LEGISLATIVE ASSEMBLY OF
Monday, April 6, 1992
The
House met at 8 p.m.
COMMITTEE OF SUPPLY
(Concurrent Sections)
HEALTH
Mr.
Deputy Chairperson (Marcel Laurendeau): Order,
please. When the Committee of Supply was
last sitting this afternoon we were considering the Estimates of Health, No.
1.(b) Executive Support Salaries on Page 82.
Shall the item pass?
Mr.
Leonard Evans (Brandon East): I would like the opportunity, because this is
a general item and also because the matter of the
We had the representative of the board, Mr.
Singleton, who did his best. He did a
fairly good job. We had Mr. McCrae representing
the government in his riding and myself in the opposition in Brandon East, and
neither Mr. McCrae nor I could give that many answers, but Mr. Singleton was
right front and centre, as perhaps he should be as the acting representative of
the board and former chairperson of the board.
I would like to ask by way of obtaining some
information from the minister firstly whether‑‑and I am only
talking about the
Yes, indeed, there was an increase in the
budget, a substantial increase, and I acknowledged that at the meeting. I am not debating that, but obviously that
increase still was not enough‑‑for whatever reason I do not
know. This is why I want to get some
answers‑‑to allow the administration and the board of Brandon
General to maintain the status quo.
Therefore they have come up with some cuts that are widely known, the
layoff of nurses, the scaling down of the palliative care ward and the elimination
of the gynecology ward and its absorption elsewhere in the hospital and
whatever.
It was a very emotional meeting, people did
not understand, and they wanted some information. There is no question in my mind that the
board would have been well advised‑‑and hindsight is easier than
foresight‑‑to have had some kind of public dialogue of maybe two
months ago or whatever, in fact, before they even made a final announcement to
enable the public to be clued into what their problems were and to what they
were suggesting, what they were looking at, and to offer some feedback and some
legitimate dialogue.
In fact, if anything came out of that meeting
it was the importance of having more public participation in decision making to
the extent that you can have it in this type of setup. Mr. McCrae furthermore agreed with them, and
he is on record as saying that he agrees that there should be more public information
consultation by boards prior to any major decisions being made of the nature
that we are talking about that has caused such a great stir.
As I said earlier today, I have not in my
history of representing that area have known any rally or public meeting to express
concern and dismay over reduction of services at the hospital. That is a new development in the city of
I wanted to ask some questions that I think
the people there would have liked to have asked the minister. I would like to see if I can get some answers
by way of being productive and positive about this. I wondered if the minister could tell us whether‑‑and
I am just assuming that because of MHSC now being integrated into the
department. We live in the day and age
of computerization. I know that there is
enormous amount of detail published even in the annual reports of the Manitoba
Health Services Commission on all kinds of costs of operation.
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(2005)
I know the minister and his senior staff have
access to all of this detailed information.
They have a planning division, there is analyses that go on all the time
and so on. I would assume that the
minister was aware of the fact that Brandon General was facing a $1.3 million
shortfall, even though we are talking about an increase‑‑[interjection]
Well, the minister asks, this is the statement made by the administrator of the
hospital and the representative of the board.
They have stated publicly‑‑it is
their words not mine‑‑a $1.3 million shortfall to maintain, even
though the revenues have increased, the level of services and the status quo
that existed last year. Now that is how
I used the term "shortfall," the term that was used by the hospital
itself.
So maybe one general question is: Was the minister aware of some of the
consequences of the level of funding that was approved for this year?‑‑the
increased level, I repeat, I appreciate that.
It was an increased level, but was he aware that there was, what the
administration of the hospital said, insufficient amount to maintain the status
quo and that there was going to have to be a reduction in service levels? Was the minister aware of these consequences?
Hon.
Donald Orchard (Minister of Health): No, Mr. Deputy Chairperson.
Mr.
Leonard Evans: One of the very emotional areas is the downgrading
or downsizing of the palliative care service level. I wondered if the minister
could advise whether from his knowledge and the department's knowledge, is
there any way that he can see the
Mr.
Orchard: Yes,
I can, because it is my understanding in making the decision to reduce the size
of the palliative care ward that the administration and board are downsizing it
to reflect the occupancy pattern of the last 18 months, and the number of beds
proposed in the reorganized structure of the hospital will accommodate that
patient load.
Mr.
Leonard Evans: This was
the type of answer, I guess, that the representative of the board, Mr.
Singleton, gave, but then members of the audience, including one person who was
suffering and, I guess, still is suffering from cancer who spent time in the
unit, maintained that all beds were filled when he was there, all 19 beds.
He pleaded, I mean, he said he was alive
today, and five of the people who were living there at the time he was there
have already had their obituaries in the paper.
In other words, they have passed on, but he was pleading for the same
level of service. By that I mean the
same number of beds, the same size of operation. He maintained that really, well, he
questioned the hospital's figures on it, and there were other members in the audience
who did that as well.
Now, I am no expert on this. I do not have the data. I do not work there, obviously, so there was
this concern expressed that the scale‑down proposal would not be
sufficient really to accommodate people in these circumstances.
There was also the other angle that was thrown
out that organizations such as the IODE Diamond Jubilee Chapter, which over the
many years had raised money in teas and bake sales and however that
organization raises money to provide furnishings and so on to make it a very
comfortable place for the family of people who were terminally ill, they were
distraught to see that that work and those contributions were seemingly pushed
aside in this type of reorganization.
I am asking the minister then, I am suggesting
to the minister that a lot of people dispute these figures and believe that a
downsized palliative care ward is not sufficient.
Mr.
Orchard: Mr.
Deputy Chairperson, as I indicated to my honourable friend in my last answer,
the board analyzed the use of the palliative care ward over an 18‑month
period of time and found that downsizing it to the flexible capacity ranging
from, I believe, six to nine beds would accommodate the needs for palliative
care. Possibly I might help my
honourable friend by‑‑and I presume this quotation is
accurate. It is out of Friday, April 3,
It is a quote from Robin Singleton, who, I
understand, represented the board at the meeting: It is important to emphasize that the beds
taken out of service were unused beds.
A continuation of the quote: Some of those beds in palliative care are not
used for what they were designed for, he added later, noting the unit is for
the terminally ill and chemo patients should be in regular medical beds.
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(2010)
I, without having direct knowledge, would
assume that the palliative care ward was used for other than palliative care,
in that the new configuration of beds, which at the press conference that I was
at to support the board and the administration's decision some three weeks ago,
they indicated that they had some flexibility within the hospital system to
increase the numbers if the demand warranted such flexibility but that their
analysis of 18 months of utilization would indicate the new configuration would
provide for adequate patient care.
I tend to believe that because, as I have
indicated to my honourable friend, in the last four years the budget for home care
in the city of
Some of that service went to palliation in the
community, in one's home. That is what
caused the reduction over the last 18 months, I would speculate, of the
utilization of the inpatient palliative care unit. So what we have in this example is exactly what
many people, including my honourable friend's party critic for Health‑‑that
when you move services from the institution to the community and you have empty
beds, you do not staff empty beds, that you close empty beds if you have
tranferred some of the service to the community by increased funding of
services in the community. You then
transfer the budget from the hospital to the community and you close the beds.
The shortfall in funding is a deficit that the
Even with the generous funding increase to
Brandon General Hospital‑‑not my words but the member for Brandon
East's words‑‑of last year, they still project it to be running at
a deficit. Based on their analysis of
utilization, a downsizing of the palliative care ward would not compromise
inpatient palliative care. The capacity
would be there as needed.
Their analysis of the occupancy rate of three
other wards indicated a 51 percent occupancy rate over the past 18 months, a 67
percent occupancy rate, and a 68 percent occupancy rate. Those three wards were
collapsed into two wards, which I believe, if my memory serves me correctly,
will average about an 85 percent occupancy rate on two wards‑‑in
other words, a staffing or a utilization of those beds which will fully employ
the staffing patterns.
Now when you close one ward, the staff
accompanying that ward will be laid off, or else you continue to pay costs for
staff not to look after patients because the beds are empty. Now that is a difficult decision any time you
have the prospects of layoff. The alternative is you pay staff to occupy and
serve empty wards.
Every dollar you put in there you take away
from the community or other areas of health care spending and further confound
and deny the ability to reform the system and continue the shift to the
community. That is why I had the
opportunity and created the opportunity of a press conference in
I did not duck the issue. I went out and met with the media in
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(2015)
Mr.
Leonard Evans: I
thank the minister for that information. Even though the organizers of the
event had an empty chair and put up a sign for Don Orchard, because I know
people do make such plans and they do like to be with their family, I want the minister
to know that I made no issue whatsoever.
I made no mention of anything with regard to the minister's plans. That was not my business. You were not there and that is your business. I want you to know that I‑‑because
frankly I think that would be very unfair if someone did that. Although I have seen it happen in the past in
different situations, and I am not going to mention any names or any places.
What I would like to ask the minister, you
said the home care units were increased, and I think you said 149. I was just wondering if you could tell me,
what were the number of home care units in‑‑I think you said 1987
and then you compared it with 1991, did you?‑‑or April or March
1992?
Mr.
Orchard: I will
give my honourable friend two figures which I think will demonstrate the issue
that I am trying to point out to my honourable friend. I will give my honourable friend the Continuing
Care budget for the Westman region and the units of service for two years.
The first year is 1987‑88. I do that very deliberately because that is
the last year that my honourable friend had some responsibility for the
budget. The budget for Continuing Care for
the Westman region for home care was $2,190,500, and in that year of 1987‑88,
269,811 units of service were purchased.
The budget is projected to be‑‑and
this is a preliminary projection for year‑end fiscal year 1991‑92‑‑$5,717,000. More than double the budget when we inherited
government. The units of service
purchased with that increased budget is projected to be 442,000. Not a doubling of units of service obviously,
because we have had some salary increases so that a unit of service costs more
but individual units of service almost doubled for Westman region.
I will give my honourable friend the same
figures for
An
Honourable Member: Excuse me, 100,415?
Mr.
Orchard: One
hundred thousand, four hundred and fifty.
Mr.
Leonard Evans: Excuse me, just for clarification‑‑'87‑88
units for
Mr.
Orchard: Fifty‑three
thousand, two hundred and seventy‑one units of service were purchased in
1987‑88 with a budget of $424,276.
It is estimated that the budget for the past fiscal year just ended will
exceed $1,056,400 and that will have purchased in excess of 100,450 units of
service.
Mr.
Leonard Evans: I
appreciate the information, and obviously we are glad to see the numbers
increase. The only point I can make is I
have been told by some people who work in the system, even though the level is
higher, that there are still insufficient funds for home care. Now this is what I have been told by people
in the system. They are not politicians,
and I am not going to repeat their names.
They do not necessarily work directly in home care, but they are in the
health care system in that area. They
say that if you want to take more pressure off the hospital, that budget has to
be substantially increased. I offer that
opinion from people who are health care providers or whatever the expression is‑‑health
care administrators, actually.
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(2020)
I just wanted to say about the palliative care‑‑I
know the minister has given the reasons and he did so at a news conference in
Brandon‑‑it certainly did not register with the 500‑plus people
here, because one of the highlights of the evening was a fellow by the name of
Henry Buhler, who probably should not have been in the palliative unit because
he seems since to have been cured. He
was at the meeting, and by his own statement maybe he should not have been
there. He was told he did not have very long
to live, and apparently the doctors are amazed that he made such an important,
significant, vital recovery.
He went on and on about how it was all filled
and there was a standing ovation for minutes.
I mean, for minutes people were just taken by his description of the
service in the palliative care unit and really expressing a concern that, even
though these average figures recorded by Mr. Singleton and so on, there still would
not be the level of service that had been available up until that point.
You know, it was a very emotional thing. I had never met the gentleman before in my
life, but he was there making that presentation. I am just saying there is a feeling out there
or understanding out there that there is this insufficient level, that it is
not going to be provided in the future.
This is why I get back to my original point
that the hospital should, all hospitals should have public information
sessions, allow for dialogue, provide information, allow questions to be asked,
suggestions to be made and so on. The
people there were certainly‑‑the 500‑plus people who were
there as I said‑‑well, there is a picture of them standing and giving
a standing ovation after a 15‑minute eloquent description of his
particular situation and his feelings on the matter. At any rate, I gather the minister is
satisfied nevertheless with the decision made by the hospital and believes they
should live by it.
I wanted to ask another question and that is
whether the minister and his staff, senior advisers, believe that the administrative
costs at the
Mr.
Orchard: Mr.
Deputy Chairperson, I really cannot answer that question tonight, but I would
be fully prepared to get into that discussion when I have appropriate staff
here in the hospital lines. Appreciate
that the detail of that kind of question is not available tonight to
accommodate my honourable friend. My honourable
friend must understand that I do not know the exact details, but there was a
collapse of two positions or three positions into two at the senior management
level at the hospital, and the elimination of one senior management position.
You know, my honourable friend makes the point
that at the public meeting a man who was on the palliative care ward, and is now
alive and well, maybe should not have been there. I think that is what Mr. Singleton is saying
when he was saying that the occupancy, when it was full, it was not always with
people dying, terminally ill from cancer, so that was not an appropriate use of
the palliative care ward. That is for,
unfortunately, where you have people terminally ill who are going to die and
you provide them with as much comfort as you can and as homelike an atmosphere
as possible. It is not for people with
chemotherapy. It is not for people with other treatment modalities suffering from
cancer or other serious diseases.
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(2025)
You know, I understand the emotion behind the
issue and there will always be emotion behind any health‑care issue, but
the budget increased and increased significantly to the
Now, my honourable friend, when he
communicated with constituents in January, 1987, indicated to Dear Constituent:
You should understand that the decision to close beds at
My honourable friend is saying that is the
reason for bed closures then. I am
saying that, in part, sure, more money to the hospital would have averted that,
but we gave them a generous increase‑‑not my language, the member
for Brandon East's language‑‑and still they ran a deficit. But in trying to come to grips with that
deficit they did not compromise the program service delivery in the hospital,
because they analyzed their use of palliative care, downsized to accommodate
use. They analyzed occupancy on three
other wards‑‑51 percent, 67 percent, 68 percent‑‑collapsed
three into two.
The same bed capacity for acute patient care
and admission is there today as was there last year, the difference being they
are going to save dollars by not staffing empty beds. Now my honourable friend can say, as he has
said at that meeting, well, you should just give them the money.
That is the point I have been trying to get
around all this afternoon. If that is
the solution that you proffer to the
That, sir, is why this debate on health care
is going to go on for an awfully long time, until we get some consistent
answers to pressing problems in health care, because I want to assure my honourable
friend that in this province, no different from any other province in
We cannot afford to fund‑‑I will
be very direct‑‑a 12.l percent increase in taxpayers' dollars
demanded by the MMA on behalf of physicians in
If you think we are unique, ask Ms. Lankin
from
That is why the Minister of Health in
The Premier of
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(2030)
That is where I started this afternoon's
discussion, saying what we need is some honesty, and I have to give my
honourable friend in the second opposition party some credit for laying issues
on the line. You have not even answered
today, neither of you have answered today, whether you have changed your mind
on the policy you have put in place of no deficit. You will not even give that candid
admission. Yet you want every answer of
me.
How can you debate health care reform? How can you debate the principles of health
care reform if we are not talking about starting from even policy keels. If you say hospitals can run deficits and I
say they cannot, we are not talking the same kind of health care reform. My health care reform is based on no deficits
in the hospitals. My health care reform
is in moving hospital budgets to the community as quickly as possible by following
the patient with the budget. That is
what I explained in my opening remarks and I will continue to explain that, and
I want to tell you that the public, when informed of that, agree with that
process.
Mr.
Deputy Chairperson: Order, please.
At this time I would like to remind the honourable minister the word
"hypocritical" is unparliamentary and does not fall under the other
category of being parliamentary, so I would ask him to retract that statement at
this time.
Mr.
Orchard: Mr.
Deputy Chairperson, I gladly retract that statement.
Mr.
Deputy Chairperson: Thank you.
Mr.
Leonard Evans: Mr.
Deputy Chairperson, first of all I want to make it clear, the minister seemed
to infer, or at least I thought he was inferring, that somehow or other I
organized this meeting. I was invited to
the meeting, and I had nothing to do whatsoever with the organization of it.
I was not even sure who else was going to
speak. I knew someone was going to speak
from the board and I knew Mr. McCrae. I thought maybe there would be city
councillors and so on. I had absolutely
nothing to do with the organization of the meeting. It was really a truly
grassroots meeting organized by a citizen in the community who put ads around
the community, posters and in no time got this response. The hall was paid for by silver collection or
at the door. Furthermore, I want to make
it clear that, yes, I have a petition.
The petition I was talking about today signed
by 5,300 people, this was done by people I have never met. I do not really know these people, although
one of them advised me that he was a student of mine some years ago, but I have
not seen him for about 25 years. The
fact is, I had nothing to do with this petition. This is from people who are concerned and
distressed.
Now, it is directed to the board of the
This is where I was getting my question: What else could the board have done? I do not know what else the board could have done. It seems to me they are between a rock and a
hard place in terms of how you cope with not having enough money to maintain the
status quo from last year, even though there has been an increase, and at the
same time provide these services that the public obviously seemed to think are
pretty vital and have requested.
I might add that the people who signed this
were not the city of
I also want to make a point to the
minister. You know, he says, well, when
we were in office, and he keeps on harping back at '87, if you want to talk
about '87, fine. In this area we had some
cutbacks and that was it. Therefore, we
are being hypocritical because now we are being concerned about cutbacks. The
fact is that there was a lot of reform going on at that time and a great deal
of money was being spent to make the system more efficient. Home care was being expanded then too, but
besides that, around that time we brought in the day surgery program which was
very significant in the hospital‑‑well, in around that time‑‑to
take pressure off.
Also there were other developments in the
hospital that helped to improve the level of service, the CAT scan, that came in
around that era and also very importantly there were 320 nursing home beds
built at a cost of over $18 million in that period, '87‑'88.
An
Honourable Member: Was
Mr.
Leonard Evans:
To that extent a place was provided for them
but there was still‑‑so it did take pressure off of the system in
that respect. Furthermore, in the years
ahead it will be there, unless this government ceases to fund it for whatever
reason, as part and parcel of the nursing home supply, if you will, in that community.
There were a lot of major reforms that took
place and more very top‑class beds, top‑quality accommodation put
into place so there was a development.
Obviously, the people in the community were not concerned that there
were a few beds closed in the acute care side because of the other
developments. There was certainly no
public meeting to criticize the government at that time. There was no outcry as
we have today. It was not perceived to be
as anything‑‑maybe there was the odd doctor who might have been upset
or what have you. There were no layoffs
of nurses. Ask the nurses' union, they
will tell you.
The point is, we were in the process of reform
and the process of upgrading the hospital in terms of the kind of equipment and
the kind of programs that it had.
Mr. Deputy Chairperson, I was asking the
minister whether he could advise this committee whether the administrative
costs of that hospital were in line, because a great deal of that meeting was
spent on people questioning various specific positions in the hospital, and
there seemed to be an inference that too much money was going into
administration, and if that money was not going into administration it would
have resolved the problem of the palliative care ward and the gynecological
ward closures, or scaling down.
To some extent I thought some of the people
were unfair, I really did. I thought
they were unfair in their statements, but nevertheless there was that strong
feeling that somehow or other
The minister said earlier, well, he does not
have that kind of detail with him, but this brings me to another point and that
is we should be given more information.
There should be a report on the administration of hospitals. I know there are annual reports but they do
not give you very much information. I
have seen the Brandon General report and it is not detailed enough as far as I
am concerned. The citizenry would be
well served if we had that type of report.
So I ask the minister, does he have the impression that there are
excessive funds going into administration of the
Mr.
Orchard: Mr.
Deputy Chairperson, I will deal with the administration issue later, but lest
my honourable friend get too far out on a limb about the wondrous days when he
was responsible for bed closures and whatnot in
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(2040)
I know that my honourable friend while he was
in the Pawley government saw the end of International Nursing Home and two others
because I toured both of them as an opposition critic. Those were in part
replaced by Dinsdale home, so that before my honourable friend starts getting
into this dynamic that they put 320 additional new beds in
Let me deal with the issue of
administration. I have a concern over
administration costs in our acute‑care health system. I have concerns, for instance‑‑and
I will give you some of the concerns and some of the areas of reform that we
are going to be working towards.
Communities, and some exist where there are separate administrative
structures for the personal care home side and the acute hospital side. I say other communities are operating very
effectively with joint administration and with cost savings. So in those areas we are going to be very
solidly encouraging the boards and the administrations of those facilities,
before they cry insufficient budget to government, that they look at ways of
economizing on administration within their communities, because I do not see a
whole lot of sense for a personal care home which is 150 steps away from an
acute‑care hospital to each have its own separate administrative CEO and structures
paralleling, when I know communities that have the acute‑care hospital and
the personal care home, both of them fairly substantive units, administered by
one administration and they are a half mile apart in the town. I know it can work and it can contain costs.
I want to deal with another couple of areas on administration. Brandon‑‑I cannot give my honourable friend a sense for whether they are above or below the administrative costs of comparable‑siz