The Committee met at approximately 9:00 a.m. in Room 5083.

CHAIR (Sweeney): Order, please!

I am sorry for the slight delay. The first thing is just a little bit of housekeeping. When you speak press the button, release, and then when you finish speaking release the button. The other thing is as you speak introduce yourself, just for the matter of recording the minutes. Oh yes, we have a sheet there we need signed. As far as the rest of it goes we will introduce our Committee: Mr. Gerald Smith, Mr. Gerald Reid, Mr. Jim Walsh, Mr. Jack Byrne and Ms Sheila Osborne.

Minister, would you like to introduce your officials and start the preamble?

AN HON. MEMBER: (Inaudible) exclude the preamble (inaudible).

SOME HON. MEMBERS: Oh, oh!

MR. GRIMES: Thank you, Mr. Chairman, I appreciate the warm welcome.

I will, as usual, try to be very brief in what we are doing and leave the time for the questions that I know you want to ask. Most likely we will probably try to get some of the officials to give the answer and then you might get a very direct, straightforward answer, short, brief and to the point.

The group that I have with me are: Deborah Fry, who is the Deputy Minister, and for those who are back from the Committee she was here last year as well in the same department. On my left, the person who would know most of the answers for you this morning, if you don't get them from me, is Donna Brewer who is our Assistant Deputy Minister on the financial side, the whole of the support services for the department and so on. Loretta Chard is at the end on my far left. Loretta is Assistant Deputy Minister who deals with our boards, both the institutional boards and our community services boards, so she is the direct link and liaison with them. On the far right is Beverley Clarke. Beverley is an Assistant Deputy Minister who does our policy program and services work. Gerry White, on the corner, some of you have met before, and he has been with the department for a number of years in different capacities. He is the Assistant Deputy Minister. I call him our Walter Noel. He does our government and agency relations and so on so he is our IGA man, I call him. We also have Dr. Ed Hunt with us. Dr. Hunt is our medical consultant who spends I think it is four days a week with us, and one day actually still being a doctor. I am trying to get an appointment with him, actually, for a checkup before my fiftieth birthday.

AN HON. MEMBER: (Inaudible).

SOME HON. MEMBERS: Hear, hear!

MR. GRIMES: I am sure he could be, and he might need to be here this morning.

In any event, just by way of introduction, if I could, Mr. Chairman, I would make a couple of very brief comments and go directly to the questions.

It is clear to everybody, I think, that health care initiatives are at the forefront of the agenda in Newfoundland and Labrador as they are in the rest of the country. We are currently involved in discussions with the Government of Canada as to the level to which they are going to commit to stay involved in funding the publicly funded health care system to a realistic level. The discussion that is in the country right now that formed most of the meeting that we just concluded outside of Toronto in the last few days was that when Medicare, as it is referred to, in Canada started over thirty years ago now, the notion was that certain services - hospital related services and physician based services - would be cost-shared 50-50 between the Government of Canada and the provinces and territories that have responsibility for delivery of the service.

There is no question that certain services if they happen in a hospital and so on, if it is physician related, are still significantly cost-shared by the Government of Canada, but there have been so many add-ons in terms of requirements, needs and changes in the system, in each of the jurisdictions, that in our Province now, for example, if you take the total budget that is spent on all health related initiatives in Newfoundland and Labrador, the Government of Canada really is only contributing in the range of about fifteen cents on a dollar for the total programs being run.

In an area, for example, as in home care and home support - which is a big issue where there was a report released just recently - that is an area that was never contemplated under the original Medicare plan. There were no fifty-cent dollars apportioned by the Government of Canada for supports that you would provide in someone's home even though it is clear, over the thirty-five years, that it is good. It is a good initiative. It is the right thing to do. It is cost-effective and beneficial to support people in their homes where you can rather than institutionalize them, for any number of reasons. Again, that is the debate, I guess, that is raging with the Government of Canada as to whether or not they are going to participate more fully on other initiatives that were not part of the original Medicare plan in the country.

There seems to be some resistance at this point to increasing the funding on a permanent basis even though they put significant funding, again, of $2.5 billion into the budget. I have been describing it, as the minister here locally, to suggest that we have taken what we have described as a small gamble in terms of spending all the money in one year, even though currently the decision of the Government of Canada is that it is a trust fund account that you can draw down over a four-year period. We have drawn it all down in the first year. The sense is, while there was no commitment again on this weekend past, that sometime between now and the end of this year the Government of Canada will commit at least that amount permanently to the Canada Health and Social Transfer so that we will realistically expect to have at least the $43 million or $44 million that we have put in this year from that source sustainable into the future, if not more. Because the big push again, and I will be issuing a statement as an update in the Legislature later today, is to have the Government of Canada put that money into the fund permanently, and also to have some escalator provisions because there are certain cost factors in health care that increase annually. Drug costs, for example.

When new drugs come on the scene there does not seem to be anyway to have - one of my favourite phrases that I have used for years - a drop and add procedure for drugs. If a new drug comes on the scene you cannot take the old ones off. It is a bill that just continues to grow despite everybody's best efforts, and often triggered by something completely beyond the control of physicians or health care professionals. The researchers come up with a new drug that is found to be effective and everybody wants it. Then the big pressure is: Do you add it to the prescription drug base in the Province or not, and how many of those get added in any one year?

I know there are members of the Committee in this room, for example, that have contacted myself and the department about a new drug for dementia, Alzheimer's, aricept, as to whether or not the government is going to add it to the formula this year. That is just one example, and there are new treatments, new drugs and so on, and fairly expensive. Those are the kinds of constant growth pressures that are in the health care budgets in any event. Despite everyone's best efforts to contain and manage fiscally and prudently, there are cost drivers like drugs and technology, because every facility wants to have the latest diagnostic equipment; and if you do not have it, you feel like you are a second-class citizen in a second-class part of the Province in a second-class part of the world.

There are always pressures for CAT scanners and those kinds of things that are tremendously expensive in the health care side. I think it is known to many people that similar types of machinery and equipment that are used to do analysis on objects rather than people, but use the same technology, are much cheaper when they are not described as a piece of medical equipment. The same kind of scamming that is done, if it is done on a piece of metal, can be done using a process and using, basically, the same technology for one-third or less than the cost that gets charged once the equipment becomes known as a piece of health care equipment. The prices charged are astronomical, everybody pays it, and it drives the cost of the system, annually, repeatedly higher.

Those are the general comments. What we have tried to do clearly in our Province is try to respond to the pressures in our own system. We have our boards that are operating at deficits, some of them very small deficits, some of them a little bit more significant. We have tried to alleviate most of their deficits as a year-end exercise and also put a significant increase into their base budget starting April 1 for this next fiscal year. They would like to know that they are going to have that money on a permanent basis so that they can enter into plans for three or four years and operate their systems as efficiently as possible.

Unfortunately, at this point we can't give them a budget beyond this year because of the discussion we are having with the Government of Canada. There are still some deficits that remain. They are going through an exercise in the next three months - hopefully it will be concluded at the end of June - whereby we would all look at the roster of programs and services that are going to be offered in every region of the Province with a plan to try and come within fiscal balance. Again, despite the fact that we don't have two or three year definite numbers to give them, they are going to try and develop a two- to three- to four-year plan as to when they can maintain service levels and live within budget over that time period. That is an exercise each one of the boards is going through on the institution side. Our community services boards are spared that exercise right now but their deficits are small in comparison in any event.

We are looking forward to that exercise. As I understand it the boards themselves are - it would be a bit of a stretch to say that they are looking forward to it. They are willing to participate fully and openly in the exercise because they want to demonstrate that they are being as efficient as possible, because there is always a debate as to whether or not there is money wasted in this system. They want to have that whole issue explored and exposed so that if there is obvious waste or inefficiency they will take the correction. If there is not, hopefully there will be an exercise gone through with health department officials, their own officials, and Treasury Board officials that will demonstrate that we are being as efficient as we possibly can at this point.

It is a similar, related exercise to the one that is going on with the Government of Canada. My sense of it is that the difficulty that Minister Rock is having within the federal Cabinet is no different than the provincial health minister would have here. There are others in the Cabinet who are not convinced that there is not some waste in the health care system. They are reluctant to add large amounts of money permanently until there is another bit of proof that there isn't room for some more efficiency in the system, even with current funding levels. Because there have been reports from the Prime Minister's own task force, from the Fraser Institute, from the Atlantic Institute of Market Studies and others, that all suggest and conclude that there are significant amounts of money, and maybe even sufficient amounts of money in the health care systems today, and that it does not require new funds.

They do understand the point that I made at the beginning, that there are certain things that grow anyway, like drug related costs and technology costs, but they are pretty certain that other operational costs should be able to be fairly well contained and should not have to move much more than an inflationary cost of 1 per cent or 2 per cent a year. When we talk about drug costs, they don't move at 1 per cent or 2 per cent a year. Some of them move at, like, 10 per cent or 15 per cent a year, so there are significant pressures in certain areas.

That is why we have tried to respond here by putting in a significant infusion of cash at the end of the last fiscal year, almost $50 million, and we have added to the base budgets again this year. Between the two exercises we have put over $130 million into health care between the end of last year and new money into the budgets for this coming year. It will be a big help. It won't solve all the problems. There will always be things that we will try to address as time goes on. I have met with each of the boards. I have met with almost all of the different community based groups and the advocacy groups for different organizations in the last couple of months. They would all like more from the Department of Health and Community Services. We are able to help them in some cases, and in other cases we are just fortunate, at this point, to be able to hold the line, which is not fortunate at all from their point of view. They would like to have some more help.

That is the circumstance we are in. We look forward to continuing to work with the boards and the different groups, and we look forward to working with the federal government to convince them that the money that is in the system, if not a bit more, has to be put in on a permanent basis, sooner rather than later. Then we will all be able to do a little better forward looking planning exercises than we have been able to do in the last little while where we have done a little bit of day to day issues management rather than as much planning as we would like. We would like to do more planning. Still, as in any department, there are issues that arise from day to day that have to be managed in any event, but the more we can plan the less we will have to do those kinds of daily interventions.

I will probably just stop there, Mr. Chairman. I look forward to answering the questions if I can, and if not, have the officials answer the questions for yourself and the Committee members.

CHAIR: Thank you, minister.

Before I ask Elizabeth to call the first subhead, I will just explain how we normally operate. Jack, this is your first one here. We usually call the first subhead and then all the questions usually follow that subhead. At the end we call the subheads and get them approved.

Just one other item of housekeeping. Could I have a motion to adopt the minutes of Thursday night's meeting?

On motion, minutes adopted as circulated.

CHAIR: Okay, Elizabeth, would you like to call the first subhead?

CLERK: 1.1.01.

CHAIR: 1.1.1. Who is first for questions?

MR. GRIMES: Carried. That is the one where I get paid, isn't it?

CHAIR: That is the one where you get paid, yes.

We have the minister's salary approved, so now to the next one.

MR. GRIMES: Can we go on to 1.1.02?

MS S. OSBORNE: We have the flexibility to float back?

CHAIR: Yes, whatever you want to do. Just start with 1.1.01 and go on.

MS S. OSBORNE: (Inaudible) here for the day.

AN HON. MEMBER: No, but we should encourage the minister to keep his answers brief.

AN HON. MEMBER: Yes, I agree.

MS S. OSBORNE: That will be a first.

Under 1.1.01.01, Salaries, there is a little variation there. It is up to $292,600 from $271,000 (inaudible) $273,700.

MR. GRIMES: You noticed that, did you?

MS S. OSBORNE: I did. That is yours, is it, Roger?

AN HON. MEMBER: No, it is a lot more than that.

CHAIR: You can't slip anything by.

MR. GRIMES: The wishful thinking answer would be that they figured I was worth that much (inaudible) gave me a raise (inaudible).

There were some staff added partway through the year last year with respect to communications issues and some public relations issues for certain public information that we provide. You have seen some of our pieces in the paper on a regular basis when we do health facts and so on (inaudible) publication. A decision was made as well, that person would be left in the department full time, and there are now actually two parts to our communications effort. One is the Director of Communications who works specifically with me, and always does, in terms of public issues and issues that the minister is involved in publicly; and we now have a communications person assigned to this part of the budget that deals with communication of health related information issues from the department that the minister might not necessarily be involved with but would be aware is happening.

MS S. OSBORNE: Thank you.

Do you want to go, Jack?

MR. J. BYRNE: I have questions here. We usually go back and forth.

MS S. OSBORNE: Go ahead.

CHAIR: The only thing we have to be careful of with the mikes is that the system can only have six energized at a time. We could be -

MS S. OSBORNE: The reason I asked (inaudible).

MR. WALSH: Mr. Chairman, we are going to allow the other members of the Committee to pursue their questions. If at some point we feel we want to ask some ourselves we certainly will. Being privy to most of the budget from this side, we are fairly comfortable with what we see. We may want to interject somewhere along the way but in the interim I would suggest that those who want to ask questions proceed and, if we need to, we will interject.

MR. J. BYRNE: Thank you, Mr. Chairman.

That was a big surprise on that statement, Mr. Walsh, that you are comfortable with the budget.

I just have a few questions with respect to your opening comments. The CHST is down to 15 per cent now from the feds and you talked about the $2.5 billion that was put in this year in a one-shot deal, nationwide really, and the Province of Newfoundland and Labrador really received eleven point some per year, I think it was, or whatever. It worked out to be $43.7 or $43.8 million, was it?

MR. GRIMES: Almost $44 million.

MR. J. BYRNE: Yes, and you are saying that hopefully this will be put back in on the long term, on a continuous basis type of thing. I understand from the deficit with the health care, Mr. Peddle, was it, with the St. John's Health Care Corporation, said that if they received $100 million - the St. John's Health Care Board - they could utilize every penney of it. There is some $40 million deficit, I think, from memory, and we are only getting eleven a year. That won't go - it is only 25 per cent of what the deficit would be. Are we hopeful, or what are the negotiations with respect - you just came back from Toronto, you said. I would imagine you are trying to get significantly a lot more money than that put into the long-term budget. Is that correct?

MR. GRIMES: The position taken unanimously by each of the provincial and territorial representatives is that the $2.5 million added this year by the Government of Canada -

MR. J. BYRNE: Billion.

MR. GRIMES: Billion - gives us a little less than $44 million over the whole period of time; but if it was to be there every year we would get $44 million every year.

MR. J. BYRNE: Oh, every year?

MR. GRIMES: If it gets permanently added to the base. That is part of the problem with it; right now it is a $2.5 billion transfer into a trust fund which you can draw down any time over four years. So, if you draw it down in equal installments it is $11 million a year. If they put it in permanently then the full $44 million, which is our share of the $2.5 billion, will be available each year on an ongoing basis.

The provincial and territorial representatives, in full consultation with the leaders of each government with the First Ministers, have indicated that is a good start but it is insufficient, that it should basically be closer to $4.2 billion that should be put in annually and regularly because that would only then take us up to 1995 levels before the reductions actually started to occur. That would then get us up closer to $60 million annually, if that is the case - and maybe even a little more than that - that we could have annually in the budgets.

The sense again is that the Prime Minister is saying they will be adding some money permanently. He is not saying whether it is $2.5 billion or $4.2 billion and he is not saying when. The Finance Minister for the country, Mr. Martin, is saying, based on reports back from the Health Minister, that they do expect to put some money and have to put some money permanently into the CHST transfer. That is why, based on that information even prior to these meetings this last weekend, we took the position here in the Province that we would take the full $44 million into account this year. There is a little bit of risk in it, understood; but, knowing that, our sense is that at least $2.5 billion, which was announced this year as a one-time fund, will be annualized by the Government of Canada before the next budget.

In our view, and again coming out of the meeting on the weekend, while there was no commitment made, it doesn't sound like if it is going to happen; it sounds like when it is going to happen. It is timing more than money. There is one remaining piece of work to be done probably by the Premiers and the Prime Minister, which is: Can they bump it up from $2.5 billion to $4.2 billion? Are they going to be able to get it increased? The idea of a permanent thing seems to be just about assured. It is only a matter of when they are going to be willing to announce it.

MR. J. BYRNE: Hopefully they will, and they will increase it up to $4.2 billion or $4.5 billion.

When you look at the surplus that was announced by the feds last year - I think it was $8 billion they had - in reality some people are saying it could be as much as double that. It is not a lot when you look across the country and the number one priority for everybody is health care, bar nothing.

With respect to home support, you mentioned that the feds really don't consider home support as a part of the traditional medical care plan across the country. In actual fact, if what is supposed to be happening is actually happening with respect to home care, it is supposed to be saving a significant amount of money. Are the feds really taking a serious look at that to pump some money into that, do you think? That would come out of the $2.5 billion or the $4.-something billion. That is extra; but, what is going there now, are they planning on putting any money in, even if the $2.5 billion doesn't come?

MR. GRIMES: One way or another they have expressed an interest publicly through Minister Rock of becoming involved in home care and home support, because they recognize all of their information is the same as it is in the provinces and territories. They understand that it is a beneficial service, it is the appropriate type of care, and it is cost-efficient. It is more cost-efficient in almost every case than institutionalized care for the same level; not always, but almost every case.

They have already indicated that at our next meeting, which is to be removed from this budgeting, to be looking at programs that they might like to get involved in with some national standards and with some national basis to it, home care and home support is one that they have identified. They have also suggested - we don't have the full details yet - that they would like to get involved in a national home care program on a 50/50 cost-shared basis with the provincial territorial jurisdictions. In our case we would welcome that, and we have already said that publicly, that it would come out of part of the $2.5 billion extra or maybe if it moves up to $4.2 billion.

We have moved - just for information, Mr. Chairman - from a $3 million program just ten or eleven years ago to a program that will be almost $40 million this year, all from provincial sources. It is a program that is growing in need, growing in cost, and we would love to participate 50/50 because we could effectively take the money we are putting in now, which is almost $40 million, double it to $80 million, dedicate it to home care supports and be able to do two things that are important. One is to provide better treatment for the individuals providing the home care and support, because it is basically at this point almost a minimum wage industry in most cases. It is very important care, it is not being paid at the appropriate levels at this point, and we would be able to expand coverage in terms of more support available for a broader number of people; because right now there are times during the year where people qualify under the rules but are still denied the care because the budgets are exhausted. We would like to provide broader coverage to a wider range of people who need the care, and treat the care givers better than they are treated today.

MR. J. BYRNE: In reality, the federal government is behind the times on this one compared to us.

MR. GRIMES: Absolutely, no question.

MR. J. BYRNE: I have three more questions and then I am going to move on to someone else if they want to take it.

With respect to the review that is being done, the three month review, from my understanding in talking to people in health care and personally knowing people in health care - working in health care, I mean - in the past a number of these reviews have been done and it is my understanding that normally you go into a department, it could be whatever within the health care, and say: We want you to cut $1 million, or $500,000, or $200,000, or whatever the case may be; now, find a way to cut it.

This review, I hope, will be a bit broader than that and go into the departments and say: Yes we want a review, we want to know where your money is going, but also, if you need more money it should be included. Not just to cut money. Do you want to make a comment on that?

MR. GRIMES: Yes, I do not disagree with your description of it, actually because the reviews in our Province dating back to the early 1990s, the first ones would have come from our mini-budget exercise that we used to do almost every year in November, whereby departments of government and health care boards and institutions would be told in November, almost three-quarters of the way through their fiscal year: Between now and the end of the year you have to cut your budget by 10 per cent.

MR. J. BYRNE: Whatever, yes.

MR. GRIMES: It was not much of a review. It was just fiscal necessity taking over and very difficult decisions being made. There have been reviews conducted in the last year or so that concentrated, again, more upon: Could you deliver the same level of service with less money, because of this whole issue in the public of: Is there waste in the system? This one is described, though, as the review whereby we would look at a core of programs and services that we want and expect the boards to deliver, and look at the amount of money that it takes to deliver that most efficiently. They are expecting that, in some cases, they will be able to demonstrate that they are actually short some money.

MR. J. BYRNE: (Inaudible).

MR. GRIMES: That if there is an expectation from the government that they should be delivering this service that we have actually underfunded it in some cases. That is probably part of the reason why they are willingly participating because they think there are as many areas where they can show us -

MR. J. BYRNE: Where they need more money.

MR. GRIMES: - they legitimately need more money. Whether we can provide it or not - we cannot at this point unless we get some money permanently from the Government of Canada, and they understand that as well.

MR. J. BYRNE: It is an argument to make up (inaudible).

MR. GRIMES: It will help build the case for us to take elsewhere and I believe, again, in the discussions I had with them, as much as they were frustrated initially at being reviewed again, because it seems to be nonstop, their sense was that as long as it was a legitimate review in the nature that you described and that they were going to be given a fair chance to plead the case as to what it is they are doing and why they are doing it, and that if we are going to stop doing some things that we should all say it together. If we are going to say we should not be providing that service, we should tell the world we are not going to provide the service either, not because we cannot afford it, but in some cases we might we doing some things because we have just done them for thirty years and maybe we should not be doing them any more. If they identify some of those, the expectation is that they could have that discussion this time around as well.

MR. J. BYRNE: Just on a personal note, I have been involved with the health care system in the Health Sciences Centre for the past ten years, actually, pretty very serious stuff back and forth, and I can see a distinct difference there today than what was there ten years ago with respect to availability, waits to see doctors, all these kinds of different factors. I have spent time in the hospital itself. I went for a week sometimes. There is a big difference in the service there now. I am not knocking the people who are in the system. I am not. It comes down to the buck. They really do not have enough staff on and all these factors, and I think that is something that needs to be looked at in that review. I really do.

With respect to something that came up in the House not long ago, heart surgeries for children versus adults, basically. You are sending adults out of the Province at full cost, from what I understand, for them to have heart surgery or whatever is required; and children only get, after $500, get reimbursed 50 per cent of the over and above. (Inaudible) and it costs you $1,000 you get back $250. Do you have any comments on that? I think that is something that needs to be addressed.

MR. GRIMES: No, only that one is a regular program that has been around -

MR. J. BYRNE: That does not mean it should not be changed.

MR. GRIMES: - forever and a day and probably will be in that if there is a particular treatment that is not available in the Province and needs to be done elsewhere, that there is assistance with the travel. Someone can correct me. I thought the notion was that the assistance that you are describing is for others accompanying the individual, that the patients themselves are treated the same as they would be for their heart care, that the patient is transported and taken care of, but if somebody has to accompany the child, then part of their expenses are paid for, up to 50 per cent depending on certain limits and so on. I do not know the full details of it. Someone else could describe it to you.

The cardiac one is being done, again, as a special interim measure while we are continuing with the renovations to the operating facilities, the O.Rs, and also continuing with the training of the specialty nurses and so on who are needed for the additional care, and having the facilities available so that we can go from twelve to fifteen a week and end up with an additional 150 cardiac surgeries being done in the Province annually once the program is fully up to speed. Because our wait lists are the longest in Canada in this particular area, we offer to those that are appropriate candidates who want to go an opportunity to have the procedure done outside the Province. I think we certainly pay the full shot for the individual, and I do not know exactly what the details are. You suggest it is full shot as well for someone accompanying in that circumstance, but it is a short-term measure that we expect to only have to do for a limited period of time and then -

MR. J. BYRNE: Isn't that unfair to the parents, say, who have a child who has to go outside the Province? Isn't that really discrimination against that family?

MR. GRIMES: It could be described as such. It is just that we have -

MR. J. BYRNE: It could be.

MR. GRIMES: - again a program feature that is always there, the program that we can sustain, annualized for everybody that needs the service, is one that provides 50 per cent.

MR. J. BYRNE: Just to butt in, why, if you have to send a child outside the Province - do children have to leave the Province for heart surgeries? So what is the difference?

MS CHARD: It is an area that we recognize that needs to be assessed again, particularly in light of us agreeing with the offer to send escorts out with the patients who are waiting now. We also recognize there are some inequities and we are reviewing that policy.

MR. GRIMES: Mr. Chairman, could I make one little political comment -

CHAIR: Sure.

MR. GRIMES: - that Mr. Byrne would appreciate. Maybe if we spent even less money on debt servicing, we might be able to spend more money on escort fees.

MR. J. BYRNE: You are not spending any money on debt servicing. Can I make a little political statement? No, I won't go there. Later.

I think Sheila has a few questions on the Janeway. Someone recently told me, and I do not know if it is true or not, with respect to the equipment for the new Janeway - we have X-ray machines, CAT scans, MRI and whatever - that there was so much money allocated for the Janeway, and of course they have gone over budget on that a number of times with respect to the construction, is all the equipment that was planned to go into the Janeway new equipment going to be going into the new Janeway, or will they be utilizing some of the older stuff they have down at the old Janeway?

MR. GRIMES: The understanding again is that they did a full assessment of the equipment. Anything that was new and recent and was not going to be adversely impacted by a physical move, portable types of equipment that you would wheel around and use in the facility anyway, that is still new and functional, will be used. The fixed types of equipment that are actually bolted on the floors and so on, an assessment was made that I guess there was not much if anything at the existing Janeway that could be unbolted, uprooted, transported and bolted down again without probably impairing its effectiveness. Fundamentally it led to a decision that just about everything that is going into the new Janeway will be new. It will be new state-of-the-art capital equipment.

The last bit of funding I think that went in in this budget was in the range of some $6 million at the end of the year again, added to monies that was already there. It is in the range of $16 million or $17 million altogether that it will take to actually physically equip the inside of the building with the appropriate capital equipment needs, ranging from the diagnostic equipment right to the beds themselves. It is in the range of $17 million. I would not hazard a number but I would guess well in excess of 90 per cent of what is in that building will be brand spanking new. Some of the portable things that were new anyway to the Janeway and will not be negatively impacted by the move will be used in the new building.

MR. J. BYRNE: Just one other question with respect to the Janeway. When there were talks of the Janeway being built it would be a separate entity, attached to the Health Sciences Center, and it seems to me, from what I am hearing, that there is going to be a fair bit of merging with the Health Sciences Center in the - what is the right word I am looking for? - in the sharing of services within the facility itself, both buildings. Is that going to happen? Because I am just thinking, small children in, say, the emergency of the - I do not expect that it will happen in the emergency of the Health Sciences Center, but there will be sharing of services within those two facilities, will there not?

MR. GRIMES: When and where it makes sense on a day to day basis.

MR. J. BYRNE: Such as?

MR. GRIMES: The commitment though from everybody is that if there is a shared service - whether it be for some diagnostic imaging or otherwise - that the first call would always be for the Janeway use. If the Janeway use is completely taken care of and the rest of the Health Sciences Complex can avail of some of the facilities that would be dedicated to the Janeway, then they will get it on a second call basis, but the primary call for every service in the Janeway is for the Janeway first and foremost. They don't want to be inefficient; they don't want to have things left idle that could be serving patients in the rest of the complex just because it is the Janeways and say: No, the rest of the complex cannot use it under any circumstance.

MR. J. BYRNE: How about vice versa or the other way around?

MR. GRIMES: They have worked out the protocols that are fully in place for when the transfer takes place, I guess towards the end of this summer.

WITNESS: September.

MR. GRIMES: In September.

MR. J. BYRNE: What about the other way around? The children going into the Health Sciences, they utilize the -

MR. GRIMES: They have always had access as needed. There has been a facility or a service at the Health Sciences. There have been regular occasions of transport from the Janeway up and back for certain services and functions that would be there. It is just that it will be easier now because they will wheel down the hall and through a door out into the other facility instead of having to get into an ambulance and be transported.

MR. J. BYRNE: One more question, just to finish up, on the utilization of equipment. You hear stories sometimes like the MRI, the CAT scan or whatever, that it is being used eight hours a day, ten hours a day, twelve hours a day or whatever the case may be, and we have people waiting. I had an individual contact me and he said he was going to have to wait from October till February, and we have another person having to wait from now till September. Are there any plans being put into the budget or whatever the case may be that if a piece of equipment is now being utilized say eight hours a day, then utilize it twelve hours a day or fourteen hours a day or whatever the case may be? Are there any talks or plans about that?

MR. GRIMES: There are two components to it. One is that certain pieces of the equipment have a certain life in any event, that they can be used for so many procedures before some of the parts start to wear out. That piece is built in so that it is usually preferable that it be used a certain number of hours a day. It might be capable of being used twenty-four hours a day, but a certain number of hours a day. The biggest factor in it, though, is the staff component, the people who actually operate and run the machinery and the equipment, whereby we are having difficulty in many of those diagnostic areas of attracting the professionals that you need to run and operate the machinery, and then also to properly assess and interpret the information that you get. So there are two components to it.

The biggest bottleneck at this point in time seems to be the inability to attract the appropriate level of staffing. That seems to be the one that limits it more so than the actual piece of equipment itself. There are always efforts ongoing to try to recruit more professional staff into the area. Radiation therapy, for example, is a prime example of it in cancer treatment. We have funding in the budget, I think, for fifteen or sixteen and the most we have ever been able to actually get on staff at any one time is thirteen. The equipment is there, the machinery is there, it could be used for longer hours each day, we could be shortening waiting lists, but the problem is the radiation technologists and therapists themselves are in short supply in the whole country and we just can't get them. We just haven't been able to get them.

MR. J. BYRNE: There is always more to it than meets the eye, isn't there? Anyway, thank you.

CHAIR: Gerald, do you have a question?

MR. SMITH: Yes, Mr. Chairman, it will just take a couple of minutes.

One of the areas that I have pursued in the past - but I haven't had occasion to pursue it with the new minister, so this is probably a good opportunity to do so - relates to Memorial University Faculty of Medicine. 2.1.01 is the line item in the budget. We are talking about a vote here of $18 million. Minister, right now at the university how many seats are we talking about? How many students are accommodated? How many do we graduate in any given year? What is the maximum?

MR. GRIMES: There are sixty seats that are funded in that $18 million.

MR. SMITH: Okay.

MR. GRIMES: The arrangement has been, annually, that forty-five of those seats have been reserved for Newfoundland and Labrador residents and fifteen of them have been available for non-residents of Newfoundland and Labrador.

MR. SMITH: Okay. Now the fifteen - this is the area that caused me some concern. I understand that there are some reciprocal agreements because we do have some professional schools that are not in this Province whereby we had arrangements with some of the other Maritime Provinces. Of the fifteen, how many would be taken up by these reciprocal arrangements?

MR. GRIMES: It used to be ten. It dropped back to five for the rest of Canada. It is going back up to ten. To try to give you the short answer, the short answer is that ten basically almost primarily used to be an arrangement with us and New Brunswick where we used to have some seats reserved in some of their law schools, because we don't have a law school in Newfoundland, and they used to have some in our medical school. They dropped out of the program about five or six years ago, thinking they had enough physicians, and they notified us that they no longer needed the seats. They are back this year asking for them back because they found out that, like everybody else in the country, they are short of physicians and they would like to -

MR. SMITH: So this year it will be ten?

MR. GRIMES: They will go back up to ten starting in this next year.

MR. SMITH: Where will the other five go?

MR. GRIMES: Just about all from the United States - Americans.

MR. SMITH: This is the area, I guess, for me that has always caused some concern. I know - and it has really hit me within the past number of years. My son has been going through a science program at the university, hoping to get into medicine. As a matter of fact, recently he had an interview, but I know that there are some of his friends and classmates who did not even get an interview and that a lot of those who have been interviewed, Newfoundlanders who obviously are interested in pursuing a career in medicine in the Province, cannot make it.

Even the five - now I understand the idea. I am sure, for the university, our medical school has a good reputation, and I am sure a lot of that is built on when you bring in people from outside who come here and graduate and then go and practice elsewhere.

I have always had great concern because I can remember the debate when this medical school was being established. The big selling point to the people of the Province is that we were building, in this Province, a medical school to graduate doctors to serve Newfoundland, especially rural Newfoundland, and in recent years we - and I represent a rural district and this is a constant concern. In my hometown, we don't have a resident doctor now. There are times we can go for years without a resident doctor. Beyond that - we are getting serviced, but I have difficulty when you go up today to see a doctor and next week you go and there is a different doctor. I am not a physician but I understand enough about the practice of anything, that unless there is some sort of continuity - if you are seeing a different person every time you go up, quite frankly I don't think that is a good practice of medicine. It is certainly not ideal. I think if you are seeing somebody on a regular basis who knows your symptoms and understands your conditions, just reading it off a chart is not the thing.

I guess what I am getting at is - and in the past I have raised it with previous ministers - to begin with, is there some way that we can be taking more of our own people into the program? Beyond that, is there some way that we can have them sign an absolute contract, hard and fast, that if you come into that program - if you are going to pick up your credentials at our school that has been paid for by the taxpayers of this Province - that you are prepared to commit to us, for example, three years of service? In that way every year - how many do we graduate every year? Are there sixty every year? Every year you would have sixty new graduates coming out who would be committed to provide you with three years of service. Really, if you looked at it over three years, you would actually have 180 new doctors who would be available in this Province.

It sounds almost too simplistic to be actual fact, and I am sure there are other conditions, but I don't know if we are being as aggressive on this as we should be, because I really think personally - I have difficulty. Even our own young men and women are going to the medical school because of the attraction of going South where the money is better and all that. I think they owe us something. We, as taxpayers, are subsidizing that program and I don't think they should be going in there, availing of that program, and then just walk away and say: I am sorry but I got a better offer down South and that is where I am going. I am just wondering, those issues, are they things that are being actively pursued by the department?

MR. REID: Before you get into that, minister, what does it cost the Province to graduate a doctor from medical school?

MR. GRIMES: I do not know the number, although I guess if you look at the full cost you can take the $18 million and divide it by sixty, because that is how many people are going through the program. You have the facility itself, all the related staff, and the facilities -

MR. REID: So the tuition fees are minuscule compared to the actual costs?

MR. GRIMES: Always, as in any case. What we do, just to give you the background of it, for the Newfoundland residents, they are charged a tuition; I think it is $6,250. There are Newfoundland residents who are in medical schools elsewhere paying a lot more than that. So, if they do not get in here it does not mean you cannot ever get into medical school, if you cannot get into ours. You can try to apply to others but you do not necessarily get the rate of $6,250. For the other fifteen seats, we charge $30,000 tuition.

MR. REID: A year?

MR. GRIMES: A year, which again comes nowhere close to covering the full cost of the training but it is closer to market prices for tuition elsewhere in Canada and in parts of the States.

One issue is a budget one. We could take the full sixty seats and have them for Newfoundlanders and Labradorians and have nobody from outside the Province, and we could fill them annually. That was not the case in the first few years, in the early days, but it is the case today. All it would require is $300,000 or $400,000 annually for us to give to the medical school in lieu of the funding, the $30,000. If we pay the difference they would gladly take all Newfoundlanders and Labradorians. I should not say that, though, because there is a point of contention. They say there is always a good mix of having other people around, and the fact that you should not be too insular and so on, and there are advantages in having people from other areas, and it gives you access to other areas as well where you can send people off and -

MR. SMITH: (Inaudible) heard all of those (inaudible).

MR. GRIMES: Absolutely, but good for arranging for specialty trainings and other types of things afterwards on a reciprocal basis if you have some contacts.

The first one is money. When we are ready to put anywhere between $300,000 to $500,000 annually additionally into this budget, if we want to, as a matter of policy, then with that money we can say sixty seats for Newfoundlanders and Labradorians. That is just money.

The second issue on return-of-service has been absolutely resisted. It has been an issue that has been put forward to the medical school on prospective students. These are Newfoundland and Labrador students who have resisted it vehemently from the point of view as a matter of principle. They do not think they should be forced into servitude, that you are supposed to have a right to practice your trade and your profession wherever once you go. We do not demand, for example, that our teachers in training sign a return-of-service, that they can go and teach -

MR. SMITH: We did at one time.

MR. GRIMES: We sure did.

MR. SMITH: When we had the similar problem that we have in medicine right now, that we did it to teachers in this Province. (Inaudible).

MR. GRIMES: The biggest issue now seems to be, and the argument that comes up when it has been raised in the last few years, are charter arguments about the fact of mobility and you cannot really tie somebody down.

The last and practical part of it, Gerald, is this one: even when there have been return-of-service contracts entered into, because we are basically doing it now with nurse graduates for just a $3,000 signing bonus, what it guarantees is that you get your money back. It does not guarantee you they stay here. So, they commit to serve in the Province for an investment of an amount of money but if a recruiter comes off from Texas and says, well, I will pay that debt for you, the only recourse the Province has that they do not show up is that they owe you the money.

The return-of-service issue, I concur with you totally. I believe personally, because the staff here first when I went into the department were talking about the nurse issue just after Christmas and I said: Well, if we have a nursing shortage - the same issue with the physicians - in the Province and in the country, and we have 200-something seats for nurses in Newfoundland and Labrador for training, why don't we tell the world now that starting with the next intake, which will be September, that there is nobody coming into our training institution unless they are going to nurse in Newfoundland and Labrador; that you do not have the choice to go and take an offer from Texas or Florida or Arizona or Alberta; that, if you are going to go to our nursing school, you commit the day you go in there to nursing in Newfoundland and Labrador; and if it is a four-year program that we are going to do and subsidize you significantly every year, because even with full tuition students only pay about 30 per cent of the cost of the training, if the investment of the taxpayer is 70 per cent, that you provide at least 70 per cent of your time back into it. So, of a four-year program, at least a three-year return-of-service; that you do not get in; that you do not even get considered for acceptance unless you are willing to say I will nurse in Newfoundland and Labrador. If you are going to get a four-year program subsidized by the taxpayers, you give at least three years return-of-service. I am advised by the group here that it is not a good idea, and we are not doing it, so we are offering them cash instead.

We are doing the same thing, actually, with the physicians. There are certain incentives to sign physicians into rural Newfoundland and so on. This year, currently, we have retained 70 per cent of them, the highest number we have ever had, but again with some incentive programs instead of a return-of-service program. They have resisted it themselves. The students have resisted it, the faculty has resisted it, there have been threats of charter challenges on the mobility issue, if you bring in a return-of-service, and they have always told us that even if you make us sign it and we want to go somewhere else we can get someone to send you back the money anyway. They have always said: Entice us more than force us.

It is most frustrating and I don't disagree with the point of view that you bring. At some point we might have to do something that would be described and seen to be by others as being hard-nosed and draconian in terms of saying: You don't get into our school unless you are going to spend some time working here.

MR. SMITH: Just another point (inaudible) really, and just speaking from experience, I know in my own hometown we have had some good doctors over the years but the only thing is that most of them are on their way somewhere else. They are passing through. A lot of them are just biding their time. Beyond that, very often as well, because a lot of these are people who are coming from other countries, sometimes there is a difficulty with the language. I have had older people who have come to me, who have gone to see the doctor. They leave - they have to bring someone with them and even then they are not sure when they come away what the diagnosis is. It is that serious in some cases. I tell you, at the risk of having all kinds of charges leveled against me, there is an awful lot to be said if we could keep some of our Newfoundland graduates, especially in rural Newfoundland, because there is a lot about rural Newfoundland that is kind of unique and not everybody can come there. We can romanticize it, and it is a great place to come and visit for most people, but if they have to come there and take up residence and stay there year round they find that after the first three or four months there is only so much you can take, looking at the ocean, the beach and everything else. After three or four months you would have had your fill of that, so you had better be able to find something else. That is the difficulty we are into, so it is a real challenge and somehow -

MR. GRIMES: You had better give them a weekend in St. John's.

MR. SMITH: We won't touch that one.

Anyway, the university really bothers me, that whole issue. I have great difficulty, because I remember that debate. I tell you, back then when that debate was ongoing - you can remember that debate, you are not that young - the whole issue, the argument of the day. People were speaking with such passion that we need this medical school. This medical school is going to solve the medical problems of Newfoundland. It is going to provide us with qualified young Newfoundland men and women who are going to go out and take care of the areas of rural Newfoundland.

I tell you, I really feel - because that was the argument used to convince the people this is what we had to go to. I think we should be going back and visiting it now. If it means being hard-nosed and taking their (inaudible) decisions, as far as I am concerned if they want to challenge it under the charter let them challenge it.

We have problems. In rural Newfoundland we are not getting doctors, and when we get them we are getting people who come in there for two or three months. We are not getting the level of service that the people of rural Newfoundland.... I know, in the area of rural Newfoundland that I represent, I have seen it because I have lived there. I still live there and I see it on a regular basis. I tell you, we have to address it and we have to deal with it.

That is enough on that issue.

MR. GRIMES: Mr. Chairman, could we invite Dr. Hunt just to make a few comments about it, because he is a former president of the Newfoundland and Labrador Medical Association as well as serving us now as a health consultant. Feel free to make a few comments with respect to Mr. Smith.

WITNESS: Tell Gerald he is wrong.

MR. GRIMES: No, I don't think he is going to say he is wrong. Like you say, it is an issue that has frustrated -

MR. SMITH: He is one of few people who won't say I am wrong.

MR. GRIMES: It has frustrated a lot of people for a long time, and he might share some thoughts from a range of experiences.

DR. HUNT: Thank you, Minister, for the invitation.

Again I don't disagree, Sir, with your comments. I am a product of Memorial University Medical School and I felt an obligation myself to go into practice, and I did for twenty years.

The problem, I guess, is whether you can force everybody to go into practice. I guess the question is: What happens if we get an over supply? What do we do with those people to whom we say, you must provide a service? That is a question that the university has been asking for some time.

If you look at what is happening in the university, before Memorial was open we had a ratio of about 20:80 doctors in this Province in relationship to a specialist or GP. Since Memorial has been open, our specialty numbers have increased to the point where now we have more specialists than GPs. That is creating another problem in that we have a GP problem, as you alluded to. We have a lot of specialists in this Province which we would not have if we never had the medical school. A lot of these people are international people of very high quality. A lot of them are from other parts of Canada and are very high quality. There is, I guess, as you say, sort of an academic freedom that they sense, and that if you start to force servitude onto their students - it is a question of whether or not this medical school would actually attract and keep high quality students.

Now once they graduate from medical school they can go on then of course and do what is called a matching service, CaRMS, which is a resident matching service with all the schools across Canada. This school is one of a pool of a number of universities across Canada. We provide the undergraduate training here but the post-graduate training is offered everywhere. We may have half of our students, for example, going to different universities in other parts of Canada. If we are going to have a servitude type of arrangement here - and they don't have it in other parts of Canada - as soon as they finish their fourth year of medical school they are all going to be gone to somewhere else where they can get their training and then possibly pay back the money, but not have to come back here to provide the service. That is the risk and the concern that the Dean of Medicine at Memorial University has expressed to me.

Having said that, though, the Dean says: We do have a problem here, we recognize we have a problem here. At some point in time, he says, he is of the opinion that we may have to take more stringent action to try and get these people to stay here. My point is that we have tried to use the - rather than the stick, as the minister referred to, we tried to use the carrot approach. If you look at the bursaries that we have used in the past to attract people here, we have about an 80 per cent return rate on our bursaries. We hear about the numbers that left, about the people that did not come back, but we don't hear about the people that stayed.

Last year we tried for a family practice incentive program and we got fifteen out of twenty people returning to this Province, which is quite a high number. The year before we got three out of twenty. So the incentive programs do work. We might look at the front-end and say it is going to cost more money but the risk of going with the stick is that you could turn people off from coming to this Province, and you could reduce the risk of lowering the quality of people that we get in this Province. I don't know what the answer is, sir, but these are the arguments for and against.

MR. SMITH: If I could just make one other remark. It is a question, I guess, minister (inaudible). (Inaudible) like the possibility is there that we could, in terms of the sixty seats that are there, say these are exclusively Newfoundland. While we are going through this problem that we are into right now - acknowledging at some point in time we may resolve the issue we have here - at that point in time then we can loosen the strings a bit and allow for more open admissions. With the sixty, right now if we did that - because the other thing it seems to me is that the people from outside the Province are coming - if we can't keep our own people, I am sure as heck, I don't think there are very many of those who are coming from outside the Province who are deciding to stay here after. They are almost certain to be gone. At least if you went with sixty students from Newfoundland and Labrador it would seem to be me, just by virtue of the fact that these are young Newfoundlanders, that the ratio would probably be better. As Dr. Hunt has pointed out, we have done fairly good. If you had the sixty instead of the forty-five, then just on the ratio alone you would end up with more of these doctors, it would seem to me, staying in the Province. That then might be a good argument for doing that.

If we can't get into the other thing by demanding servitude from the graduates of our program, then maybe the preferred route would be to say, at least for the next three, four years or whatever: This is it, we have a serious need here, so our program is going to be exclusive. It would seem to me that, in terms of the actual dollars, we are not talking large monies in terms of what is required in the health care program in this Province. I am sure that would not be a major challenge to you and government to come up with the extra $400,000 or $500,000 a year to accommodate that.

MR. GRIMES: No, and I think you are right. The issue, again in my own thinking about it, is that as much as we would - and there are advantages that have been described of having others other than all Newfoundlanders and Labradorians in the program. Some of the issues that Dr. Hunt just discussed, I would be much more inclined to discontinue the American seats and take at least those five and up the Newfoundland content from forty-five to fifty, even if we keep about ten others in Canada for reciprocal arrangements. Because they are in some ways tied to the fact that we do not run a law school. We have to have some kind of buddy-buddy relationships with other jurisdictions to get our people into - we do not have a dental school and those kinds of things.

I do not think we would be in a position maybe to go to the full sixty. The money then would be the smallest component of it in terms of dedicating those extra seats for access. I do not know - but curious by your raising the point - and I do not know if Dr. Hunt knows off the top of his head, but an assessment - I would sense inherently that you are correct, in that we automatically get a higher ratio of the forty-five staying in any event because they are local residents than we do a ratio of the fifteen who are from elsewhere. My sense would be that 90-odd per cent of those have probably gone someplace else.

They have performed and rendered valuable service for us while they are here, because while they are training they are available to us to work at the Health Sciences Centre for various periods of time as well. So there is another service that we get as a part of having the medical school there that has been invaluable, really. It is an issue that I will look into further, and particularly to research, and see where we go in a year or so with the American seats and maybe bumping the Newfoundland component up, knowing that in the budget we would have to add a few hundred thousand dollars. I think many people would agree that it would probably be a priority for us if that gave us an opportunity to maybe get three or four of those additional five that might stay here. Because this year's retention, I think, was the highest one yet. I believe it was 70 per cent of the graduates; that is the highest number we have ever had stay here.

We had two, for example, go to Port Saunders. Two Newfoundland residents are out now and practicing in Port Saunders. So far, as you have indicated, because they are Newfoundlanders and Labradorians, they are loving the experience. They were from rural Newfoundland. They went back to rural Newfoundland. They are content. They are happy if there is a prospect that they might be there to treat families for years instead of months and those kinds of things. That is the experience that I sense that you hope we are to replicate more regularly so that we have that kind of thing.

I think there is one other piece of information, Mr. Chairman, if I may. Again, I will check the stats and try to get it for you at another time, but I believe it is fair and accurate to say that there is a higher ratio of Newfoundland and Labrador-born physicians in the Province today than probably any time in our history because of the medical school. Because years ago we would have a few Newfoundlanders and a lot of foreign doctors, the foreign doctor component. Interestingly enough, it was an issue raised in Markham on the weekend by another Newfoundlander who happens to be the health minister for New Brunswick, Dr. Dennis Furlong, who many of us in this room know. He indicated a point that Dr. Hunt and others would be interested in. We match residencies to the seats, so that if we have sixty seats we arrange for sixty residencies that we fund as well as part of the program, because they have to go out and get their residency work done. He says we have a problem in Atlantic Canada, that we need some more residency spots for foreign doctors who come over here and have to reach the Canadian standard, but then it becomes a competition. Who do you put into the residency, a foreign doctor who might be out in Twillingate who is already out there who needs to get the residency done, or a student coming out of the university who needs the residency done and we do not have enough residency spaces?

He is making the plea to the Government of Canada, on the human resource side, that one of the things that the Government of Canada could do is fund an additional 20 per cent of residency spaces in the jurisdiction so you would have a spot for all of your students coming out of your medical schools and a spot for the foreign doctors who are coming here and needing to go through that particular experience as well. It is an issue that a lot of people are dealing with today, and everybody is grappling with: how do you get the appropriate match of human resources into your system? We are all a bit short at this point.

Here it has switched over now, as Dr. Hunt was saying, from specialties where we are better off than we were before, to family practice, general practice, where we are slipping a little bit particularly in rural parts of the Province where they don't want to go for very long if you can get them there.

Thank you, Mr. Chairman.

CHAIR: Sheila.

MS S. OSBORNE: I would like to stick with the Faculty of Medicine, with the student doctors.

You said that the taxpayers pay 70 per cent of the nurses and that the 30 per cent is picked up by the nurses. Is that the same ratio for the medical students?

MR. GRIMES: I think it is basically the same. When we say that it is for education programs at the university level, generally the tuition that is charged to students, on average, gets you somewhere in the high twenties to 30 per cent of the actual cost of delivering the program to them.

MS S. OSBORNE: Okay.

MR. GRIMES: The rest of it is borne by the taxpayers through the transfer of funds to the institution. The transfer of the $18 million here would cover that and they actually collect some revenue as tuition.

MS S. OSBORNE: Thirty per cent, okay.

On the return-of-service issue - I don't know if I am being too simplistic - I wouldn't be afraid to ask them to return service and then if somebody did buy out their package, somebody from the mainland or from the United States, at least we would still get the money back. We wouldn't be at a dead loss; we could get money back to pump back into it.

In terms of a few comments that Dr. Hunt made regarding being a bit cautious about asking them to put their service back into the Province, if we did get an over supply couldn't we revert the policy or then start relaxing it a little bi?

Like Gerald Smith, I have been concerned about this for some time. I am not from rural Newfoundland, although I have spent a lot of time there, but I am particularly concerned also knowing the lineups here for doctors in the city. Sometimes you have to wait three or four days or a week just to get into family practice. I can't imagine how horrible it would be to be in rural Newfoundland and get to a different doctor every time. The continuity, especially if you have something chronic, it must be absolutely horrendous to have to go in and explain it every single time because there is a new doctor there. I do have some concerns like that.

If we did ask them to return the service and then somebody did buy them out we would have the money back. If there was an over supply we could start slipping back. God bless us that we would ever be blessed with an over supply of doctors. Wouldn't that be wonderful!

I have a question with whether or not we would attract a high quality of students. This is just a question. Is there a lineup now of folks trying to get into medical school here?

MR. GRIMES: Yes, there is.

MS S. OSBORNE: So, among them, I suppose, we could pick the highest quality of those. I don't know that we would suffer. I think we have some very fine students here and that we would pick up a high quality of students.

That is my comment on that.

Mr. Chairman, I don't know if you are going to take a break now because I think we are going to go on for awhile.

CHAIR: Sure. Will we agree to a stretch?

MS S. OSBORNE: Before we get on to another subject.

WITNESS: (Inaudible).

MS S. OSBORNE: Oh, yes, we are here for awhile.

MR. GRIMES: You must be getting such good answers, I suppose, you just want -

MS S. OSBORNE: They are so long!

MR. J. BYRNE: I told the minister (inaudible) same problem. Your answers are too long.

WITNESS: Carry on, Mr. Chairman.

MS S. OSBORNE: Oh, I thought we were going to have a break.

CHAIR: No, we will continue on.

MS S. OSBORNE: Alright.

Back to home care. You said that the provincial cost was up from $2 million to $40 million.

WITNESS: Three million.

MR. GRIMES: My understanding of it is that the program originated in Newfoundland and Labrador about eleven or twelve years ago. There might have been some slight traces of it before that but it largely started as a program where clients of social services were offered opportunities to go into some homes and help some families, to give them some work skills and those kinds of things. It developed from that, over time, into the programs that are there today with agencies and otherwise contracting on behalf of families to provide some services and other individual arrangements, but the global costs have gone from a program in its initial days of around $3 million - this would have been about ten or eleven years ago, the late eighties. Today, I think our budget line is $34 million or $35 million and, because it is a little open-ended, the expectation is that this year we will close in on $40 million in the 2000-2001 fiscal year that we are likely to spend on home supports in this fiscal year. It is a twelve- or thirteen-fold increase in ten or eleven years.

Again, it is not a defined service under the medicare plan with the Government of Canada, the Canada Health Act and so on, so the provinces have been funding these initiatives themselves. We have been funding them ourselves. The Government of Canada is suggesting, though, quite openly, that they think there should be a national home care program and that they would fund it 50/50.

MS S. OSBORNE: Absolutely.

I might be misinterpreting this but I am looking at home care now and in some instances it is almost two tier. I have an example of a constituent who came in and her husband had been diagnosed with brain cancer. There was absolutely nothing else they could do for him in the hospital so she took him home to die, and he did pass away. When she got home, the home care she paid for herself, which basically is saving the government money because they now do not have a person as an in-patient. That is almost bordering on two tier there, in that if you were in hospital everything there would be paid for, including medications and things. On the home care she had to pay HST, and on the rental of a hospital bed for her husband to lay in while he was dying at home she had to pay HST. So, 50/50 would be really welcome. Because we don't get enough funding from the feds on the home care, we are almost into - I suppose you could call it two tier if she wouldn't have to pay any money if he were in hospital but when she took him home she did, and had to pay HST on it as well.

I know I am looking to spend money that we do not have. In an instance like that, where ordinarily she would have a choice, I suppose, if she said, "I can't take him home. I am sorry, I don't have the capacity to pay." - in that instance we would pick up the cost of the drugs, I suppose, wouldn't we?

MR. GRIMES: At times. That is only recent as well. Again it dates back to what I said at the beginning, that in the founding of the medical care plan for the country the idea was that the Government of Canada would cost-share 50/50 services in hospitals, and physician services outside the hospitals. If you were in the hospital it was paid for. As soon as you went home it wasn't paid for.

Even now the Auditor General, for example - who, some days people like Mr. Byrne is a great fan of, depending on what she is saying, depending on whether she is criticizing the government enough or not -

MR. J. BYRNE: She always does a good job.

MR. GRIMES: The Auditor General suggests from time to time that when hospitals and institutions make arrangements whereby they send people home - in a circumstance like you described, a very difficult circumstance - they make a decision, because they say that if this person stayed in the hospital we would provide all the drugs.

MS S. OSBORNE: Absolutely.

MR. GRIMES: The rule is, if they send them home - according to the Auditor General - they are not supposed to pay for the drugs because they are no longer in the hospital. Now, some hospitals and boards have taken the decision and said: No, we understand this person is going home to die, unfortunately -

MS S. OSBORNE: They are also saving the hospital -

MR. GRIMES: - and because there is a net saving to the system, clearly they are saying it is in our best interest and the family's best interest to at least provide them the drugs as they go out the door. The Auditor General will go in and check that and say: They just provided some drugs for somebody who wasn't in the hospital. That is wrong.

When you look at it, in the Auditor General's mind that is wrong because there was a budget line for drugs for use in the hospital. There wasn't a budget line for drugs for use at home. I think anyone else looking at an on balance -

MS S. OSBORNE: Well, it could -

MR. J. BYRNE: Could I make a comment on that? (Inaudible) brought me into it. The situation here is what is morally right and what is technically right or legally right. That is the problem.

MS S. OSBORNE: Yes, really.

MR. GRIMES: Exactly.

MS S. OSBORNE: Also when you balance it against what the government would have paid had they remained an inpatient in the hospital. We have to strike a balance there so that when folks who probably can pay for it, are proud and want to pay for it, but, I mean, some drugs are phenomenally expensive. It doesn't put a crimp in their budget, it blows it right out of the water. Financially, probably they have to go out and get a loan because some drugs can be quite expensive.

MR. GRIMES: When they go home, normally, regardless of the circumstance, we apply the general rules for home support which is a limit, a cap, as to how much we provide in any one month in any event, regardless of need. It is means tested. If you can afford it you pay for it yourself. Then if you exhaust your own money government will assist, but again, to a certain limit. It is an issue where immediately that we heard the Government of Canada was willing to get involved we said yes. Because I think it would allow us to develop better policy and to give more consistent treatment and to accommodate the very kind of issue that you just talked about. Why don't we look at a full health care perspective instead of just saying the institutional budget is this, the home support budget is this, but when you meld them -

MS S. OSBORNE: We should be able to blend.

MR. GRIMES: The service blends because the individual's circumstance required access to both.

MS S. OSBORNE: Obviously, there is an advantage to the family in terms of tracking back and forth to the hospital of having the patient home. In many instances, in unfortunate situations like this one, the patient wants to be home to die, especially if there is nothing else that can be done in the hospital. When there is an agreement that says: You can stay here and die or go home and die, then there should be a merging of what would be provided by the system.

MR. GRIMES: Right now, on an individual basis, they are trying to accommodate it as best they can. Because the institutional boards are running deficits, because they are under tremendous pressure and scrutiny to be asked: Are you spending your money efficiently, wisely and well? Even in a circumstance where anyone having it described to them would say: Yes, it was the right thing to send the drugs home, someone else could look at it and say: That wasn't in your budget, you spent some of your money improperly or inefficiently.

MS S. OSBORNE: When the budget is being crafted maybe it could be factored in and the other side of the sheet show: because when we send them home we will save this many millions. Then we will provide much less in drugs because if they were in hospital they would still get the drugs and they are saving so much when they go home.

MR. GRIMES: If I might too, Mr. Chairman, the issue again is not a matter of - you can make the case for the cash saving and actually show it as a number on a piece of paper. We are not really interested at this point in time. It is like an over supply of doctors, we don't have to worry about it. We are not going to save the money because what we will do by vacating the bed is we will just shorten waiting lists, but we will have another benefit in the system. These wait lists that you hear of and the frustration that people get, the surgery is cancelled, there aren't any beds available, they can't get in. If we can get the person home and properly taken care of we will be able to shorten up - we won't save any money in the institution but you can show what it would have cost had you stayed here in this setting verus there. That money will stay in the system to shorten wait lists and get more people into the system. You actually won't subtract any money but you will provide a better service and shorten some wait list on the other end.

MS S. OSBORNE: Also probably save money in cardiac. That brings me to cardiac. You are going to do 150 more per year when the Health Sciences Centre is fully equipped and stuff. What is the present wait list?

MR. GRIMES: It depends, but the last statistic that I saw publicly is that for the least urgent I thought some of them were up as far as sixty weeks.

MS S. OSBORNE: How many people would be on the wait list?

MR. GRIMES: Right now, 365, with 255 of them considered urgent by their attending physicians, not emergencies but urgent and should be done, and 110 who are strictly elective and that the doctor is saying: If we get a chance we will do something but you are at no risk at all.

MS S. OSBORNE: So we still won't raise the wait list, we will just reduce it with -

MR. GRIMES: At this rate it will take us a couple of years flat out to make a dent in it.

MS S. OSBORNE: How many are being added per year to the list? Is it going down year over year or is it remaining about the same?

MR. GRIMES: I don't know. Maybe Loretta might be able to answer that question for you more directly. My sense of it is that with our diagnostic abilities and so on actually we are identifying more potential people for some kind of procedure. How many we get done decides whether the wait list grows or not, but (inaudible) on how many people are actually looking or identified that should have a procedure or could have a procedure?

MS CHARD: Yes, we are going down marginally. In 1998 we had 493 and in 1999 we had 485. I guess everybody in this room knows that cardiovascular disease is our most troublesome of chronic diseases and is growing, particularly as the population is aging, so we are seeing more and more people come on to the wait list as well. Part of that is due to earlier diagnosis and part of it due to the aging population. We are seeing marginal decreases. Sometimes they may fluctuate up and down month over month, but we are seeing some inroads. We will be going up to fifteen cases a week, hopefully by September. That will increase to twenty next year. So by also funding a number of people to go out of Province we are able to address the backlog and then by that time we will have the capacity in-house to be able to increase the cases.

MS S. OSBORNE: Okay, thank you.

You go ahead.

MR. J. BYRNE: The Minister's Office. I am going to get into the subheads now. Under 1.1.01.03, Minister's Office, Transportation and Communications, you budgeted $41,000 and you spent $59,000. Which one of the ministers spent that extra $18,000? Yourself or the previous minister?

MR. GRIMES: Actually, there was a little bit of combination of both. One of the additional responsibilities given to the minister last year was the International Year of Older Persons which required additional travel above and beyond normal travel related to that initiative. Because there was a change in portfolios in the last couple of months of the fiscal year I did what would be considered an extraordinary amount of travel in a couple of months by going out to visit each of our boards, to meet with them, to discuss their issues with them and to visit with many of the advocacy groups, some here and some outside the city. The amount of travel was above and beyond what would normally be expected for those two reasons.

MR. J. BYRNE: Under the same subhead, Purchased Services went from $8,100 up to $16,000, doubled. What would those services be? What type of services?

MR. GRIMES: I have never known what that means anyway in these budgets.

MR. J. BYRNE: No, me either.

MR. GRIMES: So I am going to -

WITNESS: Printing and entertainment.

MR. J. BYRNE: What?

MR. GRIMES: Printing and entertainment, and I can tell you I didn't do the entertaining, I was too busy.

MR. J. BYRNE: So we spent $8,000 on printing and then we spent $7,900 on entertainment. Is that you?

MR. GRIMES: It wouldn't be me. I haven't had time to entertain anybody. I was hoping to entertain the Committee some time for lunch but we didn't have time for that.

MR. J. BYRNE: Under Executive Support, Transportation and Communication, page 197, 1.2.01.03, went from $40,400 budgeted to $65,000 actually spent, and you have $60,400 budgeted this year. Why the dramatic changes and differences?

MR. GRIMES: I think that one largely again was the issue of -

MR. J. BYRNE: Bringing someone with you when you went on these trips.

MR. GRIMES: No, it was a communications exercise done again in the department to provide factual information to the public of Newfoundland and Labrador about services offered in the department. So that was the communication side. There was not much travel associated with that but there were some -

MR. J. BYRNE: Oh, that was to counter the questions brought up by our critic in the House, was it?

MR. GRIMES: If that makes you happy to describe it as that then we are going to leave -

MR. J. BYRNE: I'm not making myself happy, I am only asking for answers. One way or the other, all I want to do is ask him the questions.

WITNESS: You have to get the truth, haven't you?

MR. J. BYRNE: That is right, I suppose, yes. That is why I am asking the questions now. You have to get the truth out there, that's right.

Administrative Support, 1.2.02.01, Salaries. There was, $2,356,500 budgeted, and the revised figure is $2,393,400. An extra what? An extra salary? Did somebody get hired on? Pardon?

WITNESS: Thirty-seven thousands dollars.

MR. J. BYRNE: Whatever.

WITNESS: What number are you on there, Jack?

MR. J. BYRNE: 1.2.02.01, page 198, Administrative Support. It looks like an extra position somewhere there.

MR. GRIMES: Mr. Chairman, it is largely funding actually to provide for part of the year, because it will only take us three months for some people to work with us to do this review with the boards. It might even be actually contributions to more than one person who will be on for part of a year working with the health care boards on this review that is going to happen in April, May and June. This is where the money is funded for this to happen. (Inaudible) reflects an effort for this special review team that is going to occur.

As well, there has been a changeover which is going into the budget on a permanent basis for - the MCP administration is now going to be done by the Department of Health and Community Services, and we have transferred some administrative functions over from MCP into the department so that it is done directly in the department.

MR. J. BYRNE: Subsection 1.2.05.03., Policy and Program Services, Transportation and Communications, again there was $99,200 budgeted, $128,300 actually spent, and you are looking at $246,300 this year. That is an extra $118,000. Why?

MR. GRIMES: There are a couple of initiatives, Mr. Chairman, that are occurring. There are some new responsibilities under the Young Offenders Act and so on that are being incorporated into this particular department. Some of these funds are cost-recoverable from the Government of Canada; most are not. Also, we now have, full time for a year, a staff person assigned on the tobacco coalition with respect to our initiatives with the Teen Tobacco Team, and also initiatives for promotions to reduce the amount of smoking in the Province more specifically amongst young people because there seems to be an increase in young people taking up smoking while there is an increase in older people quitting smoking. There are a couple of initiatives with respect to that.

MR. J. BYRNE: The person you said you have appointed to that committee with teen smoking, why would that be included here? Wouldn't that be in a salary somewhere, rather than in transportation and communication, the cost for that individual?

MR. GRIMES: Most of the transportation and communication is respecting the Young Offenders Act and the fact that you have to go and meet them where they are, take care of them and so on, and intervene as appropriate under the act.

MR. J. BYRNE: Under the same subhead, 1.2.05.06., Purchased Services, you had $82,000 last year, you spent $82,000, and this time you have $349,600. That seems to have taken quite the jump. Why would that be, and what would those purchased services be?

MR. GRIMES: This one is actually a major program in terms of putting together as well a program guide to health services in the Province that would be available to Newfoundlanders and Labradorians; because right now people say: Well, if I need to contact someone from mental health services, who do I call, where do I make a contact and so on.

There was an initiative as well that we launched awhile ago. There is an Internet site as well, and there is an actual written guide where people can make contact and say: If I want to avail of any kind of health related service in the Province, where do I go? Where is the contact? How do I get access to the service? The funding is here to complete that initiative through this year and make it available so that there is information out there as to where I really access the system for different needs, everything from prevention and education right through to actual service for a particular ailment.

MR. J. BYRNE: You just popped something in my mind now with that answer with respect to programs. The program was - I suppose you would call it a program; I don't know what you would call it really - with respect to addictions and those gambling machines, the video lottery machines, where you put the sticker on it and there is an 800 number now. I heard a lot of complaints about that. You phone this number which gives you a machine, that puts you onto another number that gives you a machine, before you get in contact with anybody. I am curious now. They are taking in $90 million in those video lottery machines. How much money are you planning on putting back into addictions, out of that $90 million? To me it seems like a - I won't say a joke, but there is not nearly enough money going back into addictions when we are reaping money out of it.

MR. GRIMES: Directly from video lottery machines there is $300,000 just from that source that is dedicated to give people access to at least root them towards where they might get some counseling and some services.

MR. J. BYRNE: Out of $90 million?

MR. GRIMES: Again, that is not the only addiction service and health guidance that is available in the Province. That is just earmarked from - and it is money agreed as well that the bar and restaurant owners agreed to help put in place a few years ago in return for their share of the proceeds.

MR. J. BYRNE: Are you finished with that one?

MR. GRIMES: I am finished with it. I don't use the things. I am frightened to death of them.

MR. J. BYRNE: No, I mean the answer was kind of short. You took me by surprise.

On page 200, subhead 1.2.06.03., Government and Agency Relations, Transportation and Communications, there was $43,400 budgeted and you spent $63,400, an extra $20,000. What would that be?

MR. GRIMES: Where did you go, Gerry?

MR. WHITE: This is where the department took on, mid-year, some new responsibilities for some of the community services and there were (inaudible) provincial meetings that some of the staff had to go to, and others in connection with the International Year of the Older Person.

MR. J. BYRNE: The next one I have is on page 201, subhead 2.2.01.05., Professional Services, $947,000. It went down to $917,000 and this year it is $787,000. In actual fact we are seeing a decrease.

WITNESS: (Inaudible).

MR. J. BYRNE: Not necessarily, depending on if you are out there trying to get a few drugs and you are a senior.

MR. GRIMES: No. I understand as well this is an area actually where xwave solutions does the tracking for us through an information technology program and they came up with some efficiencies. They are getting all the work done and are actually saving a bit of money. They are getting a little bit more work done, actually, for less money.

MR. J. BYRNE: Yes, more for less.

Under the same subhead, 09., Allowances and Assistance, you end up with almost $3 million; $2.5 million, I suppose.

MR. GRIMES: This is the heading under which we provide the drugs to our social services clients, and the expectation is that there will be some increased usage this year. This funds and allows - this is the budget, and this always is a little bit open-ended because you never know how many of your clients are actually going to need medications during the year but there has been annual growth. This just budgets for some annual growth.

MR. J. BYRNE: We are putting $37 million into drugs for social service recipients?

MR. GRIMES: Absolutely.

WITNESS: And the seniors are below (inaudible).

MR. GRIMES: And the seniors are another $26 million or $27 million.

MR. J. BYRNE: I am asking legit questions; don't get too upset over there.

MS S. OSBORNE: Can I interject there, while we are on the drugs for social assistance? Well, I guess it is not just social assistance but everybody, where we are picking up the bill on the social assistance. Is there an index now? Is there some way that we can put a control on that, where - as we know, some people are going from doctor to doctor to doctor getting prescriptions and then going to different drug stores. I am just asking this as a matter of interest. We know that there is a lot of abuse and a lot of things like Ritalin and stuff being sold on the streets. Are we in control of it? If not, is there any way that we can introduce some sort of a technical thing through computerization where we can put in their MCP number and that would be linked to all of the drug pharmacies?

MR. GRIMES: Yes, there are two things, Mr. Chairman. One is that there is currently what is called a triplicate prescription program that tries to track exactly that, so that there is information shared as to which prescriptions have been filled and for what reason so that you don't end up with extra prescriptions being provided.

There is also a major piece of work. The first part of it has been concluded under the health information system - I think is the group that were doing it - with what is called a unique personal identifier. They have identified that the MCP number is not the appropriate number to use, but that there would be a number assigned so that you could do exactly what you described: be compatible so that you could track, through the computer, through pharmacists, doctors' offices, and others who need to know exactly which medications are out there in the hands of which people, for what purpose, so that some of the unfortunate stories that we have heard and have been actually happening in the past can be avoided in the future. It is an issue that is currently well into development and it is one of the priorities under this whole program.

You mentioned the issue of Ritalin with young people in our schools and so on. The concern came more from seniors -

MS S. OSBORNE: Really?

MR. GRIMES: - where there were several medications, and some medications were actually -

MS S. OSBORNE: Contraindicated with the other?

MR. GRIMES: Those kinds of things were actually undoing the benefit. They would go to get two or three different medications over time and nobody was really tracking it and so on. That brought the issue to light before an issue like Ritalin, and they are well along the road now to having a (inaudible) in place.

MS S. OSBORNE: I guess there are other drugs, too, that are not just child-centered that are being sold on the streets, Librium and Valium and so on. I am not an information technology or information systems expert and I don't know how difficult it would be to have a link between all the pharmacists, that as soon as a certain number is keyed into the computer up it comes on the screen that: Last week they were at Wal Mart and got Valium and now they are down here at Lawtons getting more Valium.

MR. J. BYRNE: It has to be done.

MR. GRIMES: That is exactly the notion, yes.

MS S. OSBORNE: I don't know how difficult that is to do but it would be wonderful if we could do it.

MR. GRIMES: There is some voluntary sharing going on now. There is this idea of what they call a unique identifier that will enable it to be automatic. There are a couple of issues around protection of information and so on that are being worked through as well, privacy and those kinds of issues, because they contradict each other sometimes. The view right now is that it is in the public good as well as the individual's benefit to have this tracking system in place.

MS S. OSBORNE: Absolutely. It would clean up a lot of things. It would save money. Not only that, it would keep the drug, from that source, off the streets.

You can carry on, Jack.

MR. GRIMES: Mr. Chairman, just as information, there is an amendment that we made and will be dealing with in the Legislature this spring to provide the pharmacists with the tools they need to share this information, to enable them by law to share information.

MR. J. BYRNE: Good idea.

MS S. OSBORNE: We won't argue that one. I think..

MR. J. BYRNE: Under 2.3.02.05, Physicians' Services, Professional Services, you have $129,535,700 there and there was none budgeted last year. Of course, that is because of the -

WITNESS: MCP.

MR. J. BYRNE: I am just curious with respect to 2.3.02.10, Grants and Subsidies. You have $50,947,400 but last year and the year before it was over $170 million. Just explain to me what is going on there, would you?

MR. GRIMES: I think it is just where it has been split into the two categories. Before it was all in Grants and Subsidies, and now with Professional Services and Grants and Subsidies it is separated out. The two notions of payment there are fee-for-service and salaried doctors. I don't know which line is which line but I think it is a split to show that some of them are paid for on salaries and others are -

MR. J. BYRNE: It was all inclusive last year.

MR. GRIMES: It was all inclusive, it was all in the one pot. There are just two lines done for accounting purposes to show that there are two methods of paying our physicians.

MR. J. BYRNE: I only have a few more questions.

2.4.01.09, Road Ambulance, Allowances and Assistance. You had $3,813,500, you spent $4,096,800, and you have $3,805,700 this year, but under .10, Grants and Subsidies, it looks like you have added around $3 million there. That is the $3 million you announced recently with respect to that. Weren't those people looking for $6 million or something, double that or more?

MR. GRIMES: Yes. They had a report done by, again, an accounting firm, that just said that if these levels of service were put in place this is what it would require to pay for it using all of today's current grant and subsidy programs, and it was in the range of $7 million to $8 million. What we have been doing in the discussions with the three different groups is suggesting that we will phase in some improvements for both the machinery and equipment, the actual vehicles and equipment, phase in new standards for the attendants and the drivers in terms of their training levels over the next three years, and that we won't get all the way there. If we went all the way where we wanted to go in one day, like from yesterday to today, it would cost $7 million or $8 million. We will get there over a period of time by spending about $3.1 million. We haven't gotten a final arrangement with them yet but they are still trying to sort it out and divvy up the money amongst themselves. There are still some disagreements amongst the three groups.

MR. J. BYRNE: 3.1.01.03, Community Services, Transportation and Communications. You budgeted $130,000, you spent $222,000, and this year you have $40,000 budgeted. In the next section, .04, Supplies - I might as well do two of them the same time - you had $1,725,100 last year, $1,564,300 actually spent, and you have $1,724,300 this year. Do you want to address the two of them now? You are taking a cut of $182,000.

MR. GRIMES: Basically, Donna informs me that the issue in last year was that there were a whole group of initiatives under the child youth issues that were being brought in for the first time. In order to go out to the community services boards and so on and do the in-service and the information about them took an extraordinary and inordinate amount of money last year. It will go back to regular contact with the boards this year because we won't have to do that kind of in-service, training and information sessions. The issue of the Supplies is going to show a little bit of growth in that particular area but nothing exceptional. It is back to normal.

MR. J. BYRNE: In actual fact, with respect to Transportation and Communications, in the 1998-1999 budget it would have been $40,000, because you had anticipated $130,000 and you went up -

MR. GRIMES: I think in the Child Youth and Family Services Act it was the first time in twenty-five years and so on that it had been significantly changed, and there was a major, intensive, in-service program done with the deliverers and those who are responsible for enforcing the act last year that took it up to the $222,000.

MR. J. BYRNE: 3.3.01.07, Furnishings And Equipment, Property, Furnishings and Equipment. You budgeted $4,500,000, you spent $23,039,300, and you are back to $5,000,000. That $23,039,300, what is all this about now? Is that the Janeway?

MR. GRIMES: That was the year-end funding that we provided for capital equipment. Again, we put an additional $6 million in one time with year-end cash to the Janeway. We funded a whole series of capital equipment improvements throughout the Province for another $10 million or so. There were other initiatives with respect to equipment for renal dialysis and others that we all purchased at the end of the year.

What we are showing with the $5 million is that the annualized amount would have been $4.5 million. We are actually increasing it on an annualized amount by another $500,000 for this next fiscal year. I think the actual budget statement indicated that we were going to spend $45 million over three years. We are hoping that that number will go from $4.5 million to $5 million, which it does now, up to $15 million in the budget in the next year out so that we can renew, upgrade and replace a lot of our actual equipment that is in the institutions.

MR. J. BYRNE: Two more questions. Under 3.3.02.10, Health Care Facilities, Grants and Subsidies, you had $2,500,000 million. It went up to $13,150,000 and is now back down to $2,890,000 this year. If you add that, that is another $10 million there, we will say, onto that $20 million. That is $30 million really, isn't it? Is it going to be used for the same thing?

MR. GRIMES: What we actually did, again at the end of the year, is we put in some cash that bumped it up on one time for a group of facilities, renovations and preparations, again for breast screening. This is where the money was put in for the Janeway Hostel that we announced, the $1.5 million. We increased as well in a block fund for some renovations and urgent repairs in certain places a total of just over $10 million or so that we funded at the end of the year.

MR. J. BYRNE: With respect to the Janeway itself, I think when we first started out it started at $60 million, it went to $80 million, it went to $100 million, it went to $120 million. What is it really up to now? What is the bottom line figures? That is everything, equipment and all.

MR. GRIMES: The latest number that we have heard is $130 million. He keeps referring to it, Mr. Chairman, as the Janeway. It is much more than that. It is the whole reorganization of health care delivery in St. John's. The Children's Rehabilitation Centre is combined with the Janeway in the new facility. The Grace is closing. There are major renovations occurring at St. Clare's. There have been some renovations done at the Waterford. There have been renovations done at the Miller Centre. The whole issue is that the cost to reorganize institutionally based health care delivery in St. John's is going to be $130 million, but it is a lot (inaudible).

MR. J. BYRNE: Yes, but the reorganization first started - because all this was factored in at the time, at the beginning - at $60 million, wasn't it?

MR. GRIMES: I think the first number I heard was closer to $100 million.

MR. J. BYRNE: No, no. I can remember having the PAC here, having them in.

WITNESS: Go on boy, you should put a couple of hundred in here.

MR. WALSH: Mr. Chairman, I would like to move 1.1.01 to 3.3.02.

MS S. OSBORNE: (Inaudible).

MR. WALSH: Oh, I am sorry. I saw the book closed so I -

MS S. OSBORNE: 3.1.01, under that (inaudible). What portion of that budget is estimated to go towards the transition and maintenance of the thirty-seven individuals who are in the pre-vocational training and assessment centre?

MR. GRIMES: I could not tell you that directly, although this is likely to be - and Bev can probably give you a more detailed answer - the heading under which our portion of it and our department is funded here. The transition is occurring, as I understand it, on an individual case-by-case basis. The families and individuals are being counseled, supported and approached as to what alternative services were made available. I think this is the right heading, that any portion that would be funded from our department would be somewhere here. It is a joint cooperative initiative between the two departments, as you know.

Beverley, do you have something that you can add?

MS CLARKE: The actual dollars have not been transferred yet because we are still working on the details of where each individual is going to go and what their plan will be. Until we finish that process we haven't needed the actual transferred dollars, so it is not actually in this budget at this particular time. It will be transferred from HRDC to Health and Community Services.

MR. GRIMES: The amounts that are needed for community-based services funded in this department.

MS S. OSBORNE: Okay.

Do you have a breakdown of the expenses of the boards individually, the eight institutional boards and the four community boards? Is there a breakdown of the cost?

MR. GRIMES: Yes, there is.

MS S. OSBORNE: Is it available here?

MR. GRIMES: It is not in the budget.

WITNESS: It is right here.

MR. GRIMES: Okay, it is. It is in our information. I can certainly provide it to you.

MS S. OSBORNE: Okay.

MR. GRIMES: Again, it is information that would be here. The block is $187 million, as you can see here, for the community services boards. There is another block, another heading, for the institutional boards, and I can provide you with a listing of each -

MS S. OSBORNE: How much? One hundred and eighty million for the institutional?

MR. GRIMES: Community services.

WITNESS: Do you also have the different institutions broken down? How much money will be budgeted (inaudible)?

MR. GRIMES: We wouldn't have that. That would be in the Central East Health Care Institutions Board's information. We have a global amount for the Central East Board that we fund.

MS S. OSBORNE: Can that be provided afterwards, just a copy of it, rather than go through all the details now?

MR. GRIMES: Yes.

MS S. OSBORNE: That will save a lot of time.

MR. GRIMES: Then, in each board which provides an annual report, in their annual report they would provide the information on how much is spent on each service from the community side and then each institution from the facility side.

There are a couple of lists here available that we can leave with you from both types of boards.

MS S. OSBORNE: Thank you.

Subhead 2.2.03., Special Drug Programs, appropriations for the supply of drugs and accessories to residents with CF and other medical conditions. You don't need to give me all the medical conditions, but are there any other examples of what...?

MR. GRIMES: There was one that I was aware of several years ago that got added because there was a child in my own district, in Point Leamington, with neutropenia. There were several families with that congenital disorder. It is issues like that where there is a particular disorder that gets identified. There is a particular drug treatment for it. There are a few isolated cases. Actually it is one of those things that, at some point, for purposes, the heading could almost be rolled into either one of the other two expect for the fact that the first group is income support for families on social assistance and some of those families are not. They are just very expensive drugs that the family needs, regardless of their circumstance; and the other one is for seniors. It is tempting at some point just to roll it into one or the other but they you get caught into some of the definitions and (inaudible) issues.

There is $750,000 budgeted this year for cystic fibrosis, schizophrenia, MS and neutropenia in particular, those four.

MS S. OSBORNE: Under subhead 3.2.01., is there a breakdown of what the Canadian Blood Services would cost as opposed to - there is acute care, long-term care, emergency care, diagnostic services. Do you have breakdowns of that, that you could provide as well?

MR. GRIMES: I don't have it with me and it is not a separate line in this budget head but there is a number under which the provincial contribution to the Canadian Blood Service is identified.

MS BREWER: It is $16.4 million.

MR. GRIMES: Donna tells me it is $16.4 million in this year coming up.

MS S. OSBORNE: Okay. I just have another couple of questions, and 3.2.02. reminded me. In the beginning of the Health Care Corporation there were some employees who were reclassified. They filled out all these forms, they came over and they rested on the Finance Minister's desk for a long, long while. Have those forms ever been signed? Do those people know where they are?

The problem that was arising there was when they signed the form they probably had themselves reclassified as whatever, as they thought, but because it was never signed by the Finance Minister and returned to him, sort of signed off, if a new posting went on the board they did not know, if they applied for it and got it, if they would be better off or worse off. Has that problem been solved now?

MR. GRIMES: To my knowledge the issues - there were two issues. There were some classifications done within bargaining unit groups that were done at a certain point in time.

MS S. OSBORNE: The managerial ones I am specifically referring to.

MR. GRIMES: Those are the ones I was just going to refer to. The managerial ones were done, and largely because it was tied into issues of collective bargaining there were significant increases for some management reclassification. Because the management component was downsized and additional responsibilities added to a lot of the management units, their classifications went up. I think it was just a matter of a judgment call. The Finance Minister of the time did not want to be publicly discussing how much of an increase or raise some of these managers had legitimately gotten through the process, not by bargaining but by going through reclassification, when he knew that the public service unions were going to be opposed to it or upset because they were being told that 7 per cent is all you get. My understanding now, though, is that the reclassifications that were done have been paid and the monies have been released. There might not have been a big public announcement about it.

MS S. OSBORNE: No, but they all know where they sit.

MR. GRIMES: They do now.

MS S. OSBORNE: I am not even talking about the money. It was just that there were some people who called and said: Look, I don't know where I am. There are jobs going up on the board and I don't know where I will be, what my salary will be. That has all been put together now?

MR. GRIMES: Yes it is, on the management side. There are issues today with pay equity where, at some point - there are people, for example, like the nursing classifications and others who are now receiving a salary grid number and a pay equity adjustment as well. We now are in the stage at this point of putting them all together at a new point on the scale because some people are saying: Well, my scale is here but I have this money in my pocket and if I get a raise or something where will I be on the scale? They want to know.

MS S. OSBORNE: Yes.

MR. GRIMES: That issue is sorting itself out through this new speedy reclassification that is being done, to be concluded some time this summer for the nursing groups and the social workers.

MS S. OSBORNE: Okay.

Alright, Mr. Walsh, move away.

On motion, subheads 1.1.01. through 3.3.02. carried.

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

MR. GRIMES: There is no amendment to increase the minister's salary or anything?

MR. WALSH: Don't push your luck there now, Minister.

WITNESS: If we had been out of here at 10:30 a.m., that was a possibility.

MR. REID: Mr. Chairman, could I make a comment?

Minister, for the past two years your staff - because of a little incident on Fogo Island - I guess have been harangued and abused, but through it all I must say that they have cooperated fully with me. I would like to thank them for that cooperation and apologize for the inconvenience that I have caused them by trying to build a hospital on Fogo Island.

Thank you.

On motion, the Committee adjourned.