital. So he said you could close up Corner Brook and you could have twenty cottage hospitals; you could have hospitals in twenty little communities, but in his professional opinion you would not be able to deliver health care near the magnitude that you are delivering by having regional hospitals. Of course I agree with him. The cottage hospital era is over, and we have to adapt to a new era, there is really no place for the cottage hospital system as it was in 1935. It is a place for primary care, but it has to be a part of an overall system. Thank you, Mr. Chairman.

MR. CHAIRMAN: Thank you, Mr. Minister.

Before I acknowledge Mr. Power, I just want to welcome another Committee Member in the person of Mr. Art Reid, the M.H.A. for Carbonear.

Before we go to Mr. Power, I was wondering if I could get somebody on the Committee to move the minutes of May 2.

Moved by Mr. Gover and seconded by Mr. Power.

On motion the Minutes, as circulated, adopted.

MR. CHAIRMAN: Mr. Power.

MR. POWER: I don't think I am going to need my fifteen minutes but I would like to ask the Minister some questions. Obviously the idea of the Estimates Committee is to delve into the intricacies of where the money is spent in the system. One of the problems we have, certainly as Members of the Opposition in dealing with some of the lobbying interest groups in the medical field and the health care field, is the fact that the Minister has finally acknowledged this morning at the end of his comments the downgrading, the cutbacks in the health care system. I think the words he just used were 'would not seriously damage the health care system'. I guess we need an interpretation of what seriously damaged means. I think the Minister has been giving off the wrong interpretation of his budget to the public since it was done in the Budget of March 7: the idea that this is a new improved health care system. In effect I think you have to acknowledge that those are tough financial times, and because of tough financial times health care has taken its share of a downgrading, and when its share of the budget, $800 million, is such a hugh chunk, then obviously they have, I suppose, to do their proportionate share. But somehow this idea that we have a new improved health care system - I mean the system in Newfoundland was always three phased, primary, secondary and tertiary care is not something brand new. I have seen those terms for a long period of time and combined that with chronic care, you are going to revitalized it, reorganize it, but I think the reality that we have to acknowledge in Newfoundland and which the Minister has now said, is that we are not going to get the kind of money for health care that I am sure Dr. Williams and his staff would like to have. I am sure you got $836 million this year, you could have easily spent $860 million and you could have done a primary, secondary and tertiary health care system which would have been simply that much better. I think the reality is that we are in a period of very serious fiscal restraint and the health care system is going to have to take its knocks the same as all other parts of Government and I think you are better off acknowledging that upfront, as the Minister should and has begun now to do, and to say that we are going to have a tough time and lets try to live with it as best we can. That is really where we are.

I have some concerns about the downgrading system. I have been around Government for a fair period of time and I know that when downgrading starts, when rationalizing starts, next year's budget is based on this year's budget and once it starts it is a never ending sort of scheme that goes on and on. I have, and I am sure some of the people that I have talked with have serious concerns about where the health care system is going to go next year. Is the Newfoundland economy going to be vibrant enough to allow the Newfoundland Government next year to get into a spending mode? The general feeling from anyone you speak with is that it is not and that next year we are going to have the same kind of budgetary problems except probably worse.

We in the Opposition do not believe the health care system is going to be able to live exactly within the Budget. There is going to be some overrun. The $10 million figure that the Newfoundland Hospital and Nursing Home Association put out shortly after the Budget says they cannot do it. They do not have enough lead time. I think there was a mistake there. I am sure the Minister can address it and I think the Newfoundland Hospital and Nursing Home Association have looked at it since then and maybe have reduced their figures somewhat, I do not know. But certainly the concern is they did not have enough lead time to implement all of these new decisions in one fiscal year and that is normal for a very large system. You have to give it some advance warning that something is going to happen. Had that warning come last October when the Government knew it was in financial trouble, I think they would have had a better system starting off the 1st of March. Be that as it may, I think you will have some significant overruns in the health care system this year. I do not know how you can avoid that.

I hear terrible rumblings among doctors, who are saying that the MCP system of capping at $125 million is going to cause them untold problems later on in the year. Some doctors will get a larger chunk of that upfront and some will not. But some general practitioners are saying that is definitely going to cause major problems for some of those.

Look at how the health care system was done. I believe you have to have fiscal responsibility, you have to have some restraint, but I really think that in cases, for example, like Placentia and Port aux Basques there is a role for people to play on the hospital boards. I do not think the Government can simply use hospital boards as a scapegoat, as the first line of defense to take the first lot of criticisms from the public. The hospital and health care boards are more than that and should be more than that, they were set up not simply to take the flack, they were set up to give advice to the Minister and his officials. I think in many cases the hospital and health care boards were not listened to, they were seen to be nonprofessional, nonexpert, and when they made suggestions such as in Placentia and Port aux Basques and Labrador West and other places I do not think they were listened to. I think it was said: okay you are simply a bunch of amateurs, you are okay to run the board for us but do not come back to us with any serious concerns about how health care should be run, that should be left to the professionals in the Department. I think that is wrong, those health care boards do serve a very valuable function. They are a sounding device from the local people as to what they perceive is required in health care. They may be wrong. But I think they have to be listened to a lot more than they were listened to in this budgetary process and I think Placentia is an example of where we really did not listen.

I would like to ask the Minister - I asked him last week and I have not seen the answer - exactly what adjustments have been made in the health care system. How much money has Placentia gotten? How much has Port aux Basques gotten? Has Lab West received any extra funding? And if you are receiving extra funding, as the Minister answered in the House, is the funding coming from within the overall health care budget, the $836 million, or is it going to be additional money? Are you simply robbing Peter to pay Paul all the time, which does not improve the system significantly? The other question I asked in the House of the Minister of Finance, and that the Minister of Health has not tabled, is if you expect the public in Newfoundland to accept the health care system being downgraded like it is, then you had better give us the facts and figures to tell us why the money is in such short supply? The Minister has said on several occasions that we are going to receive no money from EPF after the year 2004. As one Member of the Opposition I have asked the Minister of Finance, and the Minister of Health, to table the documentation that says that, because I do not believe it. I do not think it is going to happen in 2004. It may happen in 2014 or 2024 but the tax credits and cash which make up part of the established programme funding, I do not think will run out that quickly. I think you have to assume that an awful lot of bad things are going to happen to the Canadian economy over the next fourteen years for us to be out of federal transfer payments as it relates to health and post-secondary education. If the Minister has the facts that says that, that there is not going to be any federal money in health care after 2004, then it would be a lot easier for Members of the Opposition, the ARNN, the nursing assistants group, the Newfoundland and Labrador Home and Hospital Association, if we had all that information.

We have a lot of particular questions we want to ask the Minister about different subheads but the underlying part is that the Minister has got to acknowledge that in effect we have had a downgrading, how are we going to exist while we are being downgraded, and what happens? I think the real concern in people's minds is what happens next year when we are into the same kind of fiscal problems. Do we then have another significant downgrading? With this plan that you would like to have, this primary, secondary, and tertiary developed in a certain fashion, can you really develop that without money? What happens next year if we do get a freeze?

I say to the Minister, and I am sure he is aware, from the Budget document of March 7 the most concern of the people of Newfoundland whom I have talked to is health care, where it is going, are we going to be able to have a universal Medicare system somewhere in the future, or is this really the beginning of the end of Medicare and universal hospital access in Newfoundland, being the poorest part of Canada, and in effect is it going to be destroyed in Canada itself? Of course the Federal Government, conservative though it may be, deserves a fair amount of the blame for the process of cutting back on medical transfer payments. Still we have to live in Newfoundland and I do not think the Newfoundland Government has assisted in an awfully great fashion. They have compounded the problem and I think Newfoundland is going to have a worse welfare system as we go along, worse than any other part of Canada, as both levels of Government cut back on money for what is basically an essential service.

We have a lot of individual questions we will ask the Minister as we go on but certainly those are our initial observations.

Thank you.

MR. CHAIRMAN: Thank you, Mr. Power.

Perhaps before I go to Mr. Gover the Minister might like to make a short comment.

MR. DECKER: I have a few brief comments, Mr. Chairman. The hon. Member said that I said there is no serious damage to the system, and I stand by that. I had to face the fiscal reality. Under the circumstances we did what we had to do within the fiscal reality considering the amount of money we had. I am being misquoted on this. They say I am saying that: we have a better system as a result of this. This is certainly not what I am saying. I do say we are moving toward a better system, because the reality is that if we try to do tertiary care in Burgeo we are not going to get the expertise to go into Burgeo and do it. We are not going to be able to afford to do it anyway. By rationalizing the system, I believe that if next year we have less money we will be able to deal with that a lot better than if we tried to be all things to all people throughout the Province.

The Member talks about next year, now the reality is I am not the Minister of Finance and I do not know what will happen next year, but the reality is that we might have to close some hospitals, that is a possibility. On the other hand, if we can restore some fiscal responsibility to this Province, which is the very thing we are trying to do and taking a lot of flack for it, we can try to get back out of our fools paradise and start spending the money we have instead of the money we do not have, hopefully we will be able to overcome. But if we fail as a government, then yes the hospital system will suffer and so will the education system and the whole thing.

The hon. Member says there will be overruns in the system. There well may be. Thus far we have received most of the budgets from the hospitals and the Department has gone through them and we do not see any serious overruns. I will not argue. I think there may be one, two, or three hospitals in the system who may have a problem with their budgets and that is nothing new.

The MCP capping: Again the Member talks about some of the complaints of doctors. The Newfoundland Medical Association has been involved with what we are doing. Nobody likes to cap. The Newfoundland Medical Association does not like to cap. There was a formula put in place whereby when the bills came in doctors were paid under a certain formula. The Newfoundland Medical Association have come back and said that formula may not be the right one, maybe we should not be capping until you reach a certain income. I heard on the radio this morning in Ontario they capped up to $400,000 then they prorate. In New Brunswick they have had this system in place for a year or two now where they cap at $250,000 for GPs and $350,000 for specialists and they do not cap until they get beyond that mark. So, we are quite open to the Newfoundland Medical Association.

The role of the hospital boards: The Member says they were not listened to. I do not know where he is getting his information. We had extensive consultation with the hospital boards throughout the system. Every single hospital board made presentations to Government as to how they were to deal with the problems this year and every single one was gone through with a fine-tooth comb. In the vast number of cases we accepted the recommendations which were made by the hospital boards. In some cases we did not because we had to look at the region. Early in our review we realized that if we treated everybody equal it would jeopardize the system. In some cases we did not take any money from a board but we took more from some and as the Member said robbed Peter to pay Paul, but for the benefit of the overall system we thought that was the proper way to go.

The Member asked about the EPF: if the present trend continues the EPF will run out in this Province the latter part of the year 2003 or early 2004, somewhere around then. In 1995 it is going to run out in Quebec. Now the Newfoundland Medical Association have publicly released this information. The Association of Registered Nurses, their national body met in St. John's last October and their was a press release carried on that. They have done their research and they also (inaudible) Newfoundland Hospital and Nursing Homes Association. So, the hon. Member is probably one of the few people in this Province who has not had proof that this will happen. I am sure the Department of Finance does have that information and I will attempt to get the Minister to make it available to the Member. So it will be by the year 2003, late 2003, if the present trend continues. Now, if they lift the cap it will be 2014 as he points out and in the place of that we are getting back some tax credits. Tax credits are great if you have the money. Tax credits are not as good to us as they would be to a wealthier province.

Can we develop without money? No. We cannot develop without money. If we do not have more money next year than we do this year then allowing for inflation we will have to close more beds and probably have to close hospitals. But I am hoping we can restore some responsibility and hopefully not have to do that.

MR. CHAIRMAN: Thank you, Mr. Minister.

Mr. Gover.

MR. GOVER: Just to pick up on that last point, it was a point I intended to question the Minister on today about established programme financing and how it relates to health. At our last Committee meeting we had a dissertation from the Minister of Education as to the impact on post-secondary education and basically the Minister of Education felt as I feel that this particular effort on behalf of the Federal Government to restrict EPF transfers is basically unwinding the social net which is a major factor in Canadian identity and a major factor in holding the Country together. Now, perhaps in the fall when we find out the new constitutional position of the Federal Government we will see what we have here is really a process of deconfederation.

Getting back to the Minister's comments about Bill C-69 which was the capping Bill. I recently received a letter from - I am sure the Minister received it as well - the Newfoundland Medical Association, the MDMHA update. And in that particular letter signed by the President, Peter Roberts, as I said dated April 17, 1991 they list what Bill C-69, the capping by the Federal Government will do in Newfoundland and Labrador: longer waiting lists for surgery, closure of more hospital beds, further reduction of hospital services, enormous difficulties in keeping doctors and attracting physicians to Newfoundland, especially to our smaller communities. Basically, the letter to MHAs is an assertion by the Newfoundland Medical Association that this particular procedure which the Federal Government is engaged in is the first step to the destruction of Medicare in Canada. And while we may argue about whether or not the funds are going to run out in 2004, I think the trend is clear from our own budget documents. In 1989 the actual EPF transfer was $224 million, the projected 1991 transfer of EPF to the Province on current account is $210,400,000, a reduction of some $14 million from the Federal Government. In addition to that in 1989 equalization to the Province was $942 million and this year the projected equalization to the Province is $934 million, a reduction of $8 million. So you put equalization and EPF together and since we assumed power we have a net reduction, not a freeze, but an actual reduction in dollars of $22 million from the Federal Government to finance Health, Education, and indeed all our programmes because equalization is for all programmes. And I must say that it is to the Minister's credit that notwithstanding that decline in Federal transfer payments on current account when we look at health expenditures on current account, in 1989, the first year we assumed office, our current account expenditures on health were $644 million and the projected expenditure in 1991 is $723 million, a growth of $79 million. So as the Federal contribution to health in our Province has decreased, the amount of revenues generated by the Province and put in health care on the backs of our own people is up quite significantly to $79 million. I must say to the Minister's credit I am sure it was not easy to get that additional funding with all the other competing priorities around the Cabinet Table, especially when one considers that the funds have to come out of Provincial sources.

So we see two trends there. It seems like the trend is, to summarize, that more and more we are going to be left on our own, and Mr. Power can talk about tax credits and cash, but my understanding is that you take 13.5 equalized tax points across Canada, which gets your block funding, then you take out the amount of provincial revenue generated on 13.5 tax points and what remains is the cash transfer. Now when EPF was set up these 13.5 points were vacated back to the provinces, but previously they were collected from the Federal Government, so the only difference to the taxpayer is that instead of paying it on your Federal Income Tax you now pay it in the Provincial one, and of course with inflation the amount of Provincial Income Tax goes up and up every year, so the amount of actual cash transfer is on a decline.

But what I would like the Minister to comment on, and if I have the time I have a few more questions, if not I will wait my turn again. How does he feel this withdrawal by the Federal Government from one of the most fundamental basic programmes in this nation, Medicare, how does he feel that this trend is impacting on health care in Newfoundland?

MR. CHAIRMAN: Mr. Minister.

MR. DECKER: One of the main things about Medicare right now is we have from St. John's to Vancouver a system which is pretty well similar. The care you get in Ontario or here in a hospital is similar, now mind you there are exceptions, but generally it is a system which is universal right across the nation. What I see developing is going to be ten different provinces with ten different systems, and the health care which is delivered in each province will depend on the ability of each province to deliver, so it is quite conceivable that unless we become a have province pretty fast we could end up with a health care system which is not as good as that of our neighbours over in Nova Scotia, for example. This is a concern. This administration is committed to keeping Medicare and we certainly accept the concept of universal access, but I cannot say what will happen at some future date, either some future Government, or our Government if still in power. How many highways are you suppose to stop ploughing? How much are you going to downgrade your education to have universal access to Medicare? It will be one of the last things we would want to do away with. The downgrading in the EPF is definitely having an impact and it is threatening health care and universal Medicare. If there was some other way on behalf of the Federal Government to make up for it, but I do not think tax points is the one, unless, as you pointed out, unless we have the tax base to do it. Maybe there is a possibility in the transfer payments. We do not care if we receive the money from EPF or in transfer payments, but there is no indication, as you already pointed out, that is the case. If the dollars we need were to come under EPF or transfer payments it really does not mean that much, but the way the trend is going transfer payments are not being picked up either. I am seriously concerned about the future of Medicare in this Province. Certainly, we will not be able to keep universal Medicare unless we put in place a rationalized, streamlined system to deliver health care.

MR. CHAIRMAN: To ensure that everybody gets a fair first round we will go back to you later Mr. Gover. I think you indicated you had some other questions.

Ms Verge.

MS. VERGE: Thank you.

I have a list of points here.

MR. DECKER: I cannot hear the hon. Member, Mr. Chairman.

MS. VERGE: I will speak up, Mr. Minister.

On the subject of federal transfer payments to the Province. I see in the first pages of the estimates document that the Province is expecting to receive $40 million more this year than it got last year from all federal sources. We in the Opposition share the Government's concern about the federal changes to EPF, however, we are glad that so far there have not been any changes in the formula for equalization or for the Canada Assistance Plan for this Province. However, because equalization is tied to the Canadian economy and the economy nation wide has been in a recession we have had a negative outfall in our equalization payments. As the economy picks up we can expect to see an improvement. Now, in the case of EPF which is designed for health and post-secondary education, there has been a change and the change has resulted in a freeze, or you could say a slowing in the rate of increase compared to what we would have gotten if EPF had been left alone. The first negative change to EPF was made by the Liberal Government in about 1982 and unfortunately the changes made by the Mulroney Government have worsened the problem. Last Fall in the House of Assembly we had a private Member's debate about the federal legislation that is dealing with EPF Bill C-69. The motion was made by the Member for Bellevue and I remember after the debate while the Member for Bellevue and some others in the Government claimed that the federal plan would lead to a withdrawal of federal support for health by the year 2004, a claim that has been made by some national organizations, the Premier agreed with the point that I made that that is not so, because EPF is made up of two components: the transfer of tax points which is not being changed and cash. And, as the cash decreases the extent of the tax points transfer will become more significant. That is not to say it is still not a negative development but it is not catastrophic the way some people would have us believe.

I would like to move quickly into the choices that the Provincial Government has made in this Budget. I would share the view that restraint in spending is necessary and that change in our health care delivery system is necessary. However, I am very much afraid the changes that are being made have not been properly researched and cuts are happening in an unplanned uncoordinated rash and thoughtless way. The Minister talked about his theory for primary, secondary and tertiary care and there is nothing wrong with that theory. He also talked about his ideas for chronic care and the increasing demand for chronic care as our population ages. I do not have any quarrel with his outline, however, what is actually being done on the ground is different. I will use the example of Western Newfoundland. The Minister talks about the Government's aim of regionalizing or centralizing secondary care, in the case of Western Newfoundland the designated regional center is Western Memorial Regional Hospital at Corner Brook. The smaller hospitals and clinics in the region, those at Burgeo, Port aux Basques, Deer Lake, Norris Point and Bay Verte are either being closed or down scaled, presumably the Government is expecting people from those areas to go to the regional hospital at Corner Brook for secondary health care services. Therefore, the Minister must accept that the workload at the regional hospital is increasing significantly, indeed that seems to be what the Minister wants. However, the Government has cut the budget for that regional hospital at Corner Brook to the point that the hospital board has been forced to close thirty acute care beds and lay off approximately seventy staff. I will not quibble about semantics, it may amount to the elimination of about seventy positions but nevertheless the number of personnel has been reduced.

One area that has already provoked quite an amount of talk and worry among the public in the area is the cuts in the lab and X ray departments. Eleven staff have been laid off from the lab and X ray departments at Western Memorial Regional Hospital in Corner Brook. At the same time, the Deer Lake Clinic which provided lab work and X rays has been closed. That inevitably has lead to much longer waits for patients and I am told from people working on the inside - I hasten to add at a lowly level, the people who are doing the nuts and bolts work - that just in the past couple of weeks since the layoffs have happened, that specimens are lying around longer than they should. Urine samples are deteriorating before they are being analyzed and the readings are not accurate.

The Minister talked about his philosophy of health care by headings: primary, secondary, tertiary and chronic. I am concerned because there was no mention at all of education and prevention. The language seems to have been perverted. We talk about health when really what we mean is illness. I think it is very regrettable that a disproportionate amount of emphasis and resources are going into treatment of illness, and a comparatively insignificant amount of effort is going into education and prevention. We see an absolute cut in the Provincial effort in education and prevention in this new Budget.

AIDS is a deadly disease that is on the increase. I know the Minister and the Provincial Department of Health have paid lip service to the need to mount an education programme to try to prevent the spread of the HIV virus and AIDS. I have questioned the Minister and his staff about this each year since the change of Government and the answer has always been that a grand education programme is being developed and is about to be unveiled. But I have not seen it.

I would like to ask the Minister about the current statistics for the incidence of HIV and AIDS. I would like to ask the Minister if his Department has made a decision about continuing to provide AZT to people with AIDS without cost. Since last fall AZT has been approved by Health and Welfare Canada and technically has the same status as other fully approved drugs. Yet the difference is that AZT is extremely costly and if patients are made to bear the cost of AZT then some of the people with AIDS who need it simply are not going to be able to afford to get it. I would also like to ask the Minister whether his Department has responded to the request of AIDS groups and the lead of the Government of Ontario in moving to anonymous testing. It has been shown that where anonymous testing for HIV and AIDS is provided that more people at risk are actually having a test and getting diagnosed.

Next, on the subject of MCP, I would like to ask the Minister whether in view of the changes that are being forced upon us, and the changes that we perhaps should be seeking ourselves, whether he favours, and whether he is willing to make any moves towards, having MCP coverage for health care professionals other than those now funded, namely physicians and in some cases dentists or dental surgeons and optometrists. For example, does the Minister in light of the new realities and the new knowledge, favour MCP coverage for nurse practitioners, midwives and chiropractors?

We have always had trouble attracting physicians to rural parts of the Province and I would suggest to the Minister that with the changes the Government has made recently and the changes that they are committed to for the future - closing rural hospitals, giving up on the cottage hospital system - we will have even more difficulty holding physicians in rural areas and attracting physicians to rural areas. Before the modern era nurses and midwives provided a valuable service to people in many parts of our Province. I wonder if the Minister favours empowering these health care professionals and providing MCP funding for them to give primary care.

What does the Minister think about the positive experience of publicly funded nurse practitioners and midwives in Scotland and the Scandinavian countries? Where services provided by them, as opposed to physicians, have resulted in better care, fewer infant deaths and maternal deaths and illnesses, for example.

And another area that I would like to get into that perhaps I will in my next set - I will just mention now - and that is the area of mental health services. I am afraid that our mental health services are woefully inadequate and the very grave needs for mental health services on the part of children and adolescents, to cite one important example, for victims of child sexual assault and abuse simply is not being met.

Thank you.

MR. CHAIRMAN: Okay. I am glad to see the Minister's pen is working. And he has lots of paper.

MR. DECKER: Yes, Mr. Chairman. I am just saying that the hon. Member does not accept the changes that we made and I can understand that, and that they were not properly researched. Now in my original address I pointed out that we are following the Royal Commission report very closely. We have not done anything to date which contradicts the Royal Commission which was an extremely valuable piece of work.

Before we speeded up our process, I pointed out earlier that we went from October till well into January, where the Department had the resources of the Newfoundland Medical Association, the Hospital and Nursing Home Association, Registered Nurses, and I just name them on. And it was a very thorough investigation of the whole system. Now, I do not know how to convince the Member that this was enough, and maybe it was not. But in the circumstances that we acted I am satisfied that we did have adequate research. So it is just - I am saying we did and she is saying we did not. So I do not know. Maybe God can decide who is right. But I am satisfied. And at this moment it is my responsibility. But we had to make that decision.

The Member talks about the impact of the role changes in other institutions on the west coast, the impact on the regional hospital in Corner Brook. And again I have to say, yes we are very much aware of that. But the presentation which was made to the Department of Health by the board suggested that we would close fifty beds in the Corner Brook hospital. That was a recommendation that was brought in. And considering what we would have to do in other regions we said no, we would rather - well, we would have liked to have kept twenty beds. But we ended up closing thirty.

Now some of these thirty that we closed, as I pointed out in the House a short while ago, were really pediatric beds. Totally underutilized. So we do not see any great harm done there. Also I understand a couple of departments were not together in that hospital.

AN HON. MEMBER: (Inaudible).

MR. DECKER: Yes, that was done before, the surgical and medical departments were put together. So that way you can get better utilization of some of the beds which were already there.

The lab and X ray at Deer Lake: Now this has been quite a thing in the media., I believe I am meeting with some people today. I am meeting with a group from Deer lake today to discuss that matter.

Again, the Member for Ferryland earlier talked about not listening to boards. Well the fact of the matter is we do take a tremendous amount of advice from the hospital boards. And the local administrator, when he made his presentation, suggested that the role of the Deer Lake lab should be changed drastically. And what he wanted to put there was a combination lab and X ray person. Yes. There are a few of them. Are they still training them or not?

AN HON. MEMBER: No they are not (Inaudible).

MR. DECKER: No, they are no longer training those people but there are quite a few in this Province who can do both. And in the opinion of the hospital board it would be more cost effective for the amount of work which is done there to have a combination. And I understand from him that they are still trying to recruit such a person. And when they do they will continue to provide lab and X ray. Well, they are doing lab now, I believe, aren't they?

AN HON. MEMBER: They are taking blood.

MR. DECKER: Yes, they are still taking the blood there. But they are hoping to recruit this person. But in the meantime we are assured that the system in Corner Brook can still handle it. As a matter of fact I understand some of the layoffs in the lab and X ray were actually teaching positions, I think. That is what Doctor -

SOME HON. MEMBERS: (Inaudible).

MR. DECKER: One of them was a teaching position, yes. And we are back and forth with Dr. Watts out there and he explains that sure, we have just experienced a cutback. It is not as good as we would like for it to be. But he is quite satisfied that nobody's health is being jeopardized, and that things are going well.

But the hon. Member makes a very serious point which I am going to pursue. She claims that specimens are lying around. So I would ask maybe if we could call Dr. Watts even before this meeting is over. Because that is a very serious accusation. And if there is any basis to it we certainly will have it checked out.

Education and prevention: I did not mention that in my speech, and I am sure there are a lot of things I did not mention in my introduction. I only had fifteen or twenty minutes. But that is so self-evident I suppose that it is one of the things that you are going - you cannot mention everything. Education prevention as such is self-evident. The whole advances that have been made in medicine have had nothing to do with treating someone who is in hospital. It has all been prevention. I mean, tuberculosis was prevented. Smallpox is prevented. Hopefully some day AIDS will be prevented. The whole thing - we do have education prevention. I am going to ask the Deputy Minister, Dr. Hogan, a little later if he would sort of elaborate, especially on the AIDS thing.

The AZT at this moment is still being paid for by Government. It is costing Government $8,000 to $10,000 per person. And it is an issue in the Department which I am trying to come to grips with. What justification do we have to pay for one expensive drug if we are not prepared to pay for all expensive drugs? And what justification do we have to pay for expensive drugs if we are not prepared to pay for inexpensive drugs? So there is an issue of fairness there which I am trying to address. I just learned over the last few days that there is now another drug on the market - not for AIDS, it is for another disease - which costs $40,000 per year. Requests have come to the Department to pay for those drugs.

So it is extremely difficult to know where we are going. And the future of drugs since the generic drug formula - we all know the situation there where it takes ten years now after a new drug is developed before the generic drug can be used. And the cost of drugs is going to continue to escalate. So far we do have a drug programme in this Province. It is not as expensive as in some other provinces. But it is an issue that we are wrestling with and trying to come to grips with. Nobody should be put bankrupt because they cannot afford to buy drugs. On the other hand, if people do have insurance coverage I do not see how you can expect the Province to take responsibility for it. Or if someone is financially capable of paying for it, I (Inaudible).

The Member makes a very valuable and valid point about anonymous testing for AIDS. It is an issue that I have discussed with the AIDS committee over the past year. And to be quite honest I did not really have any great belief that it should be done. Because I was of the absolute total opinion that anything that happened in a hospital was strictly confidential, but any illusions I had about that disappeared last week. I have decided that I am going to look into anonymous testing because it is very obvious that a person can no longer go to a hospital without having it, and in this case it happened to be me, and maybe they do have a point when they talk about confidentiality.

The MCP coverage for other physicians.

MS. VERGE: Would I be allowed a couple of questions about AIDS before we leave this subject?

MR. DECKER: I am asking Dr. Hogan to deal with the AIDS question.

The MCP coverage for other physicians: At this moment we have brought in a chiropractor's act, as the hon. Member knows, but we have not expanded Medicare to the chiropractors at this time, and there is no immediate plan to do so. We have had to cap Medicare to meet our needs.

MS. VERGE: If I might interject. Might it not be more cost efficient to have many of our health care services delivered by lower paid professionals? Surely, a lot of the work that doctors are doing now could be done satisfactorily by nurses, midwives, or chiropractors who would probably have a lower scale of fees. The point of my question is trying to improve our quality of care and service delivery by drawing on a greater variety of professionals and making the delivery more cost efficient, learning from the positive experiences in other countries such as Scotland and the Scandinavian countries.

MR. DECKER: As I was about to say, Mr. Chairman, before I was interrupted, Medicare is really a form of public funding and we pay doctors who bill Medicare direct. Now, we have in this Province about 300 doctors who are paid on salary, the same way nurses are paid, so the issue is not so much MCP as public funding. If a nurse is doing her job out there in the system it is publicly funded. All the physiotherapists are public funded, are they not?

AN HON. MEMBER: There are a lot of physiotherapists in private practice.

MR. DECKER: But we do have physiotherapists on salary?

AN HON. MEMBER: Yes.

MR. DECKER: So the public funds do pay for a lot of these things.

The role of the midwife is a role that is coming to the forefront across the nation. The position which the Department maintains is that we have no big problem with midwives delivering children on the condition that they are within a very short distance from an obstetrician, or in very short distance of someone who can perform a section if something goes wrong. That is the view which is held by the local Association of Registered Nurses. I have discussed it with them. We are not prepared, at this time, to encourage midwives setting up private practice and delivering children. I can give firsthand information on that. I belong in the North where for years and years that was the system, where nurses who were midwives, as part of their training, had to deliver children, and I can tell you, Mr. Chairman, it is not the desirable thing to do. You do it when you have to do it but any woman today who has a choice between staying in Roddickton and having a midwife deliver her or going to St. Anthony where a midwife might deliver her but in the next room is an obstetrician, or two minutes away there is an obstetrician and all the modern facilities are available in case something goes wrong, I would have no hesitation where my wife would go.

MS. VERGE: Has the Minister looked at what has happened in Scotland?

MR. CHAIRMAN: I think the Member has had more than a fair chance to put a lot of questions to the Minister, and if the Member continues to add on questions it obviously is going to impact on the time that other Committee members have to ask the Minister some questions. I ask the Member if she might be kind enough to let the Minister finish answering the questions she has already asked and then in the second round she might reintroduce the supplementary.

MR. DECKER: Thank you, Mr. Chairman. On the southern shore -

MS. VERGE: I just want to speak in my own defence. I am not trying to hog time, but I just thought it would be more efficient while we were dealing with the subject to try to finish it instead of having a lot of loose ends with it.

MR. CHAIRMAN: Mr. Gover identified the fact that he had other questions and he gave the Minister the opportunity to answer. If one Member constantly interjects I think it steals from the others, so I would ask the Member if she would be kind enough to let the Minister answer questions and she will have an opportunity to rebut the answers when we have a second go around.

Mr. Minister.

MR. DECKER: The role of the nurse practitioner: we are presently running an experiment on the southern shore where nurses are doing a lot of this primary care. It is an experiment which is costing us about $180,000, so that is a three year programme. We have the World Health Organization involved in it; we have some input from Denmark, I believe, Danish nurses. So the role of the nurse practitioner is one which we are looking at, but I still believe the way to attract physicians to rural Newfoundland has to be done through the Medical School. Over the past months I have had extensive meetings with the Medical School and we are trying to devise a plan whereby we grow our own physicians to serve in rural Newfoundland. That is not to downgrade foreigners who came in and gave their service, but the changes in medicine right now with the two year intern programme which is coming up it is going to be more and more difficult for us to get foreign doctors to serve in rural Newfoundland. I am hoping that we can address it with the medical school who addressed the issue with the urban areas of the Province. I think the medical school solved that problem, but I think now that we have to address the other one.

I am going to ask Dr. Hogan if he will address the issues raised about the education and prevention in AIDS and mental health.

MR. CHAIRMAN: Yes. Dr. Hogan, would you introduce yourself and your position please.

DR. HOGAN: I am Kevin Hogan, the Assistant Deputy Minister for Community Health and Mental Health. With the Member's questions regarding AIDS, and education in the province, perhaps I will just give a summary of our activities to date. The Department of Health has developed for AIDS, ads which are now ready, and we are in the process of negotiating a discussion between ourselves and the Newfoundland and Labrador AIDS committee for the airing of these ads. The intention is to have the committee show these ads and have attached to them their 1-800 number so that individuals in the Province will be able to contact a number and get some advice and have their questions answered. We have also participated with the AIDS committee along with other groups in a training programme for individuals who will be volunteers who will provide the human resources for this 1-800 number. So that is in process and it should be available reasonably soon.

MS. VERGE: Do you mind if I ask a question.

MR. DECKER: Did you want to address the mental health?

DR. HOGAN: Yes, I can -

MR. CHAIRMAN: Yes, I will give the Member the opportunity for a very quick question just to pick up.

MS. VERGE: Just to repeat the latest statistics for the incidents of AIDS and HIV infection and Dr. Hogan's projection for the next few years. And secondly, what kind of ads? I guess what I am interested in is the overall thrust of the Government in educating the public about the risk of AIDS, how HIV is spread, and what people should be doing to prevent the spread of infection.

DR. HOGAN: These ads: the four of them address that, they address one for females and one for males and there are some general ones for the public as well for general information.

MS. VERGE: Are they television, radio and newspaper?

DR. HOGAN: They are.

MS. VERGE: How will they be aired?

DR. HOGAN: The strategy: these are television ads and they will be linked in for follow up to the 1-800 number so that people can get some direct information.

MS. VERGE: What kind of money is allotted for placing the ads? How frequently will they run? Will they be in prime time?

DR. HOGAN: We have developed a marketing strategy which is acceptable to the experts in this area, which I think is to run them for a block of time, I think it is about six to eight weeks and have a space and then run them again for six weeks.

MS. VERGE: Will they be in prime time? How frequently will they run in the six to eight week periods?

DR. HOGAN: Well, depending upon what the ads are. The strategy addresses the target audience. So if it is young females or youth, for example, then it will be placed in programming times where they are known to be viewing the television set.

MS. VERGE: When will they start?

MR. HARRIS: A point of order, Mr. Chairman.

That is a very interesting question and the answer is even more interesting, but as long as it is clear that when the hon. Member is finished I will have an equal amount of time to have exchanges with the Minister and Members present. It seems we have very fluid type of rules here and I am quite happy to hear the Member speaking.

MR. CHAIRMAN: Your point is well taken Mr. Harris and I will ask the Member now again, the Chair does not want to interject, I mean we are here to seek information from the Minister and his staff then fine but please remember there are other Committee Members who would want to partake of fairness and balance.

MR. GOVER: To the point of order, Mr. Chairman.

By my calculations the Member for Humber East has had about half an hour and I had ten minutes. Now, I am a Member of this Committee, we are all Members of the House of Assembly, whether I sit on the Government side or the Opposition side is totally immaterial. I am sure my colleagues who also happen to sit on the Government side have questions they would like to ask about the health care system and while I do not diminish the importance of the questions from the Member for Humber East, in fact I found her questions very edifying and entertaining and the Minister's response likewise, I think we have to give some consideration to the fact that not only the Members of the Committee be they on the Government or Opposition side but also the health critic, all have questions to ask and I mean three to one is not exactly in keeping with the principle of fairness and balance.

That is just to your point of order but your ruling has already cleared that up and I will abide by the Chair's ruling on time.

MR. CHAIRMAN: Yes. Just a quick comment. The hon. Member will only find that in the end she will probably have equal time with all the other Committee Members because the Chair is also observing the time that she is taking now.

Are you finished, Dr. Hogan, discussing the Member's question?

DR. HOGAN: Could you provide your question on statistics again, please?

MS. VERGE: The incidence of HIV infection and AIDs and your projection for the next few years?

DR. HOGAN: The prevalence at this point in time in our Province, these are the reported numbers, there have been eighty-six individuals reported as being HIV positive, which means they are infected with the virus. Of those eighty-six, twenty- one people have been identified as cases and of those twelve are dead.

In terms of provincial projections: I do not think there is any scientific formula that is available in a population of this size with this geography to be able to predict what the cases are going to be. The trend has been and will continue to be occasional cases reported on an ongoing basis.

MR. CHAIRMAN: Thank you, Dr. Hogan.

Thank you, Mr. Minister.

Mr. Reid.

MR. REID: I would be quite satisfied to let my colleague from Corner Brook continue on all morning if she had let me know in advance, then I would not have had to come around the bay at such an early hour in the morning to come to this meeting. She always does that, Mr. Chairman, on every one of the Committees she is on, do not feel one bit bad about it.

MR. CHAIRMAN: I do not feel bad. I do not think anybody here feels bad. It is very difficult when you are dealing with politicians to cut them off.

MR. REID: I agree with my colleague from Bonavista.

On the question of the federal government transfer payments, and I know I have asked this question a number of times, and I am going to get the same answer again. But I think personally that Newfoundlanders, Mr. Minister, today are more receptive to paying at least a share. In my riding alone I have heard a number of people say recently after hearing about the cuts and the financial restraints we are under that maybe it is time for the Government - and not only the Provincial Government but the Federal Government as well, because there is a connection - to look at the possibility of user pay.

My personal gut feeling is that yes, most people would be happy I think, and will I think be more receptive in the next few years, if things keep deteriorating, as it relates to Federal transfer payments and the amount of monies that the Province can actually put into health. I think people are going to start to realize that maybe it will mean that we as individual people will have to pay a certain share of the cost of the health care system.

I do not know if the Minister has made any comments to his Federal counterpart or any other, I suppose, counterparts in the provinces. I know that there are provinces that are trying to get out of it. But how do you feel about the possibility of some sort of a small fee as it relates to hospital visitations or X rays or whatever, anything? That is the first question. I would like to hear the answer. I have a couple of other questions if you do not mind, Mr. Chairman.

MR. CHAIRMAN: No problem.

MR. DECKER: Mr. Chairman, the Member is quite right. More and more this suggestion is coming up about user pay. You know, it is a suggestion. Doctors tend to use it - some doctors, not all. Usually, normally, people who can afford will do it. And you get all kinds of arguments as to why it should be there. One argument is that there is some abuse of the system and this would be a deterrent (Inaudible). But I want to say right up front that personally I find the concept revolting. I believe one of the best things we have in Canada is universal medicare. And that is my personal feeling on it. In the United States a person can become bankrupt if his wife has to have serious surgery. And I would hate to see that happen in this country.

But quite apart from my feelings or Government's feelings on the matter, the Federal Government - the first time it was dealt with I think Monique Begin was the Minister of health, when she threatened if any province brought in user pay to take dollar for dollar off the EPF. Now, EPF is going to run out in 2003 for us, 1995 for Quebec, and somewhere in between for all the other provinces. So immediately this administration in Ottawa saw the temptation of provinces to meet their need with user pay. So they have just recently announced that they will take dollar for dollar off the transfer payment. If we had a government which wanted to bring in user pay, if the present trend in Ottawa continues, it would not work anyway.

But I believe that as a Province we can deliver for about a quarter of our Budget a health care system which will make sure nobody is forced into bankruptcy and that nobody is denied health care services. And I think we can do it. But I think if we ever allow that to go to 35 per cent, I do not think we can do it. But I believe the answer is not to slap a user fee on, not to put in a health premium as some of the other provinces have done - which is really another form of taxes - but to streamline the system. And if there is any abuse there I think it has to be taken out, whether it is by the patient, the doctors, the system, or whatever. We can put checks and balances in place to stop the abuse. But if we were to lose Medicare, Mr. Chairman, I believe we would certainly have lost one of the best things that this nation, not just this Province, has.

MR. CHAIRMAN: Mr. Reid.

MR. REID: I can understand and appreciate your comments and I feel basically the same way, yes, 100 per cent universal coverage on MCP. I have no problems and I would never argue contrary to that, but, Mr. Minister, universal coverage of MCP is a dying entity and it will be dead. You know and everyone else knows. We may want universal coverage but in a very short period of time there may be no MCP at all left in either Newfoundland or Canada. If you are here in 2004, and let us hope you are, you may be forced with having to make a decision on user pay.

MR. DECKER: That is a possibility.

MR. REID: I have a number of individual questions as it relates to the Estimates but I will leave that until after, until my second turn comes around.

I am hearing a number of public health people, especially nurses in the field, talking about home care services and how home care services can provide and save big dollars for Government, for hospitals and for Government. Do you wish to make a comment on that because I know you must be familiar with some of the comments that are being made?

MR. DECKER: Right now, Mr. Chairman, there are two formal home care programs in the Province, the St. John's district home care program and the central which is in Gander. The one in Gander, especially, was a pilot project to see if this home care would work. It comes as a problem from two angles, one, is that people are being released from hospital, discharged from hospital earlier. They are taken out of a $600 bed and sent home where the nurse goes in and various people will visit. The other angle is that seniors, or mentally handicapped people, or physical handicapped people, are kept in their own homes as long as possible, and they are paid one, two, or ten visits a week. What you will find throughout the Province is that it is quite possible, before this day is over, that someone somewhere will receive four or five home care visits. They will probably get the person from social services, they will probably get the health nurse, and they will probably get the VON. There is over kill in some parts but in the vast parts of the Province there is no home care, so it is patchy.

We announced in the Throne Speech that we are in the process of putting in place five regional home care boards which will take responsibility for all this area you are talking about. We plan now that the next step is going to be Western Newfoundland. Hopefully by this Fall we should be ready to go there. In the North the Grenfell will be the board to deliver the home care. Basically, it is a single point of entry into the health care system. If you are living in Bonne Bay and you are a senior citizen, right now, or it has been, that if you had some contact in the nursing home you probably got admitted. If you knew the Minister of Health he would probably phone and get you into a nursing home, but we are going to do away with that so a professional body will determine whether Aunt Mary should be in a nursing home, whether she can be sustained on home care, whether she should be in a personal care home, or whatever it should be. The social services program, the Enriched Needs Program will be tied in very closely with the home care program to the point that they will determine where the enriched needs people go. It still has to be charged through social services because it is funded by the CAP funding. Our home care program is indeed being enlarged and we are going with it.

MR. REID: Is it saving you money?

MR. DECKER: We are hoping in three years to have the whole Province covered. Is it saving money? In Alberta it is costing an absolute fortune, however the institutionalization in Alberta is substantially down compared to what it is here. You will find that there are some people in home care at this moment who are costing the Province $5000 or $6000 a month so that is not really saving any money, but you will find in some of our nursing homes there are people who could very easily be out there in their own home, yet they are costing the Province $30,000 in a nursing home. They should be out there for about $600 a month, that is the difference. If we could only deal with that. We are hoping the single point of entry - we are not going to take anyone out of the homes and put them on the street, but we are hoping that once those boards are in place that people who go in the level three nursing homes really need the service. At the moment there are people in there who are not appropriately placed. It is not fair to them, nor is it fair to the system, nor is it fair to the Province who is paying the shot, but it can cost less money. But more important than that, it would be a more appropriate treatment because the Senior Citizen Federation and the senior citizens are saying, 'we do not want to go into an institution until we have to. We want to stay in our homes as long as we can.' Of course you get into the whole issue of adequate housing in the Province, so there are other factors that come in, but home care is one of the things that we are following.

MR. REID: I will yield now, Mr. Chairman.

MR. CHAIRMAN: Thank you, Mr. Reid.

Mr. Minister.

MR. DECKER: To avoid duplication our public health nurses which are out there, they will now become employees of those public health boards. At the moment they are direct employees of the Government, but they will become employees of the board whereas a few years ago in the hospitals the nurses were employees of the Government, now they are employees of the hospital board. And so the public health nurses -

MR. REID: Are they going to be set up in Conception Bay South and particularly in those areas?

MR. DECKER: That is right. That is the eastern; that one will not be going until next year.

MR. CHAIRMAN: Thank you. I guess this is probably a good time to take a short break, anywhere between five to ten minutes. When we come back I will give Mr. Harris an opportunity.

MR. CHAIRMAN: Order, please!

The Minister has a prior commitment, we are going to lose him for ten minutes, I suppose.

MR. DECKER: How long does it take to get to the Radisson?

MR. CHAIRMAN: About five minutes I suppose. The best way to go is down Cochrane Scree and right up Duckworth Street and you are there, or you can go up here and then go in around and down. It is only five minutes maximum.

We would have to adjourn at 12:20 p.m. at the request of the Minister who has an engagement but I am sure the second time around, because there is no way we are ever going to get a chance to pass all these subheadings, that we can make up that ten minutes. In saying that I would now pass it over to Mr. Harris.

MR. HARRIS: Thank you.

The Member for St. John's South obviously does not know St. John's East very well. I would suggest that you go up by the Basilica and down Garrison Hill and turn west, you would get there a lot quicker.

First of all, I have a lot of issues I would like to raise with the Minister and his officials, but I want to say first of all I was very pleased to hear the Minister's comments this morning regarding the situation with midwives and to hear that the government has no difficulty with midwives being the primary person involved in the delivery of children provided it is within reasonable access to health care or other emergency care in case of medical emergencies.

I wonder if the Minister would be prepared to indicate his Government's position or intention, I suggest today or this week, because yesterday was International Midwives Day and this is the special week for the nursing profession in this country and as most of the midwives are registered nurses as well, I wonder would the Minister be prepared to indicate his Government's intention to move on this issue given that we do have a Midwives Act which is on the books and is still on the books. There is provision in The Midwives Act for a board which would certify individuals as qualified to act as midwives. I understand no board has been appointed although I believe the Act says that the Minister shall appoint, but no board has been appointed for some years. I think perhaps since the early fifties maybe even since Confederation, I do not know.

Would the Minister be able to tell us whether or not they are prepared to move now to start to recognize midwives and what they do by the institution of that board as a first step?

MR. DECKER: There is the problem of saying something and the interpretation of what you have said after you have said it.

MR. HARRIS: Yes.

MR. DECKER: As I have said, we have no objection. I was quoting the position of the Association of Registered Nurses that midwives can deliver children with the understanding that all the backup services are within a reasonable distance. That is not to say that we are actively encouraging that midwives would do all the deliveries from here on. I think you will find it is a stated fact that in some hospitals, especially in Labrador, the midwife is doing the vast number of deliveries I would think, with all the doctors on standby.

Now the Member talks about our Midwives Act. There are midwives and there are midwives. We really have not written the Act for the trained midwife who is a nurse, or at least that is my understanding. In this Province, in addition to the trained nurse who is a midwife, we had lay people who delivered babies. That was very prevalent. My grandmother, as I said before, could spell one word, and I do not know why that word happened to be cat, c-a-t was the extent of her vocabulary in spelling, yet she delivered 500 babies. She boasted on her 94th birthday that she had not lost one child in delivery, that she was lucky. But that was quite prevalent in Newfoundland and Labrador, that was a necessity. Women who - what is that one: she never saw the ocean and she never saw the sea, but she did all the things that women do. Women - it is a natural act, and usually an older woman in the community took it upon herself to deliver children. In the fifties, I believe, Mr. White, did we start training them? Was that the fifties or earlier?

MR. WHITE: During the fifties and later probably. The modern midwife is primarily - I stand to be corrected, but the modern midwife is probably a nurse in the first instance.

MR. DECKER: Yes, I know, but I am just thinking about our act. The Government of the day recognized that maybe some training should be made available so they started to bring them in for a six week course, I believe it was. Something like the lay supply school you get in the Church. They took them into locations and they gave them -

MS BISHOP: (Inaudible).

MR. DECKER: Maybe Ms Bishop can address the whole because this comes out of her area, but the act which we have does not really address the nurse midwife, it was a special case, that is why we have an act. We want to address the role of the old midwife, the untrained midwife.

MS BISHOP: Thank you, Mr. Minister. Mr. Chairman, the access on the books now from my understanding - I have not look at it in some time. It was developed in the early fifties and it did address those people in the community that acted as lay midwives and they were sent into larger centres for about six weeks to observe what is going on and then went back to the community. And the work that they have done over the years for the most part is now extinct.

MR. DECKER: That is correct.

MR. HARRIS: I should say that maybe I should take back my congratulations to the Minister then because he did say it was the Government's position, but now he is saying that it is the ARNNs position, and I would suggest perhaps -

MR. DECKER: (Inaudible).

MR. HARRIS: I have read the act. Ms Bishop has not, but I have read the act and although it may have been designed for non-professional practitioners, it appears perfectly adequate to establish a qualification and set the standards for people who could be designated or licensed I think is the word used in the act. The Minister may not be aware, but I am, that the school of nursing at Memorial puts on a one year course usually for nurses to get midwife training (inaudible).

MR. DECKER: (Inaudible).

MR. HARRIS: It is a post-nursing course for RNs to get specific training in midwifery, and it strikes me that this aught to be examined by the department if the department is serious about what it has said, that perhaps the act can be looked at to see, although as Ms Bishop has pointed out it may have been designed for specifically another purpose. It seems that it would be quite adequate to allow this designation, and perhaps the Minister could undertake to do that.

MR. DECKER: This issue came up, Mr. Chairman, about six months ago, I believe. Just out of the blue someone in the media came after me, a woman in the media wanted to talk to me about our role in midwifery. And I did undertake at that time to look at the act because I do not believe that all of the other provinces have midwife acts, do they? I believe we are one of the few Provinces that do. But the direction over the past number of years, Mr. Chairman, has been to get to a position where we were not totally dependent on midwives. Now the problem we have had in Newfoundland and Labrador, is that the only person available to deliver a child was, either the untrained midwife or a British nurse who, under their training studied midwifery for a year to be a registered nurse in Britain; I do not know if it still is or not, but it was understood that you were practically trained to be a midwife, but the problem Newfoundlanders had is that we only had midwives.

Now we recognize the role of midwifes in the overall health care programme, I have no problem with encouraging it in the context of doctors and nurses and midwives and everyone else who make up the very elaborate health care system, but what we were trying to get away from for years was, the position where only midwives were there to deliver children and that certainly was not adequate.

Now we are at the stage at this moment where midwives in some hospitals are probably not playing as big a role as they should, but I am more concerned with having safe delivery of children than I am with making a specific job for a nurse or a midwife or whatever, it is by necessity you do what you have to do, but it is not something that we have any strong position on one way or the other; I am hoping to get to the point where we can have the safe delivery of children, which is really the issue.

MR. HARRIS: I think the Minister, if he does look into the matter, will find that the issue is part of the quality of the delivery of health care, part of choices for women who are about to give birth and there is a high degree of, certainly quality of care and delivery and that is why the choices are being made, not because they cannot get a doctor or it is a remote, isolated area, and provinces like Ontario are now actively developing a programme to licence and give assistance to it, and in fact I have requested information on that and I will make it available to the Minister.

MR. DECKER: I appreciate that.

MR. HARRIS: That is one point on which I will ask for the Minister's comments, but I want to say something about the overall issue of the Medicare system and the whole debate about established programmes financing.

The Minister seems to be a bit schizophrenic about this issue, on the one hand saying that he has a great degree of commitment to the Medicare system, particularly its universality, and on the other hand keeps telling Newfoundlanders and told us this morning that it could end up all falling apart and obviously as we all know we would have serious problems keeping up the system.

On the other hand, the Minister has made a statement that we can have a system that would prevent people from being forced into bankruptcy. Now, I do not know if that is the criteria in terms of what level of individual support for health care the Minister could tolerate on a user pay basis though he objects to what the Member for Carbonear says; he used the term forced into bankruptcy, presumably as the standard, so I am a little worried about that and if I did not know better I would be worried that the Member for Carbonear's comments about user pay is part of the softening up of the populace for this type of approach by Government and I am concerned about that because we have seen the whole debate on C-69.

I know there was a Private Member's motion, not a Government resolution in the House last November, debating Bill C-69 while the Bill was in the Senate and I wonder if the Minister can tell what plans he has to deal with this issue with the Federal Government, in view of the fact that his Government did not see fit to participate in the debate about Bill C-69 when it was before the House of Commons and when the Committee was holding hearings in Ottawa.

The Government apparently sent no representatives to that and did not make any representations to that Committee, did not have anything to say really about Bill C-69 until a private member from their own Government side, decided to raise it when it was I suppose, too late, it was already in the Senate; the debate had taken place and the Newfoundland Government had not participated in it. Can he explain how we measure the commitment that Government has to the Medicare system if the Government is not prepared to be engaged in the national debate on it?

MR. CHAIRMAN: Mr. Minister.

MR. DECKER: I attended a function at the Arts and Culture Centre, it was a graduation for nurses, and I was confronted by some people on picket lines waving those placards and that sort of thing, and every single word I said they plucked out of context: Hear this. Hear this. The Minister said this. This is the same mentality which my friend here is using today. I said, forced into bankruptcy. I referred to the United States where people can be forced into bankruptcy. So, the same mentality with respect, Mr. Harris, I see in people on the picket lines. If you say it is raining, they say, the Minister wants rain. This is the same thing, so I do not know, and I would not suggest that there is any relationship between the unions and the NDP. God forbid, I should not even say that, but I cannot help but notice the similarity. That is not the criteria, of course it is not. I said that this administration is totally committed to universal health care. I did say that if we do not restore some common sense to the finances of this Province the whole darn thing could fall apart, and I believe that. I believe it is fortunate, that at this particular time, this administration is sitting where we are, because I do not believe, and as Peter Fenwick pointed out, certainly the previous administration did not have the political will to do what we are doing, so I believe it could fall apart but it is not going to fall apart, because as Peter Fenwick points out, we do have the political will to do it. The issue of federal/provincial financing: what my plans are and what we plan to do with it, at this moment there is a review going on which will be completed in 1992. It has been suggested, and again I must say now that I am not speaking Government policy, but it has been suggested, and other things have been suggested, too, but one of the things which has been suggested is that maybe if we could pick up more transfer payments the EPF might not be as serious as you would think. EPF is paid on a per capita basis, Ontario gets so much, and all the provinces, so maybe as this review is going into place we might be looking at dealing with the transfer payments because health and education are the responsibilities of the provinces anyway, so rather than the Federal Government going directly in that might be a way to do it, through transfer payments. Finance is doing a total review as Dr. Williams pointed out.

MR. HARRIS: What the Minister did say was that he believed that for about a quarter of our health care budget we could have a system that would not force individuals into bankruptcy. Those are your own words and I did not put them in your mouth, and I did not take them out of context. That was the exact context in which they were stated, and if the Minister does not want to be quoted then he better not use those kind of words because that is the impression he gives, that, that is the standard that works. He has not answered the question as to why his Government and his Department chosed not to participate in the hearings that were held on Bill C-69 when the matter was before the House of Commons and when the parliamentary committees were considering it. I believe other Governments did participate but this Government chose not to. Was it a part of your strategy to stay away from these things and wait for one of your own Members to bring it up in the House in the Fall, or was there some other reason that I do not understand?

MR. DECKER: That was a Parliamentary Review Committee of the Parliament. Is that the one you are talking about here? We have taken the position that we talk directly to Government level and the system is in place to do that, so that is going on, but I should say in addition to that Bill 69 has been given considerable debate by all the health Ministers. As a matter of fact we had a special meeting of all the health Ministers right across the nation, the ten provinces and the territories, to discuss this matter. Just because we are not out waving placards and shouting does not mean that we are not negotiating. Negotiations are going back and forth and the Federal Government knows full well our position on Bill 69, a position I should say by the way is similar to all the provinces regardless of their political stripe, it is a matter which all the provinces have to deal with. Our strategy is to deal directly with government and that is why we have not been appearing generally to senate hearings or to the review committees.

MR. HARRIS: On an other matter that the Minister alluded to in terms of the increased cost of drugs as a result of the consequences of the Federal Government drug patent legislation Bill C-22 - which the Minister will know was debated for some time nationally - one of the political comprises, I guess, reached by the Federal Government in order to sell this legislation was that each Province is going to get a certain amount of money which is part of the selling job, there was to be more research all across this country and that this money was going to come from federal revenues.

Can the Minister tell us how much money the Newfoundland Government has gotten since Bill C-22 was passed for its research purposes? Can you tell us what has happened to it?

MR. DECKER: We received $2.5 million and we are paying $18.5 million for a medical school which is doing a considerable amount of research funded by us as well as funded by various grants which they get from different sponsors. We took the $2.5 million, for a while we kept it in a trust account, but this year when we were met with the fiscal problems that we had we put it into our general revenue.

MR. HARRIS: So, this $2.5 million that is ended now, there is no more coming for that now is it?

DR. WILLIAMS: (Inaudible) the spring. I think so.

MR. HARRIS: Was there not a committee set up at one point in time to decide what to do with that money and how it might be used to promote research (inaudible)?

DR. WILLIAMS: Yes, they recommended that a research foundation be set up but we decided against that when we reviewed the programme planning.

MR. HARRIS: I am sorry, you were talking back and forth, what did this committee recommend?

MR. DECKER: The committee recommended a research foundation, I believe.

DR. WILLIAMS: There was no committee. The committee that you referred to was the possibility of sitting up a health research foundation in the Province. That would be the committee.

MR. HARRIS: Okay.

MR. DECKER: Where did the recommendation of that research foundation come from?

DR. WILLIAMS: It came from our discussions with people in the system and through a royal commission implementation committee.

MR. DECKER: Okay, so I will say that at one time consideration was given by the department into setting up a research foundation, that action was never taken. This year we decided to put the $2.5 million into general revenue.

MR. CHAIRMAN: Thank you, Mr. Minister.

I would want to consider that I gave Mr. Harris of course twenty-four minutes. I am sure he would agree -

AN HON. MEMBER: How long did you get Jack? Did you get your half hour?

MR. CHAIRMAN: Of course, we will get back to Mr. Harris but I wanted to give Mr. Oldford an opportunity to put some questions to the Minister and his staff.

AN HON. MEMBER: (Inaudible) people jumping the line, I think.

MR. OLDFORD: Thank you, Mr. Chairman.

Mr. Minister I would like to make a general comment and some suggestions to you. Your budget from this year to last year, you put an extra $34 million into the budget.

MR. DECKER: Pardon?

MR. OLDFORD: You put an extra $34 million into this year's Budget and about $25 million from the revised Budget from last year to this year's estimates. But you are still being criticized as tearing the guts out of our health care system. I realize it is the Opposition's role to criticize and to oppose and the union's role to protect their membership. I guess what I am getting at is if that Opposition is not constructive eventually you get into a situation where people lose confidence in the system and when you do that I think it undermines the system. This doom and gloom that we have heard over the last little while I think needs to be counteracted and I think people have to have their minds put at ease that you are committed and that Government is committed to a quality health care system.

I think what I would suggest, and I do not know if this is possible, that you probably need a better system of public relations to let the people know because there are some people out there, and I am thinking of seniors in particular, who are possibly upset because the only thing they hear is what the Opposition and the unions are saying and I would ask that maybe you would consider this, not for political reasons, but to put their minds at ease.

Now, I would like to get into a couple of specifics, and I would like to ask you a couple of questions about the average cost per visit for the same services in a public clinic as opposed to a private clinic. I think back to figures that were being kicked around when the Come by Chance Clinic was being closed. Could you tell me what the cost is in a private clinic versus a public clinic per patient for the same type of service?

MR. DECKER: Would you like me to take down your questions?

MR. HARRIS: Okay, this situation was brought up a few days ago in Catalina. I am not sure if this is right or wrong.

MR. DECKER: I have to question what you mean by a private clinic.

MR. HARRIS: In communities you have private practitioners operating their own clinic, if I were to go there with a broken finger or whatever, what would the cost of that service be to the Government versus if I went to the Cottage Hospital in Bonavista?

MR. DECKER: Maybe a broken finger might not be the one. It would be $14 or $15 if you went to your GP and it depends upon what he does. You might have to have a general assessment which is $30 something. Usually it is $14 or $15.

DR. WILLIAMS: I think the question arises out of the study that was done probably on the clinic in Come By Chance where the board did a study and showed I think the average cost was $185 a visit, that included the salaries of the three physicians who worked there, the support staff who worked there, in other words, the whole budget of that clinic. That would not be the norm.

In the case of the clinic at Come By Chance with three physicians employed, two physicians who had been working in the area for about eighteen years and had set up private practice in Arnold's Cove, and, of course, the vast majority of patients were going to these two physicians in private practice. So, in essence we had an underutilized facility and that is why I think the cost was extraordinarily high.

If you look at a fee for service and a salaried system, the fee for service payments are higher than we pay in salaries to physicians. One of the reasons for that is that the physician in private practice has an overhead component which is the cost of doing business, the cost of their office, supplies, equipment and this type of thing. Depending on the person's level of income, the cost of operating a private clinic for a general practitioner might run $40,000 a year, it varies on where the person is located.

I think the figure you are discussing is so much out of whack when you compare a public funded clinic to a private practice setting was because of the utilization factor in that particular area. I do not know what they included in the cost, they may have included more than the doctor's cost.

MR. OLDFORD: Generally speaking thought the cost of a public clinic would be much higher than a private clinic?

DR. WILLIAMS: I would not want to make that statement. I think one would have to do a detailed analysis and one would have to look at a salaried medical system. In fact in this Province we have a larger number of physicians generally being remunerated by a salary basis than we do in most provinces of Canada, a much higher ratio, and you have to look at our past history to recognize why that was. Back in the 30s and 40s they set up a system called the cottage hospital system because Newfoundland was very rural and still is very rural with 50 per cent of the population in communities of 2500 or less. It was very isolated because most of the transportation went by boat and many physicians were paid on a salary basis and that has continued today in some of our smaller communities. In comparing the cost of a publicly funded system, such as salary versus a publicly funded system such as fee for service for physicians, I think one would have to do a detailed study to see for the salaries we pay physicians how many people they actually looked after. Not necessarily the number of visits that were made to them, but how many people they were responsible for, for their health care. I do not think the figures we are looking at for Clarenville are a valid comparison. I would not want to make a judgement, and it would be a judgement issue of what system works best and what system is less costly.

MR. OLDFORD: This leads to what I was getting at. In Catalina the question was asked, why is it that if I go to a private clinic in Catalina, say, and I have to have a bandage replaced, I get charged for that bandage and I get charged for that service? This is what was related to me so I am just wondering if this is a fact. Yet, if I go over to Bonavista to the Government run clinic it does not cost me anything to have my bandages changed. I am just wondering what the relationship is between those two, and if there is a possibility, or if it is covered here some place that some of these services can be paid for if they are in a private clinic. Eventually what could happen is, if the Government run clinic is busy or their services are overextended, or whatever, then it would be to the benefit of Government to encourage people to go to the private clinic. Do you know what I am getting at? I am not sure what the cost of those bandages is. Maybe it is only minimal and maybe it is not worth your while to drive all the way from Catalina to Bonavista to have that service.

MR. DECKER: Well, in that particular case I am sure it is not, but the issue could be broader.

MR. OLDFORD: It is a broader issue, I am sure. I would like for you to comment on that, and then there are a couple of programs at the hospital in Clarenville, the cytology program and the mammography program. They are important to women, not only in my district, but in Bonavista South and in the whole catchment area that is serviced by the Clarenville hospital. These programs are not licensed. I am not sure if that is the terminology, licenced, sanctioned, or whatever. Is there a possibility that those could be?... because the expertise is there, the medical people are there, and, of course, we have a problem attracting specialists to rural Newfoundland anyway.

MR. DECKER: I do not know what you mean by licensed. Dr Williams could address that afterwards, but certain hospitals have a mandate to carry out, have a role to play, and I do not know what the situation on mammography is in Clarenville, do you Dr. Williams?

DR. WILLIAMS: We are talking about two issues. The Department has just had a review done on cytology with people from the Province who are expert in that area. It has just been presented so we have not had a chance to review the issue of cytology. When you look at a service such as cytology where specimens are taken and can be sent in, and where there is no inconvenience to the patient, if the cytology service is done at some other area there is no inconvenience or no problem. In looking at cytology service one has to look at the issue of quality, and that is an issue that we have to look at in cytology service in the Province. For instance in a province like British Columbia which is recognized to have the best PAP smear screening programs in Canada they have a centralized cytology service operated by the Cancer Control Agency of British Columbia. So there are certain economies built in to if you have people in that kind of a system, and a centralized system, with put through. They have a high volume, they have expertise there, and we know that there is a good quality assurance.

Now when we look at cytology, if we break it up and piecemeal it, we are a little concerned about the quality assurance issue. I know the arguments from Clarenville. There is no decision made on that. As regards Clarenville, it is not an approved service. It is a service that the board, with the funds that we gave them, have been operating and providing that service. The service would still be provided, if Clarenville did not do it then it would be done at the centralized service, at the General Hospital.

So we are looking at the whole issue of cytology services from a perspective of quality. We want to make sure that if we do have a Provincial screening, where it is so important with this particular disease, and with a disease that we know and have good experience that is preventible, we want to make sure that the quality is there. And we want to make sure that we deliver the service in the most efficient manner possible. So that is why we are looking at the whole issue of cytology screening for the Province. But that is a quality issue and I guess an efficiency issue.

MR. OLDFORD: Seeing we are doing estimates I just wanted your assurance that it was not a cost issue, cost in this case (Inaudible) -

DR. WILLIAMS: No. We have to look at quality. Quality is an issue and this committee was set up to look at the whole issue of the delivery of cytology services in the Province.

MR. OLDFORD: Okay.

DR. WILLIAMS: That is a committee made up of health professionals mostly from outside the Department of Health. And they did actually have an opportunity to visit the programme in British Columbia. Several of the committee members did visit British Columbia to see what system they have because they are recognized to have a very good system.

MR. OLDFORD: Okay. I do not think I have any other questions (Inaudible).

MR. DECKER: (Inaudible) because I think it is a good point which the hon. Member made, Mr. Chairman and I have to agree with him. For some reason - and I cannot tell the media what to do - but the media takes more - they accept piecemeal criticism whether it has been researched or not. And some of the things which have been carried - well, the Baie Verte case were the absolute lies which got out there. The word in Baie Verte was that we were going to not do any more obstetrics in Baie Verte. That we were not going to make provision for emergencies in Baie Verte. And the people actually believed that.

The board finally came in and met with myself and officials of the Department. And when we explained to them what we were doing the board went on the public record as saying that they were in agreement with what we were doing and thought that it was in the best interest. So how do we get that message out? Where we have boards which are cooperating it is not as difficult. Generally the boards go back and they have a level of expertise and they listen and they get the message out. You would be surprised at the number of changes we have made leading up to this Budget. Things which the board suggested and we went back and said we do not agree with that. And then the boards came back again. Springdale is one case in point where (Inaudible), Bonavista is a case where boards were back and forth in the process.

So what is happening is done with the knowledge but our PR is not good. Now one way to deal with that I suppose would be to put on a big media campaign where you pay to have your message out. But you have to ask yourself: is it really right to take $1 million, $500,000 or fifty cents and put into PR when you are forced to close beds, when you are forced to lay off nurses? So it is a judgement call. We would love to get our message out, and if our message was out based on health grounds - base it on the delivery of health care for $800 million; it is no good to base it on politics - and I think we do have a good message.

But we have decided not to take any money and pay for a PR campaign. Because as much as it is probably desired politically, but it would not really make any difference to the health care system (inaudible) but I agree totally, we have a PR problem.

MR. OLDFORD: May I say one thing.

MR. DECKER: Yes, go ahead.

MR. OLDFORD: If you have a hospital that has thirty beds in it and you know that over the last five years only ten have been used, that is it, ten is the maximum that have been used; you take the other twenty beds out of the system, are you really closing beds?

MR. DECKER: That is right. The Curtis Hospital in St. Anthony, there were forty-two beds which we closed, but the reality was that those beds were underutilized, so, did we close forty-two beds or did we not close forty-two beds?

MR. CHAIRMAN: Okay, thank you; those were interesting comments. Now that we have had an opportunity for all the committee members to ask questions, in the time remaining, we have half an hour, maybe we should now lead with Mr. Power, who opened up, and have some more direct type of questions and answers, so we give everybody an opportunity. Mr. Power.

MR. POWER: Do I have five minutes or ten minutes?

MR. CHAIRMAN: Well, let me say there are five committee members; we have thirty minutes left so, how about six minutes?

MR. POWER: I have a brief question so I hope the Minister gives a brief answer. In 1990-1991, about your long term plan which the Minister said on several occasions began in 1989 when you took office, in 1990-1991, you opened more hospital beds, you hired more staff, you had a health care funding increase in excess of 11 per cent. In 1991-1992, you closed hospital beds, you laid off staff, you have a funding increase of about 3.6 per cent, how is that a plan?

MR. DECKER: We closed 400 and some odd beds, 442 care beds, then we changed eighty of them to chronic care, so they were not closed; I think the net was 360 beds, half of these beds will never be opened again in the Province, but the other half will, so 160 beds are closed because of the fiscal problem and that is the planning because you do not have enough money to pay your installment.

The other half were underutilized and they were in places like St. Anthony as I just pointed out, there were forty-two; they were in places like Springdale where we changed the role but we use them as chronic and places like Bonavista that sort of thing, but it was not the plan to close the 160, that was re-acting to our fiscal problem.

MR. POWER: My second question which I do not really care to bring up after last week, but the Minister has mentioned it twice in an off-the-hand kind of remark. The Minister says that he will look at the confidentiality of Aids testing because of his own problems last week relating to confidentiality.

I would like the Minister to acknowledge that the problem last week was not a matter of confidentiality, it was a matter of the Minister of Health receiving, I think the term is: prominent citizen status, to get some work done in a hospital.

If that is true, if the Minister would acknowledge that that status: prominent citizen, is obviously not available to every one, will he also re-assess the reasons and the complaints about long line-ups in lab and X ray which we have received in a large amount of phone calls and letters to our office?

First of all, will you acknowledge, and I checked after I asked the Minister some questions the other day in the House; I checked with thirteen hospital boards, they all use walk-in service for lab and X ray; it is not different in other places, it is the same all across the Island, so will the Minister simply acknowledge that what happened last week was not really a confidentially problem, it was a problem of somebody receiving special treatment?

MR. DECKER: Mr. Chairman, that is not (inaudible).

MR. CHAIRMAN: I will give the Minister the opportunity to say he will answer or he will not answer, because we are in an Estimates (inaudible).

MR. DECKER: Well that is like 'do you beat your wife?'... you know one of these do you beat your wife questions. I think Sister Elizabeth answered that question to the best I have heard; it is unfortunate that she had to be dragged into this, but when she explained that in her opinion, and it was her opinion, that I had a special need and a special need to protect my privacy. I do not apologize for that. It is ironic but I did not want the whole damn world to know that I was going in to piss in a bottle to put it in plain terms. I thought this was a very legitimate reason as the Sister has pointed out. She has done it for other people as well and she explained the need where she took the old lady and gave her a ride home, she had a special need, so there is no big deal with that.

The other thing is on a province-wide basis whether or not you have appointments or whether or not there are long waiting lists, that is being monitored daily and whether or not you have to wait all day to have a blood test, the reality is that you do not have to wait all day to have a blood test done. The fact that we do have walk-in clinics is testimony to that. I could not conceive that the system was so efficient that you could have a walk-in clinic. But the fact of the matter is the walk-in clinic is testimony that there is no long waiting list. If there was, then there would be appointments and you would be making your appointment for next week or the week after which I assumed I was doing. But the walk-in clinic is testimony that there is no problem. That is the way I interpret it, Mr. Chairman.

MR. CHAIRMAN: Thank you, Mr. Minister. Mr. Gover.

MR. GOVER: I would like to go back to the point my colleague for Trinity North raised about the health care system. It is very easy when you are in Opposition, I suppose, even if you wanted to be a controversial Government Member it would be very easy to say the Government is ruining the health care system when it closes an acute care bed and it is very easy to be political about it. In fact, the Member for Humber East said that it is for sure we did not have the political will to do what the current Government is doing. And the Member for Ferryland says that these things have not been very well researched. But, just by way of preliminary comment as we all know there was a royal commission on hospital and nursing home costs and out of that royal commission came a bed study in 1986. Now the Minister may have some dispute with the exact recommendations of the bed study. Of course, we know these recommendations will change over time but I believe in that bed study it was recommended in rural hospitals, since it did not deal with urban hospitals, that 360 acute care beds close in rural hospitals around the Province and the hospitals were listed out by region and utilization was all considered. Yet we find that when I was researching this and I went down through the list of recommended bed closures unfortunately, I believe, the only ones I saw acted upon were by and large the majority happened to be in districts held by liberals.

For example, the eighty-six bed study recommended the closure of Grand Bank and St. Lawrence as soon as the regional health center in Salt Pond is build yet that was not actioned when the hospital commenced operation. So it is very easy to be political and hurl political epithets at this particular Government but when one looks at the record of hospital closings one can see where the politics was played and where the priorities were not adhered to.

Getting back to my point about bed closures, it is easy to say that when you close an acute care bed the system is worse. But I will take my own case as an example. In Bonavista we had fifteen acute care beds and the hospital board did an extensive questionnaire and survey of the needs of the patients who utilized the facility and the people in the catchment area. We have fifteen acute care beds at the hospital, we did, and we had sixty long-term care beds at Golden Heights Manor. What the study found out based upon patient needs, catchment needs, and physicians opinions and nurses opinions was, there was a great need for respite care for people who were looking after their elderly parents in their own homes, there was a need for institutional care for elderly people, there was a need for Alzheimer's care and there was a need for community services both for acute care people and for people who looked after their elderly parents in their home.

I suppose, it is a comment on our society that we find fewer and fewer families now caring for their elderly parents in their home and it seems like we have gotten over the years more and more of an attitude to put our elderly parents into institutions. But notwithstanding that, when a survey was conducted we find a need for respite care, long-time institutional care, Alzheimer's and community services. In conjunction to that, when this issue came up I asked the administrator of the hospital to do a utilization study of the acute care beds in the hospital and he found by and large acute care beds in the hospital were used by chronic care patients, people who should be in Golden Heights Manor and not in the hospital. In fact the number of specifically acute care problems, even including long-term patients who were there on an acute care basis in the hospital we needed seven point five to eight beds.

With the restructuring that the Minister has undertaken we now have ten acute care beds which is two in addition to the prevailing demand that we found, and we have a fifteen bed Alzheimer unit, which can take people out of the hospital and put them into an appropriate setting or people out of the home and put them in an appropriate setting for their condition. By closing five acute care beds at Bonavista Hospital and opening more long-term care beds, in this case a particular wing, services on the Bonavista Peninsula have been enhanced and not downgraded.

There is no point in me coming to the table and saying: My God, the Government is ripping the guts out of the health care system because five acute care beds have closed on the Bonavista Peninsula, or indeed 360 or whatever the number is all around the Province, because if you looked at the 1986 bed study that is exactly what is happening. There is a misallocation of resources which has been allowed to go on under the former administration who did not have the political will to act, did not have the political will to rationalize the system, and what we are doing now is not necessarily a downgrade in service but may enhance the delivery of health care to people around the Province. I would just like to comment on that.

MR. CHAIRMAN: After that very, very good question, I would ask the Minister to make it short.

MR. DECKER: Okay. The Member is absolutely correct. Acute care beds are only a small portion of the overall health delivery system, you deliver the system as the Member pointed out.

What did the royal commission suggest about the number of acute care beds that we should have in this Province? The royal commission recommended that we should have 2198 beds by now, this year. How many do we have this year? We have 2,191. So, we need seven more beds to meet the recommendation of the royal commission on acute care beds. But as the hon. Member points out health care is not just an acute care bed in a hospital, there is a (inaudible).

MR. CHAIRMAN: Thank you, Mr. Minister.

Ms. Verge.

MS. VERGE: I would like to come back to western Newfoundland where people generally are seeing and experiencing -

MR. DECKER: I cannot hear the hon. Member.

MS. VERGE: I am coming back to western Newfoundland where many citizens are complaining about what they see as a deterioration in the quality of hospital services through the combination of closure and downgrading of the smaller hospitals and clinics in Burgeo, Port aux Basques, Deer Lake, Norris Point and Bay Verte, placing many more demands on the central facility at Corner Brook when at the same time the regional hospital in Corner Brook has been cut to the point of having to close thirty acute care beds and lay off about seventy people including seven staff in lab and X ray.

Among the negative outfalls that are immediately apparent are the delays that I talked about in diagnostic services, with people having to wait much longer, delays in outpatients where people are having to wait much longer, and number three, the pending dislocation of patients.

More people from White Bay, Bonne Bay, the southwest corner are having to come to Corner Brook for acute care services, but at the same time, at the central facility in Corner Brook there are twenty-three patients from the immediate Corner Brook area in acute care settings who do not require acute care, who are either chronic care patients or are medically discharged.

Now in that central building in Corner Brook there is empty space. It is a large building, it is a multi-use facility; there is acute care diagnostic services, emergency out-patients; The Humber Wood Centre at the Alcohol and Drug Dependency Commission is set up there; the Red Cross has their blood donor clinic there, the Department of Health have offices there and there is empty space there.

The plan, if you can call it a plan, is to uproot the twenty-three medically discharged/chronic care patients from the immediate Corner Brook area, put them in Bonne Bay, Burgeo, Springdale wherever the grand scheme calls for new chronic care space, so you have people from Burgeo, who used to be able to get acute care in Burgeo having to come to Corner Brook; you have people from Corner Brook who are labelled chronic care about to be transplanted to Burgeo, when there is empty space in Corner Brook, now, how does this make sense?

MR. DECKER: I am surprised the hon. Member does not understand the answer to this question. What is happening in Corner Brook today which is different from what happened last year and the year before, and the year before and the year before - nothing.

In Burgeo last year, if a person had a broken arm, that person was seen in Burgeo last year, the year before, the year before; the person was stabilized and was sent to Corner Brook; Bonne Bay was the same thing, Springdale in some cases if they chose, some went to Grand Falls, some went to Corner Brook; Baie Verte half and half went to Corner Brook. Nothing has changed in these places.

The primary care is still there, the doctor is still in Burgeo, the nurses are still in Burgeo, the Lab is still in Burgeo, the Lab is still in Bonne Bay, the Lab is still in Baie Verte, so the impact which the Member is talking about is overestimated; the primary care is being kept, but Burgeo is no longer attempting to do something which is better done in a regional hospital, but this impact is over-stated; I believe the re-organization (inaudible) changed.

The dislocation of patients: There were some medically discharged people in that institution - are they still there?

MS. VERGE: Twenty-three in (inaudible).

MR. DECKER: They are still in, yes and there are 400 in the system by the way in the Province, there are 400 people who may be discharged, it is just that there is no where for them to go. We are hoping that some of them will be able to go into Bonne Bay because of the role change in the Bonne Bay hospital -

MS. VERGE: But if they are from Corner Brook, why not accommodate them in the empty space in Corner Brook instead of moving them to Bonne Bay?

MR. DECKER: You will probably find, Mr. Chairman, that some of these very people are from Bonne Bay, some of them are from Burgeo and some of them are from other parts of the area.

MS. VERGE: I have checked, there are twenty-three from the immediate Corner Brook area including three children who have been at the Corner Brook hospital up to ten years.

MR. DECKER: The empty space in the hospital, Mr. Chairman, she went on to say was not used and then she gave us fifty ways that it was used and so, I would think that the space is being utilized-

MS. VERGE: Well quite a bit of the space is not being used -

MR. DECKER: I would suggest that instead of talking to the cleaning staff in a hospital, she should be talking to Dr. Watts, who is the Administrator out there and could probably explain to her what his plans are for it.

MR. CHAIRMAN: Okay, Mr. Minister, thank you-

MR. DECKER: The obvious thing is that it is inappropriate to keep the chronically ill and acute care centres and we are trying to get them out.

MS. VERGE: Why not convert some of the space to chronic care? That is what would be sensible, and not convert space in Bonne Bay to chronic care and move transplant people from the Bay of Islands to Bonne Bay when there is empty space in Corner Brook that could be converted to chronic care to serve the population from that immediate area? By all means serve the people from Bonne Bay and in Norris Point but do not start transplanting people in both directions.

MR. CHAIRMAN: Thank you. There is no need to comment.

Mr. Reid.

MR. REID: (Inaudible) the Director of Nursing and the Director of cottage hospitals, are those positions eliminated? They are gone this year, are they?

MR. DECKER: The what?

MR. REID: The Director of Nursing in cottage hospitals. Remember that one last year? They were eliminated were they not?

MR. DECKER: The administrator at Hoyles-Escasoni, that position is gone this year. For some reason the previous administration privatized that institution in 1985 and kept the administrator working in the Department of Health up until this year.

AN HON. MEMBER: How is privatization working?

MR. DECKER: Excellent.

AN HON. MEMBER: Is it saving some money?

MR. DECKER: Yes, now they have to make their increase like everyone else, but they are delivering an excellent service there.

MR. REID: Mr. Minister under Medical Facilities and Equipment there is an increase of in excess of $4 million. Other than the new clinic in Grand Bank where else are we spending money this year?

MR. CHAIRMAN: What subhead is that Art?

MR. REID: That is on Page 209, Hospital and Nursing Homes.

Increase in hospital facilities. What is the breakdown on that?

MR. DECKER: What page are you on?

MR. REID: I am on Page 209, subhead 4.4.03, total hospital facilities, gone from $3,700,000 to $8,329,000, and then the bottom line of course for all of it, I think, is an increase of something in excess of $4 million.

AN HON. MEMBER: I can read through the capital equipment budget and the capital budget if people want to know.

MR. REID: I am interested in hearing it.

AN HON. MEMBER: Hospital equipment, the budget last year was $8,200,000 and the budget this year is $8,200,000. Coastal Labrador clinics, there is a $2 million figure in the Budget which works out to about (inaudible) net because there is a federal/provincial cost sharing arrangement on the Labrador Coastal Agreement, federal/provincial that is to build a new medical clinic in Hopedale and to do some planning for a new medical clinic in Davis Inlet. The Hopedale facility, at a cost of about $1 million should be built this current year. There is $250,000 to furnish the Roddickton Health Centre which was started back in 1987. That is to furnish it. It is a new health facility that was planned for back in 1987, and it will be furnished and opened this year. The James Paton Memorial Hospital, there is $1 million in there to upgrade the fire life safety electrical systems there. There is a problem there with the grounding and this type of thing. This was identified about two or three years ago. There has been a study underway to look at redevelopment of the James Paton, but there is $ 1 million put in there to look after fire life safety equipment, sprinklers and the electrical system. Various alterations in hospitals $1.8 million. Again, that will be allocated through our facility planning division based upon need, and there are small projects that total $1.8 million. A lot of this is roof repairs and such things as that which need to be done. The Newfoundland Cancer, Treatment and Research Foundation, there is a $2 million vote in there to commence the construction of a cancer facility for the Province. There is a $400,000 project that was started last year to finish the fire safety program at the Grace Hospital. There is $2.7 million in there for renovations to hospitals in St. John's to enable the rationalization of service which had some major ongoing operating and service advantages to occur.

The Melville Hospital: there is $800,000 in there to commence planning and design work for a hospital at Melville. That will be about a fifty bed hospital. Brookfield Hospital: there is $300,000 in there to review the role of Brookfield Hospital. We have two health boards operating in Brookfield. One a nursing home, (Inaudible) lodge, one hospital, operating about a mile apart. We are looking at future health care facilities in the community of Brookfield and there is $300,000 in there to plan that and do some design work. Basically arising out of what is recommended.

There is $1.5 million there to build a multi-purpose facility in Burgeo. That is in keeping with the direction set in the Royal Commission and the Bed Study. We feel that there is a need for good primary care in a community such as Burgeo with lab and X ray services, physicians' offices, a small number of acute care beds and some chronic care beds. To operate a facility you have to have a minimal staffing, and if you are going to have that, there are chronic care needs there, there is more economy (Inaudible) incorporating the chronic care needs of people in Burgeo who can not have their chronic care needs met in the community. Because whereas acute care, you need specialists, high-tech, and a critical mass to maintain it. So you have to regionalize your acute care. But we try to maintain chronic care. It is a service that does not need to be regionalized as long as you have some of these support programmes in place.

So Burgeo, the same at Port Saunders as well, at $1.5 million. They were both referenced in the bed study as a multi-purpose facility.

AN HON. MEMBER: (Inaudible).

DR. WILLIAMS: There is $48,000 for Heart's Delight clinic, there is some work needs to be done to maintain that clinic. That is just maintenance. One hundred and twenty-four thousand dollars for rental purchase. I am not sure exactly what the details of that would be.

Various hospital facilities, $1.5 million. Again, that is another thing that is broken down between a number of projects and to get the details, we really have not finalized the details of what work is going to be done in that until our Facility Planning Division and ourselves meet next week. Long term care equipment is $1 million, and nursing home alterations, there is $500,000 in there for that. The Curtis Hospital, St. Anthony, and the Interfaith Home in St. Anthony, there is $1 million allocated to that, to look at the chronic care there. The Interfaith Home is having some major problems. It was a trailer. I guess (Inaudible) about fifteen years old now and it was these modular trailers put together to make a nursing home, and it is really not - from the facility perspective - the thing you want to do on a long term basis. So some work needs to be done there.

Forteau Health Centre. People in Forteau are having to go to Quebec for chronic care or move to - you know, go to the island portion of the Province. So there is $1 million there for an eight bed chronic care facility. Blue Crest Nursing Home, Grand Bank, and the Grand Bank Community Health Centre. Because of the role change in Grand Bank we are going to build a community health centre contiguous to the nursing home. And the two boards are going to come together and merge on their own into one board for the Burin Peninsula. So the Chronic Care Home Board and the Acute Care Board are merging.

Bonavista Hospital, $300,000 to provide for the development of the Alzheimer unit. A million dollars in Baie Verte to convert Baie Verte to a more suitable facility for chronic care. A nursing home will be built in St. Lawrence. There is a need on the Burin Peninsula for more chronic care beds, and $3.5 million for that. Corner Brook Interfaith Home, there is an engineering review going on there for $340,000. And that is basically it.

MR. CHAIRMAN: Thank you very much. Now -

MR. REID: (Inaudible) I want to make a final (Inaudible) -

MR. CHAIRMAN: No, no, sorry, I am sorry, Mr. Reid, we have run out of time. And as much as I would like you for you to continue I think that the Chair would want to give (Inaudible) -

MR. REID: You just took up my time. Thank you very much, Mr. Chairman.

MR. CHAIRMAN: Mr. Harris.

MR. HARRIS: Thank you, Mr. Chairman. I wonder if the Minister could tell me when he plans to provide an answer to the question put on the order paper some time ago regarding the fifty beds that were announced or identified in last year's Budget as being added to? And I think the question was sort of specific as to where were these beds put and how many in each place, and how many beds were reduced in those institutions where the beds were added? It might sound complex but that is why I asked for it in writing. It has been on the Order Paper for some weeks and I wonder whether the Minister has someone working on it or is he going to ignore it or what?

MR. DECKER: No, I am not going to ignore it, Mr. Chairman, there is someone working on it and hopefully in due course we should be able to have that answer ready to table.

There is another one on my expenses and, I believe, that is being worked on as well. You are working on that are you Cec?

MR. HARRIS: That was the official Opposition question and most Ministers have answered that one. This one seems to be pretty straightforward, it is just a matter of getting where were they and what happened.

MR. DECKER: While the question is on the Order Paper I will not take the liberty of being out by one cent, one jot or one tittle. You took the time to write it and, of course, we want to make sure that you get an absolute total answer.

MR. HARRIS: So, this will be before the House closes this year.

MR. DECKER: Hopefully, but if it is not we will make sure that you get this answer and I will deliver it myself.

MR. HARRIS: You cannot be any more specific than that.

This is a general question, but there will be more specifics afterwards, on prevention: The Government has indicated additional revenue from tobacco taxes of $8.5 million and an increase in alcohol taxes as well, I do not have the amounts in front of me as to what revenue that is supposed to generate. I wonder has the Government considered using any of that additional revenue to increase its programme of prevention or treatment in either alcohol or, well prevention, I suppose, in the smoking field an increase, a special programme to use some of that money and in terms of alcohol again prevention or treatment facilities. Are there any attempts to look at mixing these types of revenue generating and matching that with some sort of special program?

MR. DECKER: There is no attempt to earmark the tobacco tax or the alcohol tax. Mr. Chairman, the fact of the matter is that the Government takes in money on one hand and spend it on the other. I am sure if you really start looking you might find the twenty cents that you paid on your cigarettes probably did (inaudible). But we spend $800 million on health care and some of that $800 million comes from tobacco tax, some comes from income tax, some comes from transfer payments, there is no attempt right now to earmark this specifically. It might be a good way to sell an additional tax but we did not take that approach.

MR. HARRIS: This may have been answered in Question Period but I would like to know the answer. How much money the Government expects to save as a result of the two items coming out of the Medicare support: the one for dental surgery in hospitals and the eye care?

MR. DECKER: Dental surgery, I think, is about $500,000, optometry is $2.5 million for a total of $3 million.

MR. CHAIRMAN: Thank you, Mr. Minister.

We have a couple of minutes, Mr. Gover.

MR. GOVER: I just have one question and it came up in Public Accounts. In these times of restraints nothing angers the public more, I suppose, than to see senior executive of boards having funds which, in the public's mind, they have wasted. Recently it was in the news how the former administrator at a particular hospital had a vehicle, rotary club memberships, golf club memberships, various perks paid for out of these discretionary funds that boards generate largely off interest on advances that the Government gives them. It came up at Public Accounts and we had an examination of it. I wonder has the Government taken any steps to ensure that these discretionary funds that the boards generate primarily (inaudible) Government advances go towards the provision of medical services as opposed to perks for senior Administrators?

MR. DECKER: Mr., Chairman, that is an excellent point which the Member has raised. And it is something that we have been wrestling with. You did not mention the fact that some administrators are also receiving additional pay from that discretionary funding.

MR. GOVER: Overtime (Inaudible).

MR. DECKER: No, not overtime. It is a supplement, that is the word, yes. Yet the positions are classified for certain amounts of money but yet boards have done that. Now, there is always an argument between the boards and Government. What is discretionary funds? Is the interest on money, is that board funds or is it not board funds? I would almost think it is board funds. But in their - what is the name of their book they have out, what do you call it?

AN HON. MEMBER: Trustee book.

MR. DECKER: In their trustee manual this is listed as board funds. If they set up a little shop in there and they make a profit on that, is that board money? I think they may probably have a better case for that being board money, you know? But it is something that we have been discussing back and forth. As a matter of fact I am meeting with the Newfoundland Hospital Association in the not too distant future to discuss that very matter. But we have addressed it. We are addressing it, I should say, but it is not easy. And you heard the Premier talk about the problem getting cars back from the civil service. And we are finding an awful lot of resentment. And hospital boards see it as Government poking our nose into their area. Because they operate under the Hospitals Act and they do have a certain amount of autonomy. And where does Government have the right to say: no, you cannot pay your administrator an extra $15 or $15,000 or what have you?

But it is an issue which is under active consideration and I should say that the Newfoundland Hospital Association does not always agree with what Government's trying to say about it.

MR. CHAIRMAN: If we have an opportunity between now and a week Wednesday, I think it is, we must conclude the estimates. I want to thank - I know you are in a hurry for another commitment - both you and your staff for this morning and hopefully we will get around to moving all our subheadings. So again, thank you for a good morning, and I would now ask for a motion to adjourn.

On motion, movement to adjourn, carried.