The Committee met at 9:00 a.m. in the Assembly Chamber.

CHAIR (Mr. Ridgley): Order, please!

First of all, welcome to everybody this morning. I ask the members of the Committee to introduce themselves, please.

MR. JOYCE: Eddie Joyce, MHA for the Bay of Islands.

MS JONES: Yvonne Jones, MHA for the District of Cartwright-L'Anse au Clair.

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

MR. R. COLLINS: Randy Collins, MHA for the District of Labrador West.

MR. YOUNG: Wally Young, MHA for the District of St. Barbe sitting in for Felix Collins.

MR. FRENCH: Terry French, MHA for the District of Conception Bay South and Holyrood.

MR. O'BRIEN: Kevin O'Brien, MHA for the District of Gander.

MR. T. OSBORNE: Tom Osborne, Minister of Health and Community Services.

MR. JOHN ABBOTT: John Abbott, Deputy Minister, Department of Health and Community Services.

MR. JIM STRONG: Jim Strong, Assistant Deputy Minister of Corporate Services, Department of Health and Community Services.

MS KAREN LEGGE: Karen Legge, Acting Director of Financial Services.

MS MOIRA HENNESSY: Moira Hennessy, Assistant Deputy Minister for Regional Health Operations.

MS LYNN VIVIAN-BOOK: Lynn Vivian-Book, Assistant Deputy Minister of Public Health, Wellness, and Children and Youth Services.

CHAIR: Thank you all.

We will follow basically the same format as we have in the past. We will allow the minister a few minutes for introductory comments. What we have found is that we have started the questioning - now, if a person wants to make introductory comments before the questioning starts, that is fine as well. Other than that, we will allow each member of the Committee about ten minutes for questioning, and then according to the wish of the Committee that member can either finish his or her questioning or we can pass to another and revert back to that person.

We will begin then with the minister, please.

MR. T. OSBORNE: Thank you.

I guess there is no need to introduce the officials from the department as they have already introduced themselves. First of all, it is a pleasure to be here as Minister of Health and Community Services. Officially I am here three weeks now, so I will ask the Committee to be a little bit easier on me than you would normally be.

Health and Community Services is a department, I think, that touches the lives of everybody in the Province. It has the largest expenditure of any department with almost half of the provincial Budget. More than any other department, I think it is a department that each and every individual in the Province has a heavy reliance on.

Over the last year, there have been a number of investments made in the area of health care, and some of them more significant announcements. Under Minister Ottenheimer, who was the previous minister, there was the release of the Gambling Prevalence Study; the launch of the mental health and addictions framework; the first announcement on wait times progress - and there will be another wait times update within the next couple of weeks; the enhancement of medical transportation assistance; key investments in diagnostic equipment - there was over $23 million including the third MRI for St. John's which is set to open next month; the expansion of the Picture Archiving and Communications System throughout all regions of the Province; we are proceeding with the new primary health clinic in Grand Bank, with renovations to Blue Crest and a new CT scanner for Burin; investments in new cancer clinics in Gander and Grand Falls-Windsor; expansion of dialysis services in Carbonear; implementation of the new Smoke-Free Act in the Province; and the launch of the Provincial Wellness Plan. We hope to build on these investments and to continue with the foundation that has been laid.

There have been some significant investments in Budget 2006 and some of the priorities there include: the continuation of major capital projects including long-term care facilities in Clarenville, Corner Brook and Happy Valley-Goose Bay; the new health facility in Labrador West; continued investment in mental health and addictions including the new Provincial Addictions Treatment Centre for Corner Brook and the introduction of new mental health and treatment legislation - the act will be introduced into the House this year; continuation of ongoing consultations toward the development of a new healthy aging strategy; further rollout of the Provincial Wellness Plan; continued focus on improving wait times for the Province; continued focus on cancer prevention and treatment; the implementation of expansions to the Newfoundland and Labrador Prescription Program, including the coverage for drugs related to Alzheimer's and the expanded coverage for low income families and seniors; development of new dialysis satellite units in Burin, Happy Valley-Goose Bay and St. Anthony; and strengthening the public health capacity for the Province.

These are just some of the highlights in our ongoing commitments through the department and the many boards, agencies and community partners that are working together to improve the health and well-being of Newfoundlanders and Labradorians.

At this point, we will open it up for comments and questions and certainly be pleased to take any questions from the Committee.

CHAIR: Thank you, Minister.

I need to just go back a little bit, because I neglected to fire the official starting gun which is to ask the Clerk to call subhead 1.1.01.

CLERK (Elizabeth Murphy): 1.1.01.

CHAIR: Shall 1.1.01 carry?

That allows the debate to begin, so we can start questions now officially.

MR. JOYCE: I was going to ask just a few questions.

I thank Yvonne, as the critic, for giving me the opportunity. I will not go through the Budget, the highlights of it. I will just be asking some general questions.

First of all, Minister, to you and your staff, I agree that the Department of Health and Community Services touches everybody. It is a hard portfolio. I understand the struggles that every person in your department has to go through, because it is a very sensitive and emotional department. At the outset, it is very difficult. Sometimes when we raise issues - and myself, raising issues on the West Coast - I am sure you appreciate the reasons why we do have to raise issues, but I do understand the dilemma that anybody in the Department of Health and Community Services must face.

First, the long-term care facility in Corner Brook. In the Budget, I think, there was $16 million allocated for the long-term care facility. What was the total money needed to finish the long-term care facility? There have been no tenders called yet.

MR. T. OSBORNE: I think we are estimating - and again, being here three weeks, if I make a mistake I will ask my officials to correct it so that it is correct for the record - I believe the estimated cost of completion on that facility is in the range of about $47 million. That is correct, isn't it, John?

MR. ABBOTT: Yes.

MR. JOYCE: Do you have an expected date for the completion of that?

MR. T. OSBORNE: The anticipated completion date at this particular time is in 2009.

MR. JOYCE: In 2009?

MR. T. OSBORNE: Yes.

MR. JOYCE: How many beds, Minister? Because there is some discussion in Corner Brook that once the facility is completed there are going to be forty beds less than what are currently available.

MR. T. OSBORNE: There are188 beds in the long-term care facility in the new project. In the existing project, there are 225 beds. Some of those beds that are in the three existing sites are housing light to moderate dementia patients now.

Having said that, I have heard the concerns that have been raised. I know there was a Licensed Practical Nurse in Corner Brook who raised some concerns, as well as other individuals in the Corner Brook region who have raised concerns about the numbers. What I can undertake, and what we are doing, and I will undertake for the Member for Bay of Islands, I am doing a review of the numbers. If we are going to put a $47 million investment in Corner Brook, I want to make sure that we do it right, so we are doing a review of those numbers to ensure that the numbers are accurate.

MR. JOYCE: These are general questions about the Interfaith Home. Will it remain open once the long-term care facility and dementia unit is up and running?

MR. T. OSBORNE: Those decisions have not yet been finalized. We will continue discussions with the Western Regional Health Authority to make a final decision on that, but I think there are a number of things that have to be looked at in order to come to a final decision on that. That decision has not yet been reached.

MR. JOYCE: Mr. Minister, I mentioned respite beds in Corner Brook. I am sure it is in the media, but I have not put it in the media yet because I was trying to get a solution to it. In Corner Brook, they closed down the two respite beds for the people who need to put their loved ones in there for a day or for a week. The reason why they said it was done was because it was underutilized, but I guess it is hard to say to somebody who is trying to keep their loved ones home for, say, fifty-one weeks of the year and need a week break, that you should have used it more - and put someone in an institution.

Is there any solution or is there any possibility that the department can help out in some way to find a solution for that, because I am getting a lot of calls. I guess a lot of people do not want to go public that they need the use of this bed, but there is a need for it in the Corner Brook area.

MR. T. OSBORNE: I respect the concerns that the residents in the area are rasing as well. I became aware of this particular issue after the decision was made. Since becoming aware of the decision, which was late last week, we have started dialogue with the Western Health Authority and we have asked them to try and identify solutions, and I feel confident that we are going to find a solution. I believe that it probably should not have gotten to the stage that it did, where the families were contacted prior to looking for solutions, but I feel fairly confident that a solution will be found for those families.

MR. JOYCE: There is one lady, Mrs. Sharp, who wanted to know if you would give here a call. This is not a confrontational call. Her name is Gertrude Shape, 632-2432. Mrs. Sharpe would just like to explain to you, personally, the trials and tribulations that she has to go through with her husband, as she is the only care giver at home with him, just so you know personally that she could use the facility more but she would rather keep him at home. It is just that a scattered day, a month, or a week a year, she just needs a break from taking care of her husband. It is just more to pass the personal side of it. Thank you for that, because she would definitely -

MR. T. OSBORNE: I will certainly give her a call and I will indicate to her, as well, that the issue is not finalized, that I believe we are close to finding a solution for the families.

MR. JOYCE: Excellent.

MR. T. OSBORNE: I believe there were five families booked in for respite care this summer, and I believe we are close to getting a solution for that.

Moira, are we...?

MS HENNESSEY: Yes.

MR. T. OSBORNE: Yes, we are just about there on a solution for them.

MR. JOYCE: Excellent. Thank you.

The other big issue in the Western Health Care Corporation is the debt that the Health Care Corporation has as we speak. In this Budget, were there any funds there for the debt for the Health Care Corporation?

MR. T. OSBORNE: In this Budget, we have allocated an additional $60 million, and that is over and above the - we have allocated additional funds to the four health authorities under the 2006-2007 Budget, over and above the money that was originally budgeted in the Estimates. We have provided additional funding to them to try and eliminate their deficits. This year there is an additional $60 million that is being provided to the four regional authorities to try and help them reach their mandate of providing quality care within available resources, because obviously they face challenges as well. I guess that additional $60 million will help them to reach -

MR. JOYCE: In this Budget, 2006-2007?

MR. T. OSBORNE: Yes, in the 2006-2007 Budget there is an additional $60 million.

MR. JOYCE: What I am hearing out in Corner Brook, from a few of the people who are involved with the board, is that they have such a high debt that they have to find some way to pay it down. That is a major burden that they do have.

MR. T. OSBORNE: There are debt servicing costs to the regional health authorities. Obviously that is a challenge as well. I think the four authorities now combined carry a significant debt, so between government and the authorities we are working together to try and help them deal with that particular situation. That is, I think, part of the reason there was an additional allocation of $60 million this year between the four authorities, to try and meet their operating costs and try and help to prevent them from going into deficit for sure.

MR. JOYCE: Minister, I brought up in the House of Assembly, not with you as the minister, the Hay report in Corner Brook. Is your department moving ahead with the recommendations of the Hay report or is that dead?

MR. T. OSBORNE: I think it is fair to say that some of the recommendations in the Hay report have been adopted by Western Health. Others have been completely disregarded, as you know, and the others recommendations that are there, I believe, will be assessed on a case-by-case basis. Western Health, again, they have a responsibility to deliver quality care within the resources available. We have increased those resources in this year's Budget, but it is incumbent upon them, within their mandate of delivering quality care, to look at each and every recommendation, to make a determination as to what recommendations will best suit their operations and the delivery of quality care.

MR. JOYCE: Is there any way of getting - because most of the people that I deal with out in Corner Brook and the Bay of Islands area are not sure which ones are being recommended and which ones are not, because we are getting some taken off the table and some not. When you ask the health care authority, they say, well, we are not implementing the Hay report. We don't know. We, as the general public, don't know.

I know the Department of Health and Community Services has the final say, but is there any way that someone like myself, or the general public, can find out which ones are being recommended? If you come out with a Hay report and you make it public, and then, with all due respect, you get a minister of the government standing up and cancelling two outright - everybody in the Corner Brook Western Region realizes that the Hay report is dead. I will give you my example: Recommendation 172, moving seniors from Corner Brook to Port aux Basques, I just think that is cruel.

MR. T. OSBORNE: As far as recommendation 172 is concerned, that recommendation, I do not think, has been adopted.

MR. JOYCE: Oh, no, you are absolutely, categorically, positively wrong.

MR. T. OSBORNE: I do not think that is has been adopted as a policy, Eddie. I think what is happening there is, we have announced a long-term care facility for Corner Brook which hopefully will expand the number of beds - and again I am reviewing those numbers - and, as well, the AD dementia units that are going to be in Corner Brook. Some of the surgeons in Corner Brook have expressed great frustration with having to cancel surgeries and there have been cases where there have been surgeries scheduled and they just did not have the bed space to carry out those surgeries.

I will ask John or Moira to elaborated on that, but I think I can say that 172 has not been adopted as a policy, as a short-term measure, until the long-term care facility is built. The priority to perform surgeries and to look at acute care patients is obviously there. If a patient is medically released but waiting for a long-term care bed, obviously I have great sympathy for those patients who are medically released, and for their families, but I think we also have to place the proper priority on acute care patients and surgeries that are scheduled, and unfortunately it is a situation of space availability right now.

We have made the commitment for the long-term care facility and for the duplexes. There is a long-term solution. It is a matter of bridging the gap between now and the time the long-term care facility and the duplexes are built. Beyond that, I do not think 172 is on the books as a policy that is there to stay. It is a short-term measure.

John, can you elaborate on that above what I have?

MR. ABBOTT: Minister, I guess that is -

CHAIR: Could you introduce yourself?

MR. ABBOTT: I am sorry. I am John Abbott, Deputy Minister.

What the minister said is, I guess, exactly the situation in which they are finding themselves. It is a capacity issue, so we are working with them. Only as a last resort will they move any patient or resident to a facility outside their immediate area. As soon as we get the new facilities in place, we are optimistic that really should go by the wayside.

I guess, as the minister explains it, the hospital and the senior management are faced each period with the emergency rooms being blocked, surgeries not being able to be performed, and we have to move some of the patients to another facility, and there is a lot of consultation with the families. From time to time there is a case or cases where the family obviously prefers to stay - in this case in Corner Brook - but they are only done, literally, as a last resort.

MR. T. OSBORNE: As well, I think it is fair to say, first of all, this is only going to happen on a case-by-case basis when there is a demand for the availability of the bed for acute care or surgeries. I think in Central Newfoundland we are currently looking at a pilot project out there with the personal care homes and the category of patient that is going into the personal care homes. If that works well between now and the time the long-term care facility and the duplexes are built, we may be able to look at extending that pilot into Corner Brook. That is something that we are looking at and reviewing, simply as a short-term measure, to get us to the point that we don't have to remove patients from Corner Brook, which is where they want to be, into Stephenville or Port aux Basques, or wherever.

MR. JOYCE: That was going to be my suggestion to the department. There are one, two, three, four, five homes in the Corner Brook area, and I know all the beds are not utilized. If you could get two or three beds, or three or four beds, one in each home, even if you have to pay the homes extra, whatever it costs for the beds and the appropriate services.

John was aware of the situation there two weeks ago. I was just totally amazed. This eighty-year-old woman, who could not even speak, was told she is being moved to Port aux Basques, and no family member. Only because the Minister of Justice -

MR. T. OSBORNE: Yes, and that is highly regrettable. It is.

MR. JOYCE: I know it is a personal thing, and I know no one over there wants to do it, and I understand that everybody is trying, but there has to be some way, with four or five personal care homes, to say: Boys, it is going to cost us a few dollars but can we set one or two beds aside for this? Because it is hard on the families. It is hard -

MR. T. OSBORNE: Absolutely.

MR. JOYCE: - and I know the families. In this particular case, this poor old lady, eighty-years old, couldn't even speak, and she is going to Port aux Basques.

MR. T. OSBORNE: Well, I can give you the assurance that is something we are looking at. Again, there is a pilot project in Central. There are some issues we are dealing with between the boards and the personal care homes. If we can iron those issues out, that is something that we are looking at.

MR. JOYCE: Is there any way to initiate a pilot project for Corner Brook? This is just a suggestion.

MR. T. OSBORNE: Well, I will certainly have a look at that and I will -

MR. JOYCE: Because this is where the big issue - I am going back a month now, and I am sure John and the other staff are aware of it. There was a move there. They were moving eight or nine, and they were all.... I know everybody feels for these people, and I know that no one really wants to put these people through this stress. One lady got a call. Her husband came in at 10:00 o'clock, and she said: You know, they are moving me now to Port aux Basques. They said: No, no, we are not doing that now. He went home and he got a call. By the time he got back to the hospital she was gone - that quick. He never even got to say goodbye to her.

MR. T. OSBORNE: Like I say, it is very regrettable that happens, but I will give you that assurance, Eddie, that we will - and I will further consult with you on it, after consulting with the officials in the department, on the pilot project in Corner Brook as well.

MR. JOYCE: Because I feel that if you put one or two beds aside, and I don't know how to do it, the experts out in Corner Brook, but I am sure there may be, in the few home care facilities, if you put one or two beds aside and then had the appropriate.... According to the hospital, they are saying some are maybe just for forty-eight to seventy-two hours. By then, I am sure we could set up the appropriate sources somewhere. If you could consider that, it would be a great stress off a lot of families in Corner Brook. Just consideration is a start.

MR. T. OSBORNE: Definitely, we will have a look at that. If we are doing a pilot in Central, we will look at expanding that into Corner Brook. I am not sure at this point what the logistics of doing that are, but if we can do it we will.

MR. JOYCE: Excellent.

CHAIR: At this point I just want to ask the Committee, is it their wish for Mr. Joyce to wrap up or to switch speakers?

MS JONES: No, he will continue on.

MR. JOYCE: I have about three more questions, Mr. Chair.

CHAIR: Okay.

MR. JOYCE: The dementia unit in Corner Brook -

MR. T. OSBORNE: The duplexes, you mean?

MR. JOYCE: The dementia unit.

MR. T. OSBORNE: The existing dementia unit or the -

MR. JOYCE: No, the new one that is going to be built.

MR. T. OSBORNE: The eighty units within the duplexes?

MR. JOYCE: Yes.

MR. T. OSBORNE: Okay.

MR. JOYCE: Is there any money in this year's Budget for that? I could not find any money in this year's Budget for it.

MR. T. OSBORNE: Yes, we are moving ahead with the long-term care facility and the dementia units.

John, did you want to elaborate on that a little bit?

MR. ABBOTT: There are no actual dollars allocated because, depending on how that project proceeds, the intent is that the successful bidder, if we proceed down that road, would do the financing and then the payments for that would be based in their operating grant on a go-forward basis.

MR. JOYCE: So, what was in the Western Star for the tenders was looking for the P3, public-private partnership. Is the department continuing on with that, with the P3?

MR. T. OSBORNE: We have received four Expressions of Interest for the duplexes. All of them were private businesses. We did ask for community groups and non-profit groups as well.

I guess, similar to Agnes Pratt and St. Luke's which are in my district, they are not-for-profit groups that operate those long-term care facilities. They are publicly funded, to a large degree, but they are operated by the not-for-profit sector. It is something that is currently happening, and that is a road that I guess the Province had gone down several years ago with those particular institutions as well as others in the Province.

We are looking at, internally - obviously, my preference here, Eddie, would be to look at a publicly funded, publicly operated facility. Having said that, I think it is incumbent upon government to look at all available options and to choose the best available option for the residents who are going to be utilizing those duplexes.

MR. JOYCE: When is the expected start date for that unit, and completion date? Is that too early to calculate?

MR. ABBOTT: It is probably too early to say. We are expecting the detailed proposals on, or before, April 17. We would evaluate those and make a recommendation from the department to the minister and then, I guess, to Cabinet.

Because the intent and the design to build those would be similar to a housing construction, we would see that they could start this year. We would not necessarily do all units all at the one time. We would phase them in over the next year or two or three, depending on demand, and we would start construction this year and we could see occupancy as early as next spring.

MR. JOYCE: The Gambling Prevalence Study that was done by the department, is there any money allocated? Because in the meetings that we had with the Public Accounts, this was the first study that was done in the Province. Are there any funds allocated to continue on or follow up on the study?

MR. T. OSBORNE: Yes, in this year's Budget - out in Corner Brook, for example, there is $1.1 million allocated towards the total cost of a $3 million treatment facility in Corner Brook. That is for a number of addictions, obviously. There is a $1 million allocation - and, again, I will ask my officials to correct me if I am wrong - in this year's Budget to continue on with addictions, including some of the recommendations that were in that study, including an awareness program. There are nine new addictions counsellors. There is training for the addictions counsellors. There were five addictions counsellors put in place under last year's Budget. There are twenty offices throughout the Province that deal with addictions, so there is ongoing training for all of those, as well as resources internally within the department.

I am not sure if that answers your question.

MR. JOYCE: It is just because, in the Public Accounts hearings that we had, when the Gambling Prevalence Study was done, that was the first one done in the Province. The question raised, of course, was: Will there be a follow-up study done, and the information - because I would assume there would be just base information on the study. Will there be another follow-up study, or an update on this prevalence study, so that at least you can see if the gambling is rising or lowering, or the need for addiction services is rising or lowering?

MR. T. OSBORNE: In just speaking with my deputy, there is nothing set out yet. We have not given any thought to another study, or an extension of the existing study, but that is certainly something that I am prepared to look at. It is something that, certainly, based on your suggestion, we can bring back and discuss within the department.

MR. JOYCE: The treatment facility in Corner Brook, is the total amount of money allocated in this year's Budget to finish that, or just enough to start it?

MR. T. OSBORNE: It is $1.1 million allocated in this year's Budget. The total cost of that facility is $3 million.

MR. JOYCE: It is $3 million?

MR. T. OSBORNE: Yes.

MR. JOYCE: When is the expected completion date?

MR. T. OSBORNE: Two years, I believe, on that, is it, John?

MR. ABBOTT: Yes.

MR. T. OSBORNE: Yes, two years on that.

MR. JOYCE: Two years. So, 2008?

MR. T. OSBORNE: Yes.

MR. JOYCE: Okay, I am finished.

Minister, thank you for that respite bed. I will be conveying it on, that you will be contacting Ms Sharpe, if I am speaking with her. Thank you, because it is a big concern. Thanks for your support on that.

MR. T. OSBORNE: No problem. You are kindly welcome.

Thank you for the questions.

CHAIR: I am going to pass it to Ms Jones, I think, at this point. I just want to make note that Ms Jones is not a member of the Committee but sitting in. Would that be correct?

MS JONES: Yes, I am the critic for the department.

CHAIR: Yes.

MS JONES: Thank you, Mr. Chairman.

Good morning, Minister and officials. I am pleased that you came this morning to answer our questions. I am going to probably be until about 10:15, if you don't mind, Mr. Chairman?

CHAIR: Carry on.

Then you are going to pass to Mr. Butler?

MS JONES: Then I am going to pass, because I have to leave.

CHAIR: Is that okay with you, Mr. Collins, or did you want to get some time in between?

MR. R. COLLINS: I would like some time in between, but Yvonne can go now. That is not a problem, but when -

CHAIR: I will give ten minutes to Ms Jones and then pass, and then -

MS JONES: Okay.

MR. R. COLLINS: Yvonne can go now, and I will go after Yvonne.

CHAIR: I am just trying to be fair to everybody.

MR. R. COLLINS: If not, I can go now.

MS JONES: Okay, I will continue and whenever Randy wants to intervene that will be fine.

MR. R. COLLINS: (Inaudible).

MS JONES: Okay, thank you.

CHAIR: Okay, as long as we are all happy.

MS JONES: All right.

I want to start with the merging of the health boards, which was an initiative of your government. I am just wondering what the accumulated savings have been from doing that. Yes, maybe I will start there.

MR. T. OSBORNE: Okay.

First of all, I think that the boards themselves, the merging of the boards has gone extremely smoothly. I had a meeting with the four boards just last week, and I think they have expressed their satisfaction with how the process has gone.

As far as the accumulated savings, I will ask the deputy to respond to that.

MR. ABBOTT: In terms of how we structured that, we have identified, for the first year, approximately $7.5 million in administrative savings.

MS JONES: How much was that?

MR. ABBOTT: It was $7.5 million.

MS JONES: Okay.

MR. ABBOTT: We are pretty well on track on that, and basically what we are looking at here are administrative positions, management positions, executive positions, some operating savings, to avoid any impact on patient or client services, and we have identified that number. As I said, they are pretty well on track. We should achieve that full saving in this fiscal year.

MS JONES: What is the current debt of the boards now?

MR. T. OSBORNE: About $120 million, I believe.

MS JONES: Minus the sixty that you - is the sixty taken off that figure that you just announced in the Budget?

MR. T. OSBORNE: No, I think the sixty will go into operations of the four boards. They can expand on services provided as well as eliminating - or helping to eliminate, at least - the possibility of deficits.

MS JONES: So there was no money to pay down the long-term debt that they have?

MR. T. OSBORNE: No.

MS JONES: I misunderstood when you responded to my colleague then.

MR. ABBOTT: Ms Jones, if I may for a second, I said $7.5 million. It should be $7 million.

MS JONES: Seven.

Did any of the boards run a deficit this year in their boards?

MR. T. OSBORNE: I am waiting on the final numbers to come in. There was additional funding provided to the boards on two occasions. I think there was $14.7 million provided to them earlier, or I was going to say in the last fiscal year, but earlier in the last fiscal year there was $14.7 million to try and help them meet their budgets. In addition to that, we have just allocated an additional amount to the boards. I think it was $6 million?

MR. ABBOTT: Yes.

MR. T. OSBORNE: Yes, $6 million we have just given again to the boards. That should bring them at or near a balanced budget for this year. We are waiting on the final numbers to come in from them. I have not yet seen them but, if you wish, I can report back to you once I receive that.

MS JONES: Yes, I would like to know because I know they are trying to tackle the accumulated debt that they have. If they are doing that just on savings within their corporation and they are still running a deficit, I am....

MR. T. OSBORNE: They will be pretty close to balance, I think, this year, based on the additional funding provided. Again, the $60 million should bring them at or near balance, for sure, in this fiscal year.

MS JONES: The government did a review of the Labrador Health Corporation. That was before the merger with the Grenfell Corporation, but one of the things that was identified there was the excessive spending on the community health side. When I say excessive I mean in excess of what their budgeted amount was, not necessarily wasted money, so let me clarify that. I know that the demand for them was very much in the northern region of Labrador. I am wondering if government has increased their budget to reflect what that report showed and to give them additional resources that they needed there.

MR. T. OSBORNE: I can honestly say to my critic - I hope this doesn't happen in the House, but - I honestly don't know the answer so I am going to ask my deputy to answer that.

MS JONES: Okay.

You have only been there a short time. I don't expect you to know all of that.

MR. ABBOTT: I will be sure not to (inaudible)

MS JONES: I do expect John to know.

MR. ABBOTT: There are two, I guess, parts to the answer. One issue was around the need for additional social workers and community support workers, particularly in the Aboriginal communities, the Inuit communities in particular. We have, and continue to add each year, additional social workers, which we will do this year. The other component is for services, particularly for, at this point, sending children out of their communities and, in many cases, out of the Province. Unfortunately, that number continues to rise, given the social issues in the communities.

What we are doing, and one of the reasons why their budget had increased this past year, we provide additional funding, and we will for the coming year provide additional funding, to meet that need.

The simple answer combined is, yes, as the service demands increase we are funding those increases. We still have a challenge of recruitment in the coastal communities for social workers but we are working very diligently on that with the board, and part of that solution, obviously, is working with the leadership in the communities. That is improving. There are still some challenges, but we are seeing some significant improvements over the past year or two, certainly in Sheshatshiu, and we are moving towards working closer with Natuashish once things sort of settle with the leadership there.

MS JONES: I know there is a challenge with recruitment. Are all the social worker positions filled, that the government allocated for that area?

OFFICIAL: There are still a couple of vacancies. I know, because we were in Labrador just two or two-and-a-half weeks ago meeting with the senior executive there, and they are trying hard to recruit.

MS JONES: The children who are going out of the Province for care - and I know there are probably about twenty children now, aren't there, in Labrador, who are outside the Province getting care?

OFFICIAL: I am going to ask Lynn Vivian-Book. Lynn may be able to....

MS VIVIAN-BOOK: In Labrador we have a total of, out-of-Province or individual living arrangements, twenty-two Innu children and youth, and six others from Labrador are in out-of-Province placements, so it is twenty-eight.

MS JONES: It is twenty-eight.

Can you tell me what kind of care they are getting at these centres? I am familiar with a couple of them, but I have never visited them.

MS VIVIAN-BOOK: Many are out-of-Province due to solvent abuse or an FASD related condition, behavioural conditions. Some are in Alberta and some are in Ontario, primarily Ontario. The treatment facilities often are therapeutic foster placements connected to counselling and so on.

What we are looking at is trying to figure out residential options where many of these youth will be able to come back to the Province and have a similar kind of residential option here in the Province because, for many of these youth, it is not true treatment. It is long-term supports that they will require.

We are working with some of the facilities in Ontario, and working with the staff at the Labrador-Grenfell board to come up with some residential models. One of the positions that we are putting in place this year is a psychologist position to help us with coming up with some of those options that will meet the needs to be able to bring some of those youth back to the Province.

MS JONES: All of these children are under the age of eighteen, I understand, is it?

MS VIVIAN-BOOK: All in this grouping that I just mentioned are, yes.

MS JONES: I have been led to believe, and maybe I am wrong, that most of these are living in commercially operated homes.

MS VIVIAN-BOOK: Privately operated, yes.

MS JONES: Not family homes, it is a commercial business, and that there is no resident social worker, there are no resident counsellors, but rather they are set up with a neighbourhood social worker, counsellor or whatever, that is assigned to them and they deal with for the duration that they are there. I guess my question is: Why aren't we offering that service in Labrador? Why are we sending our children to Ontario and to Alberta?

MS VIVIAN-BOOK: That is the question we are trying to work through in terms of those options for Labrador.

Residential placements, we will never be able to provide placement for all options but we are hoping to be able to expand the residential options in Labrador, particularly in Happy Valley-Goose Bay, to be able to accommodate more of the needs of these children and youth.

MS JONES: I am not entirely sure that Happy Valley-Goose Bay is the right place, because most of these kids are coming from that area, from Sheshatshiu area, as I understand, but I would like to see something done in Labrador to house these children. I think that any region of Labrador would be appropriate, whether it is in the west, the South Coast, the Straits or whatever. It does not necessarily have to be next door to their community, because I understood from health care professionals that the reason they were relocating them out of the immediate area in the first place is so that they would not have that direct connection with their home community, or their family, or the people who have been abusers to them, or whatever the case may be. If you are going to look at it, I would seriously like to ask you to look at all of the regions of Labrador and not just Happy Valley-Goose Bay.

MS VIVIAN-BOOK: We would need to put in place a continuum of supports. One of the bases that has not been well developed in this Province is therapeutic foster care, which is a family home within a community, with additional wraparound services for that home. We would need a continuum, so those homes could be anywhere in the Province. That would be the first step. Then, only when that is not a suitable placement, would you move into a placement that would have more supports around it.

You are absolutely right. The continuum that we need starts in the community, in the home first, then outside of that home in a supportive environment that is therapeutic, and then into something more, where more services can be wrapped around it. That continuum does not exist right now.

MS JONES: Who makes the decision on the placement of these children? Is that done by the Labrador-Grenfell health board or is it done through your Department of Health directly?

MS VIVIAN-BOOK: It is done in collaboration with the Director of Child Youth and Family Services, because 99 per cent of these children and youth are in the care of the Regional Director, and that, as the parent of that child, makes that decision. However, if it is an out-of-province placement that is done in consultation with the Province as well.

MS JONES: How much do you pay this group home in Ontario every month to house one of those children?

MS VIVIAN-BOOK: That varies each month, it can be a year up to $250,000, in that range, depending on the child, but $10,000 to $12,000 a month is not uncommon. I can give you more exact figures, but in that range is not uncommon.

MS JONES: I have heard it has been up to $20,000 a month.

MS VIVIAN-BOOK: For some placements.

MS JONES: Yes.

MS VIVIAN-BOOK: The average would be $10,000 to $12,000.

MS JONES: Do you guys have a detailed list of the wait times for different tests that you have done in the Province, like MRIs and all the rest of it?

MR. T. OSBORNE: We did put out an update almost three months ago, I guess, which was our first report on wait times, and we are scheduled to come out with an update on that. There has been some improvement. Obviously, there is significant investment in this year's Budget to try and reduce wait times. Unfortunately, some of the investments that are being made in this year's Budget will take some time to get up and running, such as dialysis units, different breast screening or cervical cancer screening units, CT scanners, that type of thing. Some of those investments that are in this year's Budget will take some time to get up and running. You will see a bit of a lag time between now and the time they are up and running before they have a real impact on wait times, but it is an issue that we are taking very seriously.

We are at or near the national benchmarks in most areas now for wait times. There are areas that we have to, you know, put a stronger focus on, and those are some of the areas that we have put additional investment in this year's budget for.

MS JONES: Do you guys keep stats on that on a regular basis?

MR. ABBOTT: Yes, Ms Jones, we do. We are just updating that and that information will be available within the next two weeks.

MS JONES: So you do not have it available today then?

MR. ABBOTT: No. Well, it is in draft. I do not have it here, but we will be releasing it within two weeks.

MS JONES: Will that be released to the public then?

MR. ABBOTT: Yes.

MS JONES: Because I know in the Budget you guys approved some money to add some new radiation equipment or machines at the Health Sciences Centre.

MR. T. OSBORNE: Yes. There was over $3 million in this year's budget and that is to do the renovations and construction at the Health Sciences Complex. The new radiation machines are larger and more powerful than the radiation machines that are currently at the centre. In addition, it is government's intention to continue to operate the two existing machines as well, so we had to construct new space for the two additional machines. Those machines should be up and running within eighteen months, which will then give the Province four machines. With the two additional machines we will have, perhaps, the most modern radiation services in all of the country.

MS JONES: Once you order a radiation machine, how long does it take for a delivery?

MR. T. OSBORNE: The companies that provide those machines do not keep them in stock. They are a special order item, so by the time the space is constructed for those units and the units are installed and up and running we are looking at about eighteen months. Now, if we can do it sooner than that, we will. We did not budget for the two machines in this year's budget because of the fact we do not anticipate the purchase of those machines in this year's Budget. We do not anticipate those machines would be ready to be installed in this year's Budget, but certainly if it can be done sooner, that would be to everybody's benefit. There are patients now who are traveling to Ontario for treatment. If it is at all possible to do it sooner than the eighteen months, it will be done.

MS JONES: So you do not have to pay for them until they are delivered?

MR. T. OSBORNE: No.

MS JONES: I want to talk about long-term care for a minute. My colleague raised a number of issues around long-term care. We had an issue in Labrador last week as it related to Ms Saunders, Doris Saunders. She was living at the Paddon Home and was transferred here to the Hoyles-Escasoni Complex at great stress from her family and from her. I enquired about the situation and from what I understood is that often Alzheimer's patients go through different stages and she was at a stage where they felt that they did not have the proper space to be able to ensure her safety. The only option they could suggest to me is if they had more personnel they could have probably had her stay there but she would have had to be supervised on a twenty-four-hour basis. I do not know if that is something that the department has considered or if the board even approached the department on it. I know that the family has been very upset by this. Ms Saunders has been, I guess, an historian of Labrador society for a long time. She has documented most of the history that has been done there. She is very passionate about where she comes from. It was very difficult for them to have to bring their mom here.

Is it possible that there could be arrangements made in situations like that? I have no medical experience whatsoever, but as I understand it this is quite often a short-term phase that these patients will go through. It is also about being able to provide for their safety at a time like that, and the only way, they felt, was with twenty-four-hour supervised care. I do not know if the request even came to your department for it or not.

MR. T. OSBORNE: I am not aware of that request, and certainly I will ask. I want to address it to some degree, but then I will ask one of my officials to elaborate on that particular request.

It is unfortunate that patients, as is the case in Corner Brook, have to be moved away from family and other support networks within their region. Having said that, in this year's Budget we have made the announcement of a long-term care facility for Happy Valley-Goose Bay. In addition, there is a health centre in Labrador City. The health center in Labrador City will have some space available for long-term care. The primary focus, I guess, on long-term care will be at the facility that is going to be constructed in Happy Valley-Goose Bay.

Outside of your suggestion - and again I will ask one of the officials to elaborate on that - but currently I do not think the facilities or the resources are in Labrador. Once a patient goes through that phase where they are high risk, that they have high risk behaviors, the preferred choice is in an environment where the best possible care can be provided for the patient as well as the resources that are required to attend to the patient. It is a difficult decision for a health board or for the department to see a patient, such as the one you are referencing, be moved from the area in which they live. The long-term solution is there in the facilities that have been announced. Whether or not the suggestion you are making on additional staff, whether or not that would suffice as far as the requirements to meet the particular needs of the individual you are talking about, and the stage of dementia that particular individual is going through, I will ask - I am not sure - Moira or John.

MR. ABBOTT: In terms of Alzheimer's and those with early dementia, again it is the stage that a patient, or resident in this case, may be at. For those who are at a wandering or roaming stage, the physical layout is critical. Obviously Paddon Home is not designed to accommodate that type of resident. A suggestion to have additional staff, really we do not think - and I do not think the board believes - would be a solution, because the issue here is: Can the individual in his or her environment, room or section of a home wander or walk about? That is why many of these units are secured units. There are locked doors, control entry and exit, those kinds of things. We had a physical space issue. Right now the home did not have the people in place to manage it. It is not the numbers, it is just the training for the staff to manage.

We reluctantly - and I say reluctantly in the sense that we too prefer, obviously, to have the residents stay in Happy Valley-Goose Bay, but the collective view was that in this case we needed to find a more appropriate facility, and consequently come into St. John's.

MS JONES: My question is more about - I was told that with twenty-four hour supervision, that means staff that would be with her all the time, they could control the environment. That would be the only way under the present circumstances. I was also told that they did not have the financial resources to be able to provide that kind of staffing. I am wondering if a request was made to your department for any funds to be able to do that?

MR. ABBOTT: As the minister said, I do not recall getting any requests. We are very clear with the boards, that if a solution needs to be found for a particular case that the financial resources will be provided. We don't think the suggested solution would be the right one.

MS JONES: You guys had a study commissioned on long-term care and personal care for Labrador. Is that completed?

MR. ABBOTT: Yes, that was done by the board. That assessment, Moira, has it been completed?

MS HENNESSEY: We have received the final draft report from the consultants on the long-term care needs assessment in Labrador. We are expecting the final report this month.

MS JONES: Is that going to be released to the public?

MR. ABBOTT: There would be no reason why that wouldn't be.

MS JONES: How long have you guys had the report then?

MR. ABBOTT: I'm sorry?

MS JONES: How long has the report been completed? I wasn't aware that it was completed, that is why I am asking.

MR. ABBOTT: The draft we have seen probably in the past month because it helped us in coming up with some numbers for our budget for the facilities. We have asked the consultant to finalize the numbers and the report and submit it to the department and to the board. We will assess it and then it will be released.

MS JONES: We did have some discussion about adding some long-term care beds to a personal care home in Southern Labrador. I do not know where that ended up in the report or even if it did, but I did meet with the consultant a couple of times and with the CEO and some of the senior people with the Labrador-Grenfell health corporation. I am interested in knowing what the pilot project is that you are doing with personal care homes in Grand Falls. It is probably similar to what we recommended, but I wasn't aware of this pilot so I would like to know what it is about.

MR. T. OSBORNE: Actually, I am aware of the pilot project in Central. It is a pilot project and I think there are issues again with the health authorities on the classifications, whether the individual is classified as a Level II or a Level III. There are some issues that have to be ironed out there before we are able to move into this type of program on a provincial basis. I guess the pilot project will answer a number of questions for both the department and for the health care authorities regarding the classifications.

As far as the particular pilot project, the numbers involved and so on - John, are you familiar with that?

MR. ABBOTT: The challenge that both the board and the department is facing is we have a number of residents, as was mentioned earlier, who are either in their own home or medically discharged from the hospital, and the question is: Is a nursing home the only solution for these residents? Central Health, as one board, came to us and said: Look, can we explore other options and alternatives, because we think that some of these residents can be placed in the community in a personal care home? We said, yes, we agree in principle, the question is: What type of resident in terms of their care needs would be best accommodated? The personal care homes built, are they physically capable of providing the care that is needed?

What we have asked Central Health to do is work with us in terms of defining the criteria, defining the physical criteria for the buildings, work with the Fire Commissioner's Office and others, to make sure that if we can accommodate more residents who are at a higher level of care but not nursing care - it would be more attendant and personal care - that we look at expanding the use of personal care homes. Everybody is trying to work through this together, and we are hoping over the next year to be able to use a couple of personal care homes, try out the model, do an evaluation, report to the minister to say yes we can or no we can't, and then extend that to the other regions.

In terms of Mary's Harbour, we need to look, obviously, at some alternatives for the home there. Once we have the assessment done as to what is needed in terms of long-term care placements, we will look at how we can use the home more effectively, and that may be one of the solutions there.

MR. T. OSBORNE: I think it is difficult, Yvonne, to do this on a Province-wide basis until we have a better idea of exactly, first of all, I guess, how to implement the change if there is to be a change. Secondly, the issues regarding the structures, the availability of personal care homes within certain areas, how that fits into how patients are categorized, the different levels at which they are going to be categorized, and it is very difficult to do this, as I say, on a Province-wide basis until we know how it is going to work, whether or not it can work, how all of the pieces fit together.

MS JONES: The issue I have is that I think there has to be a different model for delivery of both personal care and long-term care in different regions of the Province. One of the biggest issues -

MR. T. OSBORNE: You mean different models in different regions, or different models -

MS JONES: Different models for different regions because, you know, the institutional style of care is not going to work in the smaller areas around the Province, and it is not even going to be feasible to provide that kind of service. When you can have the same staff doing the work for twenty patients as you are going to have for five, yes, it becomes an affordable issue for government, but I think there has to be a different model. In the sessions that I had with the Labrador-Grenfell corporation and the consultant, I tried to explain that but it was just like talking to the desk, because they were locked into a concept of: This is the way it is, these are the regulations, and we are not prepared to look at anything else - which was really unfortunate. So, I do not know if anything ended up in the study or if it did not, but I really do think that there is good quality care that can be provided to long-term care patients in rural areas of this Province without it having to meet all the staffing requirements that are presently there, and Mary's Harbour is the perfect example.

You have a twenty-bed personal care home that meets all the standards in terms of the building code and all the things that they need to meet for both a long-term care and a personal care home. They live next door to a clinic that is about maybe a couple of thousand feet away from them, which is staffed with three nurses and a public health nurse, visiting physicians, and a social worker. All of these people are right there, a few feet away, but they would not be able to take, under our present regulations, a long-term care resident into that home without having a full-time nurse on that floor every day, although there are three next door that are on call twenty-four hours a day if you need them.

MR. T. OSBORNE: I appreciate what you are saying. In fact, Yvonne, I agree with a lot of what you have just said. I have had some discussion with officials over the past week in regards to some of the very same issues that you have just raised. Perhaps if I could extend an invitation to you to come over, to sit down with myself and maybe some of the executive, and the same suggestions, the same issues that you have raised, that you felt were not listened to at the board level, if we can enter into some dialogue with you and get a better understanding of what your suggestions were.

I agree with a lot of what you just said, and if there is a better model - obviously you can't use a cookie-cutter approach throughout the Province because there are different regions, there are different issues.

I like what you are saying there. Let's sit down and talk about what some of your ideas are for Southern Labrador, for example. If we can bring those ideas, in addition to some of the discussions that I have had with officials, have a very close analysis of that, probably at some point I will bring the boards in and review this further.

Let me give you some assurance and some level of comfort that the suggestions that you are making, I do not disagree with all of them for sure.

MS JONES: I would be happy to do that, and I will do that. I just wanted to make the point that I think there is a more affordable way, and a way to provide the services in rural areas of our Province, and it does not compromise the quality of care that these patients are going to get.

MR. T. OSBORNE: That is my only concern. If we are going to change certain models, or if we are going to explore new ideas, first and foremost for government, first and foremost for the boards, is to ensure that the quality of care for people in the Province is not compromised. If we can do something different, if we can do something better, if we can do it in a more efficient manner as far as resources are concerned, those things should be explored provided the quality of care is not compromised.

CHAIR: At this point I am going to interject.

I believe it has gone past 10:15 a.m., and by agreement we were going to go to that time.

MS JONES: Yes. I just wanted to say I have to step out for about a half hour but I will come back because I have other questions that I didn't get to.

MR. CHAIR: Thank you, Ms Jones.

We are going to pass the baton, I believe, to Mr. Collins.

MR. R. COLLINS: Thank you, Mr. Chairman.

Good morning, Minister and officials.

Let me begin by just saying that we are very, very happy, extremely pleased, to hear the announcement of a new health care facility for Labrador West. The people in Labrador West are very excited about that. It is long overdue and we certainly look forward to having a new facility where people, when they need to be in hospital, will have more pleasant surroundings than they do now. They won't have to keep worrying about plaster falling on their beds and on their backs and stuffing windows with toilet paper and paper towels to keep the draft out. It is long overdue and the people there certainly appreciate it.

I would also like to ask the minister or John to pass on our, I guess, gratitude to the people involved with the air ambulance program and the air ambulance crews. Many times we rely heavily on the air ambulance team when we have difficult medical situations. I can tell you that they need to be commended, because they flew in at times to pick up passengers where I am glad I wasn't the patient going back out. They certainly fulfill their duties to the highest degree, and I have had nothing but positive feedback from any patient who has been transported by them. The professionalism that they display and the care that they show is certainly to a degree that they need to be singled out for commendation.

I would like to just talk about another thing for a minute. It is not really a question, it is a concern that we have. Many times people from Labrador have great expense, even with the subsidies in place, when they travel out for a treatment. I don't know if there is any answer to this, but I think it is something that should be explored. It is not uncommon for people to go see a doctor about a medical condition and are told to come back in ten days or two weeks. That causes a lot of difficulty for people. It is not like you can even get aboard your vehicle and drive for ten or twelve hours and get there. It involved a $1,000 airfare plus accommodations. Lots of times somebody has to travel with the person, and there is the time off work and everything else that is experienced. I don't know if, when a person comes out if there is more input from the local doctors as to what the problem could be or the specialist they are going to see, if there is any way of coordinating that between other doctors from here to try and minimize that as much as possible.

MR. T. OSBORNE: Randy, on that - and your point is well taken - I think one of the things we are trying in areas like Bonne Bay where it is working is the primary health care, where an individual will see the specialist whether it is a social worker or a nurse or a doctor or whatever the case may be as opposed to going and being referred somewhere else and then being referred somewhere else again. I will ask John again to elaborate on the primary health are, but that I think will alleviate some of the concerns that you are raising.

One of the other things that I think is being looked at and being explored, and that is providing some services. Whether it addresses the issues - because I know that with the geography and some of the concerns that you are raising in Labrador probably some of the areas wouldn't be affected. Some of the areas could be if there is a smaller clinic as opposed to the larger hospital. Eventually, as we get Broadband services in throughout the Province, one of the things that perhaps we can look at is providing some services where people don't have to travel the great distances at great expense, you know consultation services and so on. Then if there is a need for them to go to a larger centre, they can.

I will ask John if he can maybe elaborate on both of those things.

MR. ABBOTT: In terms of primary health care, one of the things, obviously, we are trying to do is to coordinate more services at the local level and make sure that our residents know which health care provider they should be seeing at any point in time. That is evolving throughout the Province.

I think, if I understand your main question around coordinating visits to specialists, certainly out of region, that one is tricky at best and we really haven't focused on it, it would be fair to say. What we talked about in some areas, what we refer to, is sort of patient navigators, so in fact we start coordinating services. One of the things I can undertake to do here today is talk to both the CEO in Labrador as well as the others, and talk about how we can put a process in place. In one sense it is easy enough to track referrals, and we can see how we can co-ordinate those better. We may have to put a resource in place to do that.

Mr. Collins, I will take that suggestion forward and we will get back to you to see what we could do, what the problems are, and how we can improve on that, but it is a fair enough question.

MR. R. COLLINS: Okay.

On the (inaudible) transportation, air transportation medical subsidy program, under the new changes, I am running into a lot of problems. I have had discussions with some people in the Department of Health on this already, through the former minister. It is not resolved but it is something that still needs to be resolved.

When people travel now, for the first time in the year, they get $500 deductible from their travel expenses. Mostly it involves airfare. One of the problems that we are running into is that a lot of people who are just above minimum wage levels, or single parents who are working in Labrador, do not have the means to buy the ticket. Because it is a reimbursement system, you have to pay up front and get reimbursed. A lot of people are having difficulty coming up with the money to purchase the ticket.

What I suggested - and I still, for the life of me, don't understand why it cannot be done - is, say a medical ticket from my area of Labrador to St. John's is $850, of which $500 will be reimbursed, which leaves a balance - well, more than $500. It will be $500 and half of $350, $175, so $675 of that will be reimbursed, but the $500 deductible comes right off the top. Why can't the department, in certain cases where the request is made, pay the first $500 to the airline so that the person who needs medical travel only has to come up with the $375 or the $350?

I have had meetings with the former minister and officials on that, and they are saying it can't be done because of - really, I didn't understand their reasons why. It seems to me it is just a matter of the paperwork that may be involved, but it is a big problem for a lot of people. Not everybody works with the mining companies, and not everybody has insurance plans that cover it, and a lot of people have difficulty. We are still finding now we have to go to, like, the ministerial association, to the RNC. They have a charitable golf thing every year. We have to go to the Lions Clubs, Kinsmen Clubs, all of these places, to try and come up with the money so the person can go. It is a serious problem.

MR. STRONG: I think the basic issue is one of administration. To do what you suggest would be a lot more complex.

MR. R. COLLINS: I can't hear you much.

MR. STRONG: It is the administrative complexity -

MR. R. COLLINS: Just a second now. I have to play the role of Speaker here. I can't hear him.

CHAIR: You can't hear him? Oh, I am sorry.

MR. STRONG: The issue is primarily one of how to administer, and people present themselves to the program in different circumstances. As you indicated, some people have an insurance program that only reimburses people after the insurance is considered in the calculation. People's circumstances are changed in terms of their requirements for travel. Their appointment dates may change. Their air trips may change. It is more administratively complex. We can look at it again, and I will commit to do that for you, but that is the issue basically.

MR. R. COLLINS: It is done on a case-by-case basis. I mean, there are many people who will never require that. They have the ability to either pay for it or put it on a credit card or something like that, but there are many others who do not have that ability.

MR. STRONG: Low-income individuals -

MR. R. COLLINS: It causes a big problem, even if it is set up through one of the government offices in Lab West that they would put in a request through there or whatever. I don't think that the administrative difficulty should put undue stress on people who need health care, if there is a way of getting around that.

MR. STRONG: Individuals can also apply through the Department of Human Resources and Employment. They can provide medical transportation assistance as well.

MR. R. COLLINS: If you meet the criteria.

MR. STRONG: If they meet the criteria.

MR. R. COLLINS: Which again goes to that group of people who have been referred to as the working, struggling poor who do not qualify for that but do not have the means to do the other thing either.

If they qualified through that it would not be a problem, they would go there and do that, but the people I am talking about do not qualify for either and are stuck in the middle, and still do not have the means to provide.

It is a serious problem. It is one that I run into not real, real often, but often enough to know that it is a problem. You say you will revisit -

MR. STRONG: We will revisit our policies in that area and get back to you.

MR. R. COLLINS: Okay.

The orthodontic services: we have been without orthodontic services now in Labrador West for about two years. What happens is that they used to have a visiting orthodontist come into the area on a monthly basis.

MR. T. OSBORNE: Is that because that is a fee-for-service?

MR. R. COLLINS: Yes.

MR. T. OSBORNE: Yes, okay.

MR. R. COLLINS: Now the practice is, with a lack of orthodontists, they come as far as Happy Valley-Goose Bay.

In the local media not too long ago there was a case of one parent whose son needed orthodontic treatment and, for her to go to Happy Valley-Goose Bay and have her son receive the treatment that he needs, over the course of that treatment the cost would have been in excess of $31,000.

MR. T. OSBORNE: That is a difficult one to solve, I think, because it is fee-for-service.

MR. R. COLLINS: Well, I have an answer for it. I can solve it for you.

MR. T. OSBORNE: Okay.

MR. R. COLLINS: Since the service cannot be available, allow the people who require that service to travel where the orthodontist is, in Happy Valley-Goose Bay, under the medical subsidy program there.

MR. T. OSBORNE: What I will do on that, Randy, because that is -

MR. R. COLLINS: I know that the health board has been trying very hard to attract an orthodontist to the area. I know they have been working hard at that, and there are also orthodontists who come into Quebec, into Fermont. There are two who come in on a regular basis, but they won't accept any patients from Labrador West.

MR. T. OSBORNE: I will have a look at that. I am not aware of all of the complexities of doing something like that, and what that would mean on a Province-wide basis, if there are special circumstances in Labrador City that may give us some leverage in looking at something like that for that particular area, but we will have a look at that for you.

MR. R. COLLINS: Okay.

Another area that I would like to -

MR. T. OSBORNE: If you could give us a just couple of minutes, I need to speak to John for a second.

MR. R. COLLINS: Okay.

MR. T. OSBORNE: Sorry about that. Go ahead.

MR. R. COLLINS: Another area that I would like to talk to you about is the med school. I know the Department of Education plays a role there, too, but it appears to me that we have a shortage of doctors in this Province while at the same time we have a number of very bright young people who have difficultly getting into med school even though they are straight A students with great resumes in terms of volunteer services, athletic abilities, and all of these things. There are a number of people who have difficulty getting into med school even though they would agree and sign anything that was put in front of them to serve in the Province upon graduation, because they do not want to leave here and they are willing to go to any part of the Province that the health boards may want them to serve in.

I am just wondering why more things like that are not done. I know we have a number of foreign students in our med program, and I understand there is quite a bit of money being taken in from that, but I think we are doing ourselves an injustice by not allowing more of our young people into med school, who meet the qualifications, and who in turn are committed to staying in the Province and providing the service that we are desperately lacking at the present time. I am just wondering what your thoughts are on that.

MR. T. OSBORNE: I received, I guess, an inquiry. I think the person who had written had copied the Premier, the Member for St. John's North, as well as yourself, that particular individual, but it does speak to more than that one particular individual.

MR. R. COLLINS: Yes.

MR. T. OSBORNE: Obviously, there are others who are asking the same question.

It is difficult for the minister to interfere in the selection process at the Faculty of Medicine. I have asked John Abbott, the deputy - I have given him that particular inquiry and asked him to contact the Faculty of Medicine just to make sure that, for some reason, that individual was not being overlooked unfairly.

You do raise an issue around recruitment and retention. I am not sure if it warrants further investigation, but it is something that we can look at; because, you are right, if there are more students who apply and get into the Faculty from this Province, they are probably more likely to stay than an international student. I think that is the overlying premise of the question or the issue that you have raised.

MR. R. COLLINS: It is.

MR. T. OSBORNE: It is something that myself and the Minister of Education - my officials and her officials can probably sit down and look at the number of seats available within the Faculty of Medicine, the number of students they bring in locally versus the number internationally, and what those reasons are, whether or not there is any ability to move the ratios, whether they are justified in doing what they are doing or whether it is time to revisit the policies that they have laid out. That is a discussion that I can have with the Minister of Education, and maybe with Axel Meisen as well at the university.

At this particular point, I honestly cannot say if their policies are just or not. Obviously, we trust that they are. Unfortunately, there are individuals who fall through the cracks, and those individuals obviously feel that, unfairly, they have been overlooked. Whether that is the case or not, and it may very well not, it does warrant having a discussion for sure.

MR. R. COLLINS: In the Budget, you have announced thirty-nine new public health nurses. Where will they be assigned and when will that take place?

MR. T. OSBORNE: Well, it is the first year of a three-year plan to put those thirty-nine nurses in place. Over the next three years we will have the thirty-nine nurses. They will be throughout the Province. I guess, what will happen is we will probably look at the needs basis throughout the Province. I wouldn't be able to tell you today if there is one going in Labrador West and one going in Happy Valley-Goose Bay, for example, but they will be placed where they are most needed.

MR. R. COLLINS: That will be thirteen a year over the next three years?

MR. T. OSBORNE: I don't have the breakdown as to what is going in this year. There is $1.5 million, I believe, allocated to the hiring of the nurses this year. I will ask now one of the officials the numbers that specifically breaks down to. In Eastern Health there are nineteen, in Central there are ten, Western, five, Labrador-Grenfell, five, and that adds up to the thirty-nine. Now, where they will be placed in Eastern or in Central, for example, I don't know, but those are the numbers allocated and they will look at where they are most needed, I guess, within those regions.

This year, John, the numbers for this year?

MR. ABBOTT: We will start recruitment right away. We will authorize authorities to proceed to recruit as many as they can. Roughly, we are planning that they will have a little over half of those in place this year and the rest will be recruited near the end of the year or the beginning of next year. By this time next year, we hope to have them pretty well all recruited.

MR. R. COLLINS: There are also nine new addictions counselors. When will they be hired and where would they be placed?

MR. T. OSBORNE: Again, those addictions counselors will be across the Province. There were five addictions counselors last year. We saw the need for nine additional addictions counselors. They will be hired this year, and they will be within the four regional health authorities.

MR. R. COLLINS: Do you have any information on the wait times now for addictions counseling, particularly as it related to the gambling addictions?

MR. T. OSBORNE: I don't on gambling. John may be able to elaborate on that. I know that, for example, in St. John's we did have the addictions clinic open last year. I guess the number of people utilizing that clinic were probably beyond what was anticipated. The nine new addictions counselors, some of the focus we are placing on that will help alleviate some of the pressures that are there. Unfortunately we are beyond what we had anticipated. I feel that we will meet the challenges that are there by putting the additional resources for addictions throughout the Province for consultation with the patients as well as followup after treatment and so on.

As far as gambling itself, we do not have any specific information on whether or not there are wait times on that.

MR. R. COLLINS: Do you have any information on persons with addictions in the Province, where the rapid growth has been?

MR. T. OSBORNE: Sorry? Where the growth has been?

MR. R. COLLINS: Yes, for people with addictions, the number of people with addictions. Have addictions with alcohol, for example, increased dramatically or have persons with addictions from gambling increased dramatically over the past number of years, versus drug addictions or things of that nature?

MR. T. OSBORNE: I do not know. I will ask one of the officials to respond in greater detail. Obviously new substances are introduced to the market and the availability of some of the substances, outside of alcohol - for example OxyContin which spiked about a year or a year-and-one-half ago, the Province has worked to get that under control. We are out ahead of the crystal meth issue. Crystal meth has not become a real problem in this Province yet. Obviously there are people using it, but in Western Provinces and in Ontario addictions to crystal meth have already spiked. We are not taking measures and we are trying to get out ahead of that so that we are not faced with the same challenges we did with OxyContin. The unfortunate thing is there are new substances being introduced and I guess the substance of choice for people is somewhat expanded as new substances are introduced and people experiment and so on. We are aware of that and we are trying to stay ahead of new substances such as the crystal meth issue. As far as increases or decreases in particular substances such as alcohol, I am not aware of that at this point.

MR. ABBOTT: Mr. Collins, we do not have any statistical data on that. What we are finding, obviously, is that addictions, in terms of numbers, are, shall we say, consistent in proportion to the population by region, and the different areas are sort of spiking on different things. Certainly in St. John's we were seeing, obviously, that OxyContin was a major factor. What we expect to see happen now, as we have added more counselors, is that we will be able to, one, promote - and that is one of the things we want to do, promote our services so that, in fact, we draw more people out of their homes and what have you to seek services and seek treatment. We expect, actually, the numbers will probably start to increase based on, shall we say, self-reporting, people coming in for service. That is the intent here, to collect more data to support, if need be, more services and more staff throughout the Province. For us, we are still in the early stages of trying to deal with this.

MR. R. COLLINS: Gambling addictions have certainly increased in the last few years.

MR. ABBOTT: Yes.

MR. R. COLLINS: The difference, I guess, between persons with gambling addictions and persons with addictions to what you mentioned, OxyContin, is that one is supplied by criminals and the other is supplied by government. Don't you find that ironic from a Department of Health perspective?

MR. T. OSBORNE: Yes. Well, I know the gambling issue is an issue that the department is taking very seriously and it is an issue that government is taking very seriously. You have taken a very strong interest in this and you have been very outspoken and have been a very public advocate to a reduction in addictions to gambling, and I commend you for that, actually.

As far as gambling addictions, I know that we removed, I think it was, nineteen machines last week or early this week from service in the Province. The stop buttons are going to be removed from the VLT machines. We are putting in place a very focused awareness campaign this year from my department around addictions, and we will be making further announcements on that within the next number of weeks for certain. You know, some of the addictions counselors and the addictions training - obviously, there will be a need for ongoing training as we see a spike or a rise in particular addictions, whether they are gambling addictions or substance addictions. I think there is a focus within the department, not only on issues such as crystal meth, but there is a focus on gambling, a very strong focus on gambling, within the department.

Myself and Minister Sullivan and officials from both departments are going to sit down. I think up to this point the Department of Finance were doing what they had to do regarding gambling and the Department of Health were doing what we had to do regarding gambling, but we are going to get together and put together a joint committee of both departments so that we are working together and bringing, I guess, a more fluid approach to gambling itself.

We have reduced the number by ninety this year, and over the next four years the total reduction in the number of VLT machines will be ninety. I think that combined with the awareness program, combined with the training - I know there is a 1-800 number that is posted on the machines. I think we are looking at a more localized addictions number for the VLTs. What progress we make on that, I cannot report on the progress on that particular number at this point because that is very preliminary at this stage, but we are looking at a more localized 1-800 number. I think as well, with the removal of the stop buttons and so on - it is probably not as far as you would like to see it go, because I know that you would like to see the machines unplugged today and removed today. I think we are headed in that direction. Obviously, some of the establishments that have these machines - the reason the reduction in the number of machines from last year to this year did not happen immediately is we had to allow some of the establishments with the machines time to adjust to the new numbers, and that is the reason it is phased in over five years to a certain degree.

Having said that, it is not so much about revenues to government. Obviously that is a focus as well. Government would have to adjust to revenues, but that is not the focus. It is a focus on how this has affected different establishments as well and allowing them some time to adjust to the reduction of 15 per cent in the number of machines. Some of these establishments have fifteen machines, and at the end of the five years they are going to be reduced to five. You just cannot go in and unplug five machines and say sink or swim type of thing.

I can give you the assurance that the Department of Health and Community Services is dedicated, we are committed, to addressing the issue of gambling addictions.

MR. R. COLLINS: Just a suggestion that I have made before, and it is something for you to bring up, I guess, in Cabinet: that the representatives on the Atlantic Lotto Corporation currently are from, I think, the Department of Finance and the Department of Tourism. I would appreciate it if you would have a discussion about that in Cabinet and replace one of them and put in an official from the Department of Health, so that with new initiatives by the Atlantic Lotto Corporation, when it comes to gambling, at least there is someone with a health background who can at least have some input into the discussions that take place before implementation of new products, and can report back.

MR. T. OSBORNE: You are absolutely correct, and that is a discussion that I have already had with Minister Sullivan. I think measures are being taken to address that issue, because that is a gap. Now that you have reminded me, I will ask my deputy to follow through on that and ensure that we do get a seat on that committee, because I think it is needed.

MR. R. COLLINS: The subsidies for seniors' homes in the Province, you announced new money to increase the subsidy amounts.

MR. T. OSBORNE: Personal care homes?

MR. R. COLLINS: Yes.

The money that was announced, will that take care of the backlog or will it also provide for new initiatives?

MR. T. OSBORNE: It will look after the backlog. We are increasing the subsidy from $1,138 to $1,500. I think in addition to that there is a focus on the old age security and the guaranteed income supplement, on top of that $1,500 increase.

There are 150 people, I think, wait listed right now for personal care homes. There is additional funding to allow subsidies for those individuals as well. That will look after a great deal of the backlog.

MR. R. COLLINS: But it won't cover monies for new people?

MR. T. OSBORNE: There are 150 people, I think - I believe that is the number, John?

MR. ABBOTT: Yes.

MR. T. OSBORNE: There are 150 people right now who are on the wait list who aren't in the personal care homes who are waiting to get in. In addition to there, there are a number of people who are in the personal care homes who are currently not subsidized because of the $1,138 rate. It puts them under the bar of being subsidized. There are several hundred people who are currently within the system who are currently at personal care homes as well who will now qualify for subsidies because they are now over the bar as opposed to being under the bar, and they will be subsidized as well. There are several hundred new people who will be subsidized as a result of the increase in the fee.

MR. R. COLLINS: That is it for me, Mr. Chairman.

Thank you very much.

CHAIR: Thank you, Mr. Collins.

We will pass the questioning to Mr. Butler.

MR. BUTLER: Thank you very much, Mr. Chair.

I would like to welcome the minister and his staff.

I guess when you listen to someone else, other questions come in your mind. Just to elaborate a little on the one with regard to the increase from 1,138 to the 1,500, the 150 people who you said are on a wait list or existing there, does that mean that this will be able to get them into the homes that much faster? I know it increases and brings the other people who are in there now below the level that you mentioned up to a standard where they would be subsidized, but you are saying 150 people would be able to move into -

MR. T. OSBORNE: There are 150 brand new subsidies, yes.

MR. BUTLER: Okay.

The other one with the VLTs, I guess you have to be very careful how you say things when it comes to VLTs. I guess I have my own personal opinions on them, and that is not necessarily always the right way to be. I have my personal opinions on smoking and alcohol and the full bit. I understand and I appreciate where Randy comes from all the time, saying they should be totally eliminated, and then I can look at your side of it because there are businesses out there, if they were taken away totally from them, they would have to adjust over a period of time.

I happened to be talking to a couple of individuals and I thought they came up with some good ideas, and it is not what Randy is looking for, but I know you said about the stop buttons. One of the things they were saying to me was that maybe they should be closed totally on Sundays. They have heard people who have come into their establishments say: I would be in church today, only I had to come here. Then, the other thing they said, like on weekends - and I can be corrected.

MR. R. COLLINS: The hours of operation.

MR. BUTLER: Yes, the hours of operation.

I was told - and I don't know if this is accurate or not - that this is all controlled through Moncton, that they are all automatically switched on at 9:00 or 9:30 in the morning and they are turned off at 2:30 in the morning.

Like you said, it is a very easy thing that you could control a bit better probably during the weekdays. Sundays they would be closed, and during the weekdays from 9:00 to 12:00. If anyone has to stay in the building from 12:00 to 2:30 to play those machines, no doubt they are addicted to it for sure. You would think you would be home with your family. Maybe on a Friday night, the suggestion was, well, it's a long weekend, maybe they could be open until 2:30.

I was just wondering if any of those ideas in the interim would help to cut back. The way I look at the VLTs is, if I can afford to go in there and my enjoyment is to go in and I can afford to play the machines, that is fine, and I can see through that, but there are many people who go there from 12:00 to 2:30 who cannot afford to be there.

I know where you are coming from, and I know where Randy is coming from. I am just wondering if some of those ideas - they are not mine, they were passed along to me - could be implemented to help the cause as we go along the way. I am just wondering if any of those came up in any discussions.

MR. T. OSBORNE: Obviously my focus, in particular as Minister of Health and Community Services, is to find ways of reducing addictions, find ways of reducing a reliance. There are people who are lined up waiting to utilize these machines as soon as they come on. These machines suck the life out of some people. They literally destroy homes, families.

I share in the concerns that Randy has, obviously, in finding solutions here. That is an excellent suggestion. I know that has been talked about when we have talked about other ways and means in dealing with the issue. That is something that I will commit to you, that we will look further at that particular suggestion, especially when we get the two departments together to talk about other measures that can be taken and other ways in which we can reduce some people's reliance.

The thing is here, not everybody controls the game, not everybody plays the game for enjoyment. There are people who are seriously addicted, where the machines are controlling their lives. It is taking food off the table for their children and, in some cases, it is taking a home away from families. I can say that I am personally committed to reducing the reliance on these machines.

MR. BUTLER: No doubt, there are homes that are destroyed and that is why I mentioned liquor previously. The same thing with me, I know many families whose lives have been destroyed through alcohol. I know cases, I won't say in what area of the Province, but one particular case with those machines, where a gentleman passed away and his daughter kept his Old Age Pension cheque coming, didn't cut it off, because she was addicted to those machines.

It can go pretty deep. I can understand where Randy is coming from, but then I look at the clubs and the establishments that are in my area and many of them are dependent very heavily on some of the revenue they get from them. I can understand where the balance has to come in.

MR. T. OSBORNE: I think that is the balance, because obviously within the ranks of opposition there are varying opinions on this, and likewise within government. Government recognizes the problem that is out there, but there has to be a balance where you try to reduce the reliance, you try to deal with the addiction, while at the same time not going into communities and completely shutting down a business within the community.

There is a balance, and that is why government are moving forward here carefully and strategically. Is it fast enough? Well, that is something that maybe we should review. Is there more that can be done? That is something that we are looking at, but you have to weigh both sides of the issue here.

I know one of the things that Minister Sullivan said in the House, I think last week or a couple of weeks ago, in response to this, is that there is on-line gambling as well that people engage in at home. How do you approach that? How do you attack that? If you remove one form of the addiction, do you lose control by people simply going on-line and using their credit cards or whatever the case may be?

It is a complex issue. It is more than just the easy solution of simply unplugging all of the VLTs. It is a complex issue and it is an issue that I think government in general, and in particular myself, are striving to find the answers to.

MR. BUTLER: The other question I want to ask, and maybe it is only when I visit the hospital that I notice this, because my wife has to go periodically either for a CAT scan or an MRI or some other testing. We always hear talk about the long lineups, and you have to wait six to eight months to get to one of those pieces of equipment; however, I have been there several times at the Health Sciences - and I am not saying this as anything against any staff member or anything else at the Health Sciences - but if we go there and if we have an appointment for, say, 9:00 a.m., and you get there by 8:30 a.m., there is nobody in there using the machine. There is nobody in the waiting area to go in there. My wife goes in there, and whether she is in there for twenty, thirty, forty or forty-five minutes, when she comes out I am sitting in the wait room and nobody else shows up - and I can vouch for this - and an hour-and-a-half, two hours, two-and-a-half hours go by. I am just wondering, are they utilized to their fullest extend?

If you have to wait seven months to get there, and it is in use for forty or forty-five minutes, and an hour-and-a-half has gone by before you go in there, or after you come out, and people are out there crying to get into those, and I know doctors are trying to get them in, I am just wondering, has that ever been looked at? Again, are they only used from 9:00 a.m. to 5:00 p.m.? I know doctors are on later than that, and nurses are on later than that, and if we have a big backlog like that can the hours be extended for some technician to -

MR. T. OSBORNE: I think they are, Roland. Now, I don't want to say that as simply a blanket statement because there may be some instances where some machines are not used to their full capacity, but I know that there are machines in the Province - for example, the radiation machines at the Health Sciences Complex - where they have been overtaxed. They have been used so many hours a day that they have had downtime because the machines needed repairs. So, there is a point that you can use the machines and there is a point that you can overtax the machines. You have to be careful of that as well, because if one of the machines goes down and requires repairs, then that can really put a spin into the whole system and create further wait times and so on.

I want to be cautious by saying I don't think it is an issue because there may be machines that are not utilized to capacity, or are not utilized enough, but I think in general and overall the machines are used.

MR. BUTLER: The only reason I brought that up was because it is not a story that I was told - I witnessed it first-hand - but if you go to Carbonear or come to St. John's for a chest X-ray or any other kind of X-ray, once you are in there, while you are putting your shirt back on, someone else is going back in there. I thought that maybe this equipment could operate - and maybe you are right; maybe it can't operate the same way and there has to be a long period of time in between for whatever reason, I don't know, but it seems like where people have to wait six to eight months to get there and, when they get there, there is no one else, but I understand where you are coming from.

The other one, Minister, like staffing levels, I will just give you an example - and this was passed along to me by staff at the Carbonear Hospital - on a floor with thirty-one patients, there are three nurses and one nursing assistant. I understand, I have seen it from visiting constituents in both hospitals in here, how busy the nurses are. They are running around, they are run ragged. For there to be only four people on that floor with thirty-one patients - and they are not people just sitting up in bed waiting for someone to bring them a lunch; they are sick individuals. There are buzzers going, and so on. Then, I have also been told that if an emergency comes in - this is at the Carbonear Hospital - the most senior nurse on that floor has to leave then and go down to emergency. This leaves two people up there now with them.

I was just wondering, has this issue ever been brought forward? Maybe it is appropriate. Maybe that is the ratio. We always talk about ratios with teachers and students, but for thirty-one people who are sick and in hospital, it seems to me - and, like this lady told me, somewhere through the night you have to have your little break, or your lunch or whatever, and possibly there are times it is only one on one. Maybe they are all asleep by this time, I don't know.

The other thing I was told - and I can understand why, because they are run ragged, and due to injuries and everything else - is that the average age of a nurse today in the hospitals, a senior nurse, is somewhere in the vicinity of age thirty-five. That, to me, was frightening, to know that, whether we are losing them outside the Province or whether there are injuries or whatever. I was just wondering if you could make a comment on that, Minister.

MR. T. OSBORNE: I can. I had a meeting, actually, just yesterday with Debbie Forward, the head of the Nurses' Union. Overall and in general I think this Province is doing very well with nurse retention. In fact, during the meeting yesterday it was discussed how lucky we are that we are one of the areas of Canada that is in really good shape nurse wise. The nurse population, you are right, is much younger here than it is in a lot of other jurisdictions. Unfortunately, a lot of the other jurisdictions, when they are looking to recruit nurses, not only in Canada but in the United States, come to this Province to recruit nurses. That does create some challenges but, having said that, I think it is recognized by government and by the Nurses' Union, as was evident by the discussions yesterday, that this Province is in very good shape as far as the number of nurses.

There are some challenges in some geographic locations, obviously, and government and the Nurses' Union and the regional health authorities strive to reach and meet those challenges. Overall, I think both the Province and the Nurses' Union are quite pleased with the level of nurses in the Province. The average age of the nurse population, I think, is very positive for the Province. Again, there are some geographic locations where we would like to see a stronger focus. There are, as well, maybe some specialized nursing areas that need some attention, but overall we are in very good shape in this Province.

MR. BUTLER: Where I mentioned the thirty-one patients and the number of nurses, maybe that is the standard, I don't know. I am just asking.

MR. T. OSBORNE: That particular situation has not been brought to my attention. The regional health authorities, in consultation with the hospitals, would make the decision on the appropriate number of nursing units per floor and per hospital per shift. It has not been brought to my attention that there is a concern out there. John, are you - I am not aware of a concern.

MR. BUTLER: My next question - I had another one over here but the two of them tie in together. The emergency unit at Carbonear hospital - I am just speaking to that hospital because it is in my own area - has tremendous lineups, and I can understand that; people go there. Over Christmas it was just blocked and so on. I think where the problem is coming from is from our general practitioners. Just take in my district alone, we have a clinic in Spaniards Bay, we have two in Bay Roberts and there is another one up in Minister Hedderson's area, in Clarke's Beach, plus the Carbonear area. I guess my first question is: Those general practitioners, are they monitored by anybody, the schedules they work or the amount of time they spend in their clinics? Because you can call, in my area, on a given weekend and you will get three message managers: Sorry we are closed, call this number. You call that clinic that is closed. You call the third one, the last one, and the message is: Go to emergency at Carbonear. This is why there are so many people there. I am just wondering: How are those clinics monitored? Maybe it is right what they are doing, but if it is it is causing a major problem for the people down in emergency at the Carbonear hospital. I am just wondering: The general practitioners, their clinic hours, do they have set standards or anything when they should be open and so on?

MR. T. OSBORNE: Do you know something, I cannot answer that.

MR. BUTLER: You only have one more strike.

MR. ABBOTT: Obviously, I failed in my briefing with the minister for that question.

MR. T. OSBORNE: I wouldn't say that. I have to commend the staff because, as I said when I started this morning, this is officially my third week here today. I am officially on the job within the department three weeks, and there are a heck of a whole lot of briefings, there is a heck of a whole lot of reading and there are a heck of a whole lot of issues.

MR. BUTLER: I would think so.

MR. T. OSBORNE: I am not going to give anybody the illusion that I know all of the answers, at least not yet, you know.

MR. BUTLER: That's right.

MR. T. OSBORNE: Come and see me at a later date.

MR. BUTLER: Another two or three week.

MR. T. OSBORNE: They have been working overtime to ensure that I am briefed and up to date on the issues. I am not going to set out to blame you yet, John.

MR. ABBOTT: Thank you.

Mr. Butler, in terms of the fee-for-service private clinics, there are no, shall we say, controls or management systems in place that will say that they have to be open at any particular hours. They are left to do that on their own. That then causes some of the problems and some of the issues that you have identified. What we have tried to do, in working with the Medical Association is to, obviously, one, encourage them to stay open. In the recent agreements, both the last agreement with the Medical Association and the current agreement, we have put in some incentives for the physicians to stay in their offices longer, have on-call, those kinds of things.

One of the solutions we see for some of those issues is, again, around primary health care, in that we have more teams in place, doctors, nurses, psychologists and social workers working together to cover off many of the issues when people come to the emergency room. What we find, on average, with people who go to the emergency rooms, is there would be roughly 30 per cent who do not need to go to an emergency room, and that would be because they cannot see their doctors.

We are working with the Medical Association and the doctors to minimize that. We will be looking at call centres and those kinds of things, again to minimize people having to go to their doctor's offices, and in this case the emergency. What we have also found is the more services you put in the emergency room, the more people will come. Those problems do not go away, so it is trying to find the right balance here.

MR. BUTLER: Like I said, a lot of the people go there because the message manager said, if you think it is an emergency, then if something happens and they think it is an emergency they are gone like a shot to Carbonear hospital.

The other thing that comes from that, and I have seen this -

MR. T. OSBORNE: Roland, I have to give you a warning though. I mean Bob was telling me you guys were talking about Bianca's. We are almost down to A & W.

MR. BUTLER: What is it, suppertime? Is it time for supper?

MR. T. OSBORNE: Lots of time.

MR. BUTLER: I have to go back to the district, so that is why I am ignoring it, but I did not know it was Bianca's.

What I see coming from that - and like I said it leads from the clinics to the emergency. I have seen cases - thank God nobody has died through it - where they are so busy in emergency they will just check them out and say, well you can go back home, and they are only landed home when they have to head back. They are emergency cases. I mean, I can understand that. That is not blaming a doctor or a nurse for anything. If you have fifty or sixty people out in the lobby waiting to get in and you are going through them, maybe you do not detect something. I am fearful that one of those days someone will say, boy, you can go back home, you are okay, and they are not going to get back to the hospital. It is from people going in there who really shouldn't be going there, but they are being advised to go there. Anyway, I appreciate that is been looked into.

I touched on this earlier. With regard to the clinics, I will give you an example. There is a clinic in Spaniards Bay, usually there are two doctors there and there is where I go. There is one lady doctor there now. She is the only one. In the past three years, I have had five different general practitioners. I will tell you what it is like, Minister, and I do not mean to be funny about this. It is almost like the people who are coming there are coming to serve an apprenticeship. When they are finished, they are gone out of our Province and probably out of our country. I feel strongly about that.

I will give you a prime example. Many people have to wait six to eight weeks to get in to see their general practitioner even to get their medication prescribed again. If you are on regular medication, it is still six to eight weeks to get in to see someone so you can continue on with your medication. I had an instance myself where I called the clinic two weeks in advance - and I can understand where they are coming from. There is one lady down there by herself and you call up and they say: No, your doctor has left again. The next time you go down - I had a doctor who was in emergency here at the Health Sciences who just came out, out of courtesy, to give them a couple of days to try to get the backlog cleared up. You have to go to your pharmacist and say: Can you give me enough medication to put me over the weekend? Really they cannot do it. They know you are on this medication for the last five or six years and they cannot fill you prescription because you have to get in to see your doctor. It is becoming a major problem in that area.

I am just wondering if there are any plans, or maybe you have not heard of it before, anyone saying we have a problem out here. I am getting calls more often now and we are soon going to heard it more in the media. A lady called me the other night and said she has to wait eight weeks to get in and see her practitioner. I know there are problems and people are going, probably, for minor things, but when it gets to that stage, I am just wondering, are there any plans in place for more medical people, and if there are, if new doctors are coming in, in some way could they be tied to the Province for awhile rather than serving this short period of time. As I said, that is what it seems like to me, they are serving an apprenticeship and then they are gone.

MR. T. OSBORNE: Recruitment and retention has been a problem in the Province for decades really. I hear what you are saying and it is a valid point. Government has tried a number of initiatives. All of the health authorities are dealing with recruitment and retention issues. For the most part, when a regional authority goes looking they are successful in recruiting specialists or recruiting doctors. In your area I think that is a fee-for-service. We do have bursaries that government pays to the students at the Faculty of Medicine. In return for the bursaries they are required to stay in the Province and provide a service back to the Province for a certain period of time. Obviously, that has helped with some of the recruitment issues. Sometimes they stay. They develop roots or they develop an attachment and some of those doctors stay. Sometimes we have success with the retention of those doctors because they have served here as opposed to finishing the degree and moving on. Some of them stay and some of the doctors move on. Once they serve the required time here they move on and go elsewhere.

At current, I think we are over 950 physicians within the Province. That is not bad. Obviously, there are some areas, based on geography and so on, where we need to get that number up. There is a turnover in some areas as you have indicated. Those challenges are there and they may always be there. It is not only this Province, there are a number of provinces that deal with issues of recruitment and retention really.

John, is there anything that you can add to that?

MR. ABBOTT: Mr. Butler, just in terms of the last part of your question: We just signed an agreement with the federal government to help us maintain many of the international medical graduate doctors who come to the Province to stay here. What we find is there are a whole series of issues. One is cultural issues. People come, and it is just that they want a way to get into Canada and then they can go to Quebec or Ontario. Interesting enough, 40 per cent of the doctors in the Province are from other countries usually. That is 20 per cent throughout the rest of Canada. In that sense we attract more and we rely on them more, because a lot of our graduates go elsewhere. We are trying to keep them as well. We are trying to pull all of that together.

What we see happening is it is going to be more competitive, because Ontario just changed their rules for international medical graduates to make it easier for them to practice in Ontario, based on some of the things we have done here in Newfoundland and elsewhere. The problem may get worse before it gets better, but we have money this year in the Budget to try to work harder to keep them in place.

MR. BUTLER: Back to, not to the same question I suppose but in relation to that: This same clinic, the one that I go to in Spaniard's Bay - and I do not mean to be picking on that clinic. By the way, the doctors that come there for their apprenticeship, as I call it, they are all fine and wonderful doctors. I am not complaining about it in that way, it is just that we cannot hang on to them. In that particular clinic alone, what people are being told now is that: Look, I am sorry, we cannot take you here. There are files there now for two doctors on a full daily basis in that clinic, and they are being told now: The only thing I can suggest to you is take your file and go somewhere else, and there is nowhere else to go in our area.

When one of our doctors left he moved to Mount Pearl and his patients have to come in here if they want to see him. He moved to town for whatever reasons, and they are traveling back and forth to Mount Pearl to see a general practitioner. God love him, he has relatives out there and when he comes out he will do home visits sometimes because some of the people he knows do not have the transportation to get in. It is becoming a major problem, let me assure you, when you go into a clinic and there are maybe 1,000 or 1,500 or 2,000 files there and someone is telling you, you have to take your file and go elsewhere, and there is nowhere else to go. I know it is a serious problem, but like you said hopefully something can be done about it.

The same thing with regard to the Carbonear hospital. I brought it up, I think it was last year or a year and a half ago, that there were two or three doctors going to leave Carbonear hospital, and I was accused of fearmongering and spreading rumors. Those three doctors are gone. Today, I have been told, at the Carbonear hospital there are two more specialists down there who have their papers in to move on this year. I mean, you take five doctors gone out of the Carbonear hospital; that is concerning to me. I know where you are coming from and I appreciate that you are working with the federal government trying to do things about it, but it is becoming a major problem.

I just have two or three more and then I will turn it back to the critic. I know, Minister, you were asked this question in the House last week with regards to the Alzheimer's unit at the Harbour Lodge, and I just want to say to you, that I think there are three or four constituents of mine who have residents there or family members there. One of them is a gentleman who is, I think, seventy or seventy-one years old. He was asking me where they were going to be moved, whether it was Placentia or St. John's. I think your response last week was that it would be to St. John's. I am just wondering: Can that be revisited? Do they really have to be totally moved out of it or can some set-up be there for some of the residents? I can understand if some of the residents get to a certain level and maybe the service cannot be offered there. I know some of them have spread them out to other floors at the Harbour Lodge and they are staying in the area, but a lot of those older people.... He is really concerned. His wife recognizes him, but probably not other members of the family, and now she is going to be moved into St. John's. I know Mr. Joyce brought up similar situations earlier. I am just wondering if it can be revisited with regard to the Harbour Lodge. The facility is there, and just to close it down cold turkey, I am just wondering if something can be looked at in the future.

MR. T. OSBORNE: The facility itself is not going to close.

MR. BUTLER: No, no, it is that full floor.

MR. T. OSBORNE: Yes, that wing is.

There were five families affected by the decision, and I think the decision was made primarily based on the fact that there were a limited number of patients utilizing that floor. There will still be services for dementia patients at Harbour Lodge, but the patients who have behavioural risk issues - they are at that stage of dementia where they are at risk to themselves and others - obviously they cannot be housed in the same units as the other dementia patients. You need specialized services and a specialized environment for those particular patients.

Because of the low number, the low utilization out there, it just was not a good decision to have the resources, both the infrastructure resources as well as the human resources, there for such a low utilization. They can be cared for much better in a preferred site where the environment and the resources are there to look after them.

Those same patients, it does not mean that they cannot go back to Harbour Lodge when they enter into a different stage of dementia, because there will be services at Harbour Lodge. The situation is, though, for those who have high-risk behaviour, they are better served in a preferred site.

MR. BUTLER: The other one, and I am wondering if you are aware of this or could make a comment on it - I don't know how widespread it is - I have had two calls with regard to people who have applied for positions at the management level and, after they accepted the position, within a matter of two or three weeks they received a letter - and my understanding is that it was from the department, the board or whatever - saying that, beginning in 2007, your salary is going to be reduced. One of them told me her letter was for $7,000, there was going to be a reduction, and another told me $10,000. I am just wondering what is causing this. Is it only at the Carbonear Hospital? Is it widespread at all management positions throughout the Province? I am wondering why that is happening.

MR. ABBOTT: Mr. Butler, not knowing the specifics, but, as part of this bringing the boards together, there has been a reduction, both a change in duties and a reduction in management positions. If a person applied and was not successful on - for instance, if there were three program managers applying for one new position, the other two would then apply for other jobs and would probably be at a lower classification and consequently would have a lower salary. The policy has been that, if they accept the job, they have to accept the lower salary as well.

MR. BUTLER: Would the lower salary have been noted to them before they applied for this position?

MR. ABBOTT: Yes.

MR. BUTLER: It would have?

MR. ABBOTT: Yes.

MR. BUTLER: That is the thing I have to go back and check, because I wasn't told that way.

The second-last question: With regard to ambulance operators, what is the status? Because I am hearing rumblings that there may be some discontent coming down the road very shortly - or is everything fine with regard to the department and ambulance operators?

MR. T. OSBORNE: I have heard, in particular last week or the week before last, I think there were a number of calls to Open Line and Night Line where some of these issues were addressed or raised.

I will ask John if he call elaborate on where we are with the ambulance operators as well.

MR. ABBOTT: We have signed agreements pretty well with all the operators for the last fiscal year in terms of providing additional funding up to $1 million in total to address cost increases that they are facing, particularly with fuel.

We have money allocated in the budget this year to address some of their other ongoing issues. We will be commencing negotiations. We have sort of started that in a preliminary way, but we will be doing that now, soon, to reach an agreement to deal with some of their outstanding issues.

One of the complaints we hear, obviously, is that, for many operators to meet the program standards, it imposes an additional cost on them. That is one that we constantly talk back and forth on. Obviously, to run a safe ambulance service, we will want them to make sure they meet all our standards, and we are recognizing some of those costs in the next round of negotiations.

MR. BUTLER: Very good.

I said that was my second-last one, but there is one other little short one, and I asked this at all our levels.

In the Budget, and it is under public buildings, it says: We will invest $8.5 million to maintain public buildings, another $8 million to remediate or remove buildings as required.

I am just wondering, the ones they are referring to here, removing, are there are any buildings in the system that are covered by the Department of Health and Community Services that you can advise me will be removed this year?

MR. T. OSBORNE: I guess there is one that I am aware of, and that is the old Grace Hospital site. I think they are still working on that. I am not sure if there are other buildings that are former hospitals or clinics or whatever that we are dealing with, John? Generally, those are handled through Transportation and Works. Once a department no longer requires a structure or a building, if they move out of there, they are then handed over to Transportation and Works and they are dealt with at that level.

MR. ABBOTT: Mr. Butler, the only other building that may be on that list - I would have to get that confirmed - may be the Janeway Hospital down in Pleasantville.

MR. BUTLER: Very good.

Now, to begin my last question, and I guess it is the most important one that I have, I will begin by asking you this question: Where does the Conception Bay North area stand on the radar when it comes to a long-term care facility?

MR. T. OSBORNE: There is funding available in this year's Budget to look at St. John's and the Avalon area in regards to future needs, including the needs around long-term care. We will be looking at that this year. That was on the radar previously as one of the sites identified needing long-term care. We are aware of the need out there, and we are working with the regional health authority in regard to long-term care requirements in addition to hospital requirements out in that particular area.

I can't go into the specifics of, I guess, where we are right now within those discussions other than to say that it is on the radar. We are looking at it. Obviously, it has been identified as a need for the area, and in a future budget or budgets we will look at dealing with needs based on a priority basis.

MR. BUTLER: I will tell you why I asked that question. I asked the very same question last year, and I have the minutes here from last year's Estimates, and my understanding, and I don't want to sound too critical, because when there is an assessment done in a proper manner - and I will give you an example: the dialysis unit. We came in and met with a former minister during the former Administration and we put our case forward: the dialysis unit should go to Carbonear. Provincially - I just forget the doctor's name; they were doing a review - they came back, we have our dialysis unit, because it was based on facts and so on.

I was under the impression back some time ago that the Conception Bay North area was number one on the priority list for a long-term care facility, and I take it to be done in the same manner as the dialysis done by professional people who determine that. Last year, I came here and asked - it wasn't the minister. Mr. Sullivan was filling in for the minister, I think. I don't know if he was sick; he was off, anyway. I asked the very same question. As a matter of fact, I asked all of the staff, was it number one? - but I didn't get that answer and I dropped it.

What I was told by the minister at the time, and I will read it: Overall, the rankings of the three long-term care are: Corner Brook, number one; Clarenville, number two; Happy Valley-Goose Bay, number three. I can say that other facilities out there - the one that is in Carbonear or the Conception Bay North region is a strong priority. We know what it is like. St. John's has serious problems, and Carbonear.

That was the response, and that is fine. I am not against any of those areas getting their long-term care; but, if someone was priority number one, I am just wondering what happened for three to be mentioned ahead of them. That is fine. That is not bad enough. This year, when the Budget comes down, we read in the Budget, "Nowhere is the need for new investments in public buildings greater than in our health and education sectors. In our health sector, we will invest close to $40 million in new capital construction projects, including new long-term care facilities in Corner Brook..." - number one - "...Clarenville and Happy Valley-Goose Bay...".. That is the three that the minister mentioned to me. Then, I guess, the damaging part goes on "...and planning for long-term care in Lewisporte and St. John's."

Lewisporte was not mentioned last year. Minister, I am just wondering, because in my comments last year, when I ended off, I said we will leave it as it is, based on what information was given me; but, I can assure you, this is one issue that is going to be raised because there is something not right here.

If you were number one - and I can understand mistakes being made. There were three different groups put up in the priority list, and God bless them, not one thing against any of them. St. John's was mentioned with us as top priority by the minister last year. Now, all of a sudden, you are out of the picture totally and another one moves in. I won't say what is on my mind because I don't think it is fair to say it in this setting.

AN HON. MEMBER: Go ahead.

MR. BUTLER: I think it is political. I have to say it. You prompted me to say that, didn't you? Unless someone can explain something to me different. If you are number one - and I go back to the dialysis unit. We didn't try to take the dialysis from anywhere else in the Province. A study was done. We were proven as number one, and it needed to be done.

I take it that the health care, whoever did it at the time - the staff, your officials over there, they were number one when it came to the dialysis unit and the whole thing, and I think the same thing was done on the health care.

I can't understand, for the life of me, unless someone over there can explain it to me, if you were number one and now you are down to number six, there are people coming in ahead of you. You were told last year: You are not number one, there are three ahead of you. Now, this year, there are two more ahead of you and you are down to the number six position.

I am wondering if someone can explain it to me.

MR. T. OSBORNE: It is not political, Roland. If it was, the investment in Grand Bank would not be there this year, the investment in the cancer clinic in Grand Falls would not be there, the investment in Lab City would not be there. It is not political, I can assure you of that.

The thing is, those three areas were identified by Minister Sullivan last year, those three areas we have acted on this year. All I can tell you is that it is on the radar. It may not have been mentioned in the Throne Speech or whatever, but it is on the radar. There is $500,000 to look at priorities on the Avalon. Whether the Throne Speech said St. John's or Avalon, we are looking at $500,000 to look at priorities on the Avalon and that includes the long-term care unit for Conception Bay North.

At this stage I can tell you we are looking at that facility and how it relates to the hospital in Conception Bay North. Again, that is as far as I can say at this particular point but we are looking at that facility as it relates to the hospital facility in Carbonear. It is on the radar. It is something that is being talked about and worked on within the department, and I think it is fair to say, John, that there are discussions ongoing with the regional health authority in those regards as well.

MR. ABBOTT: Yes.

MR. T. OSBORNE: It is probably not comforting for me to say to you: Wait and see what happens in next year's Budget, Roland.

MR. BUTLER: (Inaudible).

MR. T. OSBORNE: It wasn't announced in this year's Budget and it is something that is being worked on. It is on the radar. That is all I can tell you.

MR. BUTLER: Minister, I will make this comment as just a little follow-up. I agree with you, it is on the radar, but I think it is now called St. John's rather than Conception Bay North, and this is the fear that I have with all of my questions today. Five doctors gone from the Carbonear Hospital, general practitioners not going to the area - I don't know why - and I can see all of this coming into play the same way as with Human Resources, Labour and Employment. You closed the social services office in Bay Roberts. They moved to Carbonear. They moved to Placentia. All of a sudden, they are at home base, they are in St. John's. People in my area now have to deal with social workers here in St. John's, and I can see the same -

MS JONES: (Inaudible) 1-800 number, the call centre.

MR. BUTLER: Yes.

I can see the same thing, Minister - and I don't mean to be critical with you because, like you said, you have only been there three weeks and this is a system, no odds who is in power, probably, that is the plan. If Mr. Harris took over today and Randy took over the government, maybe that is the plan, but I can see that happening.

MR. R. COLLINS: Relocate you all to Labrador.

MR. BUTLER: Seriously, I think that is where it is all coming from. The same thing with the long term, it is on the radar, so you are right on. It is listed as St. John's, because St. John's and Lewisporte are there. I can see all of this happening because, I guess, we are close to St. John's, or for whatever reasons, but when the boards came together, and I said it to people out in my area, I said that is the end of health care as we know it today. The same thing with the unit at the Harbour Lodge. It is the beginning of -

MR. T. OSBORNE: Again, Roland, I think there was $500,000 or $600,000, I can't remember the budget number now, but it was $500,000 or $600,000, I think it was $500,000, allotted to doing a review out in the Lewisporte area of infrastructure needs out there, and that -

MR. BUTLER: That was my last question. When was that done, Minister? Can you confirm for me when that started for Lewisporte?

MR. T. OSBORNE: (Inaudible).

OFFICIAL: This past year, the board itself did their assessment of long-term care needs, presented a report to the department.

MS JONES: It was two years after (inaudible).

MR. BUTLER: Two?

MS JONES: Three, was it?

MR. BUTLER: Three, yes.

Anyway, that is all my questioning.

CHAIR: Thank you, Mr. Butler.

MR. BUTLER: I just want to say to the minister, I am disappointed in that. Where I came from, I think I said it clearly, that is my major concern. We have to take up the battle on this one, Sir.

CHAIR: Thank you, Mr. Butler, for your questions.

I just want to make sure, before we move on, exactly where we are headed, because we are going back to Ms Jones. I checked with her maybe thirteen or fourteen minutes ago and she was good until 12:00 o'clock then, or thereabouts, so I am assuming now that Ms Jones will take us at least to 12:15 or 12:20 with her questioning. Would that be accurate?

MS JONES: I would really like to finish it today, if that is okay with you guys, instead of having to carry over, but I don't think I will be done by 12:00 o'clock. We may run somewhere closer to 12:30. Is that a problem?

MR. T. OSBORNE: No, carry on.

CHAIR: Is everybody okay until 12:30?

MR. R. COLLINS: Mr. Chairman, I have to leave (inaudible).

MR. BUTLER: Hunger pains.

CHAIR: Okay, we will carry on, then, because I think that would be the wish of most, to finish up.

MS JONES: I will try not to touch on some of the things that were already done, but I know my colleague from Labrador West, for sure, raised the VLT issue. I just have one question on that, and that is the government's commitment in the Budget of March, 2005, to reduce the number of machines in the Province by 15 per cent. I know that didn't happen. Is it still planned to happen as we move forward in 2006?

MR. T. OSBORNE: Actually, and I am not trying to be curt at all, Yvonne, we did go into that in great detail with Mr. Collins. If you wish us to go into great detail again we can, but it will be recorded in the Estimates proceedings. We did discuss that issue in great detail.

MS JONES: No, I just wanted to know if you still plan on carrying forward with that strategy.

MR. T. OSBORNE: Yes, we are.

MS JONES: Okay.

Also, did you put in the toll-free number for gambling?

MR. T. OSBORNE: No. Again, this is something that we did talk about under questioning from Mr. Collins and Mr. Butler as well. That is still there. It is something we are looking at. There is a 1-800 number now on the VLT machines, but we are looking at something more localized.

MS JONES: This was a counselling number for gambling counselling?

MR. T. OSBORNE: That is correct, yes.

MS JONES: You also were going to hire five new addictions counsellors. Did you do that?

MR. T. OSBORNE: We hired nine new addictions counsellors.

MS JONES: That is good.

MR. T. OSBORNE: Or we are hiring new addictions counsellors.

MS JONES: So they are not hired yet, then?

MR. T. OSBORNE: There were five hired last year and there are nine announced in this year's Budget.

MS JONES: Okay.

A couple of questions on the OxyContin issue. I don't know if that was already touched on or not.

MR. T. OSBORNE: It was.

MS JONES: Okay. I will keep my questions brief, and hopefully the answers will be.

The methadone maintenance program that you guys were putting in place, that was done - I am assuming that was done - in St. John's, right?

MR. T. OSBORNE: Yes.

MS JONES: Did you just put in one program, or were there two, or did you look at any other areas in the Province? Can you tell me what -

MR. T. OSBORNE: There is one - and again I will ask officials to correct me if I am wrong - at Humberwood, out in Corner Brook, and there was a new clinic in St. John's that became fully operational last month. It was a temporary clinic up to that point.

MS JONES: So, there is one methadone clinic in St. John's now.

I understood that what you were doing in Corner Brook was putting in detox beds, but you are telling me you put a methadone clinic in there?

MR. T. OSBORNE: I think -

OFFICIAL: No.

MR. T. OSBORNE: No? Okay, so that is not a part of Humberwood?

OFFICIAL: No.

MR. T. OSBORNE: Okay.

I apologize, then, for the mistake.

MS JONES: Okay, but you did put the four detox beds at Humberwood, right?

MR. ABBOTT: That was the plan. When we went to start it, we realized the cost of doing that would not be the best use of money, and that is why we are building the new treatment centre.

MS JONES: In Corner Brook?

MR. ABBOTT: In Corner Brook.

MS JONES: Okay.

What is the new treatment centre? What does that contain? Is it a detox centre, a counselling centre, a methadone clinic?

MR. ABBOTT: Moira Hennessey can answer that.

MS HENNESSEY: Currently, we have ten beds in the treatment centre in Corner Brook. The new one that we will begin the planning for shortly will be a new fifteen-bed facility. It will have ten or eleven beds similar to what are currently there and there will be four detox beds in that new facility.

MS JONES: Okay.

Is that run by the Department of Health or under the Western Health Board?

MS HENNESSEY: Sorry, Yvonne, I missed your -

MS JONES: Or is it private sector?

MS HENNESSEY: It is being constructed through public monies -

MS JONES: Who operates the home?

MS HENNESSEY: It will be operated by the Western Health Authority.

MS JONES: All right.

There were more addiction counsellors hired to work with youth and drugs. Was that done?

MR. T. OSBORNE: There were five addictions counsellors hired last year. There are nine under this year's budget.

MS JONES: Yes, but that was under the gambling piece, right?

MR. T. OSBORNE: Well, no, that is to look at -

MS JONES: That is for everything?

MR. T. OSBORNE: (Inaudible).

MS JONES: Okay.

MR. T. OSBORNE: Go ahead, John.

MR. ABBOTT: Under our primary mental health services we also have hired youth mental health counsellors as well, if that is what you are referring to.

MS JONES: That is under your mental health services, is it?

MR. ABBOTT: Yes.

They are combined but, for funding purposes, we have them broken down between addictions and mental health.

CHAIR: Just before we continue, and I am sure that nobody wants to be discourteous, some of the topics are being raised a second time. So, in Ms Jones' absence, if a topic was raised, I think it would acceptable if the respondents were to say that we have touched on it already and, Ms Jones, you could refer to the discussion that took place at that time. Would that be -

MS JONES: I would appreciate having the answers, because you do not get a transcript of the Estimates until, like, six months from now, or sometimes a year.

CHAIR: I am not quite sure how to deal with it, but -

MS JONES: My questions are really brief, so it shouldn't take too long.

CHAIR: Okay.

MS JONES: Crystal meth, is that a growing concern in the Province right now?

MR. T. OSBORNE: Unfortunately, that is a topic that we did discuss at great length while you were away. We did go into that. It is an issue that we are trying to get out ahead of. It is an issue that is of great concern in other provinces. It is not of great magnitude yet in this Province, but we feel that it is probably coming and we are trying to get out ahead of it to address it.

MS JONES: In the Auditor General's report there was a study of MCP that found 428 patients who repeatedly went to a small group of doctors to get narcotics. I think the Auditor General indicated that in one case there were over 11,000 prescriptions for narcotics and mood altering drugs that were written by one doctor that would add up to more than thirty prescriptions per day every day of the year. I think it was quite evident that this is not only a form of abuse but I think it is an absolute crime what is happening in our society under a program that should be regulated and is regulated by government, but also is being paid for by taxpayers in most cases. From what I understand from the report, a lot of the abuse of drugs were drugs that were covered under government subsidized programs.

I am just wondering what your department is doing to address this issue and what your plan is in the future to get a better handle on this situation.

MR. T. OSBORNE: That issue is being addressed. The Newfoundland and Labrador Medical Association has been brought in as part of this as well. That is being investigated. I guess in future the pharmacy network that government has invested in, in this year's Budget, will help to look at the prescriptions that are being provided. It will help government as well as those who prescribe medications to get a better understanding of prescriptions that are provided to individuals, and hopefully cut down, to some degree, on what has commonly been referred to as double doctoring. It will also give health care providers a better understanding of other medications that particular individuals may be on and hopefully alleviate concerns with negative reactions on one prescription as it relates to maybe other prescriptions that an individual is on as well.

MS JONES: This program will be able to tell you, for example, people who are on income support right now and have drug cards that are being paid for by taxpayers. Will this system be able to give you some control mechanism in terms of knowing how many prescriptions they are getting, how many doctors they are going to, how much billing is being done, when it is happening not a year after it happens and it has all been paid for and it has been abused? Will the new system allow you to have a tracking mechanism like that?

MR. T. OSBORNE: Yes. As far as I understand, Yvonne, I think that is very much a real time type of system.

John, did you want to elaborate on that somewhat?

MR. ABBOTT: There are three issues here, if I may.

With respect to the Auditor General's report, we have put in a quarterly reporting system, so based on the Auditor General's findings we now report to the College of Surgeons and Physicians any indication of excessive prescribing, and then they will review those files.

We are putting in, for the provincial drug program, an online system to monitor, obviously, the payment as well as the prescribing of drugs under that program. We are also putting in a provincial pharmacy network which will tie in, eventually, all pharmacies and all doctors' offices so that the key players, then, will have full information on the prescribing of their patients.

MS JONES: So, there will be a system where all the pharmacies will be tied in and all the doctors' offices will be tied in.

MR. ABBOTT: Yes.

MS JONES: If you give me a prescription and he gives me a prescription, both of it will be immediately documented?

MR. ABBOTT: Yes.

MS JONES: Okay.

Moving right along now - we are going to do this just really quickly. The mandatory accreditation for mammography units across the Province, is there anything being done with that?

MS HENNESSEY: The department, per se, hasn't required -

MS JONES: I really cannot hear you, Moira.

CHAIR: It is difficult to hear you.

MS HENNESSEY: The department has not required mandatory accreditation of mammography units across the Province. I do understand that most of the health authorities have pursued the accreditation process, but with respect to the details as it stands right now I will have to get that information for you.

MS JONES: It still hasn't been a requirement of the department then?

MS HENNESSEY: Our stance, from having discussions with the health authorities, is that they are committed to the accreditation process for mammography units, so the department hasn't seen a need, I guess, to issue a policy directive to the health authorities on that.

MS JONES: So, you can't tell me how many of them are accredited or not, can you?

MS HENNESSEY: I would have to get the details for you.

MS JONES: All right. Can you have it forwarded to me, please?

MS HENNESSEY: Sure.

MS JONES: Recently you guys committed to three new dialysis machines in the Province. When is the earliest we can expect to see those operational? One in St. Anthony, one in Goose Bay and one in Burin.

MR. T. OSBORNE: About eighteen months.

MS JONES: All three of them?

MR. T. OSBORNE: Yes.

MS JONES: Has there been any consideration on putting anymore kidney dialysis units in place? Port aux Basques would be one example. Has that been considered by the department?

MR. T. OSBORNE: Yes. The department, in consultation with the regional health authorities, will continue to monitor the requirement for dialysis units in other areas of the Province. We will continue to look at the makeup of the patients in those areas, whether or not the dialysis required is able to be performed at home or whether it has to be done in a hospital setting and the travel requirements for patients. There are patients who obviously cannot utilize the services of a satellite dialysis unit and would have to travel. We will continue to monitor the requirements of dialysis patients in other areas of the Province, and based on feedback from the regional health authorities and officials within the department, government will make further decisions in future budgets on where other dialysis machines are to go.

MS JONES: I am assuming that the formula no longer applies, in terms of making a decision, because it certainly didn't apply in the last three that were committed to. It is my understanding that there are ten patients right now in the Port aux Basques area that require the use of dialysis equipment.

MR. T. OSBORNE: That is correct, and we are looking at Port aux Basques. That is certainly a consideration for government. Obviously, again we have to monitor the situation there.

Moira, if I can ask you to elaborate on that.

MS HENNESSEY: I think some members may be aware that we do have a provincial kidney program that we have tasked with the responsibility to monitor the ongoing needs for dialysis of patients across the Province. They work very closely with the department on that.

MS JONES: I can't heard anything you are saying. The air-conditioning is right up over me. Unless you speak a little bit loud, I can't heard you.

CHAIR: I think you are going to speak louder, because the mike picking it up but I don't think your voice (inaudible).

MS JONES: You are going to have to come up front, because your voice doesn't carry very much.

MS HENNESSEY: Okay, I will try again.

As some members may be aware, there is a provincial kidney program in place which is monitoring the needs across the Province for dialysis care. The government has announced three new dialysis units this year. We are aware that the patient numbers are increasing in a couple of other areas of the Province, and the kidney program is continuing to assess that for us.

I think that is as much information, Minister, as I would be able to share right now.

MS JONES: All right.

I will skip over the ambulance service, because I think that was already asked and the minister is working on an issue around that for me now. I know you already did recruitment and retention so I am not going to get into that, just to ask what has been happening in Stephenville where obstetric and gynecology services were not available for a period of time. Is that available now? Have any of those positions been filled or are they still being referred to Corner Brook?

MR. T. OSBORNE: The obstetrics and gynecology in Stephenville, there are a number of candidates that are going through the process. They have identified candidates for Stephenville and they are going through the process now of looking at licensure through the College of Physicians, looking at credentialing for the regional health authority.

Can we give an update on where we are with that right now? I think there were three individuals, Moira, that we are -

MS HENNESSEY: The board has been successful in trying to attract some candidates for obstetrical services to Stephenville. There are individuals coming for site visits - it is either April and May, or May and June, of this year - so they are somewhat optimistic now that they may be able to recruit obstetricans for Stephenville.

MS JONES: I think you are telling me - because I really can't heard you very well - I think you just told me that you are recruiting somebody?

CHAIR: Excuse me, Ms Jones.

I wonder, would it be helpful if you moved to the front bench there? It is not everybody who gets the chance to move to the front bench, so consider this an honour.

MS HENNESSEY: Western has been working hard to try and recruit obstetricans for Stephenville. They do have two potential candidates. These individuals are coming for site visits, and I am not quite sure whether it is April and May or May and June, but it is certainly in the foreseeable future. At this point they are hopeful that they will be able to reinstate the service as soon as possible.

MS JONES: Okay.

What is the physician shortage in the Province right now, the number of positions vacant?

MR. T. OSBORNE: Again, we did touch on that briefly. I think there are 954 physicians in the Province right now. There was a review of the physicians required. Based on population, we have met the number of positions required, or the number of physicians required for the Province; however, based on geography and certain specialities, the department is aware that there is still a demand. You cannot base it simply on population. There is still a demand in some areas of the Province for physicians. There is still a demand.

MS JONES: How many vacancies are there? How many positions are not filled?

MR. T. OSBORNE: There are 954 physicians in the Province right now, but I can't tell you -

MS JONES: Is that positions or physicians?

MR. T. OSBORNE: Physicians.

MS JONES: Physicians.

MR. T. OSBORNE: That is up from previous years. I guess, despite the declining population, there are more physicians here than there were in previous years. There are still vacancies. We can get that number for you. I do not have that, but we can certainly get the number of vacancies that are there.

MS JONES: Okay, if you could get that for me and just send it over. Also, I wouldn't mind having the number of vacancies of specialist positions as well in the Province.

A question on the National Child Care Strategy: What has your department done to encourage the federal Conservatives to not slash the child care program that we presently have?

MR. T. OSBORNE: I have considered considerable feedback on the child care program. There are people in the Province who are basically telling us that they would rather provide the stimulation and the child care at home and leave their $1,200 alone. Equally, we have people telling us that they wish to receive child care in a regulated setting. I guess not all areas of the Province are on the same page in regard to whether or not there is child care required or whether or not they want to receive their $1,200.

The Province, and in this year's Budget there is funding there, we are developing a program for child care that will look at the affordability, especially in areas where child care services are not currently available but should be available. We are looking at training under the program, training to try and get more people involved in that particular career. We are looking at the inclusion of children with special needs and so on. So, there is a program being worked on provincially. We did receive some federal funding. There is funding reflected in this year's Budget which will -

MS JONES: Didn't you guys get $50 million under the child care agreement over a two-year period?

MR. T. OSBORNE: No, we did not. That is the reason, last week when you asked that, I had no idea what you were talking about.

MS JONES: How much did you get?

MR. T. OSBORNE: We have not received it all yet, but we are receiving a total of about $21 million from the federal government. We received some of that last year. I guess, once they get through their legislative requirements federally or whatever the case may be -

MS JONES: That must have been the first year of the (inaudible) -

MR. T. OSBORNE: It was, yes.

MS JONES: - because the agreement was signed for $50 million, wasn't it?

MR. T. OSBORNE: No, the agreement was signed for $75 million. The $50 million figure, that threw me way off base. That had no relevance to anything that I have heard within the department.

MS JONES: Tell me, now, the agreement was signed for $75 million and you guys have only collected $21 million.

MR. T. OSBORNE: That is what we are going to be collecting, yes, because once the federal government decided to cancel that agreement -

MS JONES: Yes, but that was in the last year of this agreement that they cancelled, so you would have only lost about $25 million or $23 million is the figure that was given me.

MR. T. OSBORNE: No, that is incorrect, I think, Yvonne.

MS JONES: I do not understand. How come you only got $21 million? Was the money not drawn down in the last fiscal year or what?

MR. T. OSBORNE: No, the program was announced, I believe it was a five-year project, John, and we are going to get the first two years of that five-year funding. We have already received the first year. We are going to get the second year of that funding as well.

MS JONES: It is not $23 million that we are going to lose as a result of this change in Ottawa. In fact, we are going to lose over $50 million in child care. That is what you are telling me.

MR. T. OSBORNE: That is correct.

MS JONES: Your department has not done anything to try and stop this?

MR. T. OSBORNE: No, we are putting our own program in place provincially.

MS JONES: But, you have not done anything to try and secure that other $50 million that was committed?

MR. T. OSBORNE: Again, there is probably an equal number of people in the Province who would rather see their $1,200 because they would rather provide the care for their children at home than -

MS JONES: I know lots of people would love to get a $1,200 cheque in the mail. That is not the issue. The issue here is what is going to happen to child care as we know it today. What happens when those single parents come here and want to go to university and go to college, and what happens to low-income families who have to work without subsidized child care?

MR. T. OSBORNE: Well, I will go back to what I said five minutes ago, Yvonne, that we are developing a program. We are going to be announcing that program in the very near future. We are developing a provincial program.

MS JONES: So, we don't need the federal government money; we are going to maintain our child care spaces and we are going to pay for it ourselves. Is that what you are telling me?

MR. T. OSBORNE: We are developing a program. The details of that program will be announced once the program itself is announced, but we are in the process of developing a program.

MS JONES: I just have a couple of questions on the Central West Health Corporation. The Auditor General, obviously, did an investigation or an assessment of their board and they found out that there were several instances there where employees received money in lieu of hours of pay or leave. He said that the seven employees received a total of $134,500 in pay. I am wondering if that is being investigated or if your department is doing anything with that issue as it relates to the board. There was another issue that he outlined where eight management staff were paid in excess of $48,000 that they should not have been paid.

I guess I want to know if you are going to be collecting the money back or if there is an investigation into the board as to why they did this, who is responsible for it, and are they going to be taken to task?

MR. ABBOTT: Ms Jones, we have responded to the Auditor General's findings, to the Auditor General, at the time he tabled his report. In terms of your question, are we investigating, the answer is no. We were provided all the information and reviewed the files. There have been some issues around interpretation of Treasury Board policy from the board's perspective, and this was the previous board that was responsible for this. We have an understanding of what happened there, but we will not be doing an investigation per se.

MS JONES: There are other instances as well. I guess one of the ones he raised was under the relocation policy, where there were mortgage down payments which were considered a moving expense, and there were other instances where there were wide-screened televisions, digital cameras, global positioning systems, mobile telephones - all of these things were bought and claimed as part of the moving expenses - and there were three instances where the employees were provided amounts in excess of $12,000. Don't you think that is pretty serious abuse of funds by a board and by a corporation?

MR. ABBOTT: As I said, we have responded formally to those issues. What we have asked the new board to do, working with us and the other boards, is to make sure that the administrative practices and policies that are in place are not only consistent with what government policy is, that they are applied on a go-forward basis.

When we reviewed the files in those cases, some of us would say, yes, those payments should not have been made. We have asked the managers, who would have authorized those, on what basis they did it. We have been, I guess, satisfied that they were certainly legal payments but they did contravene standard policy and practice. We have asked and directed the boards to cease and desist those.

There have been cases in the past year where a CEO has come to the department and asked about an administrative practice that they had adopted before, and whether it was still applicable. Where it was not, we have told them so and they are in full compliance on a go-forward basis.

MS JONES: So you guys have been monitoring it.

MR. ABBOTT: Yes.

MS JONES: First of all, let me ask you about the Child and Youth Advocate. There has been a request, I know, put forward, and some lobby to have an office or sub-office in Labrador. Is that something the department is considering doing?

MR. T. OSBORNE: That is not a decision that a department can make. That would have to be a decision of the House of Assembly.

MS JONES: Okay.

Back some time ago, I wrote the Child Advocate and asked him to do a review into the systemic process, I guess, in procedures of the foster parent program in the Province and they were not interested in looking at it, which was very disappointing for me in light of the fact that there have been a number of cases raised publicly but also a number of other cases brought to my attention privately, and I felt that it should have been done.

I am wondering if, in light of what happened with the Tulk family in Pasadena back in November, it has caused your department to have a look at that program and look at where gaps might exist or where it can be streamlined a little better to provide a little bit, I guess, better service to the foster parents and the children who are involved?

I am not going to get into all the issues that were raised there, but there were a substantial number of them, everything from the process of removing the child, and all the issues that went around that, to the fact that there were contracted social workers - not permanent staff by any health board in the Province but hired on a one-week contract - to go into homes and take out this foster child, and things like that. I am wondering if it has caused you guys to have a look at this program at all.

MR. T. OSBORNE: Under last year's Budget there was some attention paid to Child, Youth and Family Services as well, and I think in particular in Labrador and in St. John's there were social workers hired. In this year's Budget, we have announced there are fifty-five new positions throughout the Province that we are going to be putting in place -

MS JONES: Is that for social workers?

MR. T. OSBORNE: Not all of them are social workers. I think some of them will be, but fifty-five positions in total throughout the Province to deal with Child, Youth and Family Services issues. There was a gap there. There was a strain on some of the resources. That has been recognized, and the announcement was made to put the additional resources in place.

MS JONES: Okay.

Mr. Chairman, I don't have any other questions. I just want to thank the minister and his officials for their time this morning, and their patience. If everyone else is finished, I guess we are concluded.

CHAIR: Thank you, Ms Jones.

We will do our bit of housekeeping before I go to the minister for his closing comments, if he has any.

I would ask the Clerk, then, to call the subheads.

CLERK: Subheads 1.1.01. to 3.2.02. inclusive.

CHAIR: Shall subheads 1.1.01. to 3.2.02. inclusive carry?

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

On motion, subheads 1.1.01. to 3.2.02. carried.

CHAIR: Shall the total carry?

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

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

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

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

On motion, Estimates of the Department of Health and Community Services carried without amendment.

CHAIR: The other item of housekeeping business would be to carry the minutes of yesterday's meeting with the Department of Municipal Affairs. These minutes have been distributed, so I would ask for a motion that they be carried.

MR. O'BRIEN: So moved.

CHAIR: Moved by Mr. O'Brien.

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Thank you.

On motion, minutes adopted as circulated.

CHAIR: Minister, are there any closing comments?

MR. T. OSBORNE: I would like to thank everybody on the Committee for coming out today and asking the questions, some very good questions, some very good discussion here. Some of the issues that were raised, that we did not have the answers to, we will get those responses in as timely a manner as we can and get them back to the individuals who have asked the questions.

I guess just a thank you to the Committee for ensuring that I am going to get a paycheque next week.

CHAIR: Thank you, Minister.

I would also like to thank the Committee for having been well-prepared, and for their questions. Certainly, the questions were exhaustive, important and well put. I thank the minister, of course, for his forthright responses, and the staff for their usual degree of professionalism.

For the next meeting of this Committee there have been some changes. We are still on Monday morning; the only difference is the change of venue. We will be in the Committee Room rather than in the House.

That being said, I would ask for a motion to adjourn.

MR. O'BRIEN: So moved.

CHAIR: Moved by Mr. O'Brien.

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Thank you.

On motion, the Committee adjourned.