Mr. Chairperson (Ben Sveinson): Will Committee of Supply please come to order. This section of the Committee of Supply will be considering the Estimates of the Department of Health. Does the honourable Minister of Health have an opening statement?
Hon. Darren Praznik (Minister of Health): Mr. Chair, I have had the opportunity to speak with my chief critic from the opposition, and I think because we get into so many issues and discussion of issues, I think, if he is prepared to waive his opening remarks, I am certainly prepared to waive mine in this process in the interests of time and getting to the issues of the point. So I am prepared to do that if the critic is also prepared.
Mr. Chairperson: We thank the minister for those brief comments.
Mr. Dave Chomiak (Kildonan): I concur on the comments of the minister.
* (1450)
Mr. Chairperson: We thank the critic for those brief comments.
Under Manitoba practice, debate of the Minister's Salary is traditionally the last item considered for the Estimates of a department. Accordingly, we shall defer consideration of this item and now would proceed with the consideration of the next line.
Before we do that, we invite the minister's staff to join us at the table, and we ask that the minister introduce his staff.
Mr. Praznik: As is practice, because of the size of this department, we will be having a number of people through over the days as we advance through the various issues, so I will be introducing staff as they arrive. To begin with, today, I have of course no stranger to this committee, Mr. Frank DeCock who is the Deputy Minister of Health. Joining him are the three associate deputies of Health: Sue Hicks who is the associate deputy for External Programs and Operations. In essence, she is responsible for the delivery of health care services outside of the Ministry of Health through regional health authorities. We have Roberta Ellis, also no stranger to this committee, who is the associate deputy minister responsible for Human Resource Planning and Labour Relations. As we discussed last year, this is an element we have built into the department to manage just the mammoth package of labour relations issues, negotiation issues, and for the benefit of my critic, also the lead on part of the department for physician remuneration and negotiation issues, as well.
Third, I have, also no stranger, long service to the people of Manitoba, Mr. Don Potter who is the associate deputy minister responsible for Internal Programs and Operations which, in essence, is by and large the operations of the Ministry of Health and the services--the financing, accounting, standard-setting areas, as well as programs that are run province-wide through the ministry such as Pharmacare and air ambulance, et cetera.
Also joining us, an addition to this department, a very welcome addition, no stranger from my days in the Ministry of Labour, is Mr. Jim McFarlane. He joins us at the back of the room. He is currently a special adviser in the department, and he is reorganizing a number of our operations and today has responsibility in the area of insured services or insured benefits, and there will be other responsibilities that he will be taking on.
Of course, with Frank, Susan Murphy who is the director of Finance and Administration and probably knows more about the intricate operations of this ministry than anyone else alive in all its complexity. Also in addition to our staff working with Jim McFarlane is Jessica Benjamin who is a lawyer by trade and is working on a host of our areas as we revamp some areas of our department. So I welcome them here to the committee today.
Mr. Chairperson: We thank the honourable minister.
Mr. Praznik: Mr. Chair, before we begin, I have had the opportunity to speak with the member for Kildonan (Mr. Chomiak). I think last year we developed, I would hope, if I recall, a very amicable and I think productive way of dealing with these Estimates, and I hope and expect that we will be able to do the same this year.
What I would like to ask formally on the record--and him and I have had some discussions in this vein--is that if he can provide somewhat in advance, I do not expect that today but over the next few days a list, hopefully a couple of weeks or so in advance, of the issues he wishes to cover so I can arrange to have appropriate staff here, and with the committee's indulgence, again, and perhaps it would be appropriate to get, Mr. Chair, this approval at the outset, I would like, as we did last year which was somewhat innovative in our Estimates committees on technical matters--matters of policy are certainly mine to answer and I accept that responsibility--but on a number of the very technical issues that arise, if the committee would give agreement now that we could have those questions answered directly by the appropriate staff, I think it makes for a much better process to have those kinds of exchanges with people who are much more familiar with the intimate technical details of various areas, rather than have me convey their answers to the committee.
Mr. Chairperson: Is it the will of the committee to allow some staff to answer some technical questions on technical matters?
Mr. Chomiak: Mr. Chairperson, I concur in that recommendation as well.
I might add just further to the comments of the minister that I think that is a more appropriate way of dealing with issues. With respect to the scheduling, we did have an earlier discussion, and I also think it is more expeditious to let the minister and the staff know in advance where we are going. So I am going to endeavour to get a schedule as best I can, subject to, of course, daily occurrences and weekly occurrences of matters that may arise, but subject to that, we will try to move through as expeditiously as possible.
Mr. Chairperson: I thank the honourable member for Kildonan.
Mr. Praznik: Yes, Mr. Chair, just by way again of housekeeping before we begin this process, I take it then if we are going to use that schedule that we will not necessarily follow through on the Estimates book, and we will deal with issues on that schedule and then upon completion of our discussion pass through the Estimates. Is that the member for Kildonan's intention?
Mr. Chomiak: Actually, that is an interesting suggestion that I had not--I have tended to always go through the Estimates book religiously. I had intended to provide the schedule in line with that, but it might be more expeditious to do it on the issue schedule basis. Perhaps, if I could think about it and discuss with the minister tomorrow, we can work that out in terms of how we will deal with the Estimates book.
Mr. Praznik: I appreciate the flow from the Estimates book. The member may want to work around that, but I have often found there are issues that come up. There is availability of staff and those type of things. I am certainly prepared to have a little bit more flexibility. It has always served me well in other departments I have administered with my critics. As long as we have something in advance, not just a day, but, hopefully, if I could have a week or so in advance or a couple of weeks list ahead of me so that we can arrange for staff, particularly for those who are not part of the ministry, then it would certainly make it much easier to accommodate the member's questions.
Mr. Chairperson: This kind of co-operation is admirable. I would ask that, perhaps, the minister and the members of the committee could let me know as we go then what sections we can pass at the time.
Mr. Chomiak: Thank you, Mr. Chairperson.
Mr. Chairperson: Just if I might interrupt. We will now proceed to line 1.(b)(1) Executive Support (1) Salaries and Employee Benefits $498,300, on page 71 of the Main Estimates book. Shall the item pass?
Mr. Praznik: Mr. Chair, I understand that today the issue of hepatitis C was of priority to my colleagues. I have no difficulty dealing with it here. In fact, we have arranged for Mr. Ulrich Wendt, who is our federal-provincial person, to be here. He should be arriving shortly. So I have no problem with dealing with that today in this particular area.
Mr. Chairperson: I thank the minister. We will basically just start off on that point, and from what I understand, we can move around as you see fit.
Mr. Chomiak: Perhaps, we can commence then by the minister following up on his comments in the House this afternoon as to elaborating on his perspective with respect to the agreement that has been entered into and announced last week.
Mr. Praznik: I believe from the questions from the member for Osborne (Ms. McGifford), who joins us today, and the question from the member for Kildonan (Mr. Chomiak), the real issue is an extension of the currently announced program to individuals who are outside of the 1986 to '90 window. The logic behind that particular window in the agreement--and I should add that this was right from the outset the understanding and consensus of all Ministers of Health, of all political parties. Our provincial organization is chaired by the Honourable Clay Serby, the minister from Saskatchewan. It was also the position of the federal government, Mr. Rock, at our table, that what we were attempting to do in this particular package was to provide a compensation program for those individuals who contacted hepatitis C through the blood system in the period in which there was a very strong potential or potential liability on the part of the blood system.
The reason why that approach or that principle was taken is because it was recognized that in the course of providing medical or health care to Canadians through our health care system, there is risk regularly in the method of treatment, in pharmaceuticals, side effects, types of surgery. Each day health care workers, health care providers, physicians, nurses make decisions as to treatment, appreciate the risks involved and understand that in many of the things we do in a health care system there is risk. The risks are weighed and decisions are made on the best available knowledge of the day and that not always do the results of those procedures, pharmaceuticals, whatever, result in the desired effect, that from time to time, people are particularly maybe made worse because of a course of treatment, knowing that that is part of the risk of that treatment. As a consequence, we, as a health care system, have not directly provided compensation to those individuals in that particular circumstance.
* (1500)
The group between 1986 and 1990--and, again, my information is based on that provided by the national government, from their work on this particular matter, and there was a very strong sense that there was a potential negligence on the part of the blood system because a test for hepatitis C was starting to be used in North America. It had developed to that point. It was not used everywhere, but it had moved into the realm now of starting to become part of that standard of care.
The matter of principle that I spoke of in the House today is if we move beyond that particular principle, and we may as a country want to, we have to be prepared then to deal with other people who may have their position worsened by the treatment they receive in the health care system where there is no negligence, where risk is taken on and assumed because the alternative of not doing anything may be worse, and do we do that? If we do, what is the cost, what is that liability to the system?
I believe, and I think my colleagues, nationally, believe, without fully appreciating the advancement of that principle, we may get into an area that could potentially make our health care system far more expensive and perhaps unaffordable. So that was the logic behind the particular discussion and the principle on which this was based.
On a practical matter, the national government, who in the blood system have the responsibility for regulation, for imposing the standard of care by way of regulation and bears a fair bit of liability in this particular issue of tainted blood, and the Red Cross, who were the operators of the system--the Red Cross, by the way, does not have very much in its financial kitty. Most of it will end up in selling its system to the new blood agency, will go towards the hepatitis C compensation as the plan now stands. But the national government came to the table for compensation for hepatitis C for this particular period based on the argument of liability of that system, and they brought to the table, at the end of the day, after some very tough negotiation, some $800 million.
So if one were to take it into the next realm of compensation, I believe two things would have to happen. One is we would have to have that debate on the principle of what do we compensate, which I think should be a public debate, and we would have to have that consensus that, yes, we want to move into that area, and secondly, we would have to see the national government come forward with I believe a significant amount of financial support to make that possible.
Mr. Chomiak: Mr. Chairperson, I want to break down the minister's statements into a couple of areas. It seems to me that initially what we are dealing with both in terms of the language that was used by the minister and in terms of the resolution is effectively legal arguments. The question of liability, the question of negligence, the question of precedent, and to use another legal term, the minister did indicate that ab initio, coming to the table, the conclusion was made that the period of time would only be '86 to '90.
Is the minister saying that in the negotiations, the only framework under which the negotiations took place was the compensation would be dealt with only for those individuals for the period '86-90?
Mr. Praznik: Mr. Chair, the member asks some excellent questions. Just to put it in context before I answer directly his questions, when we looked at this period in the blood system, there are really three parties involved in the blood system: the Red Cross who administered it, the federal government who regulated it, and the provinces who were in essence the funders or purchasers of the blood. In the finding that there were problems and negligence in any sense of that term on the part of the blood system--I think that is very clear--our Canadian blood system for a period of time was not well run by the Red Cross. It was fraught with problems, and many Canadians have died or are suffering today because of the decisions in the way that system operated.
As provincial governments, we looked at this and said, well, who is responsible for this? Well, obviously those who operate it and those who regulate it bear, by far, the greatest brunt of that responsibility. Provinces--I just want to separate provinces from the other two for a moment--came at this and said, wait a minute, by and large we are the purchasers here, and yes, there was a blood advisory committee that had really no legal status, that kind of co-ordinated things across the country among the provinces. The operating decisions, particularly those on regulation and requirements, rested with other parties, and in a normal world of everyone being solvent, the liabilities here would have been borne by and large--in fact, some legal opinion that I have heard of would indicate entirely--by those other two parties. If there was any responsibility by the provinces, it was minimal at best. So we looked at this and said, coming into this whole process, where are these other two parties in accepting the responsibilities for their actions?
In the case of the Red Cross, their resources are minimal. They have somewhere between $100 million and $150 million of ability to contribute. They would be insolvent, or are insolvent, if they had to meet all of the liabilities for their actions, which means any financial responsibility falls on the other parties. The federal government acknowledges--and we are told that the federal cabinet, I should say, does not acknowledge in any way the financial costs for the health care services that provinces now have to provide.
So we as provinces came to this meeting first of all saying, yes, we are prepared to be part of a national program, but we want to ensure that it is paid for by those who have the responsibility for what happened. When we did come in to that process--and there were discussions between officials--the national government, the federal government in their work in preparing for this case, and I understand Mr. Ulrich Wendt has now joined us, but I look to him, I understand that most of the legal assessment was done by the federal government. That's right. Coming to the table, in their discussions--from my first meetings, the assumption on which they came and which provinces came was that there is a legal problem here, there is potential negligence.
We have in three provinces, I think there are class action suits having been filed. People were going to court and either these cases could proceed to court or a settlement could be offered. So that was the basis on which governments came together to deal with this particular issue. I have to underline to the member that the provincial governments came somewhat reluctantly, not from the point of view of wanting to settle our responsibility, but reluctant in that we saw the federal government and the Red Cross by and large dumping their responsibility onto us for matters that they had care and control of during this period.
So when we did arrive at that table and when we did start that process of discussion, the federal position as I recollect it was that this was the period in which there was a liability from '86-90 based on the work that their legal people had done, and we entered the discussions on that basis. That was very much assumed by everyone at the table.
* (1510)
Where this matter, in my opinion, got off the rails somewhat is that after our discussions, the federal minister made statements publicly about a settlement on the basis of compassion and led people to believe, in his words, that this was not based on law and on negligence and responsibility in the system. I think he was trying perhaps at that time to give an appearance and that has caught up with him. But from the perspective of others who were at that table, that was an issue on which, my recollection is, we came to the table trying to deal with that specific area because of that principle that I have talked about, of what do we provide for in our system where things do not work out as intended.
Ms. Diane McGifford (Osborne): I wanted to ask the minister about his comments on negligence, and I know the minister spoke in the House today, but my understanding then is that the minister believes his government, the federal government and the Red Cross are only responsible for people infected after 1985 because it is only then that a test became available which would allow blood to be screened and allow authorities to ascertain whether or not that blood was infected with hepatitis C.
Mr. Praznik: Mr. Chair, first of all, this is not necessarily a personal belief. It is the position that was developed and agreed to by governments all across the country, including Saskatchewan and British Columbia and the Yukon were at the table.
Just by way of background information, and I can say this because I am a lawyer by trade, and I know the member for Kildonan (Mr. Chomiak) will appreciate this, when we use the word negligence in a legal sense, what it means is, to have a negligence, three things are required. One is that a duty of care is owed. It is obvious that if you have a blood system you owe a duty of care to the people who use your product. Secondly, you have to prove that you have not met the standard of care in exercising that duty. Thirdly, you have to prove that damages resulted.
Well, we know that there is damage and we know that there is a duty of care. The issue then evolves around what was the standard of care at the time, and this comes back to my larger principle. Did the blood system meet the standard of care that was available and known at the time? Now, prior to '86, and again my information is coming by and large from what the federal government analysis has done here, so I may at some point stand to be corrected, and I flag that today, but I act on the best information that was provided to us as provincial ministers.
Leading up to that particular time in 1986, tests were being developed. One, I think, was in use somewhere else. There was a debate as to whether or not that test was effective. Hepatitis C actually is a relatively new virus, I guess is the correct term. So there was a lot of work going on. It was in 1986 that the test I understand started to be used in North America--not everywhere, in a number of states. So it is arguable that at that particular time it had crossed over from sort of the test or assessment stages as a test into becoming potentially part of the standard of care within the blood system.
So the rationale for the '86-90 was that this was in the period of time in which the Canadian blood system, again run by the Red Cross and regulated by the federal government, could have reasonably been expected, potentially, to have adopted the hepatitis C test. Prior to that, that was not really in terms of the review. It may have been, may not have been, but the balance probably would have gone the other way.
The reason why this becomes important again is at what point in providing health care services to citizens, most of which have some degree of risk, do you assume--everyday health care professionals with patients make decisions on treatment knowing that there is risk and if things do not work out as intended, if the risk turns out to result in someone being injured or their immediate position being made worse, the procedure does not work out the way intended, and they have suffered damage, do we then compensate that? That is really the principle that is of great concern. We may decide to as a country but, before we embark on that as health ministers, that should have a public debate and that is why the separation took place.
Ms. McGifford: I thank the minister for the mini-education on negligence. I appreciate that. Is the minister then saying that prior to 1985 there was no negligence because the blood care system met the standard of care?
Mr. Praznik: The member asks an excellent question because that is very much part of the result of the policy. The date we used in '86 was January 1 of 1986, so up until 1985, based on the analysis of this issue, the very in-depth analysis I understand that the federal government did. The reason they took the lead in there is because they--I think it was identified--have a lion share or a significant share of the responsibility here because they were the regulator.
I think Krever identifies them as having a significant share of the responsibility, so they took it upon themselves to do a very thorough analysis of this issue, and that was presented to us as provincial ministers. We did not have that capability within our own system, so we very much relied on the federal information. What they have advised us was prior to that period, that the developing test for hep C which was used, I think, in Germany and was starting to be proven and have some value, it is around that time that it became acceptable or started to be used on a regular basis in some of the blood systems in North America. So that was viewed as a point in which one could argue that it had become part of the standard of care.
Ms. McGifford: It is interesting that the minister brings up the name of Horace Krever who, of course, is on the public record as saying that he believes there should be compensation for all people who acquired hepatitis C as a result of tainted blood.
Was it then on January 1, 1986, that a test was instituted that would screen for hepatitis C?
Mr. Praznik: We would have to get exact dates for you, but my recollection is that it was beginning in '86 that some U.S. states and their blood systems started to use that test. So, in determining the dates, we decided if we are going to err, to err on the more generous side; in essence, to sort of pick a period that really was beginning of the year in which the test started to be used in some blood systems in North America as the period where it worked into the standard of care.
The end date in 1990, which I believe is July--there is a date for compensation, I think, in 1990, July--I do not recall the date. That was the period in which the test was adopted in Canada for our blood systems. So that is where the window was determined when it started to be used in some systems. It was not widespread in the United States, my understanding, but it started to be used. So we decided to err on that side of it, to have as wide a window as was possible within that principle.
Ms. McGifford: The logic is the test was available on January 1, 1986. So, although it was not used, it was available and therefore there is some "negligence," because our blood care system was not meeting what the minister referred to earlier as the standard of care.
Mr. Praznik: Essentially, yes, but because many read this transcript and there is litigation going on, the test started to be used in early January, I believe, or early part of 1986. So to pick a beginning date, we thought January 1 was one that clearly encompassed that.
Like all cases of standard of care, the standard evolves, changes, and develops as it grows and its acceptance grows. Often it is very difficult to determine an exact date. So January 1 of '86 was determined because, if I recall correctly and I may be wrong here, it was in 1986 that the test started to be used, which date, where, I am not sure, but that is why we picked the date. But essentially the member's observation that that is when a test more or less became available and it was adopted in 1990 is the reason why that window is being compensated.
Ms. McGifford: Is it not possible then the test was actually available in December 1985 or even November 1985? Why then are those particular persons, the persons who would possibly have acquired hep C as a result of tainted blood in those months or even earlier in 1984, why are they not covered under this package?
* (1520)
Mr. Praznik: The member asks an excellent question. These are the debates in essence in a real life story here. But the debates we sometimes have in law school, we discuss these issues of negligence, when does the standard of care change, and in hindsight, it is always easy to pick a particular date because you can tell if a test has worked, is it effective, does it get the result.
When you are developing a test--and again my recollection of hepatitis C is its identification, the understanding of it. I know Mr. Mark Brown joins us in the committee. He knows far more about this than I do in terms of the detail, but it is as identified virus relatively new as opposed to hepatitis A and hepatitis B. The test was one that was being developed like all tests. They go through stages in development until they become accepted by the medical community as a test that should be used. So where in that continuum of sort of early stages of development to general acceptance do they become part of the standard is often not an easy period to pick, but January 1 was picked, if I recall, on the advice of the federal government because it was viewed as encompassing on a reasonable basis the adoption of the test within several jurisdictions of North America.
Ms. McGifford: Is it not true that there was a test as early as 1982 that could have protected about 40 percent of people using blood from being infected?
Mr. Praznik: Mr. Chair, as I indicated, the test was one that developed over time. It was used, I believe, in Germany or some place in Europe before it was adopted in North America, but like all medical standards and test, there is a period of development and acceptance by the medical community. The advice on which that date was picked was the advice that was developed and prepared and offered to us by the federal government.
I am not intimately involved with all the details in that development, but when they came to the table with a sizeable amount of money and actually initially the threat to develop their own program and go it on their own, that was the window that they had identified from their own work. So one has to rely on that because they are closest to it and had a large number of very able people working on it. It may not prove to be accurate. It is probably debatable on that continuum. I do not pretend for one moment to be an expert on it, and we may stand corrected at some point, but ultimately that was the recommendation of the work that was done by the national government.
Ms. McGifford: Mr. Chair, I understand that the 1982 test was in fact developed in the U.S. I understand that the test that was available in 1982 was not developed in Germany, not that this particularly matters I suppose, but that it was developed in the U.S. and that it was used in certain jurisdictions in the U.S. Again, it could have protected about 40 percent of the people using blood from being infected.
I heard the minister say that--well, perhaps the minister could comment on this.
Mr. Praznik: Mr. Chair, just pointed out to me, my staff, that the work that was done on that particular date, I also understand it mirrored the class action suits, the first ones coming out on the work that was done on those class action suits as well. That was part of the consideration in the period in which those suits felt that they could make a case for standard of care.
The law is not a science as to exactly when these things fit in. It is very much an art. The detail, as I said--this work was done by the federal government, was presented with a logical base. It was the class action suits filed in a number of provinces which had also done the same work on assessing standard of care issues. Obviously, for filing a class action suit, they want to ensure that they have covered the time period in which they can make the case for standard of care mirror that period.
So that is the work of a lot of legal and technical and medical minds in putting that together, and I certainly do not want for one moment to give the impression that I am able to debate that one way or another. The basis on the decision of ministers was on that expert advice, by and large led by the federal government.
Ms. McGifford: I appreciate that deciding when the standard of care changes, I appreciate that this is not a science and that it is an art. That is one of the reasons that this very firm cutoff date for compensation bothers me because the date makes it appear very much that there is a science that separates persons infected and one period from another.
Mr. Praznik: Like all situations where you have a particular, either claim--you are making a claim in court, and you have to pick a period in which you are going to demonstrate the standards of care were not met, or you are offering an offer for settlement, none of it is easy, and it is always very debatable about the window which you pick, either when you are launching a legal action or you are making a settlement.
It is a difficult one, and as I said, we have--and I know the member appreciates this, the difficulty of us as laypeople arguing these particular issues, but we did rely, as provincial ministers across the country, on the significant amount of work that had been done by medical and technical and legal people on preparing these options for us.
Ms. McGifford: Now, there was not a time line fixed to compensation of persons who were infected with HIV, and I wonder if the minister could explain the differences and the reason for there not being a time line in the one case but there being a time line in the other case.
Mr. Praznik: The member raises a very excellent point, one I have struggled with because there is an inconsistency, and I think a number of things is, one, at the time the AIDS package was being dealt with, it was, I believe, a smaller group of people that was being discussed in total.
You did not have a national program, really, being developed, and, again, I was not there at the time and I was not intimately involved in the details and the development of that program and have only heard sketchy parts of it, so my information should not be taken as an expert, but my recollection of the discussions that I have heard about this on the AIDS compensation program was that there were a number of things that happened--one, a smaller group of people, so the issue of the principle of what one compensates really did not enter, regrettably did not enter into the discussion because now it has put it over to this particular issue. Is that fair? Probably not, but I wish the principle had been discussed then. It was not part of public debate.
Another issue is that there was a split between federal and provincial governments in dealing with the program, that there was not a national program, that all governments did not stand together on the particular matter.
Now, my expert who was around at the time is scribbling a note to me. There were also issues--and another point that my staff raises is that the AIDS program primarily applied to hemophiliacs at the time who get blood on a regular basis, and I am looking at my note here, so it was difficult to determine exactly when the infection would have taken place.
I know that this issue--and if I may just deal with it for a moment because there is a bit of a difference with the hemophiliac community because of the need--and the discussions that I have had with some people who are involved in that, and I understand the association in Manitoba is attempting to determine how many hemophiliacs, for example, would be covered under this plan and who would not be because probably the vast majority received blood or blood products during the window.
* (1530)
I should say to the member that all one has to have done in these cases is to have had blood or blood products during that window, and for hemophiliacs who are regular receivers of the product means that the vast majority will be covered in that particular group under this plan. Some discussions I have had with people from the society here in Manitoba, we have asked them to give us, and they have indicated they have been trying to track down the number of people who are in their organization who will not be covered by it, and it is probably a very small number. I look to some who are here today in the audience. I imagine that work is still going on to track down the number of people who would not be in the window, but I suspect it is very, very few, but that is part of that difference.
The general question that the member asks though is why the difference? Ultimately, I say this only as an observer of the first one is that there was not a national program advanced that did break down in those discussions, and I do not think at the time the principles of where things were going were fully canvassed and discussed. It was the first time, and I think governments at that time thought it would be the only issue that would rise out of tainted blood.
What we do know is that the blood supply is not totally risk free, probably never will be. So as we have seen more and more happen and we know that viruses change and develop, and blood is an excellent carrier for viruses, that there is future risk, and how do we deal with that? That becomes part of the principle as it develops as these issues tend to grow. So is it consistent? No, it is not, but as governments have moved forward in compensation, the principle continues to stick out at us, but how far do you go and what to you do in managing a blood system or health care system? I know that is not necessarily a very good answer. There is an inconsistency there, and I admit that totally.
Ms. McGifford: I just wanted to make sure that I understood that inconsistency correctly. The minister is saying that people living with HIV-AIDS who appear to have been affected before 1985, the number was extremely small, and therefore compensation was given in their case. I suppose the other part of that argument or the other part of that corollary would be that the number of people infected with hepatitis C infected before 1985 was large or larger and therefore this appears to be the only distinction, the small number in one case, a larger number in another case. The minister has already said that this particular policy was inconsistent, but I would say it is not only inconsistent, it is frankly unfair.
Mr. Praznik: No, I appreciate fully. These are issues and questions that I have put to those who have been involved in the process back when the other issue was dealt with. I think one of the things that happened is when the AIDS issue and compensation package was put together, it was the first time that the blood system had been exposed to this kind of problem and the way it operated. Its difficulties were exposed. It had a problem here and it made some very bad decisions. I think there was a push to provide a package to deal with that issue, believing, perhaps, that there were no others on their way. Here we find ourselves years later with the next blood issue, and yes, clearly a period where there is a potential negligence, a period where there is not.
What has come to the forefront in discussions we have had is this principle, because it is the second time we are into this. We know that there is the potential in the blood system even meeting the full standard of today, the best standard in the world, there is still potential risk in the blood system. There are changes in viruses and new things that can be carried and borne through blood. As we go through the process, and I say this very sincerely to the member for Osborne (Ms. McGifford), as we go through the process now as provincial ministers in setting up the new Canadian blood agency which has been sort of been dumped on our lap with real failures of the Red Cross, we are very cognizant of these issues of insurance: what are we compensating or what are we insuring? Yes, you have to insure your negligence, where you have not taken all reasonable steps to ensure the safety of that supply.
But when you start looking at, do you insure problems that may be outside of your ability to prevent, legitimately be out of your ability to prevent--if a new virus developed and passed on through the blood system, we had a massive infection, and we had people infected before we even knew we had the problem--can we afford to bear that kind of compensation? That becomes a very real issue in building the new Canadian blood system. This is why I think this principle of compensating where the system has clearly been at fault or potentially at fault versus not providing special compensation when the system could not have prevented it.
There may be arguments around the dates, and I accept that. I mean, it is not an exact science, but that general principle becomes very important because, if we say we will deal with any difficulties out of the blood system or health care system even when the system has done all reasonable things possible to prevent it, then the potential risk becomes so great, how do you estimate or manage that blood system?
You know, I just put this into context again. It is not as if anybody within our social safety--we do have a social safety net and albeit it has problems in it. But when someone is injured and there is no negligence, when they are injured, when we fall ill through no fault of our own or we do assume a risk in health treatment and we come out worse than we expected to be and we cannot work or we need other care, our Canadian social safety net does provide for that medical care, does provide for ancillary care like home care, and through things like Canada Pension Plan, disability and other things do provide some level of income assistance.
The hepatitis C program that we have put in place comes on top of that, so it becomes, in essence, an add-on to that existing social safety net. I do not leave the impression that those who are not in that program are left totally out in the cold.
Now, there are some things around the edges that do not work well in that social net, for example, being self-employed based on income. I have had discussions with some individuals about that and that is where this net may fit in. But, if we are to top up that existing social safety net for areas where there has not been a malfeasance, where there has not been some negligence in the operation of anything in our health care system, that kind of cost potentially could weight down our health care system to make it unaffordable, and that is the real kind of issue that we are struggling with.
The difference between now and a few years ago when we did the AIDS issue, two things: I do not think people expected another one, another compensation plan for another illness; secondly, governments were not in the process of taking over and building a new blood system and having to figure out how we are going to insure and what are we going to insure for. So those have made a difference, the principle again comes out, and it is worthy of a good public debate.
Ms. McGifford: Earlier when the minister was speaking about law, he talked about precedence as being a principle of law, I believe. I wonder if the HIV settlement, agreement, package, does not set a precedent and by not extending that same kind of coverage or compensation to persons with hepatitis C, infected in similar circumstances, there is a violation of precedence.
Mr. Praznik: Well, the principle of precedence means that the operation of the law in one situation, once refined, should apply equally to similar circumstances in another before the courts. Gratuitous decisions or noncourt settlements do not necessarily become precedence in law that are enforceable, but the member makes a very good point that, yes, there was a public policy precedent of compensating everyone.
At this particular time, health ministers across the country, and again the second point I make has to be re-emphasized, is the federal government with the lion's share of the liability and contribution, when they came to the table, only put dollars on the table for that window. So for provinces to say, we want to move beyond that, we have to first deal with the principle, but even if you accept it and said, we will deal with the principle, yes, we are going to provide that, we are going to follow the precedent of the other situation, there was no federal money on the table with which to make that offer. In that case it became not practical.
So the principle is important and the dollars are important. So if this were to expand, and I say this very sincerely to the member for Osborne (Ms. McGifford), the government that has to make that decision has to be the national government, who would have to be its funder. But you still have that principle issue, and perhaps why ministers of Health are more cognizant of it today is because we are building that blood system, we are dealing with those issues, and we also recognize as government is taking over more and more of the operation of the health care delivery system--you know, up until a few years ago most health care delivery was very much a private matter of private organizations, independent hospitals and boards who provided that, although we often provided their liability insurance or it would cover those costs.
There was a bit of a buffer. Today we are much more directly the providers of health care, and rightly so, in my opinion. We have to be cognizant of those issues. So we have accepted, if you are going to do top-up compensation to what the safety net allows, where there is no negligence or malfeasance on the part of the system, do we want to provide that? I guess the worry is, if you do provide it in this case, then what is the next one that comes, and of course the moral precedent or the operational precedent that the member flags becomes much stronger.
What we do not know, none of us do as legislators, is what potential cost are we looking at and is that a risk we can afford as a society to bear. It is a very real problem. I know the member flags that and it is worthy of this discussion debate, but it is not a simple answer to it.
Mr. Chomiak: Mr. Chairperson, I do not want to take this discussion down the legalistic route because it has been canvassed. The minister made reference to the post-Krever period when the standard of care issues have been already raised, and I just note that the law of negligence grew out of, and government programs grew out of deficiencies in the law of negligence, and I am not sure, in principle, whether or not we want to make decisions as governments based on the law of negligence.
* (1540)
Having said that, I am certain that all of these issues were canvassed by the ministers and their officials at the meetings. The minister in his last response to the member for Osborne (Ms. McGifford) discussed the issue of compensating, leaving aside the legal issues, and did point out that if there was compensation it would be on a moral basis or whatever term he used to characterize it, and that it would not necessarily be precedent setting.
Is the minister saying that the provincial government of Manitoba will not come to the table to deal with those outside of the '86 to '90 period unless the federal government comes to the table with money?
Mr. Praznik: Well, Mr. Chair, one of the lessons I think that we have learned out of the HIV program is I think it is very important to have a national program, because this really was a national issue. The blood system was regulated by the national government. They bear the lion's share of responsibility, and I agree, I do not want to get on the legal issues. The only point I make, though, is if we did end up in court, if there was no package and we went to court and a court had to assign liability, from all accounts the provinces would range from zero to 5 percent, 6 percent, 7 percent probably, in someone's wild dreams maybe 20 percent.
But the vast majority, 80 percent plus of the liability for what went on rests with the Red Cross and the national government, so as a provincial minister, I have a responsibility to protect the province's position and the province's resources because those who have that responsibility should be the ones paying for their actions. I think we all agree on that principle.
We have always been part of the table, and I am not trying to rely on that, but I say it just to flag our involvement vis-a-vis the federal government and the Red Cross. The Red Cross is bankrupt or virtually bankrupt. It has far more liability than it has assets, so, in essence, it boils down to the two levels of government to deal with this, and I know the member for Kildonan (Mr. Chomiak) appreciates those principles.
We have come to the table. We will always be at the table. We believe in a national program, and we will be there to work with our colleagues however this moves forward, but I say to him, as we develop this, we as provinces today--and this is not meant in any way, and I want to be very clear on how I say this--we have talked about what our additional health care costs will be for dealing with hepatitis C, and I am not trying in any way to include that in a compensation package. If we did not have a medicare system, if we had a total private system, those costs would be actionable in law, but we pay for them. We have estimated as provinces and got agreement, and the federal government has used these numbers, that the additional cost to people's health of treating hepatitis C over the lifetime of the people who have it is estimated, in today's dollars--we used today's dollars rather than inflate, et cetera--would be about $1.6 billion.
Now, we have to pick this up as provinces, so we are already paying significantly for what went wrong in the blood system, and that $1.6 billion I would argue the federal government pays nothing towards because it is at the margin in our transfer payments. If we did not have the hep C situation and we did not have that $1.6 billion in costs, we would still get exactly the same amount of money from the national government, so this is a 100 percent provincial contribution.
That was the argument that we continued to make with the federal government in putting a package together, and the federal cabinet, by the way, would not acknowledge one penny of this as being a cost to the provinces. The Prime Minister, we were told, would not acknowledge it.
Now, having said that, we did not want our battle with the federal government to interfere with getting a package because it was not fair to people with hep C. Whether you agree on the window or not, it was not fair, at least to the people in the window, not to have a package, so we did agree to provide additional dollars, but it was the federal government, who today spend nothing on this, who had to come with the sizeable amount of money for this top-up package. They came forward with initially $700 million, and we negotiated them up to $800 million. We put in $300 million, and we expect the Red Cross will contribute $100 million from the proceeds of the sale of their assets, which should create a pool of around $1.2 billion.
But if we were to expand that program, obviously that regulator who bears the lion's share of the responsibility has to take the lead in coming to the table with the additional dollars, so my answer to the member for Kildonan (Mr. Chomiak) is we will be at whatever table this is that is discussed, but ultimately the party with the lion's share of the responsibility has to be there with the dollars to do that.
The provinces do not have the capability financially, and I know the member appreciates this with the stresses on our health care system, we do not have the ability. If in fact this doubled the number of claimants, we do not have the ability as provinces to raise $1.1 billion or $1.2 billion amongst us for a package that in essence would be picking up the national government's liability.
Now, if the national government decides to move and comes to the table, they will say: we will be there if the provinces put in some money and we will be there to discuss that. But at the end of the day, if there is to be an expansion of that program--and again, you have to deal with the principle first and get over that hurdle, and it is a big one--but if you got a national consensus that, yes, we are going to get into that realm, then the national government would have to be there to pay its share, which is a very significant amount of money. So even debating the principle becomes somewhat academic if the national government is not there with the dollars to support their share.
I do not hear the members opposite. I appreciate this is a complex issue, but I have not yet heard anyone saying that the provinces should be picking up the national share of any liability or any plan here.
Mr. Chomiak: Would the Minister of Health, on behalf of Manitoba, be prepared to contact all of the provincial ministers and the federal minister and suggest that, in fact, a plan be put in place to compensate those that fall outside of the present agreement?
Mr. Praznik: The process by which we have been working is: the chair of the Provincial Council of Ministers of Health, currently Mr. Clay Serby from Saskatchewan, convenes our meetings, et cetera. We were to have a conference call this afternoon, which was cancelled because it was not possible to get all of the players on at that time. I suspect we will be talking again. If you are asking specifically where I am on this, we obviously have to deal with the principle first, because there are ramifications to that principle that become, perhaps, unbearable by our health care costs. Before I would recommend we advance beyond that principle, we would have to have a much better understanding of those ramifications. That does not mean we do not go through that process and try to do it.
* (1550)
Secondly, the national government would have to be there with the kind of dollars to support that program. I know Mr. Rock--this has been a matter of great public debate in the House of Commons. I know there are discussions. Some premiers have made comments about it, and I guess over the next number of weeks we will see how things develop. But what I find somewhat regrettable about the public debate that is raging today is that the principle of what we compensate for and why has not really had much play in that public debate. I think before a decision is made, it should. We, as Canadians and Manitobans, may decide that is the route we want to go, but we should at least know where we are going before we go there. So I advocate more discussion and debate of the principle absolutely, and I would like to have a better understanding of those ramifications before I offered my opinion, personal or policy-wise, on the particular issue.
Mr. Chomiak: What I am hearing from the minister is that in fact, and he can correct me if I am wrong, he does not believe that it is in the--he is not convinced that the principle is worthy of expansion. Pardon me, I will rephrase that. He does not agree with the fact that compensation should be expanded based on the principle that was arrived at in the agreement that was reached between the provincial government and the Government of Canada.
Mr. Praznik: No, Mr. Chair, my view is before one would advance on that principle of compensating beyond areas in which there is negligence, that that must have a very thorough assessment of its ramifications, and, I believe, because it is public money in an area for which there is not a liability, it must have a public debate because it is a matter of setting priorities, and if that is the priority of the citizens of Manitoba after a thorough discussion, then I would be supportive of it. If it was not, after a thorough discussion, then that is the position that one should take, but I think because it does get us into an area where we have not gone before in health care, we must have a better sense of those ramifications.
We have some; we do as ministers, but we must have the public debate that goes with it and not in the realm that we have today which is one of being humane or not being humane, of compensation for some versus compensation for all, but really the reasons behind that compensation, and all I am advocating is that be the subject of a public debate and a full understanding by those who are giving advice to me as a minister. I think that is only fair to ask, given its ramifications to our health system in the long term.
Mr. Chomiak: Then the ramifications are what is at stake, and we know that there is some issue of financial ramifications, and I want to get to that shortly, but I sense, from earlier comments of the minister, that the real issue of ramifications is the issue of liability, which gets us back to the legal issue. Is that not correct?
Mr. Praznik: The issue is this. Every day in our health care system, in the course of the treatment for illness, for disease, for injury, health care providers and professionals make decisions on courses of treatment. Many of those, almost all of them to some degree, have risk involved, and they make those decisions on assessing that risk on the best available information of the day, the standard of care, and sometimes that risk--things do not work out as intended, and people suffer injury, worsening condition, et cetera, but that is part of the risk of what is medicine and treatment.
If they are injured in a manner in which they are not able to earn a living or suffer other pain and suffering, worsening of condition, do we provide compensation for that, because if you think it through and you say, yes, we are going to, then do you take those risks, and if the costs of that compensation and more riskier procedures or more riskier drugs grows, you will choose not to use it, and you will let nature take its course, whatever it is, and often that might be death, with no hope. That is really what the principle is about, and that to me is a very, very serious principle, and the member for Osborne (Ms. McGifford) flagged the fact that we have one precedent, we do another. Does this become our standard practice in our health care system?
You know, if you look at the blood system, just for example, and we are, as a member of the new Canadian Blood Agency, a shareholder in this new agency, we know that the nature of viruses, of disease being spread by blood, there is a risk. We do not or never will likely have 100 percent risk-free blood.
If, with all the best science, there is still the spread of virus or injury through the blood system, a new strain of virus that we do not know about, and if we have to build that into the cost of running of our system, we cannot afford a blood system. It is very possible we cannot afford a blood system. So then we say we do not do blood anymore, then who does it, under what risk, and the ramifications, when you think them through, are very, very significant. My thought is, I do not think they were entirely thought through the last time, and maybe it was the nature of a small number of people and the dynamics of a first time in dealing with problems, and big problems in the blood system, but as we look to the future, this is a very, very significant issue.
Just look at pharmaceuticals and some of the drugs we have discussed, Betaseron and others, that have some very adverse side effects, and as we see the development of new pharmaceutical products, there is a risk with those side effects, and if some of those side effects turn out to be very harmful to that individual, do we compensate for that?
Now, I imagine there are some ways to separate this out. Maybe that can be done, but it is the path that we are going down, and I am saying to the member for Kildonan, in all sincerity, I am not pretending to have the right answers. I am flagging the problem today, and this is the problem that we flagged as ministers of Health. It is a real one, and I think he has to acknowledge that. Is this difficult? You bet it is difficult. It is very, very difficult, but in the context of Canada we do have still a pretty significant safety net system. We as a society do not let people entirely down who have been injured through no fault of their own, or ill through no fault of their own, or no fault of anyone else. It is not as if we leave them totally out of the picture. We do have other means. Perhaps some of those have to be strengthened, but those are the kinds of things that really have to be discussed out of this.
I think we often make bad public policy when we make it without a thorough discussion of what its ramifications are, and that is really all I am trying to say. We have to have that discussion. It is not happening nationally because I believe Minister Rock tried to make what was, in essence, the settling of a potential legal issue into a humanitarian effort. The result was he was caught in the inconsistency of his statement, but that was not the intention of the provinces when we sat at the table to develop a plan.
So Mr. Rock has to explain that and take the heat and deal with it, but the ramification and the extension of this do get into an area that, if we are going to do it--and I am not saying that it is not going to happen--it should be at least thought out and have that discussion as to what does it mean and how are we going to handle it in other circumstances as we move forward. That is all I am really saying, and I must say I appreciate the advice and the thoughtfulness of the member for Kildonan (Mr. Chomiak) and the member for Osborne (Ms. McGifford) and others because this is a very serious issue. I do not make light of it in any way. It has lots of ramifications, and I suspect over the next number of weeks and months it is going to develop further. How it will end up, I do not even want to predict today, but we will be at the table for whatever discussions take place.
Mr. Chomiak: I am having a little difficulty getting an exact grip because the minister, and I appreciate it is a difficult issue, went one way and then towards the end, at the latter part of his response, ended up on a different course. Fundamentally, as I interpret what he said, basically the federal minister made a mistake in not justifying the decision based on the issue of negligence, if I can characterize it like that, and the minister would like a public discussion before that principle was extended, but the minister, if the public discussion was favourable, would be prepared to extend coverage beyond that principle should it be favourable. Is that a fair assumption?
* (1600)
Mr. Praznik: Yes. Just on the first part of the member's comments. At the meeting we held--I believe it was in--we have held so many here now, we had one cancelled in Vancouver and we were in Toronto, and then in Toronto again. At the second last meeting in Toronto where we made tremendous progress in getting the principles around an agreement, we had a large crowd of people involved in this issue expecting announcements that day, which, I think, was somewhat unrealistic. It takes more than one meeting to resolve these issues.
Mr. Rock in speaking, along with Mr. Serby, made comments about treating this on a humanitarian basis. All of our discussions were around the window period and based on the fact that there is a potential negligence in the system and that it is being left to us as provinces because of the inability of the Red Cross to deal with the results of their own decisions and work. He went out and made public statements, and it made him sound very compassionate in the eyes of many, but it was not reflective, I think, of the discussions that we had had. Then, of course, when we did make the announcement in Toronto the week before last, and we had our press conference, there were many in the press corps who had heard his initial remarks and challenged him on it, and rightly so, and said, you said the program was supposed to be for this and this reason, now you are limiting it. That does not make sense.
I know many of the comments and statements that have come to the members in this committee stem from those different statements, but at the meetings we had there was no inconsistency anywhere in this on the course in which this was being discussed. The consequence was Mr. Rock has now had to answer for what appears to be a change in his position, which is in reality I think a change in his message, but his first message was not, in my opinion, accurate with respect to our discussion.
Now, on the second part of the member's question, what I am saying is in all of these things positions develop. We went into our discussions in this plan that we wanted to have full credit for the $1.6 billion that we were contributing. We felt, as provinces--and by the way, this was not just Darren Praznik in Manitoba, this was many other ministers representing a variety of political stripes. In fact, I think western ministers were very strong. British Columbia was very strong on it. There were New Democrats, Conservatives and Liberals in the group and Parti Quebecois as well. We felt very strongly that we wanted to get the federal government to ante up to their share of the total cost, even if you did a 50-50 split and give credit for what we are spending.
We fought that issue very, very hard. I think it resulted in the federal government putting some more money on the table, but at the end of the day we did not want that to be a reason why we did not get a package. So we came to the table with some additional dollars to make that package. We did not want it to end in no agreement at all, and the importance of having a national program is very evident. But why I raise that now is, I am one, we are one, of 13 jurisdictions dealing with this, and over the next few weeks--I have seen the federal government change its position and mind many times, and if it were to do that and others were to do that and the whole country was moving in a particular way, we would certainly be at the table, and we would be part of those discussions.
I do not know where this is going to end up, but I do say this. I think, for the good of all and the good of our health care system, there needs to be a public debate on that principle of what we compensate in our health care system. I would hate to see any decision made one way or the other without that thorough kind of public understanding of what we are debating.
Mr. Chomiak: What if we were to propose that a public discussion and public debate or some kind of forum be held and the issue of the principle be debated in whatever context, whatever forum, and secondly, that all governments accept and adopt the principle as already concluded in the agreement but in a nonprecedent setting, as the minister has already indicated, move, if the federal government were to come to the table with additional funds, would Manitoba sign--and I am not talking about other jurisdictions--be prepared to sign an additional agreement with those few hundred, if it is that many in Manitoba, individuals who fall outside of the period '86 to '89, would Manitoba be willing to sign an agreement with them?
Mr. Praznik: I know this may not satisfy the member today, but obviously I do not have the authority to indicate a yes or a no to the member. I would have to wait to see what in fact the terms of that were, and I would have to take it for discussion with both our Treasury Board and our cabinet for a decision.
I know the member appreciates that that is the process for approval. There is a lot of dynamic involved here. There are other issues involved somewhat in terms of relations with the federal government. If the federal government said to us, we are prepared to put a significant amount of additional money into a compensation package, but, oh, by the way, it is going to come out of reduced transfers to you, well, that would not be acceptable. So there are a lot of issues that I am sure he would want to have worked out.
I guess what I am saying to the member today is that I have been around this not that long but long enough to know that dynamics happen in issues and things move forward. I cannot predict today where things are going to be two or three weeks from now, but I can assure him that we will be at the table and we will attempt to be reasonable in whatever happens. We have attempted to be that way now, and that has not always been the case with our federal partner.
Mr. Chomiak: Mr. Chairperson, I appreciate that response. In principle, therefore, would the minister be amenable to that kind of a solution?
Mr. Praznik: The difficulty that I have as minister in making a recommendation to this committee or cabinet or my colleagues or the Legislature or the people of the province of Manitoba is that one really needs to have an assessment of what other risk areas there are where one gets into compensation for injury or damage outside of cases where there is negligence, where it is the assumption of the risk, particularly potential risk in the blood system, nonnegligent risk, as we take over the blood system. We are only beginning to develop that, I guess, and get a sense of our insurance risk.
I am prepared, by the way, to share those as we go through Estimates and other times, because I know we have meetings and discussions scheduled as we set up the blood system. So whatever is available publicly, I am prepared to share this, and I am sure that is a rational and reasonable way in which to assess this. If the member is asking me for a viewpoint today, yes or no, I cannot give him either. The reason, quite frankly, is that I asked for the assessment and we are in the process of kind of getting a sense of that.
If there is a willingness by governments to revisit this and look at it, I think we as Health ministers would all want to have a much more thorough assessment of that principle of the risks that we are taking on for other precedents, and I would certainly want to be willing to share that with him and his colleagues so that we as a province went into any change with full, open eyes as to the consequence.
Mr. Chomiak: Mr. Chairperson, so is the minister saying he would be willing to review that, he would be willing to go to the table?
Mr. Praznik: Mr. Chair, I am a member of the Council of Provincial Ministers of Health and, where this issue is discussed, I will be at the table as long as I get a pair to be at the table.
Mr. Chomiak: Mr. Chairperson, is it correct to say that the provinces are putting $300 million into the $1.1-billion or $1.2-billion portion of the compensation package?
Mr. Praznik: Mr. Chair, the finances of the package are this: the federal government is contributing $800 million; the provinces are contributing $300 million; and as we finalize our negotiations with the Canadian Red Cross Society for the transfer of their assets, we expect that there will be approximately $100 million or so available from the Red Cross towards this package. Now, if I remember correctly, the federal government dollars are contributed this year, this financial year. The provinces will make their contribution over a three-year period I think beginning next year--we are still finalizing those details--and the Red Cross upon transfer of their assets. That is still part of those discussions.
* (1610)
The intention of the fund is to really create a pool of money that would be managed by a group acceptable to the recipients, and it would pay out on the basis of really two not criteria but two basic ways, some initial lump-sum payment and, secondly, a payment based on the severity and need of the individual, which I think is a federal bureaucratic way of saying income replacement.
I know in some of the discussions that I have had with people in the hepatitis C community here, the two issues that they raise are that they want to make sure their health costs are covered, which they will be, and, secondly, that if they cannot work that there is a reasonable income replacement there to support their families, and that is really what people have been boiling down to, what they are looking for. So Manitoba has always pushed this view that this fund, by and large, should be supporting an income replacement top-up, because many of these people, not all, but many will be entitled to CPP disability and other income replacement, but this would provide some level of top-up. So if an individual with hepatitis C is able to work today, and many are, they would not access the fund when they are not able to work; they would access the fund on whatever basis that is agreed to.
So that is the way we are looking at structuring this. The pool, of course, would be managed. It would generate revenue on an annual basis and would be able to provide for the actuarial assessment of what is needed to take people right through their working years, over their lifetime.
Mr. Chomiak: What portion of the $300,000 is Manitoba going to be contributing?
Mr. Praznik: Yes, $300 million; we all tend to make that mistake. We are working on--our percentage range will be between 3.8, I believe; yes, somewhere between 3.8 to 4.4 percent, and we are still working out, with our provincial colleagues, as to how this is being split on the basis of the population of province or population of cases. We are still working out those particular numbers, but that is the range from lowest to highest based on numbers, population, whatever formula we use. We expect we will pay into this fund.
Mr. Chomiak: So, if I understand correctly, although the basis of the formula has not been finalized, we are talking about something like $12 million over a three-year period, is that correct?
Mr. Praznik: Somewhere from $12 million to $13 million, somewhere in that range over three years, yes.
Mr. Chomiak: The minister outlined some of the details of the compensation aspect of the package. Is there an agreement, per se, that outlines these criteria?
Mr. Praznik: No, we agreed in principle to these criteria. What is fundamental to the package, there are three provinces in which class action suits have been filed and, again, that is one of the things that precipitated the development of the package. The mandate of the group administrating this is to negotiate with the various class action groups, hepatitis C community, et cetera, to develop the terms and details of the package, and then have it accepted or reviewed by various courts for its acceptance. Obviously, it has to be acceptable to the courts dealing with the three class action suits, and we would want to assure that it is court reviewed and acceptable in order to be fair and be validated.
Mr. Chomiak: Is there an agreement that the minister can table with this committee?
Mr. Praznik: Yes, Mr. Chair, the principles, I think, were outlined in our press statements. We have not signed an agreement or document, but they were agreed to by us and they were outlined in the press conference. I think there were some fact sheets circulated on the detail, but the details of an actual offer have to be worked out with the various parties. They have to be court approved, and when, of course, that happens, I would be pleased to provide him with that detail. But there is not a document that I can provide today to him.
I just should indicate, in some of the discussions I had with people, hemophiliacs in Manitoba, who had been involved with this--and I have tried to keep them involved throughout this process and to seek counsel from them, a number of these people on various issues. We talked a lot about how one could administer this package and who would be administering it.
What I am happy about is that there is a lot of ability here for those affected to have a role in putting this together, tailoring the program and including its administration. So it may be somewhat frustrating for those who want details today, but I think it gives a lot better opportunity for those involved to sort of tailor their future to where they want to be.
Of course, there is a whole gamut of ideas as to how this fund should be administered between those groups, and they have to do some sorting out among themselves as well.
Mr. Chomiak: Do we have any estimate of the figure of the number of Manitobans that are eligible for compensation, as well as the number of Manitobans who potentially have been affected through tainted blood and have not developed hepatitis C?
Mr. Praznik: We believe it will be somewhere around 800 Manitobans who would likely be in those criteria. With respect to hemophiliacs, and I raised this, I discussed with the member for Osborne (Ms. McGifford), in discussions I have had with some people involved with the Hemophilia Society they thought initially that there might be about 15 people who would not be eligible. I think they have narrowed that down to five or less, so I just want to put in perspective that in terms of hemophiliacs, by far the vast majority will be eligible because they received blood or blood products during the window.
I know Mr. Brown has been involved in that, and others, about sorting that out. The last time I spoke to him he estimated that it could be five or less who would be excluded hemophiliacs from the program, so you can tell we are getting down to refining those kind of numbers.
Mr. Chomiak: The 800-odd figure the minister just gave, is that the estimation of the number of individuals who would be compensable for the period '86 to '90?
Mr. Praznik: The numbers of 20,000 to 22,000 were arrived at by the federal government again doing the calculations on a national basis and doing estimates as to the percentage in Manitoba. Obviously there might be some changes or variations in that as we actually go through the program, but that is the basis on which the federal government developed that information.
Mr. Chomiak: I understand that they also estimated there have been figures as high as 40,000 to 60,000 of those individuals who may have contacted hepatitis C outside of the '86 to '90 window, and it may be as low as 30,000. Does the minister have any figures as to how many fall in the excluded category from '86 to '90?
Mr. Praznik: One of the questions I have asked is the ability to find out who are potential carriers, et cetera, who have had blood, and I am advised one of the difficulties in doing the look-back, check-back is that hospital records end up being destroyed after a period of years, Red Cross records for blood transfusions are not necessarily the greatest, which is part of the problem with the Red Cross. So it is very difficult to ascertain exactly how many people are likely to be in that category.
Mr. Chomiak: Can we break for five or ten minutes now?
* (1620)
Mr. Chairperson: Is it the will of the committee to take a five-minute break? [agreed]
The committee recessed at 4:20 p.m.
The committee resumed at 4.28 p.m.
Mr. Chairperson: Order, please. We will reconvene in the Estimates of Health.
Mr. Chomiak: Mr. Chairperson, just to conclude the line of questioning that we had ended on just before that short break, I understand there is roughly 800 or so based on the federal government percentage of 22,000 and those are roughly the amount, the number of individuals, who fall within the '86 to '90 period, but we do not really have statistics or figures on those that may potentially fall outside of that period.
Mr. Praznik: Mr. Chair, if we do, they are not very good ones, as I said, just because of the system of records. That is one of the dilemmas, if one does agree to expand the program, is being able to get accurate information on even costing it out. That is not the reason why you do not do it, but it is a logistic reason, a logistical problem if you do agree to go there.
Mr. Chomiak: Mr. Chairperson, just for the record, I am of the view that the program will be expanded. I think that there will be a movement towards that, but that is a personal view based on how I see the issue developing.
* (1630)
I would like the minister, however, to perhaps in more detail--he has outlined the compensation scheme. I wonder if he might outline for me the other specifics of the deal. We know what the financial figures being offered are and we know what the compensation--I just want to understand a little bit about process because at this point what are the next few steps that are going to take place, and what process is going to be put in place to develop the package as it presently exists?
Mr. Praznik: Mr. Chair, just a comment. The member's statement and his opinion as to where this would go just triggered with me a thought or an observation about the nation of Canada. When you are a province with about 4 percent of the population or 4 percent of the dollars in a program, you are never likely the leader in that particular program. I say 4 percent of the provincial share of anything. When you add the national share, that diminishes even smaller.
One of the dynamics of any federal-provincial process, of course, is that the provinces that are large by way of population--Ontario, Quebec, British Columbia even, and Alberta--have a much greater ability to influence events because they have much more dollars on the table. So we are able to make points, we are able to lead the fight to some degree for a fair share of federal funding to this particular program, but at the end of the day, it is the governments that are putting the lion's share of the money on the table that are going to influence the outcome one way or another. Whether the national program expands or does not expand will be a decision that will be made in cabinet rooms in Ottawa, Quebec City and Toronto as opposed to Winnipeg, Regina, Fredericton or Halifax, I suppose, so sometimes you can have more of an impact than your dollars, but they tend to be more the exception than the rule.
I know the member appreciates that. That is why I have said to him that it is likely at the end of the day whatever happens, you know, Manitoba is always at the table with the other provinces for discussions and we will be there. We will have to see how things develop.
I understand Mr. Rock issued a press statement today that some members of the media shared with me that he was not prepared to see that open up again and move forward, but again in politics and public life there are always things that happen that we do not always expect.
With respect to the details of where we go from here, we have had a working group in place among the provinces and federal government and territories who have been working through this as we move through. Mr. Ulrich Wendt is our member of that particular working group. That group, who has framed our options and given us options on principles and data, now will have that responsibility of working with the various organizations and groups to frame the details of the program that ultimately will go to court.
So as a consensus is reached on those and positions are advanced, anything that is in the public realm I certainly have no problem sharing with members of the committee, because it is an interest to all of us as this thing progresses. But, it really now, in the detailed form, is a work in progress.
What we attempted to do as ministers is agree on really two things: the framework of a national program which we achieved at our meeting in Toronto, I guess it was in February that we met, or in March--[interjection] February. Then the next issue, of course, was how we would divvy up the payment of that program. Just by way of process--I know it is not directly on point of the member's question--despite what came out of the national media, that is how, in fact, we did it. We got agreement on the framework of a proposal including sort of the global amount we would like to see there, and once we got that agreement, then we worked as ministers on how we would pay for it, who would pay what share. That was not the way it was reported, but it was the way that it happened in fact.
So the working group will now be moving forward and dealing with the various organizations and ultimately, whatever is worked out will have to go before a judge in the appropriate courts, I imagine, to have this settlement approved. At least three jurisdictions have class action suits where that is an absolute requirement. I imagine there will be other court requirements in other provinces, so that will be the process. How long it is going to take, I do not really know, but I hope it would move somewhat expeditiously.
Mr. Chomiak: Of the $1.2 billion that is going to go in the compensation portion, if I can term it in those words, how was that figure arrived at?
Mr. Praznik: That is a very good question. The dynamics of discussion, I think, the working group spent a lot of time--if I may, Mr. Chair, one of the difficulties when you announce $1.2 billion and potentially 22,000 cases is people, the media and potential claimants do quick math and come up with a number and say, well, that is not enough money.
This program in terms of the principles behind it was never designed to, in essence, produce sort of a divvy-up payment. It was designed to become an income fund, that between capital and earnings over a 30-plus-year period would be able to support the income enhancement needs of people with hepatitis C; their health care needs, of course, already looked after by the health care system. It would be, in essence, a top-up, I would expect tax-free top-up of the CPP disability earnings and other potential liability. So it is part of the whole package to anyone who is disabled or totally disabled by hepatitis C.
It comes back to the principles that I learned very clearly from the table with dealing with people from Hemophilia Manitoba, that they were looking for insurance that their health needs would be met, and that there would be some income replacement to ensure that they could support their families and not have to go onto social allowance but support their families in a reasonable fashion if they were unable to work. That is what the expectation level was.
How the number was arrived at? We talked about what we were attempting to achieve, the population grouping, and I imagine the working group did some calculations on what would kind of be needed to meet the goals of that fund. Now, of course, the actuaries and technical people have to do further refinement as this is put together, but it is hoped and expected that it will be able to meet the need.
* (1640)
Do we know exactly that it will do it today? I do not expect so, but we will have to see how this works out over the next while, and we trust that the advice we got on that amount of money would meet that particular need. Also, what was contemplated is what we could probably raise between us and what would probably be needed to meet the need on that kind of basis of a supplement.
So, is it exact? No, it is not. It requires a great deal of actuarial work once you know the people who are applying, their state and conditions. There are just so many variables within it that you cannot be totally exact.
Mr. Chomiak: Is it therefore a definitive part of the package that, in fact, the compensation portion will be an income supplement or an income replacement? Is that the bottom line definitive compensation that will be offered?
Mr. Praznik: From my recollection and expectation, I think the principle was that there would be some degree of lump sum payment, initial payment, and the remainder paid out on the basis of need. I think one can fairly translate that into income need. It may vary a little bit from province to province depending on where you live because there are different degrees of home care service. In a province like Manitoba, for example, there are a lot of things that we provide that other provinces do not.
So I do not know how those nuances are going to be managed, but that is part of the work of the working group, and, ultimately, court approval for this will have to be granted.
Mr. Chomiak: The minister can correct me if I am wrong, but just as the criteria for those that were covered for HIV was somewhat different than the hepatitis C coverage, is not the compensation package therefore significantly different in terms of how it is going to be applied than the HIV package, and if that is the case, why?
Mr. Praznik: I am not totally familiar with all the details of the HIV package, but I understand that there is an annual payment made to individuals, an annual income payment, plus they received a lump sum. I imagine part of the difference, if I properly recollect our discussions as ministers and the advice we received from the working group, was that the life expectancy of people with hep C and their needs are considerably different than those with HIV.
There will be a percentage of people with hep C who should be able to have a completely normal working life, so their financial needs will be very different from those who are struck in such a manner with this illness that they will not be able to work for a long period of their life. So the prognosis on cases has a great variance as opposed to HIV where the results tend to be very similar within a very short period of time.
So there is a great deal of difference here, and, again, the expectation in people that I know I talked to here in Manitoba was that the real concern, the medical care, was important, Pharmacare for drugs, et cetera. That is part of our responsibility, various drugs as they become available, to deal with our Pharmacare program. But it was the income replacement, the income top-up, because that becomes important, to be able to support your family if and when you are unable to work. Many people said to me that as long as they are able to work they are not expecting to draw out of this fund, but if they are not able to work, become disabled, they want to know that the fund is there to support them to a reasonable level of income.
The other piece--and I say this to the federal government if they should ever read this and we are certainly saying this at the working group--is they are going to have to do some work on their CPP disability because a complaint I get is that there is almost an automatic denial upon application, and then people have to go and appeal. Surely to goodness, if you are in this hepatitis C arrangement and you reach the point where you are unable to work, you should be quickly processed through the CPP without an appeal in order to get those benefits which are obviously part of the total income replacement package.
Mr. Chomiak: I am looking at a document that was provided. I do not have another copy with me, but I will just briefly relate. These were the components of the proposed package as recommended by the Canadian Hemophilia Society in a presentation of approximately a year ago, but basically I will just highlight.
There were six proposals, a lump sum of $30,000, financial compensation for extra health expenses, a death benefit of $20,000 for a minimum of five-year payable, a $4,000 annual payment per dependent child, nontaxable, and basically those were the five main components. I take it from what the minister said that those recommendations were not accepted with respect to the package that is now being proposed to go back to the courts and to the various individuals for acceptance or rejection.
Mr. Praznik: Mr. Chair, Mr. Wendt just pointed out to me that the hemophilia society is only one of the groups that represent people with hepatitis C, that there are a number of organizations, and that their requests or recommendations varied, some considerably I am advised. So consequently to pick one and not others, that is part of the negotiation that will now have to go in on with respect to the fund and how it will be delivered.
Obviously when you have this process of federal and provincial ministers looking at a compensation program, you are going to have groups putting out their particular bargaining positions and expectations, et cetera, and it is a bit of a bargaining process that goes on. Now, instead of it being largely in the media in a void somewhat, at least now this fund is in place and there are numbers around which to build a very real program with real dollars attached to it. As I am sure the member can appreciate, when you have a number of organizations putting out their proposals as to how compensation should be paid and they are somewhat different, it is hard to pick one over the other and it is the beginning of a bargaining process. Now at least that will be done at a table around real dollars.
Mr. Chomiak: Mr. Chairperson, now I am confused because I was trying to ascertain specifically what the compensation package was. I was under the impression that it was geared toward an income replacement or income based, and now the minister is saying that it is part of bargaining, unless I misunderstood him. I am trying to ascertain where we are going.
Mr. Praznik: Mr. Chair, I apologize to the member if I sounded somewhat confusing to him. The principles we have agreed to in this fund is some initial lump sum payment, the amount to be determined in negotiation, and the terminology we used is an ongoing availability of dollars I believe for meeting the needs because the needs vary so greatly. Primarily those needs are income replacement.
* (1650)
In some provinces, depending on what they provide under their health care systems, there may be additional medical needs that might have to be included in an ongoing basis, and that is something to be negotiated. Like, for example, in some provinces they have very limited home care programs and Pharmacare programs, whereas here ours is much more extensive--Manitoba, Saskatchewan, western provinces. So by and large it will be income replacement, some lump sum, and as I said, the parlance that has been used in the documents of special need, I think one can translate it that income replacement, and with that exception that I think I flagged in some provinces, certain health needs that their systems may not pick up, but the details of how you pay, how much do you pay, on what criteria you pay, those things all have to be worked out in the negotiation. The principle is there, kind of how the thing will work, how the numbers actually work out, have to be done in negotiation and with actuaries and those people who are able to structure these kind of plans.
Mr. Chomiak: Mr. Chairperson, I thank the minister for that clarification.
Can the minister outline whether or not, if the $1.6-billion figure that the minister indicated was the amount of the ongoing pre-existing health costs that are going to be met by the provinces, if whatever portion is Manitoba's is presumably more because of our home care system and our Pharmacare system? Was it taken into account on the $1.2-billion compensation portion of which Manitoba's is going to be somewhere like $12 million to $15 million or whatever that since Manitoba is paying a greater share of the medical costs that there will be more or less money available on the compensation side or vice versa?
Mr. Praznik: Mr. Chair, I am advised that as the working group, that is part of the reason for a range in the percentage of how much this will cost. As the working group works through those numbers, we obviously expect that in some of those provinces where they do not offer as large a range of services and part of this plan may in fact be used to buy those services for people with hepatitis C that that is balanced out in terms of our appropriate shares.
The member raises a very good point, that it would be inappropriate or unfair to Manitoba citizens to be paying our share and then helping in essence to subsidize costs in other provinces that their health care system does not provide for when ours does. Those are the kind of nitty-gritty details that will have to be worked out and one of the reasons why we have a range.
Mr. Chomiak: Mr. Chairperson, well, how was the $1.6 billion arrived at, and what is Manitoba's share?
Mr. Praznik: Mr. Chair, again, I am going to ask Mr. Ulrich Wendt to describe the process by which the $1.6 billion was arrived at. He was part of the working group that did the numbers, and these were prepared for our discussions with the federal government in making our claim that we were already contributing significantly to the hepatitis C issue. The instruction we gave to the working group was not to inflate those numbers. We wanted to make sure our numbers were highly defensible, because we knew they were so significant. Even when you add up our contribution, the provinces are paying well over 50 percent of the cost of the hepatitis C issue. So I am going to ask Mr. Wendt if he would go over that process for the members of the committee.
Mr. Ulrich Wendt (Manitoba Representative, Hepatitis C Working Group): Mr. Chairman, there were two things that needed to be determined in coming up with this. One was, what are the actual, average health care costs across the country, and then, to whom do they apply?
The difficulty with the hepatitis C disease is that some people can live their whole lives with the disease with no overt symptoms. So we had to use the disease pattern itself as part of the basis. We compared that against actual experiences in B.C., Manitoba, and verified against Ontario data to come up with the estimated likely cost of the disease burden over a 30-year period.
The difficulty is that we do not have a full history of this disease yet, because it is a relatively new disease. So some of this has been extrapolated upward into a 30-year period. That is where the $1.6 billion came from in today's dollars, not discounted for the past cost and not inflated for future. This is all incremental dollars in addition to what the health care system would normally be paying. So, for instance, we did not count the total cost, just the costs for people with hepatitis C. We discounted that against the cost for people, what their normal experience with the health care system would have been. So this was an add-on cost.
Mr. Praznik: One other point that I think would be of interest to members of the committee and this is why this issue may not yet be settled with the federal government is because we agreed to get on with the deal between us, and we still have a day of reckoning on these issues. They should be fought out between governments, but if the Prime Minister of our country took the view that this is health care costs the provinces would have anyway--so there is no value to this. Well, if the blood system had acted the way that the hepatitis C committee argues it should have, then we would not have had hepatitis C in that group, at least from '86-90. We would not have had that $1.6 billion in costs. Those people would not be sick.
In many other circumstances in our health care system that the member is very well familiar with where there has been a malfeasance, and I hate to use legal terms, but I know the member for Kildonan (Mr. Chomiak)--we share that background in the law and he appreciates the use of that term--where there has been a negligence or a malfeasance, we today already go back as a health care system to recover our costs. If an individual is injured in an automobile accident through a formula, the Manitoba government collects money from Autopac. The cost of health care for automobile injuries is borne not by the general taxpayer but by the payer of insurance premiums.
If you are injured in the workplace, the cost of health care is not borne by the general health care system or the taxpayer, it is borne by the employers through the WCB fund. The province of British Columbia today has launched a lawsuit against the tobacco industry to recover the cost of treating victims of smoke-related illness, because they view that industry as committing a malfeasance that has cost the health care system.
So, conversely, in an ideal world, I guess, or even a legal world, I would argue that we would potentially have a claim against the managers of that blood system, the Red Cross and the regulators, for a share of this $1.6 billion if there was a malfeasance or a negligence they were responsible for. I know in the discussions we have had with the federal government, and the member appreciates this argument--[interjection] Yes, absolutely, a very cunning comment by the member for Kildonan, but in our discussions with the national government, to be told that this had no value, that they had no responsibility was downright insulting to provincial ministers in that this was not recognized.
So it just gives you a flavour of the kinds of discussions that we had on the two stages of this, getting agreement on what a program would look like, and, the second part, how we would divvy up the costs.
Mr. Chomiak: Just by way of administrative, my guess is that we will, perhaps, at most, have a few more questions when we reconvene tomorrow, but not extensive, and that I guesstimate that we will go into the normal course tomorrow without anything--just the normal course going through the flowcharts, going through some of the first few expenditure items, but no significant variation tomorrow.
Mr. Chairperson: The hour being 5 p.m., it is time for private members' hour. Committee rise.