The Acting Chairperson (Ed Helwer): Would the Committee of Supply please come to order. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health. Would the minister's staff please enter the Chamber.

We are on Resolution 21.4. Perhaps we will just wait for the minister. Here he comes.

21.4. Health Services Insurance Fund (a) Funding to Health Authorities, Acute Care Services $870,311,300.

Mr. Daryl Reid (Transcona): Could you indicate to me, are we on the line dealing with health facilities?

The Acting Chairperson (Mr. Helwer): We are on the line dealing with Acute Care Services actually.

Hon. Eric Stefanson (Minister of Health): The answer is yes, this is where facilities are funded from. Just to clarify, when I say facilities, I am referring to hospitals. Obviously personal care homes are in another line, but hospitals are funded from here.

Mr. Reid: This would deal with Riverview Health Centre then. I believe this would be the appropriate area then for asking questions with respect to that particular facility. I wanted to ask the Minister of Health: can he tell me, because this involves the food that is distributed to the patients of that facility, what flexibility do they have in amending the orders for patients that are either resident at the Riverview in more of a long-term sense or for those patients that move in and out of the facility? What type of flexibility do the patients have with respect to ordering their food?

Mr. Stefanson: Just to get a sense of the nature of questions to try and have appropriate staff here, if we are going to be sort of general, this is basically the appropriate staff, the deputy and the assistant of the deputy. If there are very specific questions, especially if we are going to get into food in some detail, there is probably a different staff person I would have join us.

I can provide some just basic information on Riverview, that I believe the menu changes on a three-week cycle at that facility. If there are any special diet requests, those are in fact met, but in terms of beyond special diet requirements in terms of any other specific adjustments to the menu, I will have to get back to the member, Mr. Chairman.

Mr. Reid: I am looking for some understanding here about the flexibility of the foods services or the ability of the Riverview Health Centre to provide the meals for patients, for people that go into Riverview Health Centre, to find out their ability to respond to short or little notice requests.

I have a specific case that I will raise with the minister, but I am just trying to get an understanding of how the system functions within the Riverview Health Centre as it currently exists. Then I will go directly into the micro part of the question, giving you some background on what I have encountered with a family in my community that has some difficulties with that centre, and then I will draw that detail to your attention in a moment. If you can just give me some background on how it is able to respond to the specific diet requirements.

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Mr. Stefanson: I apologize, Mr. Chairman. What I am told is at Riverview they can meet a special diet requirement or a dietary change in anywhere from two to four hours notice. They are on a computerized system into which that information would be obviously inputted and forwarded through to USSC and those adjustments made for an individual patient at Riverview. In terms of issues related to food services, as the member for Transcona (Mr. Reid) knows, there is a long-term care food advisory council, which deals with various issues relative to the delivery of food, quality of food, and so on. They continue to deal with any concerns raised by individuals in any facilities. They have really done a very good job of eliminating and reducing various concerns in the facilities and in the system.

So, with those comments, I would be very interested in the specific situation that the member is going to share to get a sense of what has happened in an individual case.

Mr. Reid: I appreciate the minister telling me that Riverview can respond with two-to-four hours' notice, which seems to be at odds with what I am hearing from a community family. During my door-knocking in the community I have encountered a family who has a child, an adult child, in the Riverview Health Centre, and that young adult is disabled fairly severely and has an illness, for which my understanding is there may or may not be a recovery. In other words, it is a lifelong illness. There are also other complicating factors with this young adult in that there are problems, I believe it is with the lungs. And there is an imbalance in the blood, and there has to be regulation of the diet to make sure that there is some balance and that the individual does not deteriorate further in health condition as a result of improper diet.

The family tells me that they have had to, for some time now, take food in to their son at Riverview when he is in there, because he is not in there on a continual basis, but when he does go in because of his condition, he is in there for periods of time, in other words, more than just a few days, it is into the weeks. They tell me that they have to take food in to their son. Of course, I would think that that would be inappropriate, that that would be able to be taken care of by the hospital itself.

The family tells me that they have to do that because the Riverview Health Centre cannot respond quickly enough to the change in the diet requirements for the individual to match the needs, with respect to the diet matching the condition, and they tell me that–and I do not mean to in some way say that the nurses are doing inappropriate things, because I think they go far beyond in their service to the patients at that facility, but they do provide the opportunity for alternate food in the sense of toast and other small food items. So they do help the patient out in that regard.

The family is very, very adamant that they do not want me to raise their name and that they do not want to get the nurses in trouble at this particular facility. So I say to you in very guarded comments about the situation because they do not want to have any retribution in the sense of the fear that I sense in the comments that they have made to me. They say that the hospital cannot respond in a short time to that diet requirement, and that is why they have to bring in food.

So if the minister can tell me and assure me that the Riverview Health Centre is able to respond in two to four hours notice, then I will take that back to my constituents and get them to ask that centre why the meals cannot be supplied and cannot be structured in such a way to match the diet requirements for their son who is a long-term resident of that facility.

Mr. Stefanson: Mr. Chairman, it is confirmed to me again that for that first meal, it might be a two to four hour adjustment. After that, if this individual, as has just been described, even though he is not in there on a permanent basis, comes in and then stays for days, there might be a time lag of two to four hours for that first meal, but after that there should not be any problems.

So I would certainly encourage the member to pass on that information, but I am probably more concerned with the latter part of the member's comments in the sense of the family being nervous to either come forward in any way, whether it is to Riverview or to this Legislature or to any body, because the whole objective to all of this is to continue to ensure everybody is doing the utmost to meet the food requirements, the food nutritional value, the food quality, and to continue to address and improve all these issues. Really, the only way is if people do have concerns, that they feel comfortable bringing them forward directly to the people providing the service.

I am certainly trying to do and am prepared to do anything I can to break down any of those barriers if people are feeling that in any way, because there will not be, there should not be any retribution towards any individual or family for bringing forward a concern about any kind of service, whether it is related to food or any kind of service that they are fielding in facilities. These are facilities Manitobans own and pay for. They should feel comfortable raising any issues if they feel they are not getting sufficient or adequate medical services, food services, whatever it might be.

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So that concerns me the most of the comments, and I would encourage the member to encourage this family to come forward. I can assure him that there will not be any retribution to the family, and we will collectively deal with the issue. Having said that, if it is sufficient to go back to the family and let them go directly to Riverview, that is another way to deal with it. I appreciate those comments.

Mr. Reid: Well, I appreciate what the minister is saying. I know the family, I would hope, would take some comfort in what the minister is saying with respect to their rights and their abilities to tend to the needs of their son and make sure that the health centre would do likewise. In this case, the family is also worried about not wanting to get the nurses in trouble, because the nurses do go above and beyond in trying to assist the patients who are in that health facility. When the meals, the appropriate meals that match the diet requirements for that young man are not available to meet the needs, from what the family is telling me, then the nurses do provide some food, because the individual cannot just starve, cannot go without a meal, because it will create further complications.

So perhaps what I can do is take the minister's comments back to that family and make them aware of what has been said and then have them either contact directly the minister's department, if they choose, or Riverview Health Centre directly to make sure that they can respond within the two to four hours as the minister has indicated here. I hope that would solve that particular problem.

If I can move on to another facility, can the minister advise me whether or not the St. Amant Health Centre is a part of this particular area of his budget. Perhaps he can indicate that to me now, and then I can go on with my questioning from that point.

Mr. Stefanson: When it comes to St. Amant, perhaps the reason the member asked me the question was because when we released our recent '99 capital budget there was reference to some improvements at St. Amant Health Centre. Through the Department of Health, we do provide the capital dollars. All of the operating dollars are provided by Family Services. In terms of any questions, we are not at the Capital section. When we get to the Capital section, I would welcome questions in terms of the capital, but the operating dollars for St. Amant Centre all come through the Department of Family Services. I hope that is helpful.

Mr. Reid: The question I have is with respect to a letter I received recently from a constituent, an elderly lady in my community whose son is in St. Amant Centre. She is getting billed by the St. Amant Centre for services that are apparently being provided by the centre. They include foot care and other medical costs, as is indicated on the statement of account that is sent to the family. I did not know whether it was appropriate to ask questions, because there are some medical issues that are involved here, whether or not that would come under the Department of Health budget line or that would come directly under Family Services.

So I am looking for some guidance on this. If it is not for his department, then perhaps I will take this matter up when the other more appropriate department comes before the Assembly.

Mr. Stefanson: Mr. Chairman, as I have already said, Family Services provides all of the funding to St. Amant. If the member wants to give me more specifics around the nature of the service that the individual was billed for, I can certainly follow up through our department in conjunction with Family Services. I am more than prepared to do that. If the member wants to wait and appear at Family Services, that is fine too. I really leave it up to him.

Mr. Reid: Well, perhaps I can do it through the Ministry of Health then, and then if an opportunity presents later for me, I can also do it through Family Services department Estimates.

The senior in my community who has the son in St. Amant has received billings for some time, and, of course, she is on a fixed income. She is quite elderly. Her son has been a resident of St. Amant for some time, and she has billings here for a variety of items, some of which are health related and many others which are not. One particular bill, statement of accounts, is for over $400; another one is nearly $300. She is getting these every few months. For a senior on a fixed income, of course, it is very hard to pay for that for someone who, in essence, I would think, would be protected under the Public Trustee's office for any of those expenses because there would be no other source of income, no gainful employment for the individual as a resident of St. Amant.

They are being billed for such things as Tylenol, bed pads, other hospital supplies. At least that is what is indicated in the letter that I have received. In other words, it is part of what one would consider to be medical costs. I do not know if that is appropriate, if that is a standard practice to have those costs shifted from the St. Amant Centre over to the family members who have other family members that are resident in St. Amant, but perhaps the minister can advise whether this is appropriate to have these costs, what one might consider to be medical costs, transferred back to the families.

Mr. Stefanson: I think what would be the most helpful is if the member could provide me with copies of that information. If you are prepared to leave the individual's name on it, that would be fine and would make it even easier to follow up, but even if you felt you had to block that out. But, if you could provide that to us, then we will follow up and get back to you.

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Mr. Steve Ashton (Thompson): I would like to ask the minister a question in regard to an issue that is a major concern to us, and that is the priorities in terms of health care spending in this province. I know this is a concern that the minister may have already heard. It is a concern coming out of Reston in southwest Manitoba, and it relates to a proposed capital expenditure by the RHA, specifically to establish an extension on the hospital, a clinic. What is interesting is the residents of the community are saying that they have a current physicians' clinic in place which is far more cost-effective than the capital expenditure that will be required, about $430,000, to put in a specific extension to the hospital. There have been a number of public meetings. There has been a meeting with 100 people present, a meeting, I believe, with 200 who were present from that area.

I would like to ask the Minister of Health what the position of the government is in terms of these types of priorities. Does the minister not feel that in this case, where you have the community itself saying that the existing arrangement which has the clinic available in a normal commercial space, would that not make more sense since it is far more cost-effective than to have a significant capital expenditure on a clinic extension to the hospital at a time, obviously, when capital dollars are scarce, when there are many needs in our system?

I wonder if the minister could indicate his response to the members of the community who are saying that they want the priorities for health care put toward patient care and not this capital extension.

Mr. Stefanson: Mr. Chairman, I think I can speculate what community the member for Thompson (Mr. Ashton) was referring to, but maybe he can indicate to me what community it is that he is referring to? [interjection] Reston?

Mr. Chairman, that might be the most appropriate, is to get a little more information from the member for Thompson. There is a capital project, if it is Reston, at the Reston health centre, a renovation being done at that facility. Again, as the member I know is well aware, these capital projects are done in conjunction with communities, in conjunction with the regional health authorities. In fact, the regional health authorities prioritize the capital projects when they submit them to the Department of Health. We review them with the RHAs, and so on.

In some cases, we have some relocations of some of the medical clinics adjacent to hospitals which allow for extended hours, better utilization of the staff available in communities. Certain communities have been very supportive with that change in focus by the co-location of a medical clinic and the hospital. But if the member would provide me with specific information, I am certainly prepared to look into, if it is the community of Reston, the issues he is raising here this afternoon.

Mr. Ashton: I certainly will provide more information, and I want to stress that one of the paradoxes here is that the community is clearly stating that they do not want this. There have been a number of public meetings. You will have to forgive me if I revert to my own situation in my own community where there are many capital needs, and it just does not make sense to–regardless of what the process was within the RHA, you have a community that does not want the capital enhancement. I believe it actually may even result in fewer beds with the way the facility is going to reconfigure. Quite frankly, that money would be better spent in other areas of the province or perhaps on other needs in that particular regional health authority.

I will provide the minister with details on that. I have spoken to people in that community. It may be something, as well, that he may wish to talk to the MLA for the area on. I am sure that he is aware of that as well. To my mind, it just makes sense, once again, that if the people in the community prefer the existing arrangement, why spend scarce capital dollars on this capital improvement?

I want to add on that, that there have been a number of other capital projects brought in by RHAs that have been questioned in the same way. I think with this process being a relatively new process, when so much now being weighted on the regional health authorities under the new structure. I think the minister is aware of that.

We waited for a number of years, for example, for personal care homes. When I raised the issue in Thompson of the need for a personal care home, I was told after the freeze in 1995, wait for the regional health authorities. We are now in that process. There is a process ongoing in my constituency on that particular area, but if I had more information I would ask the minister to look at that and quite frankly I am not trying to get involved in that issue directly, other than to express to the minister that there are a lot of people in that community who are saying this does not make any sense. My hope would be that whatever decision is made does not end up with a situation where the community ends up getting a capital facility that it does not want and replaces an existing structure, commercial structure that has worked quite well, and it does not make sense when dollars are scarce. So I will provide more information and I urge the minister to look into this and listen to the people of Reston in Manitoba.

He may even wish to travel to southwest Manitoba. I am sure he has done this in the past. I am not sure, he could do a lot of things this time of year. Probably he would have to take his canoe. I might be a good opportunity to go visit southwest Manitoba at a time when it has gone through a lot of difficulties economically because of the situation.

But I have been in southwest Manitoba, I have been in Virden a number of times the last couple of months and I intend on going back. It is a very interesting part of the province and you know what I found interesting, and I say this to the minister just in the completion of my remarks here, I found a lot of similarities. A lot of people in southwest Manitoba felt just as isolated as northern Manitoba in terms of decisions being made in Winnipeg and I am not talking about the Nestibo situation. I do not want to get into that in health care Estimates but just generally there is a sense out there. I visited a hospital as deputy Health critic for our party, I visited two personal care homes and what there were talking about was physician shortages, nursing shortages, difficulties in terms of access to specialist services, people having to travel into Brandon and into Winnipeg for services that could have been provided in the past in their community. Once again it gets to the point of the priority in southwest Manitoba, according to the people I met with, people working in health care, people were patients, they all identified priorities and quite frankly the priorities that they were looking at tended to be in terms of providing physician and nursing resources not this particular capital project.

So I do urge the minister to listen to southwest Manitoba on health care issues. When I find myself saying, as I said when I was out there: there are a lot of similarities. It seems the further you get away from the Perimeter, quite frankly, the more your health care system generally in this province has fewer and fewer resources and the more alienation people have from the centre of government. It is sort of ironic, in a way, that I was hearing this message in southwest Manitoba, not an area that people necessarily identify in the same way that northern Manitoba obviously gets identified that way. I mean, southwest Manitoba, with its traditional support of the Conservative Party, at least up until recent events and as I say, I am not getting into that, but that alienation although I am sure if the minister was to go out now he would want to be well briefed on the Nestibo nomination situation. I just warn him of that because I talked to quite a few of my contacts out in southwest Manitoba and it is pretty hot out there, but on health care southwest Manitoba is asking to listen to the communities in this particular case, the community of Reston, listen to the residents of Reston and perhaps talk to the RHA and urge them to make sure the health care system in that community is responsive to the needs of the community not other needs as they might be identified by the regional health bureaucracy in that area.

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Mr. Stefanson: Mr. Chairman, there really was not a question, so I will just very briefly–I do not think that there was a question at the end of that–respond. I wait for more information on Reston. I assure the member these projects are done based on input, consultation with communities, with RHAs. I know when we announced our capital projects for 1999, the regional health authorities were very satisfied with the overall package because of that partnership, that consultative process. I have said to the member before that in my short time in this portfolio, I do believe in getting out to facilities, to communities to meet with people in their work environment in their communities. I have certainly done a fair bit of that to date, but I look forward to doing more of that. I am a little restricted these days to go because I am currently in the midst of my Estimates. I have a little less flexibility than some other members have right now. I think last week the member for Thompson (Mr. Ashton) was promising me a pair to go up North, so I am still looking forward to accessing that commitment sometime soon.

I do agree with that part of his comment, how important it is for us, whether we are in government or not in government, to get out to communities, to get out into facilities, to hear first-hand from people in their communities. I have a different perspective in terms of a lot of what I am hearing from people in terms of their level of satisfaction with a number of issues, including health care. That is not to say there are not still some issues to address in terms of meeting some of the physician needs, and so on, into some communities, but we do continue to work with the RHAs and work with the communities to do just that, to make sure they have adequate physicians and quality health care services, Mr. Chairman.

Mr. Chairperson: Did the honourable member seek leave to ask questions from the front yet?

An Honourable Member: Mr. Chairperson, I was told that that was not required two Estimates ago.

Mr. Chairperson: Only if leave has–

An Honourable Member: The Clerk told me that this had been changed.

Floor Comment: For the critics.

Mr. Chairperson: For the critics. You are not listed as a critic.

An Honourable Member: Then I will ask for leave.

Mr. Chairperson: Is there leave for the honourable member to ask questions from the front bench? [agreed]

Mr. Tim Sale (Crescentwood): Thank you, I apologize. I did not realize that it was just for the critic. The minister probably expected that I would like to talk about frozen food a little bit in regard to the hospitals that are part of Urban Shared Services Corporation.

I would like to start by asking what studies were undertaken prior to the commitment by the government and the Department of Health to the Urban Shared Services Corporation approach of a shared commissary. What consultant reports, technical studies were undertaken?

Mr. Stefanson: I am told that in 1994 a cost comparison was done by Manitoba Health of the status quo versus a centralized commissariat costing. Then, in July of 1995, Price Waterhouse undertook a review of nine Winnipeg hospitals and three personal care homes in terms of their needs for food service facilities and the options to go to a centralized system. Then ultimately Urban Shared Services Corporation further refined their business plan in 1997 based on some discussions and negotiations with Versa Aramark.

That is the information I have before me this afternoon, and I will certainly look into this matter further. If there are any other studies or any other reviews that have been done relative to this, I will report that back to the member, hopefully, in the next couple of days for sure.

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Mr. Sale: Was the study for Price Waterhouse the one that was transferred by letter from Merrick [phonetic] Watts and Price Waterhouse to Michael Kirkpatrick on June 7? Shared Food Services business plan, is that the document that the letter refers to?

Mr. Stefanson: Mr. Chairman, I apologize for the delay. I have taken so long, I have almost forgotten the question. But I think the genesis of it was that Merrick [phonetic] Watts were really a part of the Price Waterhouse study, basically worked in conjunction with Price Waterhouse in the development of that study. If that was basically the question, the answer to that is yes.

I think the member referred to a specific letter and date that I do not have here this afternoon, that I could find a copy of a letter dated in, I think he said 1997. So if he has a copy, I would certainly welcome that, Mr. Chairman.

Mr. Sale: Mr. Chairperson, we have asked a number of times, and I will ask again. We are aware of the study, but we do not have a copy that is the final study. So we would like to have that. Given that the policy advice presumably was followed by Urban Shared Services Corporation, I am at a loss to know why that Price Waterhouse study would not be tabled.

The same goes for the business plan. We have drafts, but we do not have the final business plan. It seems to us that it would be sensible for the minister if he is confident of the numbers contained in it, some of which he was citing in Question Period today, and I am wondering if I could ask him again today, will he table the business plan of USSC that was given to the hospitals in July, I believe, or late June of 1997 and the Merrick [phonetic] Watts-Price Waterhouse study of June 1995 which led to the decision to go to a single commissary model.

Mr. Stefanson: Mr. Chairman, I understand this question was asked last year during the Estimates process. Again, I think what I am prepared to do is to look into the entire matter–this is not something new; it has been around for a while–what the reasons given in the past were, why it was not made available. I know one issue is that it does I believe require the co-operation and approval of the Urban Shared Services Corporation itself. I should say at this point in time, my comments are initially on the business plan.

An Honourable Member: I really cannot hear. I am saying I cannot hear whatever it is you are saying. My ears just do not work that well. I can hear the minister.

Mr. Stefanson: I was just being reminded, you had asked about both. You had asked about both the business plan and the studies that were done. I am, in terms of my response, initially splitting them. I am talking about the business plan itself initially. That request was made last year during the Estimates process. I think the previous minister wrote a letter to the Urban Shared Services Corporation, and I now need to follow up and see what happened, what reasons were given, why the information is not being made available. I have indicated a willingness to look into that, and I am prepared to look into that, as to whether or not that information should be made available. Along with that, as the member for Crescentwood (Mr. Sale) knows, there is going to be a revised business plan very shortly, so again I will continue to get the same question, I am sure, either in this House or through the media, about the revised business plan on a go-forward basis.

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So I really am looking at that entire issue in terms of what can be made available, if it can be made available, what some of the concerns are about making it available and so on. So I will look into the matter further, and I will report back to the member.

I think to a certain extent again the same applies on these studies that have been done. I know they have been asked about in the past, have not been released in the past for various reasons. Again, I am going to go back and review what those reasons were and whether there still are good and valid reasons not to be releasing the original studies.

In many respects, I see a lot of merit to having the information out there and being able to discuss it relative to today's situation, but I need to determine what concerns have been expressed in the past because these studies have been around for a few years, what they were, what the concerns are of the Urban Shared Services Corporation.

While I am on my feet, I should probably also indicate that I, as a result of questions here, have communicated with the Urban Shared Services Corporation on the contracts that I have been asked about during Question Period, and, again, we are in the process of determining what can be released there with a view of applying the same criteria that we would apply to any government document. That is going to be basically the test that I intend to have our department apply. If they are contracts that we would have to be releasing or should be releasing as a government in their totality, that would be what I will pursue. If it is releasing them with some modifications, if there are third-party confidentiality clauses that have to be blocked out or whited out, that might have to be done to protect certain issues, but that should not preclude releasing a good portion of the contract as well. So I am in the process of having that discussion with the Urban Shared Services Corporation.

Mr. Sale: Mr. Chairperson, it is probably not a productive discussion to engage in for any great length of time, but it is just astounding to me that the minister thinks that there might be something untoward about releasing a document that is clearly in the public interest to know whether the concerns being raised by the opposition and by the public have basis in fact in terms of the figures that are in the business plan. The public has an enormous stake in this issue. The mortgage is for up to $30 million. I do not know what was drawn down on it. I do not know what the mortgage rate was, although the maximum rate stated in the Land Titles Office document is 25 percent. That is clearly the legal maximum. Whatever the rate that was finally concluded will be something under 10, I would expect.

I simply do not understand how a minister of the Crown, a former Finance minister, can say that it is not in the public interest for the public to know the terms of a mortgage and the terms of a contract that is in the $30-million region in total and involves millions of dollars annually and meals, nutrition for thousands and thousands of Manitobans, many of them long-term care patients. Transparency is seen to be an important public virtue, except it seems when this govern-ment is asked for contract documents that would allow that transparency to be real for Manitobans.

So I hope the minister will find that it is in the public interest in his discussions, but I would say to him that his predecessor had a year to act. He has had more than a month to act, and when it is in the public interest of the government, it is astounding how quickly things happen. Things get built, things get done because the power of government is there to have that happen quickly. So, when things take a great deal of time, it is not an unreasonable assumption that it is because the government perhaps does not want them to happen or at least certainly does not want them to happen very quickly, perhaps does not want them to happen until after an election.

I wonder if the minister knows of the study by Leo Paul Lauzon [phonetic] and Martin Poirier [phonetic] entitled Socioeconomic Analysis: The Streamlining of Food Services in the Quebec Hospital System, 1995. Is he aware of that study?

Mr. Stefanson: Mr. Chairman, maybe just initially to respond to the comments about releasing documents, in spite of what the member may think on occasion, I do tend to agree with a lot of what he has said about releasing documents, and I do believe in it. I am not suggesting there is anything untoward about these documents. I do believe it is in the public interest to have any work that has been done, any research, any information out there, whenever possible.

I think the member indicated that I have had this for a month. I am not only dealing with just government. I am dealing with a number of entities that are impacted by these, from the Urban Shared Services Corporation itself to a private sector firm that is delivering some of the services to the hospitals and so on. So I am in the process of looking at it because, as I said in my previous response, I think there is a lot of merit to that information being out there to see what the original–when I say to see, to let others see and let the public see what the original plans were and the estimated capital costs, the operating projections and so on, to use that as a benchmark against how things are progressing today. I think there can be a lot of merit to having a more meaningful discussion on that kind of a basis. So I am going to be looking into that whole issue of what documents can be made available publicly.

Certainly, in many cases, my personal track record would attest to that. I know when we had the entire review done of the Immigrant Investor Program, when I was Industry minister, there was some concern expressed about releasing those documents. We released them very shortly after our receipt of those documents because it was important to have an informed discussion on that whole issue.

So in terms of the objective that the member was suggesting about it being in the public interest, having informed debates, I agree with that in terms of the more information we can collectively have before us, the more informed discussion we can have. Obviously, we might disagree in terms of issues around it, in terms of performance, in terms of objectives, and all of those things, and that is fair game. So I will be looking at this seriously with a view to releasing as much as I can in this area.

In terms of the Quebec hospital document that I think he said was done in 1995, or the '95 document, I have not seen that document, so I have no familiarity with it.

Mr. Sale: Mr. Chairperson, I was not assuming that the minister would necessarily have seen it. I was wondering if it was one of the documents that the department was aware of, that they might have consulted in regard to the cook-chill-cook-freeze method that was adopted.

Mr. Stefanson: Well, with the staff here with me this afternoon, there is no specific knowledge of that study. The cost comparison by Manitoba Health, of course, as I have already indicated, was done in 1994. The Price Waterhouse study was done, I believe, in July of '95.

Now, whether or not the Price Waterhouse–and this Quebec study was done, I gather, in 1995, so I am not sure of the timing of that study, the release of it–whether or not the Price Waterhouse study had accessed that as a resource in any way, I would have to check, Mr. Chairman.

Mr. Sale: Mr. Chairperson, there is another study by a professor, Dr. Denise Ouellet. It probably did not come to the department's attention because it is in French, but it is Impact sur la qualité des aliments des modes de production et de distribution des services alimentaires hospitaliers (Québec: Laval University, 1994).

That is another very useful review of the issues, which I think are very well known across the field. I do not expect that the minister would have any knowledge of that, but I wondered if the department was aware of that study.

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Mr. Chairperson: Could I ask the member for Crescentwood if he would have a copy of that, that part that he just read, so we could give it to Hansard? It would make it easier for them, rather than them having to go through the translation, if you have it available.

Mr. Sale: I have the title in the form of a footnote, which I would be glad to share with the translator.

Mr. Chairperson: With Hansard after. Thank you.

Mr. Stefanson: Mr. Chairman, again, the answer is no in terms of the department officials here with me indicating an awareness of that study, but I think it is important to recognize that there was a study done in Manitoba by Price Waterhouse in July of '95, who obviously brought certain expertise to this issue as well as working in conjunction, as we have already discussed, with Merrick [phonetic] Watts Incorporated who again bring significant expertise in this entire area. Whether or not they accessed and referenced those two studies the member refers to in any way, as I have already indicated, I will determine whether they used those studies in any way as background or resource for the work that they did here in Manitoba.

But those two firms, Price Waterhouse and Merrick [phonetic] Watts, brought significant skills in this entire area, Mr. Chairman.

Mr. Sale: Mr. Chairperson, those two firms in fact do studies all across Canada, and they never reference any data whatsoever. They do not reference studies; they do not reference academic studies; they do not put footnotes in; they do not provide a bibliography of studies. So I have no idea whether their studies in British Columbia or Quebec or Toronto or here, all of which are essentially clones of each other, were based on adequate scholarly research or whether they were based on simply replicating their recommendations from elsewhere because they, for whatever reasons, have a great deal of interest in the privatization of food services.

So I have significant interest in whether there is any scholarly research, solid research, behind a great number of the things that are contained in the assumptions about centralized food services.

I want to just reference a number of issues. I do not believe in Canada that there are any regulations similar to the British regulations in regard to temperature control of chilled processed food that has been cooked, chilled and is being held for reheating. I wonder if the minister is aware of any public health regulations that regulate the temperature and require regular assessment of the actual conditions in the food preparation chain by public health officials. Are there any temperature requirements in The Public Health Act or regulations?

Mr. Stefanson: We have dealt with the Public Health section previously, but I know the member is relating this both to Public Health and, obviously, to the Urban Shared Services Corporation and the food services to the hospitals. There are food and food-handling establishments regulations, and I will certainly return with details for the member on all aspects of the regulations here in the province of Manitoba as to all of the areas that they cover in terms of food handling and food preparation. Obviously, the relationship that Urban Shared Services has with the hospitals requires the corporation to meet the level of food quality and standards that the hospitals would expect.

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Mr. Sale: Another study that might be of interest is Nicholas Light and Anne Walker, Cook Chill Catering: Technology and Management, London, England, Elsevier Science. It dealt with some of these issues, and I am told that in Canada there is no regulation in specific regard to cook-chill technology.

The British Department of Health in England developed regulations in 1980, revised in 1983 and again in 1989, to deal with new food service technology such as cook-chill and cook-freeze. According to British cook-chill standards, food must be completely cooked and then chilled rapidly and held for a maximum of five days just above the freezing point, zero to three degrees Celsius. Immediately upon removal from chill conditions and shortly before consumption, the food must be reheated to a minimum core temperature of 70 degrees Celsius. In addition, the British standards require regular testing of all food with samples taken immediately prior to meal delivery, not at the assembly point.

In Canada, there is no regulation of cook-chill other than normal public health for restaurants, but normal restaurants do not do cook-chill, so we are in a different field here. I am well aware that there are food handling, food safety regulations. My partner has to deal with them all the time at St. Matthew's-Maryland, and they are quite extensive, but I do not believe they deal with this situation.

I want to ask the minister whether he knows the costs associated with the carts, each cart, the rethermalization, reheating carts. I believe that the cost is in the order of $15,000 a cart, but I would just like to have some confirmation that that is the ballpark. I do not need an exact cost, but a ballpark.

Mr. Stefanson: Mr. Chairman, I believe the member is in the ballpark on his cost estimate, and I will return with a precise cost for his benefit.

Mr. Sale: Mr. Chairperson, it was the hope that we could use the automatic cleaning approach here, the power cleaning as opposed to a hand-cleaning approach to cleaning the carts for all of the food residue, or do they have to be done by hand?

Mr. Stefanson: Mr. Chairman, I will return with the specifics on that question as well. I know the member has a very keen interest, a high level of interest in this whole area. His colleague was encouraging me to go to communities and visit hospitals and individuals outside of Winnipeg, and I am not sure if he has had an opportunity to visit the Urban Shared Services centralized site and to get a full briefing on the whole process and so on. If he has not, I would certainly offer to arrange that for him.

Mr. Sale: Mr. Chairperson, I appreciate the offer. I have not had an opportunity to tour through the site. I think that would be a very good thing to do. We have certainly had many reports from workers inside the site about both the positive and negative aspects of it, but I would be very glad to do that. I will just conclude this question. I want the minister to understand that I am not interested in detail per se, I am interested because the overall technology that has been purchased here has proven problematic all over Canada. For example, in Toronto, the $15,000 carts broke down far more frequently than they were advertised to have problems. The repairs are very expensive. The autocleaning function, which they were sold on, which would save labour and allow them to be more cost-effective, proved not to be effective, was not sanitary. These carts then had to be scrubbed down by hand. Now, that takes more time, it takes more labour, it costs more.

After we have a bit of a break–I believe the Chair is suggesting we have a five-minute recess–I want to simply explore a number of areas in which it seems to me that the evidence that we have from other places in Canada and from staff of this facility are that foolish decisions were made in response to promises perhaps by Merrick [phonetic] Watts, perhaps by Price Waterhouse, perhaps by goodness knows who, that this would be cost-effective, would save money and save time and would produce higher quality food.

So I simply want to draw for the minister a picture of information we have been given and the information that we have gleaned from research and invite his response. He chooses to be very personal in his attacks in Question Period in response to information which has been provided to us and which I have attempted to verify. If information is incorrect, I will be the first to apologize. The difficulty is when we ask for verification, we do not get it. We simply get a stonewall that says, I cannot provide you that information, I do not have that information, it is third-party information, we cannot release it.

So I am going to spend some time going through the studies that we have assembled, sharing the concerns that have been shared with us and inviting the minister to comment or to provide alternative information which challenges information that we have been given. I want to put on the record that it is in no member's interest, and certainly not in this member's interest, to knowingly bring incorrect information into the House or into any debate. It is foolish, would be foolish. So I think it is very important that we get as much factual information on the table as we possibly can. That is what I intend to do this afternoon.

Now I understand the Chair is suggesting a short recess, and I am certainly agreeable to that.

Mr. Chairperson: Take a five? [interjection] Sure, let us take five.

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Mr. Stefanson: Madam Chair, I really do not have anything else to say. I think the member more made a statement than asked me a question. I think he outlined that he is going to ask a number of detailed questions. I will certainly do my utmost to provide what we can today. Recognizing if he is getting into detailed operational questions or suggestions, then I will probably have to return to him with responses to those. I certainly would encourage him to take up my offer for us to arrange for him an opportunity to tour the facility and get a presentation on how the whole operation functions.

Mr. Sale: I certainly will avail ourselves of the minister's offer to tour the facility. I do not know the name of the manufacturer of the cook-chill system that is being used here. Primarily, I guess it is the manufacturer of the carts. I would just note that in Jonquière they had very serious problems, basically, finally gave up on the cook-chill system. That is my understanding. Patients were complaining about stained trays, chipped dishes, because of the force that needs to be used to clean them after things have been cooked on. It is very hard to clean them, as I am sure anybody who has tried to clean up something that has been left in the oven for a long time knows. If it has been held for a long time in a dish, it is hard to get the dish clean.

The Lions Gate and Burnaby hospitals in Lower Mainland B.C. experienced similar problems with the cook-chill system. They have had a lot of leakage from trays. Carts have broken down. The project is already one-third over budget. This was 1995. A one-year warranty on the carts, of course, is not very long when they are supposed to have a 10-year life. Two other B.C. hospitals, Penticton and Riverview forensic unit, reverted to conventional food production after experiencing serious problems with cook-chill technology, and they found, much to their surprise, that they saved $70,000 in the first year. That is a very small forensic unit, and Riverview is a very small unit. So $70,000 is a lot to save.

Another major issue which has been brought to our attention by nurses and staff at Deer Lodge, particularly in the units, the several, many units, in fact, that care for people who cannot physically open the packages–I am sure that staff have heard about this problem. Everything is packaged for sanitation reasons, and many people who have serious arthritis or other difficulties with their hands or who have had strokes or for whatever reason cannot open the packages, the nurses tell us that they have to, between themselves and the other staff on the floor, open virtually every package that comes with the trays.

That creates an awful lot of use of time which I am sure was never budgeted into the system. But because of the packaging, and this is something which is also noted in this study and it has been noted by other researchers, the American researchers Greathouse [phonetic], Gregoire and Speers [phonetic] and others, who have found from their analysis of different food service systems that food costs were considerably higher in the cook-chill system compared to the conventional method because of the wasted food resulting from volumes that have to be set longer in advance leading to surplus food being discarded, because the cycle of planning requires a number of days in advance.

The other area of wastage which Deer Lodge people tell us is amazing is the amount of packaging. There is a huge amount of packaging going out in the garbage because every single item has to be prepackaged. Even a piece of toast is packaged in my understanding.

So I do not know that these costs were ever taken into account when the original budgets were put forward. I wanted to ask the minister if he could tell the committee whether he is aware of the staffing levels that were planned for the facility at full production, the number of equivalent full-time positions that were estimated to be needed to operate the facility?

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Mr. Stefanson: Madam Chair, I think on some of these questions what I will try to do is–I would like to give the member, obviously, accurate information. I think his question was how many positions or EFTs at Urban Shared Services Corporation, how many employees do they have?

If I cannot give that to him before we adjourn here today, we are back in Estimates tomorrow morning, probably at ten o'clock. I can certainly provide him that information tomorrow morning.

Mr. Sale: I think actually we are going to be in private members' tomorrow morning, but maybe in the afternoon we would be in Estimates again.

Let me just share with the minister my understanding that the labour negotiations were based on 117 staff and approximately 84 EFT. I may be out by a couple in there, but that was the budgeted level in the labour negotiations that took place to transfer workers. My understanding is that Mr. Sheil in Toronto, in March I believe, no, it was in April, indicated that there are 137 staff numbers now, but I do not believe that is EFT; I think it is numbers.

I am wondering what the EFT is now that those 137 that Mr. Sheil referred to in Toronto might amount to. I can understand if the minister does not have the information so let me just go on then, unless the minister wants to respond.

Mr. Stefanson: That is exactly the information that I am intending to provide the member, if not today by tomorrow, the issue of the number of staff and also the number of EFT.

Mr. Sale: Madam Chairperson, my understanding is that staff are working flat out at the present time and that the Urban Shared Services Corporation board and staff are very pleased with the staff efforts. They believe their staff are doing everything possible to make the system work properly, and they feel that their staff deserve credit for that.

I certainly support them in that regard. I believe that is true. I believe that they are proud members of a proud union, and that they do the very best work they can do to meet the needs of the employer and to meet the needs of patients in our hospitals. So I have no criticism whatsoever of the staff or of the pace that they are working at, but I want to just refer to some very serious concerns that were raised in some of the studies in regard to labour issues.

The issue of cook-chill systems has been characterized by one study done by a national labour union in this fashion. While production staff may enjoy some advantages in the cook-chill system, the majority of food-service staff, those employed in assembly, delivery and washing, they find their jobs downgraded. Workers who assemble the meals often have to stand for hours doing repetitive tasks at a rapid pace. At the other end, washing cook-chill dishes is extremely difficult because rethermalization leaves stains encrusted on food. Supper dishes are usually left overnight and washed the next morning.

I believe, Madam Chairperson, that it is quite common for the return carts to sit in the trucks overnight outside the RDU, and then the dishes are washed the next day. I think that is the situation here. Not only is the work more monotonous and physically demanding, these workers do not enjoy any improvement in scheduling with cook-chill. The kitchen staff responsible for distribution and washing still work a seven-day week in the cook-chill system, so there is no improvement there. What we also have found is that the requirement for people to work in a cold environment on an eight-hour shift is extremely demanding. They are working in a situation where food is being assembled and kept at a low temperature and standing with very restricted movements for quite a long period of time.

We are continually hearing of staff turnover and the difficulty of keeping staff to work in some of the specific areas, but particularly in the chill area where people work in what we would, I think, as ordinary people would feel, would be a very damp and very cold environment for a long period of time with limited movement. So they certainly tell us that they find that a difficult kind of job to do, but I am certainly not being critical of the staff, and neither, in my understanding, is the board or management of USSC.

So I wonder if the minister has received the information that he was hoping to in regard to EFTs. Has that come down? [interjection] No.

Let me just continue with a couple of other concerns then. It is our understanding that the thawing room, which is where the frozen product is brought in and is gradually thawed until it reaches a temperature of a couple of degrees Celsius. It takes quite a long period of time for that to happen,. As anyone who thaws food out in their refrigerator knows, it takes a long time to go from 20 or 30 below to a couple of degrees above.

Our understanding is that that room is not of sufficient size and that, therefore, food gets pushed through more quickly than it should, and that sometimes it does not get properly thawed out. That is one of the reasons why sometimes people receive food that has not been properly cooked because it is still cold in the middle and may be very hot on the outside. My understanding from staff is that the room is undersized.

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Also, I understood that the roof this winter had a partial failure, and the building required some significant renovations. I do not know whether that was found to be a cost of the contractor or whether USSC had to pay that cost, but it certainly demonstrated the vulnerability of a single facility because, I believe, food had to be taken outside and stored outside the building for quite a period of time in trucks on the premises or off the premises. I think that also illustrates a concern about a totally centralized commissary in an urban area, with nine hospitals being served by the single facility. If the minister has information on that problem and how it was resolved, it would be interesting to have.

Mr. Stefanson: I too want to compliment the staff that work for Urban Shared Services Corporation. Certainly everything I have heard is they are doing an excellent job. I think, as the member for Crescentwood knows, the majority of them are represented by CUPE, and everything I have heard is that there is a good relationship, a good labour-management relationship, at Urban Shared Services. I have not had an major staffing issues brought to my attention. I recently met with Mr. Paul Moist to discuss various issues and, without putting words in his mouth, he certainly did not express to me any major concerns or concerns relative to Urban Shared Services and the staffing relationships and issues and so on. So there is obviously that whole opportunity to deal with issues between CUPE and management at Urban Shared Services Corporation, but I am not aware of any issues. In fact, quite the contrary. I have heard that there is a good working relationship, and overall a good positive environment at that facility.

The two specific issues that the member refers to, relative to the thawing room and the roof. I will return to him with specifics relative to those issues that he brought to our attention here this afternoon.

The issue of the vulnerability of a single facility. I know that there are contingency plans, just because of the nature of our climate in our winter months. I will return, providing the member with an outline of what those contingency plans are.

Mr. Sale: My colleague from Transcona (Mr. Reid) has one question that he would like to ask, and if the minister is prepared to shift gears for a moment, I know that he would appreciate that.

Mr. Reid: I have a question. I think it is related to hospital facilities and equipment, in particular, in those hospitals. I mean, there have been stories of recent, relating to the reuse of certain medical equipment within hospital facilities. I would like to ask about the procedures that are involved or the protocol that is in place to deal with the reuse of this equipment, and how the individuals who have been impacted, what process is being used by the Department of Health to notify or to contact the people that have been potentially placed at risk as a result of the reuse of the medical equipment? Perhaps the minister can advise on that process.

Mr. Stefanson: Madam Chair, first of all, on the overall issue of reusing medical devices that are designed for single use in our hospitals, back in mid-February, some concerns were raised primarily in some articles that appeared in the Winnipeg Free Press regarding the reuse of single-use devices in Winnipeg hospitals.

At that time, Dr. Brian Postl, the vice-president of clinical services, undertook a review of the issue and made the following recommendations to myself, the Minister of Health, on February 23, 1999. He recommended that the reuse of single-use devices cease in those exposures defined as critical; that a WHA committee be established to review the issue of reuse and report within six months; that this committee develop a single set of policies, protocols, quality assurance and monitoring systems; and that the ministers or their deputies initiate a national process of review.

I accepted all of those recommendations, and on February 24, 1999, the day after receiving the recommendations, the deputy minister, Mr. Carson, wrote to all of the RHAs advising them that the Minister of Health had approved the recommendations made by Dr. Postl regarding the reuse of single-use devices. The RHAs were asked to ensure that their policies and practices were consistent with those recommendations. On February 24, 1999, Dr. Postl wrote to all of the urban hospital CEOs advising them, again, that the Minister of Health had approved the recommendations regarding the reuse of single-use devices. The CEOs were asked to advise their staff and ensure that their policies and practices were consistent with these recommendations.

A WHA review committee has been established and includes RHA representation and will report by August 31, 1999. Manitoba is pursuing this issue of the reuse of medical devices at the national level through the deputy minister, and we will be certainly pursuing it at the ministerial level in terms of a national policy on the whole issue of reusing medical devices designed for single use in Manitoba. So right now there are various policies of provinces. We would have probably the most aggressive policy in terms of banning the reuse of certain single-use devices here in Manitoba right now while this study is ongoing.

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That is entirely different from the situation that recently occurred at St. Boniface General Hospital, which really had to do with the whole issue of the utilization of disinfectant procedures in a lab, where actually they can be reused and the issue was really the level of disinfectant. The individual was using a lower-level disinfectant than that individual should have been; therefore, the lab was closed. I think the member has probably seen in the news release the various information put out by St. Boniface Hospital.

They have corresponded with the patients that they believe were impacted. I believe they sent out just under 2,000 letters. They have taken a very proactive approach to dealing with the issue of informing patients. They also established a phone line for individuals to phone in if they were concerned, and to date they have received, I am told, about 150 calls. They have sent out the 1,900 letters, and they have had about 300 individuals tested at St. Boniface to date.

So, again, they acknowledge that it was an error in terms of the utilization of an inappropriate disinfectant. They have taken all the appropriate measures to inform patients that they think may have been infected, as they say in their news release and in their letters. They go on to say at length that we believe the risk of exposure to patients is very low; however, we are taking this seriously. As a result they go on to send the letters to each patient who has had one of the procedures since 1992. As I said, anyone with questions or concerns can call their patient relations office at 237-2306. They have also asked external groups of specialists to be involved to take an objective look. Of course they closed the lab, and it will reopen as soon as the hospital is satisfied that the cleaning procedures meet their current protocols and that all appropriate measures are in place to ensure patient safety, likely in early June.

So I could go on at length. I could certainly provide the information to the member for Transcona if he has not seen most of it in terms of the information put out by St. Boniface Hospital on Thursday, May 20, outlining this issue at their facility.

Mr. Reid: I thank the minister for providing some background, and, yes, I believe we have some of that information available through my colleague the member for Kildonan (Mr. Chomiak).

The minister referenced that there was just slightly under 2,000 letters that went out to inform patients of St. Boniface Hospital. I imagine he was referencing that they were potentially at risk as a result of the reuse or less than satisfactory disinfecting procedures for the equipment that was being reused. He said that he has mentioned about 300 that were tested by the St. Boniface Hospital, and I take it that was internal to the hospital operations where the tests were performed.

Is it possible that people that were infected, or put in a position of potentially being infected as a result of the reuse of this equipment, can have their testing undertaken by a private practice doctor versus the hospitals? Would that be permissible under the depart-ment's guidelines?

Mr. Stefanson: Yes, the option is there for individuals to go to their family physician and have the test done, and I am sure some are doing just that. The 300 tests that I referred to have been tests that have been actually done at St. Boniface Hospital, so I am sure some individuals are going to their family physician and having the tests done.

But I do want to make it clear that we are not talking here about single-use devices being reused, which is the issue I outlined at length initially. We are talking about devices that can be reused, but since 1992, unfortunately, this individual was using a lower level chemical disinfectant. When that came to light, that is what created the situation. That is why they are indicating that, because up until 1992 the lower level disinfectant was appropriate that the risk to the individual patients, the hospital is saying, is extremely low. They are taking the appropriate steps, and as soon as they believe that there is any risk, they are notifying the individuals. They are setting up a line, they are testing individuals at their site. But the member's question, absolutely, individuals can certainly go their family doctor and have the test performed.

Mr. Reid: The minister referenced a few minutes ago the fact that there were several documents. Because I have not had access to those, I wonder if the minister has a copy of the letter that the hospital may have sent out to the people that are potentially at risk as a result of the less than satisfactory disinfectant procedures, and if he can provide a copy of that letter for us because I have some questions that have been posed to me that I can pose to the minister, in turn, after I see that letter.

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Mr. Stefanson: Mr. Chairman, we can certainly provide that. We will try to provide it in the next short while, but we could provide a copy of the press release and the letter that went to the patients informing them.

Mr. Reid: Okay, that is reasonable. Perhaps, I can ask this question to the minister then: in that letter that went out to the patients of the hospital, was there an indication there that there would have to be certain lab procedures performed and that the reports that would be done by the labs would have to be returned back to the hospital? Is that a requirement of the process that you have in place?

Mr. Stefanson: Mr. Chair, we are waiting for copies of that letter, but I believe the letter indicated to individuals that if they wished to be tested, they could be tested at the hospital, and they would have individuals available to speak with the patients. But they also indicated, I think, that individuals, as we have already discussed here, could be in contact with their family physician for advice and support.

I know the question was asked, and is there a link back to that family physician informing St. Boniface? We will confirm whether or not that is the case, but I think it is also important to know that if any individual was determined to have hepatitis C or HIV, those are reportable to the public health officer, so that would happen and there would be the appropriate follow-up.

Mr. Reid: I do understand what the minister is referencing on the hep C, that there is a requirement to report, so I would understand that there would have to be a report going back to the Health department in that regard.

But in this case it is my understanding, and that is why I would like to see a copy of the letter, and this again comes from a constituent who is involved, has been told that first off that they had to go to the St. Boniface Hospital to have testing done, which to me seemed to be in a potential of conflict situation here.

Secondly, they were told that, oh, if you are going to go to your private practice doctor, after the constituent insisted on choosing that route, that the lab report after the test had been done on the samples that were provided by the patient, would go to the lab and be tested, but that report had to be returned to the hospital, not back to the family doctor that was involved. That is why I want to understand about the process that is involved in the procedures or the guidelines that you have set up with respect to reporting. So that is why I am asking you the question about what direction has been given in regard to the lab testing and the ability to see the family doctor for the appropriate testing. Perhaps you can advise on that.

Mr. Stefanson: Mr. Chairman, we are still waiting to get a copy of the letter which, I think, will clarify some of this. But my understanding is the letter, I guess, first of all indicated that St. Boniface was not necessarily asking patients to come in for testing, but then they were suggesting that if individuals wanted to be tested they could certainly contact the hospital. They also encouraged individuals if they thought they needed to or wanted to talk to their family physician for advice and support.

My understanding is how I have already answered the question. There is nothing stopping an individual from going to their family physician and having the test done. There is no requirement to be reporting that back to St. Boniface Hospital. We can certainly clarify that issue with the hospital, but, just thinking from a common sense perspective, there might well be some reason that an individual just wants to deal with their family physician and keep the confidences with their family physician for whatever reason. So there might be reasons that individuals want to do what the member is asking about and suggesting. My understanding is there is no requirement to be providing the results of that back to St. Boniface Hospital.

I will certainly follow up on that issue and confirm that that is the procedure that is being followed.

Mr. Reid: I appreciate that commitment the minister has made to follow up. The issue was drawn to my attention by a constituent just this afternoon. That is why I decided I would come back here and raise it with the minister, because it is her understanding that her daughter was involved in this and she had to fight first off to go to the family doctor first after the hospital was insisting that, no, they had to go there for the tests. Then, when the family absolutely refused, they went to the family doctor, but then the hospital is indicating to the family that the lab test results have to come back to the hospital, which seemed to me to be inappropriate. It should have been going to, and channelled through, the family doctor first. Then, if the family doctor and family choose to share that with the hospital, I would think that that would be the appropriate and the logical route and procedure to follow. If the minister concurs with that, then he can indicate so. I can forward that information on to the family to give them some level of comfort in this regard.

Mr. Stefanson: Mr. Chairman, that would be my position unless I could be convinced otherwise for some reason that I am not aware of, but, certainly, as I have already said, how we understood it to work was exactly as we have discussed here, that the individual has that option to go to their family physician and get the test done. If everything is fine, that is where it ends. They do not need to be forwarding those results to St. Boniface, but we will follow up. That is certainly my understanding of how it is meant to work and should work, and, based on everything I know of the issue, I support it working in that fashion. I will get back to the member.

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Mr. Reid: I thank the minister for that undertaking, and I will pass on those comments to my constituent to make sure they have full discretion over the procedures and process that are followed in this regard. If the minister can search that out with the hospital involved, I think it would help to clarify the interaction between the patient and the hospital.

I want to ask the question now. I do not know if the minister has his staff here available to assist in this, but I will ask the question anyway and he can advise.

When we were in Question Period just recently, we were asking questions with respect to neurologists and the recruitment of neurologists in the province. The minister referenced that there has been some recruitment taking place, and I know I have raised this issue with the minister with respect to epileptologists since Dr. Pillay had left the province of Manitoba for Calgary. It left us with a bit of a void in the province that we had no epileptologist.

Now, the minister referenced for us, in answer to the questions during Question Period at that time, that he had three and a half pediatric neurologists and that he had also brought four new people into the province as a result of his department's efforts to recruit. He referenced that Dr. Ahmad and a Dr. Hudson who will be joining the team of neurologists on July 1 of '99, just about a month from now, and that there have been four additional neurologists recruited, and that he is talking also about three and a half positions for pediatric neurologists and again another individual who brings some speciality in the whole area of epilepsy.

I am wondering if the minister can indicate, in addition to the two doctors that I have just referenced here, who the other doctors involved are that the minister has recruited as the four people that are coming to the province?

Mr. Stefanson: I did respond in part to the previous question the member had asked when I was responding to another question. So I will outline a detailed response to his original question. First of all, talking about adult neurology, Manitoba currently has 18 adult neurologists. Recently, as I said, four additional neurologists have been recruited. They are Dr. Ahmad, Dr. Stauber, Dr. Nagaria and Dr. Hudson are the four doctors that have been recruited. This recruitment represents a 20 percent increase in neurologists serving the needs of Manitobans. As I think I responded, two of these neurologists, Dr. Ahmad and Dr. Hudson specialize in epilepsy, which the member has inquired about.

While I am on my feet, in the area of pediatric neurology, Manitoba has three and a half pediatrics neurologists. They are Dr. Booth, Dr. Persaud, Dr. Chan-Lui and Dr. Seshia. The most recent was Dr. Persaud, and Dr. Persaud brings a special interest in epilepsy. I am told that Manitoba has never been in a better position regarding pediatric neurology than we are today.

There was also a question at that same time or subsequently about the residents. I think there was at that time some inaccurate information put forward about our residency program. There are four neurology students in residency, but only one resident is graduating this year. That individual is leaving the province, but she is leaving the province to further her education. So I think that responds to the previous question and the question the member asked here this afternoon.

Mr. Reid: With respect to the people the minister mentioned, and he mentioned the name Dr. Booth, can you tell me is Dr. Booth an accredited doctor under our Canadian certification process?

Mr. Stefanson: Obviously, I do not have the listing of all of the accreditations of all of the doctors in Manitoba here, so I will get back to the member relative to his question on Dr. Booth. We were just discussing examples where somebody might not have an accreditation. It might be if they are here from another country, they might have their accreditation from another country, might be working on accreditation here in Canada but would still be qualified obviously to provide these services. So, in terms of Dr. Booth, specifically, I am certainly prepared to return with details relative to him or return with any other information the member might ask for today.

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Mr. Reid: Well, I think if the minister, when he is able to undertake his research on this, will find that Dr. Booth–and I am not taking anything away from her on her abilities as a doctor within the system–but it is my understanding that she is practising in a field for which she is not fully accredited and has been for some time, and that perhaps the minister is taking Dr. Booth into account when he gives us his numbers of 3.5 pediatric neurologists. So I just draw that to the minister's attention to be careful on who he includes in his total there, because we are aware and we do have the list of neurologists who are practising in the province. Our research shows that she has not, in fact, she attempted to take the certification test, I believe it is through the Royal College, and that she was not successful and that she may be in the future attempting that accreditation, but has not, from my understanding, to this point. Therefore, she does not meet the criteria that I would expect would be for the minister to take into consideration as one of his people.

With respect to the new doctors that are coming in here, Drs. Ahmad and Hudson that I think the minister referenced that they will be working as epileptologists. The questions I have: will those two doctors, can the minister tell me, are they recent graduates from the medical college or university with respect to the field of neurology? Have they practised as epileptologists prior to coming to the province of Manitoba, or are they coming here as neurologists and being thrust into the field of epileptology?

Mr. Stefanson: Mr. Chair, first of all, in terms of the numbers and referring to the individuals in these various areas, it is not my listing that I put people into these categories. Obviously, the Health department, the Health labour relations division does, but even more importantly, it is done with the College of Physicians and Surgeons in terms of suggesting what qualifications all of these individuals have and so on. In terms of these two individuals, Dr. Ahmad and Dr. Hudson, as I have said on a couple of occasions, I am told that they specialize in epilepsy, and I can certainly return with more information about their backgrounds in terms of when they graduated and so on.

Mr. Reid: Mr. Chairperson, I just caution, when I reference that, for the minister to be careful. I mean, I had the list of names of the practising neurologists in the province of Manitoba here as well. I mean, any one of us can call the college and access that list, and Dr. Booth's name is not on that list. Yet he has referenced Dr. Booth as a neurologist here. So I think you need to be somewhat cautious, and I will not say anything further about that.

I hope you will report back with respect to the two doctors that are coming in, who are going to be practising here as epileptologists, because there is some concern that perhaps these two doctors–not taking anything away from their skill level, but perhaps their field is more specific to neurology versus the field of epilepsy, which is a specialization. I think that it is fair to the patients that they know whether or not the doctors that are coming in, that are going to be practising, are actually specialists in the field of epilepsy. So I think that that information should be made available, perhaps to the Manitoba epilepsy association, which has regular and frequent contact with the patients and the families. It would be fair that that would be a way of disseminating that information to the patients and the families.

The doctors that are coming in here, I would like to ask the minister if these doctors are Canadian-certified doctors and whether or not they have that certification prior to bringing them into the province to practise here.

Mr. Stefanson: Mr. Chairman, I will confirm all of that for the member for Transcona.

Mr. Reid: Perhaps the minister could repeat that. I did not quite hear his response in that.

Mr. Stefanson: I will confirm the status of all four for the member.

Mr. Reid: I appreciate that. I am wondering, too, if the minister would undertake, when he is able to confirm one way or the other, whether or not he would also pass that information along to the patients or perhaps their families through the Manitoba epilepsy association who would have that contact. I wonder if he would undertake to make that information available through that route.

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Mr. Stefanson: I think that is a good suggestion, and we will make arrangements whether we do it directly as a department or whether we do it through the College of Physicians and Surgeons. I think the suggestion to inform the organizations because of the contact they have with individuals is very appropriate.

Mr. Reid: I thank the minister for that undertaking. Also, can the minister advise that the doctors who are coming to Manitoba to practise as epileptologists, whether that is their field or not, since Dr. Pillay has pioneered here in Manitoba the vagus nerve implant process or medical procedure and has been somewhat successful in reducing the impact for patients suffering with epilepsy, whether or not either of those doctors will be taking on the caseload or the patient load of Dr. Pillay, and will those doctors also be undertaking or performing the vagus nerve implant procedures?

Mr. Stefanson: Mr. Chairman, my understanding is that Dr. Pillay would have done the assessment and then other doctors perform the surgery. What I am told is the team that was involved in the implant program, and I think I have said this before, is still at the Health Sciences Centre with the exception of Dr. Pillay. Dr. Brian Schmidt, a neurologist, has followed these patients from the vagus implants. The surgeon on the team, Dr. Brownstone, also remains at Health Sciences Centre, and he too continues to follow these patients. As we have discussed, the two new neurologists, Dr. Ahmad and Dr. Hudson, will be joining the team on July 1. As we have already discussed, they specialize in epilepsy, and I am going to return with more details on their background. So, yes, the implants will be continued.

Mr. Sale: Mr. Chairperson, can the minister confirm that the regional distribution unit is working at about 55 percent of designed capacity now and may be close, between 55 and 60, but certainly not more than 60 in terms of its meals served per day, but that it has the full staff complement, in fact, more than the full staff complement that were planned for?

Mr. Stefanson: I have the information on St. Boniface, I will table now. They just sent down one copy, but we can provide this for now. Just very quickly looking at the letter which the member will receive, it does go on to say, testing for these infections is available to you should you wish to be tested. We also have health care staff at the hospital available to speak with you and provide the individual support you may need. You may also wish to talk to your family physician for advice and support. It goes on to say, we invite you to contact the patient relations office at St. Boniface if you are calling from outside Winnipeg, and so on. So the letter itself does not link the issue of getting the test done by your family physician and saying you have to return to St. Boniface Hospital. But we will follow up on the lengthy discussion we had, and I will table these documents for the member for Transcona.

In terms of the current operating capacity of the Urban Shared Services Corporation, Mr. Chairman, that is one of many questions I have asked for a status report on the corporation. As the member for Crescentwood knows, we are also expecting a revised business plan from them very shortly. So again, I will return with an accurate percentage of the level of operations at the Urban Shared Services Corporation as of the current point in time.

Mr. Sale: Mr. Chairperson, I think the minister knows that the current centre cannot provide the meals that HSC and St. B need if they were able to receive them. The fact is that HSC and St. B are not in a position to receive them anyway at this point.

I think he will find that the current staff simply cannot produce any more meals on the three lines that are available for a variety of reasons. I hope he will inquire carefully into the reasons why this is the case. I am led to believe that it is because the compendium of meals that has been designed and required is too complex for the assembly to take place within the time that is allowed for each tray to be assembled at the volumes that would be required.

The minister knows that he has committed capital funding for nursing homes: Calvary Place, Misericordia and Bethel. There may be others in the city that have been committed, and these homes are not equipped with normal kitchens. The architectural plans for them do not have kitchens, so the assumption is that they are going to be served from the RDU as well. That may also be the case in Selkirk, depending on the redesign of the central facility there as well.

Is the minister not concerned that he has a situation where he is counting on something in the order of 240 new beds at Misericordia, 120 I believe it is at Concordia, and somewhere around 100 for Calvary Place, something over 400 beds additional in the system, and yet he is not even able with the current system to serve the two tertiary care hospitals? The volumes are simply not there. We are told that in spite of the best efforts of staff that they can barely maintain the pace required to serve somewhere in the order of 6,000 meals a day, 5,600 to 6,000 meals a day, and the requirement for the system as a whole, depending on your numbers, is somewhere over 10,000. If you add the new beds in, it is considerably more than 10,000.

So is the minister not concerned that we are in the process of committing very large capital dollars on the assumption that technology will work, which at this point has not been able to produce the volume and certainly has not been able to produce at a cost that is equivalent to or lower than the traditional food systems? It is over budget by a very substantial amount, not just on operating but on capital as well. So is the minister not concerned that we are going down a road here that is assuming that a technology will work which there is no data to show that in fact it will?

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Mr. Stefanson: Mr. Chairman, the member asked me actually on several occasions whether I am concerned. I would say no, I am not concerned, but there is an issue there that has to be addressed on a go-forward basis. I have asked for a status report of the very issues that the member is raising here today. In fact, a great deal of what he raises is basically identical to information that was provided to me by UFCW in a meeting I had fairly recently with Mr. Jim Sanford and Mr. Bernie LeBlanc. I received a subsequent follow-up letter from Mr. Sanford again literally saying some of the identical things to what the member is saying here this afternoon. So I have indicated that the information they left with me, I am obviously looking into and comparing it to the performance of USSC. I will be responding to Mr. Sanford. I believe I have a preliminary draft response to him, but there is still some more work to be done on some of these issues. I am looking forward to a comprehensive report from USSC on the issue of their capacity, their current capacity, their current needs and their future needs. Obviously, that also relates very directly to their revised business plan, which I am expecting very shortly as well.

Mr. Sale: Well, Mr. Chairperson, I have not got a copy of that letter, so I certainly was not quoting from it. If the minister would like to give me a copy, I would be happy to have it. But I think probably we are sharing the same information because we are getting it from the same people, so it is perhaps not surprising.

There are certainly major timeline questions here. I wonder if the minister can explain–he made some very strong comments in Question Period today in regard to renovations at HSC, their required changes. I again repeat my information, as given to me by engineers and by senior management staff of the facility, that the major impediment is insufficient electrical supply and that the hospital requires substantial wiring changes to be able to accommodate the rethermalization carts, which have a very high draw. That is the main problem. There are also some doorways, some structural issues in the food-receiving area that require modification.

The information from senior management of the hospital is that the total bill is in the $3-million region–estimated, because tenders have not gone out, as far as I know at least have not gone out–and that the argument is between USSC and HSC as to what portion of those costs should be borne by each party, and that is what is in dispute.

I think I also put on the record that the only data that I have available indicate that the total renovation allowance in the USSC's business plan, old business plan, was $1,042,000 for patient facilities. There is an additional amount for nonpatient facilities, which includes the cafeterias for public and other people's use. But the line that I am looking at and the business plan that I have a draft of–I assume it is a late draft, but it is a draft–is $1,042,000 total renovation budget. Now, if the minister would like to provide other information, I would appreciate that. I am particularly interested in the issue of what changes are required at HSC because the minister seemed to think today that the engineers and senior staff of Health Sciences Centre were incorrect when they gave me that information.

Mr. Stefanson: Mr. Chairman, well, first of all, we did respond in Question Period today about some of the operational issues that were raised by the member for Crescentwood (Mr. Sale). I am told by HSC and USSC that, as in the other hospitals, the meals will be rethermalized centrally and trays will be transported to patient areas at mealtime, so that precludes any needs for any adjustments of hallways and so on.

As well, the major renovations in the main kitchen include electrical upgrading, removal of some of the existing equipment that will no longer be required, and renovation to accommodate the rethermalized carts. Again, I am told that has been known for quite some time in terms of their requirements.

Again, I have an overall more inclusive budget from USSC in terms of their capital requirements at HSC, both building and equipment, which is in the range of about $3.7 million, and I will certainly return with more particulars, as I have indicated, on other issues, Mr. Chairman.

Mr. Chairperson: The hour being six o'clock, committee rise.

Call in the Speaker.

Mr. Deputy Speaker (Marcel Laurendeau): The hour being six o'clock, this House is now adjourned and stands adjourned until tomorrow (Thursday) at 10 a.m.