Mr. Chairperson (Ben Sveinson): Order, please. Will the Committee of Supply please come to order. This afternoon this section of the Committee of Supply meeting in Room 255 will resume consideration of the Estimates of the Department of Health.
When the committee last sat, it had been considering item 21.1.(b) Executive Support (1) Salaries and Employee Benefits on page 71 of the Estimates book. We had agreed also that indeed questions would range quite widely. Shall the item pass?
Ms. Diane McGifford (Osborne): Mr. Chair, yesterday we were speaking about hepatitis C and the compensation package, and I think the member for Kildonan (Mr. Chomiak) indicated to the minister that we would ask a few more questions on that issue before moving on. I wonder if I could begin by just providing a little bit of an outline as to my understanding, and perhaps the minister could address that.
I understood from yesterday that the minister said that the principles for compensation had been established and that they would include--and I am being quite, quite loose here--a lump sum that is to be determined, and that one of the other principles would be an effort to meet the needs of people living with hepatitis C. This would be income related, provide income replacement. Also, I think the third item was that the compensation package would perhaps fund additional medical needs, and that would depend on the province, depend on the kinds of supports that the province had. I believe the minister also said that there was a working group that was meeting to spell out the details, the principles having been established.
Furthermore, I think the minister indicated that the date for compensation of January 1, 1986, was taken as the first date, or the logical date, because it was at this time that there was a change in the standards of care, or that a change in standards of care could be safely determined or determined. I am talking about care in regard to the nature of blood and blood products.
Furthermore, I think the minister said that, while some might see the HIV compensation package as setting a moral precedent, that need not imply--I think the minister talked about the fact that the HIV group was very small, whereas the hepatitis group would be larger and the numbers would be much more significant. I am assuming, then, the financial cost would be much more significant if it were a compensation package that paid no attention to dates.
The minister talked about the total package being $1.6 billion, and said that the share for Manitoba would be approximately $13 million, and this would be over a period of three years. I just want to check my facts with the minister.
Hon. Darren Praznik (Minister of Health): Mr. Chair, just to clarify the member's review of our discussions yesterday, first of all, the comments with respect to the 1986-1990 period as defined were not my personal view in terms of the work I had done personally, but the recommendation that was made to us for a period by the national government and the working committee on reviewing the appropriate material and including the class action suits that were launched in a number of provinces. So we as provincial ministers and the federal minister relied on that work that was done by the research team who prepared the work for us. So if at some point in time they prove to be wrong, I have no reason to suspect that today, but I would not want the member to attribute that particular date to any work that I had done. We are relying on work that is done by primarily the national government in preparing discussions here, which of course underlines the point about where we in fact did start.
With respect to issues around negligence as we discussed yesterday that the premise of that particular period, which the member has discussed, is that it was during that period of 1986--we picked January 1 as the beginning of the year--but during that year of 1986 a test that had been developed, and again in the continuum of the development of any test or any particular medical procedure there are those who think they have a test, start to prove it, have it tested, and then of course the acceptance of it as a proven test for a particular item grows within the medical community.
In the North American medical community, it was in 1986 that that test began to be adopted in some jurisdictions in the United States, and so one could argue that the pendulum of standard of care had started to swing from the development stage into the standard period in that particular time, and that was the argument and the logic and the rationale that were presented to us as ministers by those involved in that particular process.
Is there something else I may be missing that the member may want to flag in her recap?
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Ms. McGifford: The province's share, that is, Manitoba's share of the compensation package, from what the minister said yesterday we understood to be approximately $13 million over a period of three years. I wanted to ask the minister, and I realize that the details of the package are not entirely worked out, but I wanted to ask the minister if he could tell us whether this money would be entirely devoted to the lump sums to meeting the income needs of individuals and meeting additional medical expenses, or does he foresee that some of that money might be used in other ways?
Mr. Praznik: As the press release that was put out by federal, provincial, territorial ministers indicate, and I would quote from it, and I will provide her obviously with a copy of it if one can get it copied. I quote from the release: ministers suggest assistance to individuals be negotiated on the basis of initial fixed payment as well as a variable subsequent payment based on the severity of each individual's disease.
Now, in our discussions as to what this meant, my understanding is that the severity of the disease is reflective of the ability of an individual to earn a living and that consequently the more severe the illness the less likely the person would be able to earn a living. Then of course if they are unable to earn a living, the compensation plan would be able to provide a supplement to them on top of the other assistance that they would normally get, such as CPP disability and whatever other plans they would have, so that the total package on which an individual will rely for their health care, their health needs, their support needs and their financial needs, this is one part of it. Many of those other components already exist, including for people who received hepatitis C or had hepatitis C prior to this particular period.
I do not want to leave the impression, as some did in the media yesterday on some of the coverage, that there were only health care costs being covered. That is inaccurate. Most individuals will have an entitlement to Canada Pension Plan. That is why I flagged one of the issues as speedy acceptance there. This is still a matter of negotiation and ultimately court approval, but that is the plan as we envisioned it as ministers. But we are not the only parties at the table, obviously.
Ms. McGifford: I wonder if any portion or part of this $13 million would be used to cover, for example, administrative costs or legal fees, that sort of thing.
Mr. Praznik: Mr. Chair, the cost of administering this particular program--and you have to appreciate, as well, that this is a capital pool which over the three or so years of its being paid into, I guess us beginning next year as provinces, in the completion of four years this pool will have a capital fund which will be invested and earn income. So it is not limited just to the $1.2 billion. There is an income component depending on the terms that will carry it into a long period. But its administrative cost in setting up has to be covered inside the pool.
Now, when the member refers to legal fees, et cetera, this is not a litigation fund. It is one in which it will be negotiated. There will be actuaries' fees, and I am sure there will be some legal fees in actually putting together the trust or whatever has to be established, but compared to where one would be in litigation, it is just a very, very small share of what that would be if the other route was chosen.
Ms. McGifford: I did not mean for litigation; I meant other kinds of costs. Can the minister hazard a guess at what those other costs might be?
Mr. Praznik: Mr. Chair, I do not want to even begin to do that. The working group is there. They have to deal with various organizations. There are so many factors. Virtually none of the factors that will influence that are within my control or realm; consequently, I do not even want to hazard a guess at that.
Ms. McGifford: Yesterday the minister said, I believe, that the statistics that his department had for those infected with hepatitis C before 1985 were quite rough, and he did not provide those statistics. I wonder if there are any, and, if so, would he provide them?
Mr. Praznik: Mr. Chair, I am going to ask Mr. Wendt to comment on that as part of the working group that is developing those numbers. I think he can outline some of the technical difficulties in getting a handle on the size of that particular group.
Mr. Ulrich Wendt (Manitoba Representative, Hepatitis C Working Group): Mr. Chairman, there are a number of technical difficulties. The records of the Red Cross themselves, they are not complete. Some of these records go back quite a few years. The hospital records themselves, in most jurisdictions, there is a limited requirement for record retention, and because the nature of the infection is such that it is in many cases symptom-free for so many years, it could be the case that the symptoms will not show up until after some records will have no longer been retained.
So there are a number of technical difficulties in being able to come up with a definite number, so we would need to have people actually come forward to identify themselves.
Ms. McGifford: So the short answer is that we do not really know how many persons were infected with hepatitis C in Manitoba before 1985.
Mr. Praznik: Mr. Chair, one qualification to the member's statement is that would be through the blood system. There are other ways in which people can get hepatitis C, and there is a whole group of individuals who have gotten the illness, not through the blood system. But the short answer is, yes, that is a difficulty, and there are estimates as to those numbers. They vary considerably, but I think Mr. Wendt maybe wants to comment on sort of the best-guessed estimates in the country.
Mr. Wendt: The epidemiologic evidence suggests that the number might be around 20,000 or 30,000 prior to that period.
Ms. McGifford: I am glad the minister corrected me. I, of course, did mean people who contacted hepatitis C through tainted blood and as part of the system. I think Mr. Wendt's figures reflect the numbers infected in all of Canada, and I am wondering if there is any rough guess or, even better, a definite--well, we do not have definite statistics, but I wonder what the numbers might be in Manitoba for those infected with hepatitis C through tainted blood before 1985. Do we have anything?
Mr. Wendt: We do not have a definite number. It would be somewhere in the neighbourhood of 800.
Ms. McGifford: So potentially then there are 800 persons in Manitoba living with hepatitis C acquired through contaminated blood who will not be part of this package and whose families will not be part of this package.
Mr. Praznik: Yes, based on the information that Mr. Wendt and the working group have provided, that could be the estimate as a possibility. I want to, for the benefit of the member for Osborne, make this point. As we have come to the estimate that the size of the population outside the group may potentially be as large in the group, I would like to take out of that, though, the hemophiliac group first which are regular users of the system.
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As Mr. Mark Brown indicated to me, the vast majority of hemophiliacs are likely to be included in the group because they would have received blood or blood products during the window, but it comes to a more important and a larger point. If you assume that this group of people is the same as the group we are compensating--in the case of Manitoba, about 800 in each group; across Canada 22,000 in each group, which would be, I think, the right number--the package we put together is $1.2 billion for the 20,000, the 22,000 for which there is a very good argument to be made, or an argument to be made, that there was a negligence or malfeasance on the system. Manitoba's share is our 4 percent of the $300 million of provincial dollars. For that program to be expanded, the lion share of that, on the basis of doing really an ex gratia payment, a no-fault system, with no negligence or malfeasance, the bulk of the dollars that would be needed to make that work have to come from the largest partner in the agreement, which is the national government.
So, even to get to the point, and this was what I was trying to make yesterday, the two hurdles are the principle of do you begin a compensation package for people injured where there was no malfeasance or no negligence in the system; and, secondly, how are you going to finance that? In the case of the area where we believe there was a potential malfeasance, potential negligence, the federal government had to come to the table and, at the end of the day, after very tough negotiations--I saw Jennifer Dundas's program last night on CBC, and I have never seen a more creative editing job done in many a day. It is regrettable because I do not think it does the issue justice; but, if you are going to extend that on the basis of having a no-fault compensation package, the majority of that money has to come out of the national government.
Although I guess the CBC and the member for Kildonan (Mr. Chomiak) did me great credit to think that I was an architect of preventing that from happening, with our 4 percent of the provincial $300 million, the reality of it is that the players with the most money that will have to be on the table have to make the decision to do that if you are going to have a national program.
The federal government brought $800 million to the table for the area where there was a potential malfeasance or negligence. They did not come to the table with another $800 million for other people, for a gratuitous or no-fault program.
The Province of Ontario, which was responsible out of our $300 million, their portion will be in the neighbourhood of between $100 million and $150 million, I would imagine, Ontario. They have not come to the table with that money. The Province of Quebec has not come to the table with their dollars. Two other larger provinces than Manitoba, British Columbia and Alberta, have not come to the table with those particular dollars. So if you look at how the compensation package was structured for where there is a malfeasance or negligence and you see where the financial resources have come from to make that happen, keeping in mind that the provinces, including the Province of Manitoba, for an action or a fault that was not of our making, is having to pay for the medical care side of this already.
The dollars for any expanded program, the vast majority of dollars have to come from the national government. Quite frankly, to even get that program off the ground, and the member for Kildonan (Mr. Chomiak) I think suggested it might happen, the national government has to come to the table with at least another $800 million, and anyone else looking at this, it is not going to happen without the major players being prepared to commit their dollars. In fact, that is why we have a compensation package today, because the player with the most responsibility did come with $800 million. It may sound significant, but in the overall cost of hepatitis C, it is not even half of what is being spent. The provinces are bearing that.
So my point is very clear, despite Mr. Brown and the member for Kildonan (Mr. Chomiak) and others sort of implying that at the table Manitoba and this minister, with only 4 percent of $300 million in a $1.2-billion package, can influence that decision making. In reality, it is those players that have the biggest chunk of dollars on the table who have to come to the table with those dollars and, despite the fact that Jennifer Dundas cut my sentence in half to make me say what I did not say last night in the media, my point was that where Manitoba took a hard position was not on this issue.
This issue, when we came to the table, was advanced by the federal government and it generally accepted that we are here to deal with a potential matter of negligence. The issue of a no-fault system in health care is another matter, another day, with larger implications.
But the area where I took a hard line, and I say it very clear on the record, was that the national government had to pay their fair share of the total costs. Now, we got more money out of them than they started with but, in my opinion, they are still not paying their share of the total costs that have been incurred because of the blood system and hepatitis C. Now, that is a very different issue from the compensation package, or it is an extension. I make no apologies for taking a hard line on the part of Manitoba taxpayers that the federal government should pay its fair share of the costs. I do not think the New Democrats would oppose me in taking that position, and I have never heard them do it, but that is what I said last to the media and that is the position I have taken.
I think the member recognizes that to extend the program on the same basis, you would have to raise another $1.2 billion, and if you extended it on the same basis as you are now, that means the federal government would have to be at the table with a further $800 million. They have given no sign whatsoever that they are even prepared to consider that. So just in terms of those numbers, if this issue is to change, the players who have the biggest dollars have to be at the table to put their dollars forward.
Ms. McGifford: I am very happy to hear, and I have heard before, that there will only be four or five hemophiliacs left out of the compensation package, but I am also well aware that there are apparently 796 other individuals who are either transfused or have somehow or other ingested blood products and have hepatitis C.
The minister is talking about very serious issues when he talks about financial restrictions and financial responsibilities and responsibilities on the part of government to taxpayers and identifies the role of the federal government and the federal government's responsibility. At the same time, the minister is aware and I am aware that there are and will be Manitoba families living in destitution, in poverty and, adding to that, in ill health.
Part of my experience before coming to this House was to work in the community with people living with HIV-AIDS, who were living in circumstances that were just beyond the pale--just a shame to Manitobans--absolutely terrible circumstances without telephones, without being able to purchase the foods that they needed, people living in one-room suites with cardboard boxes for their furniture. This is not the way Manitobans should live, and this is not the way people should live just before they die. I really want to know what the minister says to families, like the families I am describing. Also, I think it is important to point out it is not just the father or the mother, it is the children and, in some cases, the extended family who are suffering. I would like to know what the response to these families is?
Mr. Praznik: First of all, I appreciate sincerely the point the member makes because it is a concern that I have as well, and I appreciate where she is coming from on this. Yes, anyone who suffers from hepatitis C that is not in this group, or suffers from another severe illness, and we all have constituents who have heart disease or other things that have made it difficult for them to work and that has certainly affected the financial ability of their family to cope, along with their ill health. What does one say?
It is always very, very difficult circumstances, but that is why one should take into account that for many of those individuals, there is within our general social safety things like the Canadian disability pension. So there is a package there, and the principle that the member asks in extending a package beyond the area for which the system may have had a negligence--you know, I say, realistically, or I say to her that maybe some of these issues have to surround our whole overall safety net, because there are people in those circumstances who are not just with hepatitis C but with other ailments as well or illnesses that prevent them from working and having an income. That is very hard and very tough and that could happen to any of us through no fault of our own or through no fault of anyone else, and we recognize that and perhaps more work has to be done on our overall safety net in that particular area.
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After yesterday's discussion, a colleague pointed out to me as we talked about this principle, and this is why I say, you know, there are areas of debate and it has been a good discussion we have had in this committee about the principle. None of it is easy and there are two sides, I think members opposite recognize this, and there is a practical side to that, as the member for Osborne (Ms. McGifford) has sincerely and rightly so put to this committee.
But there are many places in the course of the operation of the health care system where there is a factor of risk. There will always be a certain amount of risk in the blood system, as one of the components, a certain amount of risk in the pharmaceutical system, a certain amount of risk in surgery, in everything we do. What area do we compensate and what do we not?
A colleague of mine pointed out that, for example, in the days before the polio vaccine, a number, a percentage of people who suffered from polio got it because they attended at hospitals for other things and that hospitals by their nature, no matter how hard they achieve the standard of cleanliness and trying to be the case, they tend to be centres of greater amount of infection, particularly larger hospitals than other places. There were many people who got polio because they accessed hospitals for other service. We did not compensate them as a society for saying you got polio in our hospital.
There are cases we have seen: the flesh-eating disease, for example, where people who have, they suspect, contacted while in hospital because that was an area where that particular--is it a virus we are talking about--[interjection] Virus or bacteria could have been there and yet standards of cleanliness are maintained, but it is a hospital where there is a higher concentration of activity that can lead to higher concentration of risk. Do we provide income assistance in those cases? Now if we decide to do that, how do we finance that? Where do those dollars come from? What choices do we make?
I think the point that we as ministers of Health nationally have attempted to come to grips with is that, if the system has through a malfeasance, a negligence, injured someone, obviously, yes, you can be sued; you can go to court. There is a responsibility; you have to meet with it. But if people have been injured or suffered injury through the regular, normal operation of a health care system and the assumption of the risk that goes along with that, without a malfeasance, without a negligence, do we compensate there?
That is a very, very difficult question. Once you start saying yes for this group of people--and, yes, I admit we did that in one particular case with HIV. I explained yesterday my observations. I think it happened because people thought it was a one-time thing. It was a small group, it would be done and it would never happen again. Well, it keeps happening. Do we do this here? Do we continue to extend it? Then, how do we put that kind of what, in essence, is a social safety net beyond what we do already in place?
We, as a society, have already said that through the Canada Pension Plan we will provide a disability pension for people who, through no fault of anyone, are unable to work and earn a living when they are permanently disabled. That system is not perfect. Perhaps some tag on to that system has to be developed to support people who are in, for whatever reason, a greater medical need, or maybe that system has to be enhanced. I accept that argument. I have many constituents who have had to go on disability and that in itself is not an easy pension plan.
But there is this principle and where do you go from here? Yes, it is always easy to say in this particular group let us do it, but then where do we proceed from and where is the fairness to those who may suffer injury in a hospital setting through no negligence and are unable to earn a living, only have the Canada Pension Plan and have no special plan on which to rely with a disability pension? So this is a very tough issue. It is tough for the families and for those individuals who are involved. I truly appreciate where the member is coming from. I am just trying to give a sense of the thought process through which federal, provincial, and territorial governments went in arriving at this particular plan.
Ms. McGifford: One of the things I think that distinguishes people who acquired hepatitis C through the blood system from people who, perhaps, died or whose surgeries were not successful is that when you have a surgery, you are usually advised of the risks involved. When you take pharmaceuticals, you are usually advised or should be advised of the risks involved. But people who were transfused with blood, up until fairly recently in history, believed that there were no risks, that they were doing this only for the benefit of their health. So I do think that there is a distinction, and I am not sure that the minister's argument is as tight as it might be.
Mr. Mervin Tweed, Acting Chairperson, in the Chair
Earlier the minister was talking about the need for some of the major players to come to the table, if this package were to be extended, and he identified several provinces who could come to the table or the federal government could come to the table. I am asking the minister why he could not go to the table and show some leadership and bring other players to the table? Is there some reason why that would not work?
Mr. Praznik: Mr. Chair, if you look at the numbers on the compensation package--first, if you look at the overall total cost of the hepatitis C issue of providing care and support for people with hepatitis C, the provinces are already at the table very significantly with dollars for which they receive no support from Ottawa. If you look at the responsibility within the system, surely one has to agree that it rests with the operator, the Red Cross, and the federal government as regulator primarily, and they have their responsibility. That is one of the reasons, I think on this compensation package at least, the federal government came to the table and ultimately after some very hard negotiations, of which I was a part, came with $800 million.
If we were to extend this program as the member suggests, which one could do just a quick calculation would be another $1.2 billion, even if we were to adopt the same ratio, there has to be a willingness for the largest player to be there, and Mr. Rock was very adamant in our discussions and negotiations that he had no further dollars. I know it is easy because we are in Manitoba in a Manitoba committee in the Manitoba Legislature dealing with an issue of health with a provincial Minister of Health, but we as a government, we as a Legislature and I as a minister, cannot accept responsibility for the wrongs or malfeasance of a whole host of players outside of our control. We just cannot do that in a responsible fashion.
What amazes me about this whole debate and watching the media coverage is that the Canadian Red Cross Society who operated the blood system during this period, whose sole contribution to what is today a $1.2 billion in compensation, and if we did see the program expand, it would be $2.4 billion that their compensation for what in essence they were responsible for, will be at the end of the day some $100 million for which they are bargaining hard to continue, and they are not even putting all their assets on the table to go towards compensating people. Where are the people out there saying where are you Red Cross? When are you going to live up to your responsibilities?
The national government, because they tend to be far away from all of us in our daily lives and from our provincial media, have the responsibility of regulating products used in health care. They regulate pharmaceuticals to ensure their safety. They have the power and the ability to regulate blood as a product used in health care delivery. Where are the demands for them to live up to their responsibilities?
Every time I, as provincial minister, made that statement to the media, I mean, you get, well, yes, that is fine but. Well, it is not fine but. They have a responsibility to those people, a very large one identified by Mr. Justice Krever. In my opinion, the national government is getting away under this program with way under what is their share of their responsibility.
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Now that does not help those people that we are talking about today, those that have hepatitis C, who did not get it in the window period, may not have got it through negligence or malfeasance but will suffer and their families will suffer. I know that does not speak to them, but I say this very sincerely to the member: Is it because we are sort of the last stop on this that we have the finger pointed at us, and everyone else escapes who have run the system? No, they have to live up to their responsibility, and I think part of the anger with Mr. Rock was, by many there, is that they have to live up to their responsibilities as the regulator.
The member for Kildonan (Mr. Chomiak) said this may happen. It may happen. The pressure has been there, and they will have to deal with it, making a decision about where they want to be at the end of the day. There is a principle and there is money. Both those issues have to be dealt with if this thing is going to proceed. But for Manitoba who represents a very small portion of the total contribution, to say take leadership, my experience in federal-provincial relations has been it is not by and large going to be a lot of the small provinces. It is the large players who have to come to the table with significant money to make it happen are the ones that have to be willing to do that.
The last thing I think we do, in fairness to the people of the province of Manitoba, is if we always rush in to assume what is not our responsibility, which is not what we should be paying, that we do them an injustice as well, because it means resources get shifted from things that they require to pay for things that are not in our realm. I say that to the member sincerely.
Mr. Rock--this was the point on which I was very hard and adamant in our discussions--is that the national government has to live up to its responsibility of regulator. They are not even paying 50 percent of the total cost to date for a potential malfeasance or negligence of which the provinces had virtually no involvement or responsibility. And we are paying far more than half.
So you know, if you look at people who are asking for that assistance and fairness, my advice to them is, if they feel that they have been done an injustice, they should be pointing their criticism, their demand, their requests, and their argument at those who have the responsibility for the system and have not yet been anywhere near their percentage of responsibility with their treasuries and their pocketbooks. As someone who has sat through this--and I know it is because the media is here, and the issue is local, and we are all in our provinces--but one has to look at where does the responsibility lie, who has to be there, who is putting forward their dollars. I say this sincerely: the provinces for a potential malfeasance or negligence for which we are not responsible, only minimally some involvement, we today are paying the lion's share of the cost. So at what point do those others who are primarily responsible accept and fulfill their responsibilities?
Ms. McGifford: With all due respect, I think the minister knows that people living with hepatitis C are aware that the federal government has responsibilities and, no doubt, are doing their work with Mr. Rock. I am the one who is talking to the minister today. I know that the Manitoba Hemophilia Society has spoken with him, but their national counterpart is certainly putting pressure on the federal government. So I do not want to leave the impression that these groups are beating up the minister or, indeed, ministers of Health in any other provinces. They are very well aware of the responsibility of the federal government, and they were very well aware of the responsibility of the Red Cross. Indeed, what really impresses me about these people is how carefully their work is researched, how well they have done their homework, and I think we should respect them for that.
I just have one last question for the minister. I understand that from the years 1986 to 1990, approximately--give or take--but approximately 1,800 Manitobans acquired hepatitis C. I might have my number wrong. The minister seems to be shaking his head. But my question is, I do understand that a number of people who acquired hepatitis C during this period do not have a record of transfusion. I wonder how that will affect their qualifying for the compensation package, what they will have to do in order to qualify.
Mr. Praznik: The member asks an extremely relevant and important question because this is something we struggled with. The principle is balance of probabilities during that period, so any type of record or verifiable recollection of a physician that would, during that period, indicate the probability of receiving blood or blood products will be accepted. I trust that within this process there will be some appeal mechanism for these matters to be dealt with, like any others on matters of fact, but I hope in these cases we can err on the generous side as opposed to the nongenerous side of it, and that is the intention of ministers. That is why I think in the case of hemophiliacs that the number will get down to be very, very small.
As in all compensations programs or all public programs, there are always issues around, factually, does one qualify, and again the principle, the balance of probabilities; I think the standards of proof are going to be an inquiry basis. Certainly, we want to make sure that there is some independent appeal function in place that would ensure that this does not become just an administrative or bureaucratic decision, that people have a chance to meet their peers in essence to be able to make their case should there be some doubt as to the evidence.
Mr. David Chomiak (Kildonan): I am sure we will have just as an enjoyable discussion today as we did yesterday. By way of administrivia, I had indicated to the minister that I would get back to him today about sort of rough scheduling. I do not know if the House is aware, but I think the Estimates is not sitting tomorrow; I think tomorrow is bills. So we will next meet, as I understand it, Thursday morning at 10 and then in the afternoon. I was hoping, if possible, if we could perhaps deal with the Information Systems section on Thursday, if that is possible, if that fits in, and then the following Tuesday when we meet again perhaps the Lab Services portion. Would that be functional?
Mr. Praznik: If I could suggest on the Lab portions, perhaps the member would, in the interests of having more productive discussion, defer that for a couple of weeks because we are in the process of dealing with that issue, and on Tuesday next I do not think I will be in a position to give him as much information, more conclusive information, as I will likely be able to do about two weeks from now.
Mr. Chomiak: Okay, perhaps we can reassess that, and just as an interim suggestion, perhaps move to--I would not mind dealing with the USSC food services on Tuesday if that is at all possible.
Mr. Praznik: What we will do is inquire if the chair of the board and Mr. Sheil, who is the CEO, would be available on Tuesday. We will make every effort to ensure that they are here as well with the committee.
Mr. Chomiak: I am just now going to go on a series of questions. I wonder if you want to take a break now or wait till--take a five-minute break if that is in agreement.
The Acting Chairperson (Mr. Tweed): Is it the will of the committee to take a five-minute break? [agreed] We will convene back here at 3:45.
The committee recessed at 3:39 p.m.
The committee resumed at 3:48 p.m.
The Acting Chairperson (Mr. Tweed): I will now call the committee reviewing Health Estimates back to order and start with questions.
Mr. Chomiak: My series of questions for the balance of the afternoon are going to be general in nature, arising out of Question Period this afternoon, and just general in this area based on whom I see here from the minister's staff, that is just by way of background.
I wonder if the minister might indicate for me at the onset who Jean Burton is.
Mr. Praznik: Yes, Mr. Chair, if this is arising out of the discussion Question Period today, I would like to, just by way of the record, indicate to the member there has been no inconsistency in the statements I made when we awarded the contract that I made in December when reiterating those comments. I say to the member in any discussions or planning that we have had at the senior level around the contract with Olsten which I am told and Ms. Hicks, my associate deputy minister, will put some information on the record.
Any discussions we had around my executive table, of which I am a part, have not been inconsistent with anything that I have said. In fact, the only issues we have had is completion of the evaluation. I believe the contract is a May-something-to-May-something contract, and if there was to be any extension around that contract, it would have to do with the completion of the evaluation and any transition that would have to take place.
We have been, I believe, consistent from the day we awarded the contract last spring. I have indicated that the results of that tendering process produced only five companies that met the standard qualifications and only one that could bring in the service on their tender less than our estimated costs of delivering the service through the public system.
By any stretch, the tendering process, that did not produce the results that one would have expected, and that is why, in fact, when we set out the quadrants we limited the number of quadrants that anyone could do to two as opposed to four. We wanted to certainly have a comparison and evaluate that comparison between the four we are delivering and the two that are being delivered by Olsten throughout this trial year.
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But, as I have said, the results, everyone has expectations; they were not met in the tendering process. We complete the year and surely to goodness if some renewal at some point, or not renewal, because we are not talking renewal, I do not want to leave that impression, but if some extension were required to facilitate completion of evaluation or transition, particularly with the Winnipeg Long Term Care Authority coming into place, that that certainly is not inconsistent with any other comments we have said.
I am going to have Ms. Hicks, who after questions were raised in Question Period, and I must say to the member, we have lots of contracts and issues going on in the department, this is one of many hundreds of issues. Any discussions that I have had as the minister around the table have been with respect to what I have just outlined. When the member came forward, and I understand after seeing this memo now for the first time, her comments said that the contract has been renewed for six months. The status of that is not something I would be up to date on in the regular course of administration. Before dealing with the press I asked Ms. Hicks as to the status and she confirmed with me that there had been no contract renewed, so perhaps she would like to add some information to this issue.
Mr. Chomiak: I just want to clarify. Is Ms. Hicks answering for the minister on this?
Mr. Praznik: I have dealt with, I think, the policy issues around this. As associate deputy minister, this area falls within the responsibility of Ms. Hicks. She confirmed with me after Question Period that no contract, to her knowledge, had been renewed or extended and there was a memo that the member has referred to, and he asked me specific questions about staff in her area, and I would like her to respond.
The Acting Chairperson (Mr. Tweed): Is that agreeable? Ms. Hicks.
Mr. Chomiak: Mr. Chairperson, I do not want to be difficult, and I am not trying to complicate this. We basically have a general agreement that technical matters will be dealt with--and have agreed--that technical matters could be dealt with by staff. I do not want to be in a position--I have never felt comfortable in a position of debating with minister's staff. It is not something that I think I should have to do, nor should they have to do. I am not sure that if dealing with the issues, the questions that I am dealing with, perhaps the minister can make an assessment, as I ask each question, whether or not he will answer it or whether or not the associate deputy minister will answer it. In that way, we get around that difficulty.
Mr. Praznik: I am not here to debate with the member today. I am here to provide as factual answers as I can. The member raised an issue today, based on a memo that was provided to him or someone in his caucus, that indicated one thing that was not the case. When I asked my senior staff for a report or an update on the facts of the matter, that was what was conveyed to me, and I have no problem with Ms. Hicks answering the questions based on the facts. If there are questions of policy, I will certainly deal with them. Perhaps we will judge each question as they are put.
Mr. Chomiak: Yes, Mr. Chairperson, and I will return. Can the minister indicate who Jean Burton is?
Mr. Praznik: I am advised by Ms. Hicks that Ms. Burton is a supervisor out of our Tuxedo office for Home Care staff. The member can appreciate with the literally thousands of people who have traditionally worked in the Ministry of Health, I am not familiar with the vast majority of the people who work in the Ministry of Health.
Mr. Chomiak: Could the minister confirm that on March 27 Jean Burton sent out a memo to all Home Care staff?
Mr. Praznik: I have no personal knowledge of that issue, so I cannot confirm it.
Mr. Chomiak: Will the minister confirm that, in fact, we tabled a letter on Manitoba Department of Health letterhead dated March 27, 1998, from Jean Burton, today in the House; Subject, Re: Highlights of Supervisors' Meeting March 27, 1998?
Mr. Praznik: The member tabled that. If it is what it is, yes, I have no problem acknowledging that.
Mr. Chomiak: Will the minister acknowledge that the memo is two pages long and had a list of 15 points that were highlights of the supervisors' meeting March 27, 1998?
Mr. Praznik: Mr. Chair, I do not think the fact of the memo--to my knowledge, we are still checking if that, in fact, is an accurate memo that was provided. I have asked Ms. Hicks to do that. But the contents of the memo, if it is in fact an accurate memo, I have no reason to doubt that today, but stranger things have happened in this place. But it has been confirmed to me by Ms. Hicks who is responsible for this area that no contract has been signed, so if there is information to the contrary in the memo, that it would not be accurate. From time to time, staff in the Ministry of Health do make mistakes, just as we all do.
Mr. Chomiak: Can the minister confirm that in the memo that we tabled in the House, the two-page memo, that on point 9, and I quote: Olsten's contract has been extended six months?
Mr. Praznik: As Ms. Hicks is responsible for that area, I am going to have her answer that question.
Ms. Sue Hicks (Associate Deputy Minister of Health): Mr. Chairperson, I understand that in the memo that was tabled today that, yes, the supervisor who prepared the minutes for the supervisors' meeting did indicate that the Olsten contract had been extended for six months. I have no idea where this information or how this information was relayed to this individual.
Mr. Chomiak: Can the minister indicate how the 15 points highlighted in the memo, which was memo titled "Highlights of Supervisors' Meeting, March 27, 1998," appeared in a memo that went to all home care staff?
Mr. Praznik: Mr. Chairperson, those are minutes of a supervisors' meeting. They share them with their staff. That is probably, I suspect, how the member obtained one. That does not necessarily mean that they are reflective of the policy of the ministry. Mistakes happen from time to time. Sometimes information is not conveying, sometimes there is speculation that becomes information. Those things happen; they particularly happen in a big organization.
If the member is asking us, which is his assertion, that the contract had been renewed secretly, as I think his leader described it, I am telling you today, based on what Ms. Hicks is telling me, that that is not the case. Any discussions that we have had as a policy matter around my table as minister, with respect to any extension of a contract, not a renewal, but an extension, had to deal with a very, very small conversation which would be around completing the evaluation, which I think is important to ensure that if there is anything we can learn out of it, we do, and any concern for a transition. I say that now on the record, and from what Ms. Hicks tells me, that is the case.
If someone at a supervisory level has a different impression, or different belief in a very large organization, it is not unusual for information, speculation to become in minutes such as this, it is not an endorsed memo from any on my management team, my senior executive, et cetera. It is representative of comments that were made at a supervisors' meeting. That does not necessarily mean they are reflective of the policy of the ministry.
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Mr. Chomiak: Since this memo is dated March 27, 1998, since numerous references were made to the Associate Deputy Minister of Health, I assume, since there is reference to--and I am quoting--"Louise Friesen will be assuming day-to-day supervisation of the nursing unit. She will report directly to Sue", is that some other Sue, or--[interjection] Sue Mackenzie, it is indicated.
Is the minister between March 27 and today's date--has a correction been sent out to say in fact the Olsten contract has not been renewed for six months?
Mr. Praznik: Mr. Chairperson, I did not even know that these minutes existed until the member raised it in the House today.
As I said, the policy issue involved here is to get the evaluation done, which we would like to see the results of, and as I said when we awarded the tender way back when last year, that the results of the process produced only one bidder that met both the quality and the price requirements. It was not a significant saving. We have learned things as we have gone through the year, and we want to formalize a process with an evaluation. I, quite frankly, can see where the member is coming from in having this document, and I can see the impression that has been left with him, but any talk at the executive policy around an extension had more to do with completing the evaluation, and any transition that would be in place, and certainly not carrying on. We want to have the evaluation done, though; I think we should.
Mr. Chomiak: Mr. Chairperson, I find it hard to believe that these minutes are speculation, or whatever term the minister or the staff might want to use to term these minutes, when in fact, if you look under the particular minutes: Home care update organization chart should be out by next week; John Brody will be moving to WCA headquarters; there will be a press conference Tuesday, March 27, 1998; new letterhead to be used; business cards are being ordered; ID badges are coming; Olsten's contract has been extended for six months.
Mr. Chairperson, this does not strike me as idle chat or speculation on the part of--and the minister characterizes it. These are relatively senior people dealing with relatively significant issues in the home care field. It is hard to believe that they could be characterized as nothing other than a minute on obviously relatively accurate information.
Mr. Praznik: Mr. Chair, I have been around government for many years. I have run small departments and big departments, and there are many occasions on which I have seen speculation of staff make them into minutes or documents that say one thing that were not a case in terms of policy decision. It would not be the first time it happened; it will not be the last. But, given the fact that he has raised this only with us today in the House and both Ms. Hicks and myself have been here and committed to Estimates, I think before we pursue this any further, in the interests of accuracy, I would be more than prepared to pursue this discussion with him on Thursday or Tuesday next after we have had a chance to discuss this in greater detail with staff. I would like to assure him that what we are saying is accurate, and I am giving him what my recollection of discussions is today. This memo does surprise me somewhat.
Mr. Chairperson in the Chair
I am assured by Ms. Hicks that no contract has been renewed. We obviously want to confirm that with the Winnipeg Long Term Care Authority in greater detail than a phone call today. So I would be more than prepared to return to this on Thursday, and if the member would do us the courtesy of having the opportunity to check back with our staff to find out more about this memo and where the information comes from. I am interested in knowing that myself.
Mr. Chomiak: Yes, well, by way of further background to the minister, the last occasion I was involved in an instance like this, there was a memo signed by the former minister, Mr. Jim McCrae, approving a particular measure that had been agreed to under the MMA agreement. It was approved and signed by the minister, and I raised it as a public issue. What the excuse was that time: Well, yes, the minister signed it and approved it, but it was conditional approval. So I have a history in this, and this is a written document of fairly senior officials that went out to all staff, and it is of a significant nature. The information surrounding it is not insignificant with respect to home care. Given the political context of home care for the past several years, it is, in my view, something that I find hard to believe. Indeed, I do not believe it was done in error. I believe the discussions have--and the last time I was involved in an issue like this, the excuse that came back was there was conditional approval by the minister. So I have had a history in this with respect to issues of a very similar nature.
Mr. Praznik: Mr. Chair, we have all had experiences, and I appreciate the member's comment. First of all, let not the record show that these are senior officials of the Ministry of Health. Our home care supervisors are certainly not senior officials in the Ministry of Health. Senior officials are the ones that I interact with and deal with at my executive table. They are senior people. This is not signed by a senior member of the staff of the Ministry of Health. It is by a program supervisor who is in the process of being transferred to the Winnipeg Long Term Care Authority, so today not even in the Ministry of Health, and certainly cannot be characterized in any stretch of the imagination as a senior official.
Secondly, Mr. Chair, I remember a year ago when the member brought to this House, to the Legislature, rightly so, the issue of changes in the deductible program for our orthopedic devices. The member, being provided by--I do not know; I gather it was one of the organizations that had been consulted about proposed changes. It was a matter I had been minister for a number of months, had never heard of the issue anywhere in my briefings or discussions or Estimates process. I remember speaking to my staff as I came into the House. I know I was arriving late that day--I had a meeting with the Concordia Hospital board--and being told by my deputy that, in the process of looking at how we do deductibles, our staff had thought that this was a good way to do it and thought, before they brought it up to our executive level for consideration, they would go and have a consultation with the stakeholders. That consultation resulted in the member getting the material. If I had been in his shoes, I would have raised it, too. It was a great concern, but my staff in the department, and by the tradition of the department, had not gone out with my authority or approval as minister to consult. They did not even know if this matter was one I wanted them to consult on. It was an initiative they undertook.
Now I have since changed that process in our department. That does not mean from time to time something like that will not happen again, but that is my experience as a minister in this particular department. I was not pleased that officials at whatever level were going out meeting with stakeholder groups about changes in public policy that had never even made it to my executive, let alone the cabinet. So that is an experience with it, and that is why I am saying a lot of things are possible that may not in fact accurately reflect what is going on.
I appreciate what the member is saying, and I am indicating to him that Ms. Hicks, who is the ADM responsible in this area, is going to endeavour over the next couple of days to find out exactly where this is coming from. I have no problem discussing it with the member on Thursday or Tuesday after we have had a chance to check this out, but I can assure him that from time to time these things happen, particularly in a very large department.
This is not signed by senior officials of the department or anyone in a policy-making function. As a consequence, we would like to know where that comment was coming from and on what basis it is there. I would like the opportunity to do that to be able to accurately report to this committee and the member the origins of those comments.
Mr. Chomiak: Mr. Chairperson, I am not going to belabour this point, although I am tempted to, except I just want to put one other point on the record. The minister constantly makes reference to the fact that it is not signed and that it is not senior staff--
Mr. Praznik: I did not comment on signing it.
Mr. Chomiak: That the memo is not signed? Then I will--
Mr. Praznik: I did not comment on that. I said the people whose names appear are not senior staff.
Mr. Chomiak: Are not senior staff. The minister has indicated that the people are not senior staff. They were clearly told a series of information about the home care, significant information that was put in minutes and circulated extensively. One of those major items is the Olsten contract issue.
Mr. Praznik: Mr. Chair, just on the record, first of all, I have never referred to it being an unsigned memo, and I have never challenged the authenticity of the memo. It may be a true memo; it may not be. I have no reason to believe it is not, but I am saying I have not challenged the authenticity. All I have said is it is not senior people in the Ministry of Health whose name that material went out under. It is the minutes of a supervisors' meeting, which meant somebody acted as a secretary and wrote up what in fact they believe transpired at the meeting. I would expect somebody may have approved that before it was sent out to everyone. I cannot even verify that. Are there errors in minutes? Yes, maybe the information was in fact brought that way. Maybe the person who brought it was under misinformation. That happens from time to time. I am going to endeavour to find out because I am not happy with it. If the member's point is that misinformation has gone out to our home care staff and that is causing concern among that staff, yes, I want to know about it, and if it needs to be corrected, it will be. I appreciate his point.
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Mr. Chomiak: Is the minister definitively saying that the Olsten contract will not be extended beyond its expiry date?
Mr. Praznik: Mr. Chair, the comments I made in the House and the comments I made at this committee were there is a provision in that contract to extend it if there is a requirement to, and there may be a requirement for some very valid reasons, to complete the evaluation or, very aptly, to accommodate a transition. Surely to goodness, we are not going to get so caught up in the battle of an issue that if a contract had to be extended for several months to accommodate a transition with the Winnipeg Long Term Care Authority because it was the best thing for patient care and people were not geared up to do the change overnight, surely to goodness we, as legislators, are not going to criticize that from happening.
The major point that, in my view, the New Democratic Party has made is the need to maintain home care in the public realm, and I think going through the tendering process last year, the industry out there that does provide home care services, the We Cares and others had always made the point that they could deliver a better product for less cost to government. They were given an opportunity to prove that in a tendering process. If they had been successful in that process, it might have been of great benefit or a benefit to both the taxpayer and, more importantly, the home care recipient. For whatever reason, in the course of that process, only five companies met the quality standards that were set for delivery of home care. One of them did not even want their bid considered because they were not prepared to do bonding, if I remember correctly, and when the remaining bids were opened, only one brought in the service at a cost that was less than the estimated cost of us doing the service. So we carried on with what we had intended, and we have the evaluation. During the course of the year we have made observations of that system. As a general point of principle, what I intimated last spring and I reiterated in the hallways of the Legislature last December or November was the point that through that process what we have generally learned is that the public sector is a very good vehicle for delivering home care, and if that is the case why would one change it.
We still want to complete the evaluation. There are still things to learn. Assuming that course continues and that looks like the course we are on, we want to go through that process. There would likely have to be a transition back to the system, so I do not see where we are at loggerheads in the result. How we get there over the next few months, I do not think why any one of us would want to endanger public health if the contract had to be extended for several months to accommodate a transition.
I would not believe, knowing the member for Kildonan, that he would--if that was the best way to do some transition, why he would oppose that. It does not make any logical sense.
Mr. Chomiak: Can the minister indicate specifically what the end date on the contract is?
Mr. Praznik: Mr. Chairman, Ms. Hicks advised me it is in May, and we will endeavour to get that exact date for the member.
Mr. Chomiak: I am going to be moving on to some other general areas. At this point I wanted to commence by asking if a few documents could be tabled in the next little while, and that is, if we could get updated lists of all the board and all board members and all executive members of all of the various regional health authorities that have been set up. [interjection]
Well, in fact, if the minister has indicated a list, perhaps what I will do is I will type up a memo for tomorrow or for the next occasion when we meet, and I will submit that in terms of documentation that we are looking for.
I wanted to spend a little time on the Betaseron issue. It has come up in the House, and I am not entirely clear what the difficulty is. Does the minister have his person?
Mr. Praznik: Mr. Chair, the irony of the moment, I think Mr. Potter is on his way to the meeting, the scheduled meeting with the MS clinic as we move forward on Betaseron.
If I could ask Mr. Godin to come up here. He is my staffer who has been working co-ordinating this. I should tell the member one of the difficulties I have experienced in the last few months is the staffperson out of my office who is working with the department, the MS clinic, Deborah Vivian, has left this role in government, and, of course, there had to be a bit of a transition in staff to sort of head it up in my area.
I can tell him though that I think everyone wants to see this move forward as quickly as possible. I just look to Mr. Godin for some detail as I give the member an update. When we embarked on a pilot project, we talked to other jurisdictions who had undergone the same thing. Saskatchewan took some seven months, six, seven months, five to seven months to get their program up and running. British Columbia took I think it was around three to four months. I had occasion to be in British Columbia on numerous issues, and I had a chance to visit with a program along with some of my officials. We had the chance to literally pick the brains of the people who were involved in it on some of the things that they had done, because they have probably one of the better programs with Betaseron in the country. It is a credit to British Columbia, so we wanted to make sure we were emulating them as much as possible. It was a very interesting experience. We gained a lot of insight, and they have also, I understand, provided us with some information as a follow-up, and there is communication going on now.
The MS clinic is the host for this program. There are a number of things that have to be developed, obviously, ensuring we have the right criteria for use of the drug. The information process of talking to the people who meet the criteria to decide whether or not they want to be on the program is, the risks and benefits, very, very critical, and British Columbia had a very effective system, we thought, of doing that, of ensuring that follow-up and work with people who are on the system. The other part that has to be put in place are the criteria for evaluation, how we are going to measure the effects of this particular drug. Those are being worked on. I know there is a great human cry from those who have expectations of being on to get on with the program. I certainly share that, and we have asked the MS clinic--there will be some discussions today--that at least we can get on to get the time frames firmed up so they can be announced publicly and to get on with the assessment and each piece as they move forward.
But very much they as hosts have to be involved in this, and we keep trying to move it forward. Currently, I understand that they are developing their lists now of people who will be eligible for the program. When I say eligible, the eligibility is based on medical reasons, certainly not on the finances for the program. There is only a certain percentage of people with MS for which Betaseron may be helpful. So it is important in sorting out that list.
So that work is underway now and, as I said, it is very much in the hands of the MS clinic and those people who are working out the logistics. As we have seen in other provinces, it does take several months to get the program up and running.
Mr. Chomiak: Can the minister indicate whether or not all of the initiatives, the financing, the technical details, et cetera, from the provincial Department of Health's perspective have been put in place?
Mr. Praznik: Yes, Mr. Chair, the finance has been approved for the product. The medical criteria, et cetera, have to meet the standards of the MS clinic and the medical practitioners, and what is being worked on today, of course, is the evaluation process or how we will evaluate the success of the drug.
This is, I should say for the member, somewhat innovative for our pharmacal economic committee, because they traditionally have only said yes or no to a product and, as the member, I am sure, appreciates, often the benefits versus the costs, you know, if a drug is low cost, medium benefit, it gets approved. If a drug is high cost, low benefit, it is easy to say no. If it is high cost, high benefit, it is easy to say yes. It is where you have a fairly high cost and the benefits are not certain, they are still developing, people have not assessed them, that there is enough doubt, and often the committee has ruled no until the information has gotten better.
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What I have asked them to do and what is in their power is to create what I call a red-light, green-light, yellow-light process, the yellow light being approval with a recommendation for a pilot or study that would be monitored to provide further data. I expect, given the growth in the drug industry in new treatments, that this yellow light is going to be a very effective tool for advancing products.
This is the first time we have done this, and so getting an evaluation tool and perfecting it is going to be very important and have ramifications for other drug products. We want to get it right, and it is somewhat new ground for all of us. I should say to the member, when we canvassed the country on their pharmacal economic committees across the country, we found just a huge divergence in how those committees operate in terms of what their criteria are to set drugs. If there really is a need for a national government to step in, this is an area I have suggested to Allan Rock that perhaps we should be doing this on some national basis instead of going through it in each province, where we can develop some acceptable criteria and a process and take products through once across the country instead of many, many times in different jurisdictions.
So something we would like to work on, but it is somewhat new ground, and I would like to think it is an improvement on the way that that committee operates.
Mr. Chomiak: Mr. Chairperson, I thank the minister for that response, and I am going to want to pursue this entire issue much more extensively when we get to the Pharmacare portion.
Mr. Praznik: Mr. Chair, on that point, because it is such new ground, if we could arrange for perhaps the people from the Betaseron clinic, the MS clinic, it may be useful to have someone here if that is possible from our Pharmacare program to be able to get into greater detail as the program advances, because it really is a new way of dealing with the evaluation of drugs. I have never heard the member criticize the need to have an evaluation process. I think we both have shared concerns about how that process works.
So I am trying to get a process that is much more receptive and fair and faster in making decisions and being able to study the effectiveness of drugs. I think we share that goal, and I would like to be able to perhaps bring some of the people working on it to give him an opportunity to get a better sense of what is happening here.
Mr. Chomiak: Mr. Chairperson, my next question was in fact for the minister to describe for me, if he could, the structure. So, since the associate deputy minister is involved in the actual structure, perhaps we will come back to this on Thursday morning. It will not be extensive. We can perhaps deal with it Thursday morning if it is possible.
I heard mention of a Dr. Auty whom I have also spoken with. We may not have to do that. I am interested in it as well. If we can just get through the structure and the function, that probably is sufficient for Thursday. If we can go more extensive, that is fine, but we do not have to. I know how these people's time is.
I was going to turn a bit to the organizational chart. Can we go through that?
Mr. Praznik: Mr. Chair, just by way of caveat to this chart, this is our chart as of January 28, 1998. As the member appreciates, we are in a huge state of transition in the delivery of health care--whereas the ministry was responsible for directly just about everything in dealing with 180 boards, different organizations, delivery mechanisms, we delivered some health care--the Ministry of Health in terms of delivery today is delivering only very few programs, things like Pharmacare, province-wide programs, air ambulance, certain parts of the public health program, and some mental health, et cetera.
Much of the delivery is now with regional health authorities, and that has triggered, of course, some major reorganization within the department. Last year I managed to reorganize our senior structure. We then took our existing pieces within it and put them under our changes in senior structure, and as we get through the spring season, we are now contemplating again some further refinement of the area underneath our senior associate deputies to further refine our function, because as I have said, the Ministry of Health, our role now is less one of delivery of service. It is one of financial administration, quality control, delivering certain province-wide programs that are important and dealing with things like federal-provincial, aboriginal, jurisdictional issues, et cetera. So it is much more a policy financial quality control organization than a delivery one. As a consequence, we will be refining this as we move along.
Just, for example, I have come to appreciate, given the creation of the Canadian Blood Agency, the whole hepatitis C issue we have discussed, the federal financing and, of course, the area of aboriginal jurisdiction, the issues with First Nations dealing with Health and Welfare Canada. I almost need to have an individual here to just manage those particular issues where we have had a very, very slim organization there, so we are still in the process of making some changes.
Mr. McFarlane, whom I introduced yesterday, who is on our books as a special adviser, is doing a major rework of our insured benefits division. We expect to have some major service improvements there. We have over 40,000 visits a year, or pieces of business a year we deal with, and we think we can deal with them in a more service-oriented manner. He is part of doing some of the internal reform as we change our role and function. I just wanted to put that on the record to give the sense to the member for Kildonan (Mr. Chomiak) that the senior part has been set up and what comes underneath is still very much a work in progress as we go through this parade of reform and change.
Mr. Chomiak: Mr. Chairperson, so the person slotted into the special advisors is Jim McFarlane?
Mr. Praznik: Yes.
Mr. Chomiak: The Chief Medical Officer of Health is now?
Mr. Praznik: It is Dr. Jim Popplaw, who is acting. That position has been posted--will be posted--within the month, I am advised, to fill it on a permanent basis.
As you know the previous Chief Medical Officer of Health retired from that position to take a job, I believe, in the Turks and Caicos Islands. I must admit to the member there are many a day that we spar in the Legislature that I wish I was still working with him in a different jurisdiction.
Mr. Chomiak: Mr. Chairperson, the nursing advisor, where is that now located?
Mr. Praznik: Yes, the former occupant of that position, Caroline Park, resigned from that position earlier this year. We are assessing how that office will now fit in with respect to the WHA regional health authorities, how that is being filled. Again, that is part of the work in process. Before we refill that position, we want to see what our expectations of it are as we do some changes within the department.
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Mr. Chomiak: I note we have a fairly extensive department of Planning, Policy and Special Projects, numbering about 22 individuals. I wonder if the minister might elaborate who occupies those. It is on page 29.
Mr. Praznik: Mr. Chair, this is the area that Mr. Wendt is responsible for, Mr. Ulrich Wendt, who was here earlier, right. It includes his people who work on these interprovincial issues. It includes also our legislative unit. That would be Heather McLaren, Donna Hill, who are both lawyers by trade, who do all our legislative regulation. Mr. Tom McCormack is in there, who does work on projects under the deputy's office on special issues that arise from time to time that do not fit into another area of responsibility. Our French Language Services Co-ordinator is based in here as well.
Mr. Chomiak: Unless I am mistaken, this component did not exist last year. It has been put together this year. Amalgamation or other, can the minister elaborate on that?
Mr. Praznik: These people, I understand, were all there last year by and large, and they have been combined from other places where they were housed, so this would not be new staff years, but a reorganization. It is part of that work in progress that I spoke about, because as the functions of the ministry are changing in a new delivery mechanism, the way in which we organize things is also changing somewhat. So this unit was brought together, I am advised, in the last year, people from other areas. But I know on a personal basis most of the people in here who I actually interact with a fair bit in the course of our work, they have all been around for some time.
Mr. Chomiak: I was not suggesting that these were new people, but I believe this is a new structure that has been developed in a planning and policy area to the minister. I wanted to ask some specific questions about it. Is the minister comfortable with me going through that now?
The specific reference on page 28 to the amendments to five acts, and I wonder if the minister might outline what five acts this policy department is developing. It is at the bottom of the page under Expected Results, where it says: "Development of amendments to five (5) Acts as approved by Cabinet."
Mr. Praznik: We will get that complete list, but I know it includes amendments to The Public Health Act, The Mental Health Act. There may be some amendments we think to the regional health authorities. I will get the complete list for the member. I know one of those areas that we are attempting to address, that this area is working on, I know is of interest to the member, has to do with the area of the extra billing and the Canada Health Act, so this is the unit that is looking at those amendments that we would be required to deal with that particular issue.
Mr. Chomiak: When the minister returns with the specific information on those acts, will the minister also be in a position to advise me when we might see these acts introduced in the Legislature? For example, I was under the impression that The Mental Health Act would be introduced this year. That was the advice that we were given last year.
Mr. Praznik: Yes, Mr. Chair, that is the case. Those amendments come from some years ago; they had to be developed. I would have liked to have that bill before the House last year, but I know with the heavy legislative agenda it was not able to complete the drafting work on it to be able to bring it to the House. That was done over the fall time, so I intend to be bringing it in. I know there are some finalizations to that bill before I am able to bring it into the House, but it is expected to be in this year's session.
Mr. Chomiak: Something stands out for me with respect to the activities of this group when I see something that says: represents the minister and deputy minister as required. Now, I am not suggesting that there is anything untoward, but it does suggest that these are fairly senior policy individuals, if in fact they are in a position or there are positions to represent both the minister and the deputy minister.
Mr. Praznik: That representation would be primarily at the technical level. For example, Mr. Ulrich Wendt, because he, within this unit, has been our person on the working group for hepatitis C, the working group on the new Canadian Blood Agency. Technically, I believe, that deputy ministers or their designates are serving on that committee. Well, in a practical matter, deputies cannot always be at these meetings, so Mr. Ulrich Wendt represents the deputy in this function. If there is a federal-provincial meeting, and it has happened from time to time, where I and my deputy have not been able to attend and it is on very much a technical matter of issue, Mr. Wendt has gone as our observer.
I know, Heather McLaren and Donna Hill, who do all of our legislative drafting and our regulation change, we have had them represent us, I guess you could say, at a variety of consultations and issues where we were dealing with the technical portions of amendments or those issues in going through. They have represented my deputy or myself in many of those opportunities to do consultation on various issues with legislation they are involved in, and they report back to us on policy issues or concerns, and anything that requires a policy decision happens. They are all excellent people and when you are managing an almost $2-billion operation with literally hundreds of issues, I know the member appreciates you have to have a group that can fill in and deal with matters from time to time just practically so that you can cover all the potential bases.
Mr. Chomiak: Could we have a list of who the managerial and the professional/technical, that is the 14, for this particular group?
Mr. Praznik: Yes, I will provide the member with a copy of this list. I understand that only Mr. Ulrich Wendt and Heather McLaren--one would classify as managers within the system.
Mr. Chomiak: The group facilitates the development of public/private partnerships is stated as one of the activities. Can we get a list of the public/private partnerships that the group is involved in?
Mr. Praznik: Yes, we will get a list of those projects for the member.
Mr. Chomiak: There is also a new result for me that I was not familiar with, and that is the analysis and assessment of Health industry proposals in consultation with the Department of Industry, Trade and Tourism. Can I have a perhaps a list and perhaps a description of what that is about?
Mr. Praznik: Just by way of general information, I found as minister on a regular basis we get approached by various private sector concerns to do pilot projects or test projects, et cetera, that in Manitoba, in the health industry, they have the potential of (a) improving health care, which is our minister's concern here, and, secondly, have the potential to see industrial health care, industrial development in the province. So we do have a liaison with the Ministry of I, T and T to be able to work on these particular projects.
We will get a list for the member, but I know from time to time, for example, some of these projects--and we will get into it when we discuss the list--often there is a proposal that a significant amount of private sector dollars would be available to set up a pilot program or an area that could be beneficial to the treatment of various illnesses in the province of Manitoba. So we want, of course, to be able to evaluate that to see if there is a benefit to us on the health care on the industrial development side, and that is why, in fact, that unit or that position exists so that relationship exists in order to deal with these particular matters as they arise from time to time. We will get a list for the member to discuss them, and I will be able to comment on where we think they are going on each one.
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Mr. Chomiak: I thank the minister for the copy of the individuals who are attached to this section. I note that there are two full positions with respect to the home care appeal panel. Are these administrative positions that assist the home care appeal panel or are they some other function?
Mr. Praznik: Yes, Mr. Chair, these are the support persons for the home care appeal panel.
Mr. Chomiak: There are also three individuals that three staff-years identified as special projects. Can the minister outline what their role and functions are?
Mr. Praznik: Yes, Mr. Dale Berry is the individual who is working on the industrial development private/public partnership issues. Tammy Mattern has been seconded to the Better Methods project across government, and Bob Rauscher is serving both myself and the deputy now in an administrative support capacity to ensure that various issues, et cetera, and decisions that are made by our executive, that information, et cetera, passes on throughout the department. So in many ways he serves as a secretarial support. I say that not in the role as a secretary to a board in essence, but to our executive.
Mr. Chomiak: What would be the duties and functions of the chief communication officer, Louis Barre?
Mr. Praznik: It is not communication, it is information, and there is an important distinction. One of the frustrations I think I have had in this role, and certainly I see it reflected in the questions and answers of the member for Kildonan from time to time, is the way in which we assemble information to be able to assess where we are, where we are going, what we are achieving. Mr. Barre's responsibility is within our department, and he is working very hard on this to develop the information reporting systems that we need to be able to assess where we are, what services we are delivering, how we collect that.
It may be hard to believe that in a ministry that spends so much money, we have not had these kinds of tools for decision making. When I speak to my colleagues across the country, they are all more or less in the same state we are, but health care has not been a very good area at generating the kind of information statistics that one needs on which to judge where you are going, trends, information that you need to make decisions.
One of the things that I have attempted to do, as minister, on a regular basis is to have--and right now Mr. Rauscher is providing that support to our executive--but to be able to rotate senior or mid-level managers who display talent and ability for promotion within the department through the executive offices on a yearly basis to be able to get a good understanding of how things work in the deputy's and minister's office, legislative issues, et cetera, and Louis Barre was the first person to occupy that position, an excellent manager. When he completed that task as of September, this was an area that we had identified as an executive. We were terribly short, and his interest and specialty is information, information technology, making decisions on information, so we viewed him as the right candidate to take on this very large task of ensuring that this is built within our department in support of executive decision making. So he is now working on that particular area.
Mr. Chomiak: Who is the Health secretariat?
Mr. Praznik: That is the support to the Manitoba Health Board. I hope I do not breach any confidences to the Legislature, but when we do bring forward some amendments in this session of the Legislature, one of the things that has been a bit of a pet peeve with me is the Manitoba Health Board. Its functions are an appeal function, and it really should be called the Manitoba health appeal board. It deals with appeals on rates for personal care homes and residential issues, et cetera, and we are now currently using it because its power includes other issues as the minister may assign, issues around boundaries for regional health authorities. Where areas would like to move from one authority to the other, this is the board that I am going to have hear those particular requests. So this is the secretariat that supports that Manitoba Health Board, which, in essence, is really the Manitoba health appeal board.
Mr. Chomiak: There is reference to the co-ordinating legislative proposals and regulations for self-governing professional bodies. Now, this in itself may not be the appropriate line, but can the minister indicate whether he is anticipating any legislative changes to any of the self-governing bodies during this legislative session?
Mr. Praznik: When we get our list of proposed legislation, which I will have for the member on Thursday, if my recollection serves me correctly, there is at least one piece of legislation that deals in this self-regulating profession. I know some months ago I met with, I think it is, the dental area, and there were some issues that needed to be dealt with as a result of some changes in federal regulation. I am not doing the member a good service--it is some time since I dealt with it--but it was demonstrated that we needed to make amendment. We will have Heather McLaren here on Thursday to be able to answer any of those questions.
Mr. Chomiak: To the best of the minister's recollection, is he then not anticipating any changes to any of the professional acts concerning nurses during this session?
Mr. Praznik: None that involve any major policy issues. To the best of my recollection, I do not think there are any changes to the professional acts coming forward. There may have been some housekeeping that may have been talked about somewhere, but it is certainly not something I am aware of today. Changes on the nursing side in terms of major policy are not part of that legislative agenda for this year.
Mr. Chomiak: Now, in the list of documents--I am going to request one of them--is a list of all of the various appeal panels. We had an extensive discussion last time concerning appeal panels. Has the minister made any significant changes in this area, or is he contemplating any?
Mr. Praznik: No, I think if I remember correctly, last year we discussed potential combination of the health appeal or the Health Board and Home Care Appeal Panel. To be blunt, we have had so many things on our agenda in the last year that that has not been a high priority. The Home Care Appeal Panel tends to work quite well and moves on. The only change that I flag with him, as I have indicated, is the Manitoba Health Board. I would like to ensure that it is properly called the Health Appeal Board.
I can tell the member that I know there are some issues around the regulation of personal care homes that may require an appeal process, and I have the power to assign it to that particular board. So that board has the ability to deal with most any or all appeal matters that I want to assign to it. Quite frankly, I do not think any significant changes are pending, other than the name simply because I think it leads to a lot of confusion.
Mr. Chomiak: The minister is going to bring back, hopefully, when we next meet or as soon as possible, a list of changes to acts and the like. Is it also possible for the minister to provide a list of any significant regulatory changes that are being contemplated by the Department of Health, and I am specifically thinking of regulations governing the care and administration of people in personal care homes?
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Mr. Praznik: I think I could say safely today without hopefully breaching any of the requirements of the legislature, one of the areas we have discussed last year--and it is important to both of us--is the way in which we license and regulate personal care homes. That is an area of great risk within the health care system. As the member knows, last year we made changes in The Regional Health Authority Act that gave us the power to step in as a ministry under certain circumstances with respect to hospitals or personal care homes to temporarily take over their management should that occur.
One of the issues that we identified was the licensing procedure for personal care homes. I believe they are currently licensed under The Public Health Act, if I am not mistaken, with a very minimal set of powers. Basically they get a licence and your only power is to take it away or one can take over temporarily, I guess, under The Regional Health Authorities Act, but we have recognized that it is important to have a licensing scheme in place that provides and, as I said, part of the ministry's role in this new delivery system of health care is to be the assurer of standards of care and the enforcers of standards.
I have some difficulty with the deliverers of the service also being the group responsible for enforcement of standards, and so one of the principles that I am trying to build into this new structure in the ministry is that with the vast majority of services delivered by regional health authorities, the ministry has to play the role of ensuring that standards are met.
So consequently we have to ensure we have the right authorities and licensing powers. So that is one area we have found is an anomaly in the legislative scheme for health care where the power to establish licensure in a more complex way does not exist. So it is likely the member will see that in legislation I bring forward this year that that will be included in that package to then empower us to be able to do that.
Of course, any type of legislation like that, most of the operative provisions are developed by way of regulation, so if we bring that forward and the Legislature approves, it will take some months after that to develop the appropriate regulations if we have such a statute in place.
Mr. Chomiak: When I attended the portions of the inquest with respect to the gentleman that died at Holiday Haven Nursing Home, Department of Health officials attended and were questioned with respect to the licensing provisions that are in place from the Department of Health with respect to personal care homes.
I stand to be corrected, but I believe that they also testified that there were contemplated changes to those provisions that were being reviewed by the Department of Health, and I am wondering if it is possible, because I have never actually had a chance, if it is possible that I could have copies of the regulations in effect and, if at all possible, if there are changes to the regulations that are being circulated, if those are possible as well. In other words, I would like the most up-to-date provisions of the licensing provisions as they relate to personal care homes.
Mr. Praznik: Yes, Mr. Chair, the day that we identify for discussion on this area I will endeavour to have as much of that information as possible, but I do just want to emphasize that out of the Holiday Haven incident, which is of great concern to both of us, I think all Manitobans, we learned a lot of things about the powers and licensure that exists or does not exist, and we took some immediate steps last year to give the province the power to step in in situations like that that we did not have.
We are now taking steps to modernize our whole process of licensure. So the only caveat I put is, much of what exists today may be inadequate for the task, and we are very much in the process now of bringing that up to, I think, a modern licensing scheme for personal care homes because of the concern that we all share.
In that context, I would be delighted to have that discussion with the member when we get to that point and perhaps next week he can identify the day that he would like to deal with it.
Mr. Chomiak: Is the minister aware or has the department been aware of whether or not the results of the inquest have been circulated?
Mr. Praznik: I know, Mr. Chair, that we should be able to expect the results of that inquest shortly. I am not sure, I think it is Judge Bueti who is doing the inquest. I do not know if he has yet reported, but we will endeavour to find out.
An Honourable Member: I am afraid to call a judge.
Mr. Praznik: Yes, I think we are all afraid to call a judge to find that out, obviously, but I understand that the report should be expected sometime around now or in the spring, so we will find out what the status is of that for the member.
Mr. Chomiak: Mr. Chairperson, as we are getting close to five o'clock, perhaps I will wrap up just with--I will outline some of the things where I would like to see us go.
We have talked about dealing with Information Services next when we meet as well as pursuing a little bit of the Betaseron issue, and roughly anticipating going Tuesday after the holiday weekend probably trying to deal with the USSC, the food services matter, if it is possible.
An Honourable Member: Tuesday for USSC.
Mr. Chomiak: Tuesday for USSC. Correct.
I want to advise the minister that, while it is not on line, I would not mind a discussion with the minister on just a couple of issues that have come up. The Victoria lodge issue and the whole status of Levels 1 and 2 care, I would not mind just dealing with briefly on Thursday, as well as a little bit of a discussion just on the status of. I am also going to query the minister on the status of some of the announcements that were made in the recent Free Press article about the minister's short-term plan for health care. So, unless other issues arise of a significant nature between now and then, it is roughly where I am anticipating we will go on Thursday and Tuesday.
Mr. Chairperson: The time being five o'clock, time for private members' hour. Committee rise.