2016 Legislative Session: Fifth Session, 40th Parliament
This is a DRAFT TRANSCRIPT ONLY of debate in one sitting of the Legislative Assembly of British Columbia. This transcript is subject to corrections, and will be replaced by the final, official Hansard report. Use of this transcript, other than in the legislative precinct, is not protected by parliamentary privilege, and public attribution of any of the debate as transcribed here could entail legal liability.
DEBATES OF THE
LEGISLATIVE ASSEMBLY
(HANSARD)
HOUSE BLUES
THURSDay, MAY 5, 2016
Afternoon Sitting
THURSDAY, MAY 5, 2016
The House met at 1:32 p.m.
[Madame Speaker in the chair.]
Routine Business
Introductions by Members
L. Larson: I have the pleasure today of welcoming new staff to the parliamentary education office.
This summer 11 post-secondary students have been hired to work in the parliamentary tour office. Over the next four months, these seven summer tour guides and four Parliamentary Players will provide free guided tours to about 75,000 school children and tourists from around the world, seven days a week, starting on the long May weekend.
You will certainly notice the Parliamentary Players, as they will be dressed in period costumes to portray four prominent personalities from British Columbia's history: Queen Victoria, MLA Mary Ellen Smith, Francis Rattenbury and Amor De Cosmos.
I would like you to please welcome Emma Byskov, Aidan Correia, Anna Dodd, Kieran Dunch, Haley Garnett, Leah Hughes, Madeleine Humeny, Josef Methot, Elexi Mills, Giorgia Ricciardi and Fregine Sheehy.
Tabling Documents
Madame Speaker: I have the honour to have a special report of the Representative for Children and Youth: Approach With Caution: Why The Story of One Vulnerable B.C. Youth Can't Be Told.
Orders of the Day
Hon. T. Stone: In Section A, I call the estimates of the Ministry of Natural Gas Development, Deputy Premier and Minister Responsible for Housing; in Section B, the continuing estimates of the Ministry of Health.
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Committee of Supply
ESTIMATES: MINISTRY OF HEALTH
(continued)
The House in Committee of Supply (Section B); R. Lee in the chair.
The committee met at 1:36 p.m.
On Vote 29: ministry operations, $17,820,706,000 (continued).
J. Darcy: I would like to begin today by dealing with issues related to the B.C. Cancer Agency. Then later my colleague from Surrey–Green Timbers will be doing mental health, and then I will be coming back to ambulance service.
I'd like to begin this afternoon by discussing childhood cancer survivors and the multidisciplinary clinic that they were promised. The minister knows well that the particular group of cancer survivors who were in the galleries today were the ones who, for several years, pressed to have their needs met. They went from one agency to another to another and said: "Once our children reach age 19 and they are no longer covered by B.C. Children's Hospital, where they were getting good care and coordinated care, there is nowhere for them to get coordinated care."
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They said that we need a multidisciplinary, specialized clinic to address the needs of these most complex patients, the ones who are experiencing a multitude of late effects of the treatment that saved their lives. That number is approximately 50 — extremely complex childhood cancer survivors.
They also said that there ought to be a system for recall of the approximately 3,500 now adults, then children who were treated aggressively with chemotherapy and radiation, which saved their lives, and who may not know, because medical science perhaps did not know but certainly knows now, that that treatment can lead to horrific late effects, that they should be monitored, that they should be recalled and that they should be referred and screened. An important part of the clinic, absolutely.
Let's be very clear that the families who initiated this and who formed the Pediatric Cancers Survivorship Society and came to this House and visited MLAs, one after another, were saying: "We desperately need coordinated care for our children, for these complex patients, because the health care professions still don't understand it, and the care needs to be coordinated."
As I said to the minister in question period this morning, a few weeks ago these families — who have taken part in working groups and in planning for the opening of this clinic and who have had great hopes that finally, finally, these survivors of childhood cancer would have a place to go to coordinate this care — were told that those other pieces will be done but that the most complex cancer survivors, the ones with the most severe medical conditions, about 50 identified in the business plan, will not get the care and treatment, the coordinated care, from that clinic that they were promised.
This morning the minister referred to histrionics. I'm going to put that aside. It is too offensive to pursue at this time. Will the minister please answer the question about why these most complex patients are not going to receive the care that they were promised at the specialized clinic?
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Hon. T. Lake: I did say in question period.... I'll be happy to repeat it again and take up time in estimates to say, basically, the same information that I provided earlier today. The member seems to want me to do that and take up the time to do it, so I will.
There's no question that when children develop cancers and undergo life-saving treatment…. Particularly if you look back ten, 15 years ago — when treatment was not as sophisticated as it is today, when adverse effects were greater than they are today and the long-term impacts of those treatments were largely unknown; many of them were new treatments — there's no question that we see children who are alive today who wouldn't have been a number of decades ago, but who will encounter complications and health challenges as a result of their cancer treatment. We recognize that this is difficult.
When you transition away from B.C. Children's Hospital into other parts of the health care system, there isn't the same level of knowledge, of expertise, dealing with the childhood cancers and the subsequent effects of treatment for those cancers. Recognizing this, the provincial health services authority worked with the Pediatric Cancers Survivorship Society of B.C. and along with the B.C. Children's Hospital and the foundations of both the B.C. Children's Hospital and the B.C. Cancer Foundation to meet and to decide what sorts of supports and services would be needed.
That work has been ongoing. The business case was created. The foundations have developed funding that will support this as we go through this. Of course, there are always bumps along the road in terms of getting to where you want to be as soon as you want to be.
First of all, if we get back to the news release, the news release did not promise a clinic. It promised that there would be supports through the adult childhood cancer survivorship program. When the group met, they decided that a clinic was something that would be helpful in terms of dealing with the long-term and latent effects of treatment for childhood cancers.
Work has been ongoing. The process is in development. I am told that the pieces are coming together and that the clinic will be running later this year — we hope as early as June of this year, which would be not much longer than a month from today.
J. Darcy: Let's be very specific. Yes, the parents are part of an advisory committee. The working group comprises, as the minister mentioned, the B.C. Cancer Agency, the B.C. Children's Hospital and representatives of the Pediatric Cancers Survivorship Society.
Back in February, at a meeting of the steering committee, two of the parents raised questions about caring for complex chronic patients, and they referred to the commitment — in the business case that the minister has just referred to — about the need for an internal medicine specialist to care for these patients. That's in the business plan that was approved, which the minister just referred to as having been approved.
They were advised at that time that the clinic would not be assisting these patients and that, rather, these complex patients — and we're referring here to 50 of the most complex — would be referred back to their GPs. Now, in the business case, it outlines the need for specialized care for our chronic complex patient survivors. Numerous times.
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This is the patient group that is most at risk. This is the patient group that is suffering multiple, severe late effects ranging from secondary cancers to organ failures, early menopause in their 20s, inability to get pregnant, neurocognitive disorders, post-traumatic stress disorder and many, many other medical conditions.
The parents were told specifically that there would not be the funding to deal with these complex patients as was committed in the business plan. Can the minister please speak to that and indicate whether that promise is going to be kept?
Hon. T. Lake: As I mentioned, the B.C. Cancer Agency, the B.C. Cancer Foundation and the B.C. Children's Hospital Foundation have secured funding for a space for the clinic. It's just finishing up being renovated. The B.C. Cancer Agency is in the process of hiring a medical director for that program and completing the last steps to make it operational.
As I've mentioned, within a month, we hope to have that clinic up and running. The clinical decision-making as to the expertise needed for that facility will be up to the experts at the B.C. Cancer Agency. I will rely on their judgment.
J. Darcy: Yes, the childhood cancer survivors and their families are well aware that this clinic is going to open soon. The issue is a commitment that was made for a particular type of coordinated care that would be provided. They have been told, first on February 15, that funding would not be provided for the coordinated care for complex patients; again, on April 15 in a telephone conversation; and then again on April 17, at the parent and family advisory committee, when they raised these issues regarding the funding and were told that the funding was not forthcoming.
This clinic came about as a result of their efforts. A critical part of their efforts was intended…. It was agreed by this ministry that this coordinated care for complex patients would be included. Page 33 of the business plan says: "The high-risk specialty clinic would serve the approximately 50 to 60 new high-risk patients' transition from pediatric services per year, as well as the historical high-risk patients post-recall."
It goes on — page 34: "A subset of the high-risk patients are a smaller number of patients with multiple complex care needs. These patients are those survivors who have multiple, severe health issues attributable to the cancer and/or therapy that significantly reduced their quality of life, including physical, neurocognitive or psychological problems."
It goes on to say on page 36 of the business plan.… It doesn't say it's going to be left up to the medical director. It outlines who the health care team is going to be in order to meet the needs not just of screening people who may not even know that they might someday suffer late effects — absolutely an important thing to do.
But the business plan also said: "There will be an internal medicine or medical oncologist. Specialty with internal medicine training will be required to support up to 50 complex patients with multiple and significant late effects impacting multiple body systems. The subspecialty support is not only appropriate for patient care but will allow the oncologists to work to full scope where required with these patients and provide opportunity to continue to take on new oncology patients."
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It couldn't be any clearer than that. It's in the business plan in black and white. That piece of the commitment, these parents have been told, will not be followed through on because of lack of money.
Can the minister please explain why that is the case?
Hon. T. Lake: I'm not saying that is the case. They are in the process of hiring people. Why don't we see what comes from that? The B.C. Cancer Agency knows and has met with the society. They've met with patients and their families. They have the expertise.
The member is, as usual, always predicting a worst-case scenario. That's the bubble that she likes to live in. But the B.C. Cancer Agency is world-renowned. We have recognized that there are needs that survivors of childhood cancer have. We've gone from where there was nothing, in just under a year, to where we are developing a program in concert with these families.
I know nothing ever happens as fast as people would like, but I am confident that the B.C. Cancer Agency, working with the society and the families, will develop the kind of clinic that will look after the needs of these complex patients.
J. Darcy: It's incomprehensible to me how the minister can refer to these questions that I'm asking, and the concerns being raised by the childhood cancer survivors and their families who were in the gallery this morning and who are here listening today…. That that's about living in a bubble. The minister should spend some time talking to some of those families.
Interjection.
J. Darcy: If the minister wants to say that on the record, I'll sit down, and maybe he can say it on the record.
The Chair: Minister, the member has the floor.
Member.
J. Darcy: The business plan says: "In the start-up, year zero." That's right now. That's not the health spokesperson for the official opposition being in a hurry. These patients, these cancer survivors and their families, have waited years to get to this point. In year one start-up for this program, it says: "Internal medicine funding and human resource needs." Not two years from now, not five years from now, not ten years from now. It's not: "Have patience. Maybe. Someday. Don't be in a hurry." No. Year zero. Right now. Start-up year.
The other members of the team…. Some of them have already been hired. That's a good thing. But the families, the parents of these childhood cancer survivors — and the two mothers who were on that committee are in the gallery today — were told specifically…. It was not: "Wait five years. Wait two years." They were told: "There isn't going to be the funding for that piece of the clinic's vital work."
So I'll ask the minister again to say, not for my benefit…. I'm raising these issues on behalf of the childhood cancer survivors and their families, who have come to me once again because a significant part of the promise that they were made has been dashed, and they are desperate.
Minister: when will the commitment be met to meet the coordinated care needs of the 50 most complex patients that it was promised would be served by the new childhood cancer survivors program or clinic? When will that happen?
Hon. T. Lake: I've answered the question three times. I think I've sufficed in my answer to the repeated question.
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The Chair: I advise the member to go to another question.
J. Darcy: I would certainly encourage the minister to meet with the childhood cancer survivors so that he can hear directly from them.
Let me go to some other questions related to the B.C. Cancer Agency. About 18 months ago, there were significant issues in cancer care in British Columbia that we raised in this House and that others who have worked at the Cancer Agency, past or present, raised. Those concerns were about wait times being amongst the worst in the country for access to radiation and chemotherapy.
There were also concerns about significant oncology manpower issues. Many people had left, and there were challenges in recruiting to meet requirements for timely access for cancer treatment.
Can the minister please indicate what progress has been made since this issue was last raised in the House? And what is the current budget allocation in order to address these pressing issues about staffing shortages, especially in the area of oncologists, and unacceptably long wait times?
Hon. T. Lake: As the member is aware, a new president of the B.C. Cancer Agency, Dr. Malcolm Moore, has been in place since September of last year. One of his first priorities was to review executive operations, and that resulted in a new organizational structure that was communicated to B.C. Cancer Agency staff on March 30 of this year. Those changes are intended to better support patient-centred care and the strategic priorities of the B.C. Cancer Agency.
Recruitment for some of those positions is currently underway, but also underway is a renewed cancer control strategy. That is work in development between the Ministry of Health and the Provincial Health Services Authority.
I met with Dr. Moore last week to discuss progress on a new cancer control strategy. It's developing a policy paper to inform discussions with the ministry, with health authorities and other partners about challenges and opportunities to reshape the system, looking at, particularly, surgery, because the B.C. Cancer Agency has a coordination role for chemotherapy and for radiotherapy.
Surgery, however, is less under the direction and coordination of B.C. Cancer. The Ontario model is more of a coordinated model, and so there are discussions about the Ontario model and how that might improve the coordination, timeliness and quality of cancer surgeries.
That is very much in discussion between the B.C. Cancer Agency, PHSA and the Ministry of Health. They're focusing on patient-centred care models, sustainability and planning, being provincially planned and regionally delivered, linkages with health authorities, improving the governance and teamwork and, of course, the importance of accountabilities as well.
We're also looking at the continuum of care, because, as in many disease processes, if we look at preventive strategies, that can certainly, in the future, lead to less pressure on the cancer treatment system if we can prevent cancer — so looking at not just the healthy living strategies to help prevent cancer but also screening, diagnosis and then treatment strategies.
We mentioned survivorship and recovery strategies as well as, of course, end-of-life care, because many palliative care patients have come through cancer treatment.
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All of that work is ongoing. The wait-time issue is something that is being addressed through the renewed cancer control strategy.
J. Darcy: According to many published reports, we will be facing a tsunami of cancer over the next ten years. It's estimated that presently there are 25,000 new cancer cases in B.C. and that that could rise to 33,000 by 2026.
That obviously will have significant implications, both for capital and operating budgets and, quite possibly, the need for capital expansion in various parts of the province; also, no doubt, significant increases in chemotherapy costs; and, no doubt, major challenges in attracting and retaining the required oncology manpower and other health care professionals to meet the needs of patients and ensure timely access.
There is no question that you need significant lead time in order to bring that expanded capacity into operation to avoid even more serious backlogs and the inevitable consequences for patients. What is the minister's plan to address what has been referred to by many as the expected tsunami of cancer patients that we can expect to see over the next ten years?
Hon. T. Lake: We know that the incidence of cancer — that is, the new cases of cancer — is increasing as a function of age. As the demographic will dictate, as people age, they're more likely to encounter a cancer of some form.
The incidence of cancer is going up, and of course the prevalence, the number of people that are living with cancer, is also going up because people are, in fact, surviving and living with cancers today when they would not have in the past. We're getting to the point where, in many cases, cancer is not seen as a fatal condition but almost like a chronic condition that you can live with, with a good quality of life. In some cases, of course, cure is available.
We spend about $500 million a year on the B.C. Cancer Agency. About $250 million of that is for the chemotherapeutic drugs that are used, which are quite expensive. We have new drugs coming and new modalities coming that are going to be very effective in treatment of cancer, immunotherapy being among the largest group of treatments that show a lot of promise. But of course, the personalized oncogenomic approach as well, in some cases, can prove to be very effective when other treatments are not working.
So we recognize the need. Although I would not call it a tsunami, there's certainly a predictable increase in both the incidence and the prevalence of cancer in our aging society. Recognizing this, in the past fiscal year, the Cancer Agency was awarded 11.2 FTEs for physicians and oncologists — that's about $4.2 million — and along with that, $5.6 million for non-physician and support staff funding.
For this fiscal year, there will be an incremental 9.2 FTEs, or $3.2 million, for physicians and oncologists and an additional $2.8 million for non-physician and support staff funding. With the development of the B.C. cancer strategy, there will be a capital plan developed in terms of looking at the need for more investments in equipment and facilities as well.
J. Darcy: When we discussed this issue last, there were some significant shortages of oncologists. The minister has talked about funding for new full-time equivalent positions in a number of areas — physicians, oncologists and other staff. Can the minister please indicate what the shortages are? How many positions remain unfilled at the present time at the Cancer Agency?
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Hon. T. Lake: I mentioned that last fiscal year there were 11.2 FTE increases. I am told that for radiation oncology, the Cancer Agency has hired several locums to be in place until six new hires start later this year. Medical oncology currently has made offers or is in the process of offering 5.2 FTE positions. They expect to fill the remaining medical oncology positions over the next several months. So the 11.2 FTEs that were awarded are either filled or in the process of being filled. While awaiting the filling of those positions, there are several locums that are in place.
J. Darcy: I want to refer the minister to something that we've discussed in this House in the past, and that is the unacceptably long wait times for radiation therapy. According to the Canadian Institute for Health Information report on wait-lists.... We've discussed earlier in this House the waits for hip replacement, knee replacement and cataract surgery, but for radiation therapy....
Can the minister explain why it is that in British Columbia, we have the worst rating in the country as far as meeting the national wait-time benchmark for radiation therapy?
Hon. T. Lake: Of course, it's important that wait times to receive radiation therapy should be as low as reasonably possible to optimize treatment and to minimize the impact on the patient.
The Canadian Association of Radiation Oncology suggests that patients should receive a consultation within two weeks of referral. Our target here in B.C. is that 90 percent of cases receive a consultation with a radiation oncologist within four weeks of referral. Currently, 70 percent of patients are seen within four weeks, and 40 percent are seen within two weeks. Again, that was due to some of the positions that were not filled. I have said, in my earlier answer, that several locums have been hired until the full-time radiation oncologists are put in place later this year.
J. Darcy: We know that a number of positions were vacant. We know that the Cancer Agency was having difficulty attracting oncologists and that a number left and that there was a crisis of confidence, so to speak, at the Cancer Agency amongst many of the leading scientists and oncologists.
The minister says there's a new strategy. Has the ministry done a thorough analysis of what led to these problems in order to ensure that, in fact, the strategy for the future means that we won't encounter these problems again?
Our wait times are the worst in the country. The minister likes to talk about us leading the country and leading the world. But when we have the longest wait times in the country for radiation therapy, clearly there has been a problem.
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Will the minister...? Has he done a thorough evaluation of why that's the case in order that British Columbians can be confident that the Cancer Agency of the present and the future is going to have shorter wait times and is going to be able to retain the scientists and the oncologists and the other health care professionals that are so critical to cancer care?
Hon. T. Lake: Well, I mentioned that we did an extensive search for a new president. Dr. Malcolm Moore — who came from Ontario, highly recommended — has brought his expertise.
I mentioned that the first priority he had was to review the operations of the B.C. Cancer Agency. That resulted in an organizational structure that Dr. Moore is very confident will better support the care and the strategic priorities of the B.C. Cancer Agency. Currently, a policy paper is being completed to look at the future of cancer care here in British Columbia.
I'm very confident that the B.C. Cancer Agency is on the right track. When I met with Dr. Moore last week — and we meet on a regular basis — I asked him about the morale and the culture of the B.C. Cancer Agency. He was extremely positive that the organization was functioning well, that with the policy development that is ongoing and the cancer control strategy that is being reviewed, there is an energy and a confidence and an optimism within the B.C. Cancer Agency. I have every confidence that he has the organization on the right track.
J. Darcy: I'm going to turn the floor over to…. Well, I guess you will turn the floor over, hon. Chair, not me, to the member for Surrey–Green Timbers to pursue some issues related to mental health and addictions.
S. Hammell: I know we've had a few minutes this morning. I'd just kind of like to reset.
I've been using, quite a bit, an article that the Premier spoke of in the Leader, in our community. Again, I'll refer to the fact that the Premier said: "What we are doing now is a system that isn't working, and I am determined to fix it."
I need again to remind the minister, through the Chair, that this comment was made while Surrey was in the height of some pretty serious shootings, drive-by shootings. The community is and was extremely distressed. Everyone from the Premier down acknowledged that the primary driver of the mayhem in the streets was the addiction of people that was being fed by the drug trade.
The Premier also said she recognized that addiction needed to be addressed in order to stop the demand for illegal drugs — which, of course, were, again, a prime function of the chaos on the streets.
To the minister — and I understand you from this morning. I know it's complex. I know the whole situation is complicated and hard, but I do agree with the Premier that the current system just isn't working. I would like to draw your attention to…. Let's see if I can find the letter that I would like to work with.
I had a letter from a mom who is trying to help her son and is quite distressed by the current situation. Of course, just at this minute, I can't find the letter. But I will move to another example.
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I don't know if the minister has followed along at all the situation around Gord Bylo and his son Brian. This, to me, is an example of how the system is so, so broken. Brian was a healthy and athletic and bright teenager when he had psychiatric symptoms starting in grade 11. He was, at that time, probably a child that you just had so much pride in and saw such a great future for. He was on the honour roll at Holy Cross. He was a soccer player. He played in the midfield. He was a leader of his team.
In grade 11, about the age of 17, he experienced his first psychotic breakdown. At 18, he was diagnosed with paranoid schizophrenia, and he spent two months at Peace Arch Hospital being stabilized. But Brian ended up self-medicating on street drugs, as the current drug regime he was on wasn't working. Once he was over 18, his parents were unable to have any say in his treatment.
In 2008, he started using cocaine to support his habit and turned to petty crime. Brian has, currently, 57 court entries in his file and has been incarcerated over 30 times. Once, being apprehended for mental health reasons and being under police, RCMP, watch at the hospital, he was found to be in breach of probation for not checking in, because he was under security guard at the hospital, and was immediately taken to jail instead of the hospital.
He was accepted at Phoenix House, but when he reported in, on arrival, with his parole officer, he was informed that being in a treatment facility, he was in breach of his orders. He was told that he would be sent to jail if he didn't go back home. In a panic, he left and was picked up by the RCMP and put in jail again.
Now, Gord Bylo, his father, is a pretty sophisticated business person. He's an investment banker. He has been unable to manage the system, walk through the system and help his son. So we have a person who is mentally ill being largely treated by the judicial system and, in fact, in jail.
I had the pleasure of listening to a person who had been a former gang member describe the Fraser Regional Correctional Centre in a description that would, for most of us, make our blood turn cold. We have a paranoid schizophrenic, who was not on drugs, now on drugs and with a petty criminal record, being treated for a mental illness by the jail system. Now, if that isn't a waste of money, I don't know what is.
My question is: is moving mental health and addictions issues from the criminal system to a treatment system under health care part of what the Premier is considering as a reasonable fix to a broken system?
Hon. T. Lake: There's no question that when you look at the corrections facilities across North America…. I would say that the situation in the United States is well documented. A large number, if not a majority, of inmates at correctional facilities in the United States suffer from mental health and/or substance use challenges.
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In some states, from the commentary that I have read, they have become the de facto mental health institutions. To say that in Canada and, specifically, in British Columbia that is also the case — I would not agree with that. However, I would say that there are still a disproportionate number of people in the criminal justice system that are there due to mental health and substance use challenges. There's no question that someone that is self-medicating, looking to use illegal drugs, tends to get involved with the police and with the justice system. We have some innovative programs that try to address that.
We have Car 67 in Surrey, for instance, where a psychiatric nurse and an RCMP officer work together to try to address situations at the street level and try to attach people, who would otherwise end up in hospitals or perhaps in jail, to social services and medical services that they require so that they can get help. That kind of a partnership has been replicated in Vancouver, in Prince George, in Kamloops and in Kelowna and is quite successful. That is part of the issue.
Police officers now receive training in mental health because mental health issues are not just an issue for the Ministry of Health. They are societal issues, and all of us need to…. I've said this to the member before. All of society must embrace this challenge. Police officers, I think, have a much better level of understanding and training regarding mental health and substance use issues than ever before.
We have created teams that work with the police, assertive community treatment teams. As I mentioned earlier today, the partnership between Vancouver police department and Vancouver Coastal Health has resulted in an international award recognizing that the number of people that have to go to the emergency department and the number of people who have encounters with the criminal justice system are much reduced.
We are doing a lot of the things that the member is alluding to, to address and try to prevent people that are seeking help for mental health and substance use from ending up in the criminal justice system. However, I want to remind the member that adults have the opportunity to make decisions. It may sound simple to say: "Well, just force someone into treatment." You can't do that under the Constitution of Canada.
Through the Mental Health Act, you can detain someone if they are at imminent risk to themselves or others. There are many situations where clinicians — psychiatric clinicians, doctors and nurses — will make an assessment. That's a very high bar. To detain someone of their liberty under the Mental Health Act, the bar is set very high because of the constitution. People have free will.
I want to say to the member that not everyone who uses drugs is addicted. That is a fallacy. Dr. Carl Hart, who's an expert in addictions at Columbia University, spoke in Vancouver. I went to hear his talk. He dispels that myth. There are many highly functioning people in society who use drugs, illicit drugs. They're not addicted.
However, we know that 15 to 20 percent of people who use illicit drugs will become addicted, and for them, it is a severe challenge. The underlying cause of being drawn to drugs may be because of mental health issues. It may not be. Regardless, they find themselves addicted, and they need to agree to be treated.
In some cases, people do not agree. All of us probably have had personal experiences — I know I have — where a patient, a person, a member of a family does not agree to treatment. We simply can't lock that person up and force treatment on them. We have to try different approaches and be there when that person is ready to accept treatment and have the resources at the right time and the right place for that person. It doesn't happen when we want it to happen, necessarily. We have to be there for when the patient, the person wants that to happen.
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S. Hammell: I guess the answer is no. So let me move on to another issue.
Interjection.
S. Hammell: Pardon, Member? Were you talking to me?
I'd just like to sort of punctuate the situation, again, that I was talking about. Maybe the minister was talking about something else.
Brian was a healthy, athletic and bright teenager before he had a psychotic breakdown. He's now 31, around that time, and has had a huge interface with not only the health care system but also with the criminal justice system. I remember raising this issue last year in estimates and talking with the minister regarding us turning our jail systems into the new asylums because so many of our mental health and/or addicted people are in the criminal system.
Clearly, a person doesn't have to give permission to be put in jail. Maybe that is the underlying reason why we choose to incarcerate people who are clearly mentally ill and/or addicted.
My question to the minister was: is part of the new plan, if it is a new plan, or the extra plan that the cabinet committee...? The Premier has indicated in this interview that the government is working on a new mental health plan. I have to assume from the minister's answer to my question that, no, looking at moving more from an incarceration and jail system to having people with mental health be more caught up in a health care system is not part of the fix.
That's interesting, because I would think that there is opportunity to have a certain shift of funding from the penal system or the criminal justice system to the health care system specifically for a particular group of people that would probably be better off in the health care system. But I'm not as wise as some of the other people that obviously are dealing with this, like the cabinet committee.
I mentioned a letter that I was looking for. I do just want to take a minute to read this into the record also. This person is from White Rock. She says:
"Our son has a clinically diagnosed mental illness and issues of addiction."
There are many, many letters, and I'm sure the minister maybe is even tired of hearing of this area. But just struggle through with me.
"Since 2012, he sought to enter Creekside Withdrawal Management Centre, in the Fraser Health Authority, several times. Each and every time he has attempted to enter this facility, the wait time has been three to four weeks.
"The staff at the facility also direct applicants to not come to the centre 'sick.' If you do not possess the knowledge of addiction, this term may not be familiar to you, but this sickness is the result of being in a state of substance withdrawal."
The question becomes: how does an individual without any support system or funds wait this length of time without continuing to abuse their substance of choice? This wait only serves to increase the economic and social costs to all the taxpayers in this province.
Rehm et al., 2006, estimated that the cost of substance abuse in the year 2002 was $6 billion, as cited in the British Medical Association, 2009. This figure does not include the additional cost attributed to the silent suffering that is endured by family, friends and significant others.
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The BCMA also identified nine gaps in the health care delivery system in relation to addiction care and proposed several recommendations. The third gap identified was "to expand flexible detoxification service capacity." I'm sure the minister knows the detail of the recommendation. It was 240 new flexible beds. This is back in 2009. A three-to-four-week waiting period for an individual to access a detoxification facility is unacceptable.
My question to the minister — remembering that the Premier is determined to fix a system that isn't working: are more flexible detox facilities part of the cabinet committee and the new plan that is about to…? Is there going to be a fix around detoxification beds?
Hon. T. Lake: The member says that I might be tired of hearing stories. I'm never tired of hearing stories. I have personal experience with these stories. I feel for the families that experience these stories. To insinuate that somehow I don't care is beneath the member. I care about these things every single day. We work hard every single day to try to make a difference.
The member wasn't there yesterday when we announced the reopening of the Crossing at Keremeos, a very important facility for people aged 17 to 24, in a setting in Keremeos where people can seek the treatment they need for substance-use challenges.
The member wasn't at the concurrent disorders clinic announcement at Lions Gate Hospital, where we are creating unique spaces for young people, adolescents, with concurrent disorders of mental health and substance-use challenges.
My mandate letter from the Premier says that we will create 500 new recovery spaces, addiction spaces, by 2017. All health authorities are on track in three phases of opening up new addiction spaces. We are in phase 1, at 76 new beds; phase 2, 144 new beds — and 220, with those two phases. Phase 3 is underway in planning, and 280 more will be added.
I think it's clear from my mandate letter, from the work we are doing — both in the ministry and in the cabinet working group — that we are addressing a gap that has been there historically, with the creation of 500 new addiction spaces around the province of British Columbia.
S. Hammell: I'd like a recess.
The Chair: Hon. Members, the member for Surrey–Green Timbers will take a moment to come back.
During this period, with your indulgence, I would like to take a moment to introduce a special guest in the gallery.
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I met him 14 years ago in the hallway in this House, and after 14 years, he came back for the first time from Beijing to visit us. Would the House please join me to give him a very warm welcome. His name is Chunming Zhang. Welcome to the House.
The committee will recess for another five minutes.
The committee recessed from 2:43 p.m. to 2:57 p.m.
[R. Chouhan in the chair.]
D. Routley: I'll have to apologize in advance for a lack of background on these issues. I'll ask these questions, in any case, and hope the minister will give me some latitude with my lack of comprehension on the issue. These are questions that others have asked to be asked.
The first one relates to fee increases. I would like to ask the minister if there have been any fee increases or new fees imposed, particularly related to mental health services.
Hon. T. Lake: When someone is in a residential placement for addiction services, there is a daily fee that is to cover, essentially, room and board — which, I believe, is $30.90 a day — and there has been no plan to increase that.
D. Routley: Can the minister share how much net revenue this is generating?
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Hon. T. Lake: The charge of $30.90 per day in residential addiction is similar to what one would pay in what we call alternate level of care. That's someone that's in the acute care hospital and waiting for placement in residential care. That is to cover the costs of meals and, essentially, the basics of room and board.
We are working on getting the amount of funds that is attributable to that per diem that is charged. At $30.90 per day for room and board, I would suspect — we will confirm that — that that would barely cover the cost of providing room and board for someone for a day.
D. Routley: Thank you to the minister.
The next question relates to transfers between ministries. What funds have been transferred from other ministries, and what programs are funded with those transfers?
There's never been a time when I've appreciated a minister ragging the puck more than now.
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Hon. T. Lake: There is one inter-ministry transfer. This is from Social Development and Social Innovation. This is for services for persons with disabilities. That is $588,000.
D. Routley: Can the minister share how many youth mental health beds currently are being staffed on Vancouver Island?
Hon. T. Lake: There are substance-use beds, and there are mental health beds. There are a total of 28 substance-use beds. That's a mixture of supported housing, of youth-supportive residential services or supportive recovery, youth transitional services, youth withdrawal or detox-facility-based and youth detox supportive residential.
In mental health, these are acute care in-patient beds. There are 13 on the Island. But there is a provincial approach taken, so if there was a need for more beds on the acute and tertiary side, there would be an effort made to find space in the provincial system.
D. Routley: Could the minister provide a breakdown of which communities those services are located in, particularly in Victoria versus the rest of the Island?
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Hon. T. Lake: The 13 tertiary care beds are located at Ledger House here in Victoria. That services the Island. Tertiary care, of course, is a very highly specialized level of care. It is often the case that the highly specialized services are located in larger centres. That's on the mental health side.
In terms of the substance-use side, of the 28 beds on the Island, 15 are in Victoria, ten are in the central Island, and three are on the north Island.
D. Routley: I wonder if it might be possible for me to ask a few questions on ER services in Nanaimo Regional Hospital. Thank you for the flexibility from the minister and staff.
I'm hearing, as a representative of part of the region that Nanaimo Regional General Hospital serves, that there have been significant changes in the way the emergency room is functioning, particularly with the recent introduction of new IT systems. I've heard from ER doctors and nurses that there is grave concern over patient safety in the transition to this new system.
The staff did not really comprehend how to use this system, how difficult it was. They felt there was poor planning in its introduction and even shared stories of being focused on entering something into a computer program that was relatively irrelevant — in fact, just a difficult quandary for the staff — and not noticing that there had been a serious adverse drug reaction on the part of a young four-year-old, I believe, who had to be air-lifted for more critical care because of this miss.
Not in an effort to politically pinch the minister here but in an effort to perhaps voice those concerns on behalf of the staff there, I hope that the minister might have some information that could help them feel as though they will get the supports needed to adequately understand how to use the system and still carry out their regular duties.
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Hon. T. Lake: I visited Nanaimo Regional General Hospital…. I want to say it was about six weeks ago. It would have been in March of this year.
Now, Nanaimo Regional Hospital has had a couple of very exciting investments. The emergency department itself is probably the most modern emergency department in the province of British Columbia. It is remarkable in the way that it flows, the way it sees patients, the new technology that's available.
What the member is referring to is the IHealth project, which is an electronic health record which connects the patient and all the information about the patient, from entry all the way through their hospital visit.
With any project of this type, there is going to be a need for a very careful change management system in place. While you can minimize the impact on staff when this change occurs, it's impossible to have zero impacts. But what Island Health has done is provide 100 support resources that have been on site providing shoulder-to-shoulder support to physicians and clinical staff.
When I was there, I walked through the process with an emergency doctor as he was using the voice-recognition software to input information about patients. The addition of voice recognition is an important part of the system that was added after clinicians indicated that it would, in fact, slow things down if they had to key-entry all the information. So the voice-recognition software was extremely helpful.
We walked down the hall to where training sessions were ongoing, where people from Cerner, which is the software that's involved, were working with team leaders and with medical personnel, going over all of the systems and training them so that they would understand how they would function. They were to go live on March 19, and they did.
Now Nanaimo Regional General Hospital is the seventh site in Canada to implement this breadth of electronic health record. I believe it's referred to as an HIMSS 6 level, which is a very high level of sophistication in connectivity of the patient's medical record. Island Health is, in fact, the second-largest organization in the country to achieve this scope of connectivity.
To the member's point, there's no question that it has required a great effort on the part of clinicians and health care personnel at Nanaimo Regional General Hospital. But since that activation, over 300 medication alerts have been triggered by the system.
With this bar-coding system and with the clinical computerized order entry, if the clinician inputs information and then the nurse goes to give the medication and scans the code, a trigger immediately occurs if it is the wrong medication or the wrong order or even the wrong dosage. So far, 300 alerts have been triggered, which in many cases would have prevented an adverse event from happening.
The turnaround time for diagnostics — that's getting lab work done or radiographs or other imaging done — has been reduced by approximately 20 minutes, which, of course, increases the flow through the hospital. As I mentioned earlier when we were talking about Cowichan Hospital, everything in a hospital is about flow. The system depends on everything moving through at a certain rate, because if one part of the system backs up, it tends to create a domino effect so that other areas back up as well.
We had a first sepsis alert, which was fired after the IHealth system came on, for a patient who presented at 5:07. So again, the communication system, the computerized connectivity, created an alert that prevented a very serious condition of sepsis in a patient so that it was able to be treated.
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While I don't doubt that there has been some really incredible work that has had to occur and that there probably were times when people felt distracted while they were doing their entries or getting used to the system, that is recognized as a problem with change management that needs to be mitigated as much as possible.
From everything I have gathered and from everything I saw on site, I think Island Health did an admirable job of managing down that risk as much as possible — not eliminating it completely, but to manage it down. We are seeing some very positive benefits with the electronic health record system that now will be expanded to other parts of Island Health. I believe that Oceanside and the residential care home close to Nanaimo Hospital are also connected to this level.
Now we will reach out through other parts of the Island.
D. Routley: I will just pass off to my colleague from Alberni–Pacific Rim.
I thank the minister and staff for helping.
S. Fraser: Thanks to the Minister and staff for making themselves available.
If you can bear with me, I have a few different local issues that I would like to touch on. I hope that'll work out with staffing arrangements.
I had a request for a meeting with a constituent, Dr. Douglas Hanton, and his wife, June, in Tofino. It was about their grandson. Merric is eight years old. He was born with a condition known as Treacher Collins syndrome. I was unaware of this syndrome before my meeting, by the way, so I learned much about something I've never heard of before.
One of the symptoms of this syndrome is its progressive hearing loss, really, right from birth. The challenge is, of course…. I have some challenges with hearing myself, and the hearing aids for mine are pretty cyborg-like. This young gentleman, Merric, has had to have repeated changes to his hearing aids to deal with the progress of the syndrome. Also, of course, at eight years old, he's a growing young fellow. It's been changing for his whole life.
The only offset to the cost of the hearing aids ended when he turned about 3½ — through the ministry. This is an out-of-pocket cost now for the family. I mean, it can be addressed through charities. Sometimes a Kinsmen Club and these types of organizations that do great work in the province can provide some assistance, but it's not a sure thing.
I want to know if the minister has any information on why funding would stop for offsetting the costs of these hearing aids at that age, or at any age, of youth. It is a necessity.
Hon. T. Lake: We're just awaiting a bit of a staff change to answer the member's question.
A previous question from another member was around interministry transfers. I want to correct the record. Apart from the one we mentioned that comes from Social Development and Social Innovation of $588,000, there is also a small transfer from Finance of $310,000 for the temporary premium assistance program and one transfer out of the ministry to the Ministry of Technology, Innovation and Citizens' Services of $161,000 for a building lease.
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I just wanted to get that on the record, and we'll be back with the member's answer in a second.
I'm advised that no hearing aids are covered under the PharmaCare program. It may be that there are programs through the Ministry of Children and Family Development. We will check with our colleagues, take the question on notice and get back to the member.
S. Fraser: To the minister, thanks for that. I appreciate that information. I know that the family will be awaiting that. I know that the minister took it on notice, but I'd just like to say that the issue, in this case, I think is larger than just the medical equipment that's required, because it's an essential tool for Merric to be able to learn at school.
I would relate it.... Maybe it's a bit of a stretch of an analogy, but children with developmental disabilities are eligible for supported child development funding specifically so that they can go to school. That funding usually deals with a care aide, which is a necessity for someone with severe autism or whatever to be able to attend school, learn and get those great outcomes.
I would suggest that the hearing aids are just as vital to Merric and other children that are going through a similar situation. Again, this Treacher Collins syndrome I'd never heard of before.
If there was any way of using this example as a rationale to make sure that there is this funding available, if it isn't already — which it doesn't appear to be, for Merric — I'm hopeful that that argument might sway, if need be.
I'll move on to another issue until we have an answer. I see the minister is receiving something, so maybe I'll just sit down in case there is an answer forthcoming.
Hon. T. Lake: The B.C. early hearing program covers the costs of the first set of hearing aids for infants and young children identified with permanent hearing loss, when eligibility requirements are met. Hearing aid services are provided through local public health audiology clinics.
Yes, the eligibility requirements for this program are: under 3½ years of age — so I think that is what the member is referring to: the B.C. early hearing program — hearing test results provided by an audiologist identifying permanent hearing loss, and approval from the child's medical doctor. Those are the eligibilities.
I take the member's point that if a child is unable to hear properly, that will impair their ability to learn. As I say, when we look at the allocation of resources we have in the Ministry of Health, these are the kinds of debates that we have. I thank the member for bringing this to my attention. We will have that discussion within the ministry and perhaps with the Ministry of Children and Family Development as well.
S. Fraser: Thanks to the minister for the answer and the confirmation of that. Three and a half.... I am hoping to have further conversation on this with the minister or his staff to find out if we can make this more universal. Does the minister or his staff have any...? Is there a rationale for a cutoff at 3½? That seems like an arbitrary age.
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Certainly, the needs for the child or children in these situations don't end in any way. From here on through to teens, there's going to be a great growth period for the child, and the refitting so that the hearing aids can work is going to probably require an acceleration of turnover of the hearing aids. What would be the rationale from the ministry to do a cut-off at 3½?
Hon. T. Lake: I don't have the history of the program available to me, but I can, I guess, offer this rationale. The B.C. early hearing program is to help, first of all, identify young children with hearing loss as they go through that critical period of learning language skills. The first set of hearing aids is provided so that they can overcome that challenge of learning speech.
Like many programs when they first start, there are a certain amount of resources — not dissimilar to the insulin pump program that was up to 18 years of age. We've expanded it to include 25 years of age. We've had discussions about expanding it further.
I think that the member brings up a relevant point about: should resources become available? Should we look at expanding this program? Those discussions will take place in the ministry, together with the Ministry of Children and Family Development.
S. Fraser: Thank you, again, to the minister for that answer.
I guess it's not a rhetorical question in any way, but…. While the early years, up to 3½, are fundamental to learning speech and verbal skills, it certainly doesn't end at 3½.
Again, I submit that there is a requirement, here, from a government. The child — Merric, or children in his case — would require the equipment to be able to further their education beyond…. I mean, 3½ is before school starts. But it's a necessity for school. A child that cannot hear appropriately in class will not be able to have the outcomes that are necessary for them to succeed in the academic world.
Would the minister…? I mean, it's not his ministry, but isn't there a requirement to provide the medical equipment so a child can be successful at school — or even be able to attend school? Again, I would use the rationale of the supported child development funding for children with developmental disabilities. There's a recognition that the child needs to be at school.
Legally there's a requirement for the child to learn — be taught — in our society. Wouldn't that take precedent over…? I know there's funding restrictions, but wouldn't the requirement of a child to be able to learn at school take precedent — even a legal precedent — of need?
Hon. T. Lake: The member brings up an interesting discussion. I accept his argument that to be able to learn properly in school, being able to hear is an important part of being able to learn. Although, certainly, we know of individuals that overcome challenges.
The Canada Health Act says that the provinces should provide health care which is medically necessary, but it doesn't say what is medically necessary. So this is the debate that is ongoing about a lot of things that we cover.
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We've had this same discussion over insulin pumps for people that are over 25 years of age. One could argue that they are medically necessary. Others could argue that there are alternatives available that meet the needs to treat the medical condition.
It is a matter of how you allocate resources. When you look at the spending on health care, it is encroaching on 43 percent of all spending by the provincial government. Yet there are still unmet needs. It is not an easy task to say what you won't do or what you won't expand because you need to do something else. The example that I've used a lot is the addition of drugs that can cure hepatitis C in many cases and the expense that comes with that.
As I say, it is a matter of dealing with the resources that you have available and allocating them in the way that provides the largest benefit to the population while, of course, taking into account that there are unique situations individuals and families face. You hope that the system will be able to help with those situations.
One person may go through their entire life with needing very little from the health care system, whereas others require millions and millions of dollars through their lifetime. That's the grand bargain that we strike through our public health care system. As resources become available, we always look at how we can best expend those new resources or, if there are savings that we can find in the system, how we would reallocate those resources.
As I said, the member has brought up a good point. It will form part of a discussion we'll have with the ministry.
S. Fraser: Thanks to the minister for that. I appreciate that the discussion is going to happen. I certainly will await any change or the outcomes of those discussions and pass those on, I hope, favourably to Merric and his grandparents and his parents. I'll move on from this issue for now, if I could.
Within my constituency in Alberni–Pacific Rim, there is a medical facility in Bamfield — a relatively small community, a fishing and tourism community in beautiful Barkley Sound. It's magnificent, actually, but quite isolated. The road is not paved. It's not maintained all that well sometimes. I've dealt with the Minister of Transportation repeatedly — or many repeated Ministers of Transportation — on that.
However, the issue right now is around the helipad that's required for medevacs and emergency situations. Because of the isolation of the area — I know that it's been an ongoing discussion with Island Health and the local government and the regional district directors and the hospital boards — the community has determined that they do need a helipad and that the favourable location for that helipad is located at the health centre. There is another identified location, potentially, at the airstrip, which is actually not proximal to the health centre. There are all sorts of problems with that.
First of all, there is no formal ground transport to move patients from the medical centre to the further airstrip, so there's that issue. There's also the fact that the emergency transport often involves the advanced life support team. They can get to the helicopter faster if it's at the health centre.
The health nurse is actually not allowed to leave the centre in many cases. In the case where he or she would need to accompany a patient to a remote setting if they did have, say, an ambulance come in from Port Alberni to transfer the patient from the health centre, that's a two-hour drive one way if the road is passable.
I just wonder if the minister can give any updates. There's concern in the community that Island Health is moving towards, I guess, maybe a cheaper option. It's the one that's more remote, at the airstrip. It's not the one at the health centre. Can the minister comment, please?
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Hon. T. Lake: Just reading the background of the situation, the landing area near the health centre doesn't meet Transport Canada regulations. There is a neighbouring property, and apparently, when a helicopter was landing one time, a couple of kayaks became airborne because of the rotors of the helicopter — so not a safe situation.
Interjection.
Hon. T. Lake: A very extreme sport.
The need is to develop an alternative. The member had talked about the private strip, which is about 1½ kilometres away from the health centre. The challenge, then, is transporting patients from the health centre to the airstrip.
Island Health has conducted a study of the alternatives. One is working with the community to develop a first-responder program that then would allow the transfer of patients from the health centre to the airstrip. The other is construction of a floating helipad. No decisions have been made. They're looking at those alternatives and, of course, would have to work with Transport Canada.
Transport Canada has been increasing their requirements for helipads over the last number of years. I know we've had situations in my open hometown of Kamloops where helipads have had to be reconstructed due to these new requirements by Transport Canada — all in the name of safety, of course, but it does raise the bar in terms of costs often for helipads.
Island Health is aware of it. B.C. emergency health services is aware of it. A couple of options are being looked at, at the moment. If we were able, through Island Health, working with the community and working with B.C. emergency health services, to develop a first-responder program in the community, that might actually be a good alternative. Of course, those first responders serve the community in many different ways, and it may be able to help us solve this problem.
We will stay in touch with the member, in terms any of updates we get from Island Health, to see if they've come to a decision on that.
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S. Fraser: Thanks to the minister for that. I'll be finishing off here, noting the time.
I would just like to comment that I appreciate the minister's comments. But if there was establishment in the future of relying on volunteers, that's not the same level of care as an advanced life support team, for instance. It would require ongoing training, especially with turnover. This is a fairly small population. There are all sorts of challenges there.
Since the health nurse is not currently authorized to leave the health centre to transport a patient to another location, if it's more remote, in a critical care situation, with a life at risk, the transportation team would require suitable training and expertise that might be difficult to guarantee with volunteers on an ongoing basis. I mean, there is a cost to that, certainly, and it would be an ongoing cost, an incremental cost.
Certainly, I would hope that the minister and his staff and Island Health will look into that, because having it at the centre, as close as possible to the centre, could save lives because of many of those situations. Again, there is no…. The Ambulance Service is two hours away, too. I would hope that will all be taken into consideration in the discussions that follow and that the regional district….
I would note, also, that the Alberni-Clayoquot regional hospital district board passed a resolution on April 13. The minister probably has that, but they sent a letter. I've sent a letter also, as MLA, urging that, hopefully, it will be proximal to the health centre to save lives.
J. Darcy: I'd like to move to the B.C. Ambulance Service, if we could. The member for Surrey–Green Timbers will not be returning today.
The minister is certainly aware of — and we have discussed in this House — concerns about ambulance wait times and concerns expressed by the municipalities, by ambulance paramedics, by firefighters, by municipal governments.
Last year B.C. emergency health services commissioned Operational Research in Health, an international expert in emergency response demand analysis and deployment modelling, to conduct a review of the services that it provides. That report clearly identifies that for last year, for 2015, ambulance call volumes — well, in recent years — have been increasing at a rate higher than population growth as a result of an aging population, changing demographics, population health needs and required care outside of hospitals.
It pointed out that response times were deteriorating and pointed out very clearly that, in the absence of change, response times would deteriorate even further over the next four years and onwards.
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The Ministry of Health and the B.C. emergency health services released an action plan a few weeks ago that said a lot of things, but it did not specifically address the significance of the current staffing needs that had been identified in this report, nor did it set out a plan that outlines and immediately addresses the service levels for the public, nor the workload and stress levels for paramedics. My question to the minister is: what are the specific staffing commitments flowing from the action plan?
Hon. T. Lake: The ORH study, demand and employment study, of B.C. emergency health services in the Lower Mainland resulted in looking at over 350,000 incident responses as well as data from 17 first-responder agencies that were dispatched to assist paramedics in medical emergencies. These are, essentially, fire departments that also act as first responders.
The action plan is based around several pillars, if you like. First of all, to improve activation and mobilization time. When a call comes in, if you take from the moment the call comes in to when the ambulance is on site, there's a series of things that happen. The activation and mobilization are the first things that happen. There are plans to improve the activation and mobilization, which will shorten times.
Change the way we respond to low-acuity calls. There are situations where someone will call an ambulance and we need to ensure that we're getting the highest needs met first. There are conditions which are not as acute as others. We want to make sure an ambulance gets to the situation where it can be life-saving in the shortest possible time. Looking at the way we respond to some of those low-acuity calls is one of the strategies.
To standardize patient handovers within health authorities is another part of the action plan. That means…. Currently when an ambulance goes to a hospital, the paramedics will stay with the patient until the patient is handed over to emergency department personnel. There is a variation in the way that this is managed in one health authority versus another. We want to look at best practices and make sure that those are standardized across all health authorities.
There's a multi-year funding strategy for strategic investments in resources — human resources and capital resources — and also to look at innovative changes and practice that will improve patient care and use resources more appropriately.
Primary response units is one of those things that may be used, where you have a single primary care paramedic going out in a car, perhaps, rather than a full ambulance, ahead of the crew to assess the patient and respond to the acute needs and be in contact with a physician and manage and triage that call, on site, to get there sooner. That's one of those changes. Another would be what is known as treat and release. Ambulance paramedics arrive on scene, examine the patient, are in communication with a physician, and a decision may be made that that patient does not, in fact, need to go to the hospital.
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Because of the other problem I identified earlier, the handoff of the patient to the emergency department, if we can reduce the number of patients that actually have to go to the emergency department, that means resources stay on the road more of the time, instead of being tied up in hospital.
Immediately, what we did, as we're developing the longer-range plan…. There was an investment of 34 FTEs and eight new ambulances — three in Surrey, two in Langley, two in Abbotsford and one in North Vancouver — and, as I mentioned, the addition of 34 full-time-equivalents to add to the human resources in the Lower Mainland. So the initial strategy: to close the immediate gaps that were identified. Longer-term strategy: to increase the efficiency and the resources available for B.C. emergency health services.
J. Darcy: I'm aware of the commitment that was announced a number of weeks ago about eight ambulances and 34 staff, I believe — 34 FTEs.
I'm not quite following the minister's response. On the one hand, I thought I heard him say a minute ago that there was a multi-year resource plan that included increased funding for staff and capital. But at the end of his comments, the minister appeared to just say that for the future, it was a question of looking at efficiencies and strategies.
That's without, really, any details in the report — that I could see — about what those efficiencies and strategies are that are going to enable the Ambulance Service to meet what is referred to in the report as a growing demand — a situation where wait times will get worse, not better, unless there are significant changes. So beyond the eight ambulances and 34 staff, what is that resource and capital plan that the minister referred to?
Hon. T. Lake: Sorry if I wasn't clear. I said that there were immediate steps taken, which was the addition of the 34 FTEs and the eight ambulances, and that the action plan identified five overarching strategies to drive performance, to increase performance over the system. Those will form part of the development of the strategy moving forward.
B.C. emergency health services is working with the Ministry of Health, health authorities, municipalities and other key stakeholders to look at a longer-term plan that will involve, likely, more human resources and more capital resources. That is in development at the moment. I don't have the results of that longer-term action plan, but that is under development.
In the meantime, we didn't want to wait, and that's why adding the resources that I described was done right away.
J. Darcy: The addition of 34 FTEs and eight new ambulances — does the minister believe that that meets the objectives that were identified in the ORH report?
Hon. T. Lake: I'm obviously not making myself very clear. We took some immediate steps, and a longer-term plan is being developed to meet the identified needs of the Lower Mainland through the ORH report. I understand that the business plan with those actions and the resources necessary has been delivered to the ministry, and the ministry is analyzing that business plan now.
J. Darcy: The ORH report dealt with urban ambulance service in urban areas. It does not address paramedic resources and plans for non-metropolitan areas — urban and rural areas in the rest of the province.
What is the solution for urban areas with long-standing inadequate ambulance resources and considerable hospital delays and considerable transfer demands like Kamloops, Kelowna and Prince George? Many of those communities, smaller cities, have serious problems with wait times, response times, and are not captured by the various strategic plans to date.
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Hon. T. Lake: Well, many of the strategies that have been developed as a result of the ORH study of the Lower Mainland will have transference to other health authorities.
For instance, decreasing the activation times will help all over the province. Standardizing the handoff at the emergency departments will help all around the province. Looking at innovative ways of managing patients, through treat and release or the use of primary care units, will be helpful around the province. There are things that were studied in the Lower Mainland that can be transferred and will be transferred, in terms of practices around the province.
Of course, one of the challenges in non-metro areas is the recruitment and retention of paramedics in smaller communities. It was certainly true of the 1990s. It was strictly a voluntary system in smaller communities. Later that developed into an on-call kind of a system, where paramedics either were at the ambulance station and were paid an hourly rate and then that rate increased when they were called out or they were on a pager and paid a smaller hourly rate and, again, that rate went up if they were on call.
With the announcement recently of community paramedicine, 80 FTEs will be added over the next couple of years. That will bolster the paramedic numbers in rural areas and smaller communities and allow people to make a full-time career of being a paramedic.
We think that will strengthen not just response times in those communities, by ensuring that we have an adequate number of paramedics — because it can be difficult to recruit and retain into some smaller communities — but also to be able to strengthen primary care, by adding on duties to a full-time paramedic that, in the past, was simply a part-time, on-call paramedic.
J. Darcy: The report that we have been discussing deals with ambulance wait times, response times, in the Lower Mainland and Victoria. Is there a plan to do a similar study for smaller or medium-sized communities, like Prince George, Comox Valley, Cranbrook, Kelowna, Kamloops, Penticton?
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Hon. T. Lake: Of course, response times in more rural areas are, expectedly, going to be longer than they are in urban areas. When we look at some of our key mid-size cities, however, the response times are actually pretty good. In Nanaimo, for instance, lights-and-sirens average response time is eight minutes and 41 seconds.
Now, there is no national standard. I know people talk about a national standard. It is probably in metro areas, urban areas. The lights-and-sirens nine-minute average is one that is often used. Again, in more rural areas, that is unlikely to happen because of the distances involved. But again, in Nanaimo, we have a very good response time of eight minutes and 41 seconds. In Kelowna, we have an average lights-and-sirens response time of nine minutes and 49 seconds. In Kamloops, ten minutes and 33 seconds. In Invermere, ten minutes and 26 seconds.
If we go to a more rural area, somewhere like Keremeos, it goes up to just over 13 minutes. So there is a difference, certainly, between metro areas and more urban areas. Much of what we have learned from the ORH study…. Once it's applied to these other parts of the system, we will be monitoring these response times. But we don't feel there's a need to do another analysis of these response times in these medium-sized cities because we feel very confident that the learnings from the ORH study in the Lower Mainland can be applied to these other centres. We'll be monitoring the response times as a result of those changes.
J. Darcy: But we're also talking about even smaller communities in rural British Columbia — Chilcotin, Peace, Columbia — where often we have long distances between communities and hospitals and long distances between ambulance stations.
Is the minister saying that we can take directly…? He just referred to ambulance wait times varying between urban communities and rural communities. Does the minister think that he has adequately studied the issue of ambulance response times in those rural communities where the distances are quite significant?
Hon. T. Lake: Well, we're always looking at how we can improve the system, and certainly, after we've had an opportunity to have the community paramedicine program in place for a while, we'll be able to evaluate what effects that has. We'll be able to evaluate changes that are implemented as a result of the ORH study, not just in the Lower Mainland but in other areas. Of course, we have an air ambulance fleet, also, that serves more rural communities — to either use helicopters or fixed-wing to transport patients from more rural and remote areas into hospitals.
As someone who represents both a medium-sized city and a rural area, it will come as no surprise to people who live in rural areas that there is a longer distance to be travelled. A longer response time is part of the expectation that people have in those smaller communities.
In a province like British Columbia, where we have a relatively small population of 4.6 to 4.7 million people living in an area encompassing the area of Europe, with terrain that is extremely challenging and mountainous — we have isolated areas — people understand that it is challenging to provide all of the same services everywhere in the province.
We try using technology, using things like the air ambulance service, to make sure that people living in smaller communities and remote areas of the province have access to health care in as quick a time as we possibly can. As I say, we know that in smaller communities, more rural areas, the response times will be longer than they are in the metro area. We will continue to monitor those.
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We meet with leaders of small communities every year at the UBCM. I can tell the member that in my meetings over the last several years, the idea of community paramedicine has been extremely positively received by these communities. In fact, many of them indicated that they wanted to be part of it. Many of them have become part of it.
I can tell you, from talking to some of the mayors of these smaller communities where community paramedicine will be implemented, they are extremely happy. They don't talk about response times as much as they talk about making sure they have the ability to recruit and retain paramedics in their communities. We feel that with this program, we'll be able to do that.
J. Darcy: The minister referred earlier to national response times. I know that we discussed this issue somewhat in this House, in question period, a number of weeks ago.
The report, as I recall, said very clearly — it was a very troubling finding — that in the greater Vancouver area, the Lower Mainland and Victoria, which were the areas that were the subject of the report, the national target, which the minister says is about urban.... I'm not going to pursue the rural response times just now, but for urban areas that were studied, that response time was only being met 50 percent of the time.
My understanding of the action plan flowing from that report, the action plan from the ministry and emergency health services, was that the new target was to meet that nine-minute response time three times out of four by the year 2020, which is four years from now. Is that, in fact, the target that this ministry thinks is acceptable?
Hon. T. Lake: Yes.
J. Darcy: The minister will be aware.... He was present when they made the presentations, I believe. The Heart and Stroke Foundation visited the Legislature and held an event. There were many members from both sides of the House in attendance. This was part of the case they were making for ensuring that there was access to defibrillators in far more public spaces.
In fact, they believe it should be a requirement that there be more defibrillators in public spaces like arenas and libraries and so on. They pointed out that once you get past the 12-minute mark when you're dealing with somebody who has suffered cardiac arrest, as I recall them saying, the chances of survival go down to about 5 percent.
I must admit that I have trouble reconciling, as I'm sure many people do, how the minister can say it's an acceptable target that still one out of four British Columbians in the urban areas — forget rural — could expect to have an ambulance within that nine-minute target — and only, then, four years from now. How does the minister explain that to cardiac patients, to the Heart and Stroke Foundation and to others who would be concerned?
Hon. T. Lake: Well, you create a system that.... Again, if the member wants to have a guarantee that 100 percent of the time ambulances will arrive within five minutes, we could use that as a target. Or we could say 95 percent of the time, they'll arrive within five minutes, and the member will say: "Well, what about the 5 percent where they don't?"
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These are targets that are set to provide a high level of care to the people of British Columbia. It is a provincial ambulance service that is one of the largest ambulance services in North America, with a sterling reputation, with highly trained advanced-care, primary care and EMA-level paramedics and dispatchers that are extremely good at their jobs.
We celebrated, just a couple of years ago, 40 years of this service in British Columbia. Before that, it was a patchwork of for-profit and non-profit services all across the province, and it has developed into one of the best services in North America.
The Heart and Stroke Foundation does amazing work. In fact, we have partnered with them, through the public access to defibrillator program, to the tune of millions and millions of dollars, to put defibrillators in place. I would say we've done more than that. The great people who work for B.C. emergency health services have provided training for people on how to use and how to maintain those defibrillators. They also provide a registry for those defibrillators so that when an ambulance is called, when 911 is called, they can tell the person where the nearest registered defibrillator is.
We have recognized people who have been on the phone, that have provided the right kind of information so that people can arrive on scene in the shortest period of time. They've stayed calm. They've done what the dispatcher has said, until the ambulance gets there.
It is a combination of people and resources that come together: the B.C. Ambulance Service, through BCEHS, the Heart and Stroke Foundation, the Ministry of Health that supports them and, importantly, first responders — who are great partners with B.C. emergency health services, who arrive on scene, have defibrillators and, in many cases, in urban areas, will have resources that are available and will often arrive slightly before or sometimes at the same time as the paramedics. They have the ability to use a defibrillator. Again, I've seen firsthand how those teams work together to save lives.
Yes, I did say there is no known standard. But the study, and the plan coming out of the study, said that our goal over the next number of years is for lights-and-sirens calls, three-quarters of the time, 75 percent of the time, to have a response time under nine minutes. I think that is an admirable goal and one that will serve the people of British Columbia very well.
J. Darcy: I wonder if the minister could provide a breakdown, year over year — say, the last five years — of the number of full-time equivalents employed by the Ambulance Service?
[R. Lee in the chair.]
Hon. T. Lake: The budget, first of all, for B.C. emergency health services has increased 117 percent since 2001-2002, from $148 million to $322 million. The number of full- and part-time paramedics has grown by 25 percent in that time period, from 3,157 to 3,945. That was until '14-15. If we go back the last…. Did the member ask for five years, I believe?
J. Darcy: Sure. Or if you've got ten, that's fine.
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Hon. T. Lake: Okay, great. Well, let's start at 2007-2008. We had 3,466 employees; in 2008-2009, 3,618; 2009-2010, 3,640. For 2010-2011, I believe that was the one year where there was a reduction to 3,596; 2011-2012, 3,678; 2012-2013, 3,814; 2013-2014, 3,881; 2014-2015, 3,944; and 2015-16, 4,007.
J. Darcy: The minister referred to a 25 percent increase. Which year-over-year is he referring to there?
Hon. T. Lake: That was, I believe, from 2001-2002 to 2014-15.
J. Darcy: The number that he referred to at the beginning of that was what again?
Hon. T. Lake: In 2001-2002, 3,157. My note here says in 2014-15, 3,945, but this other note says 3,944; there's a discrepancy of one in 2014-15, so let's call it 3,944 to be conservative.
J. Darcy: There are a number of…. I won't canvass them. We all have them in front of us. There are numerous recommendations that are detailed in the action plan — the emergency health services plan.
Can the minister please inform the House: what's the timeline for implementing those recommendations? This is an action plan that is meant to be implemented over what time period?
Hon. T. Lake: As I mentioned, the business plan outlining that strategy and the required resources has just been submitted to the ministry and is being analyzed by the ministry. I don't have that information, because we haven't had the opportunity to review and analyze it.
J. Darcy: Just a couple of last questions on the ambulance service. It is my understanding that in the last year — B.C. emergency health services — there have been approximately 30 terminations of long-serving managers in the last year, all of whom received an additional 18 months of pay and benefits in addition to their pensions.
Can the minister provide the costing? How many of these terminations and payouts occurred to long-service managers?
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Hon. T. Lake: There have been, certainly, some changes in management positions, over the last three years that I've been minister, in B.C. emergency health services. However, any terminations and accompanying compensation would be in line with guidelines outlined by the public service. I do not have a figure as to the total. We can take that on notice and provide that if it's within the Freedom of Information and Protection of Privacy Act.
J. Darcy: Can the minister confirm that there have been in the last year terminations and packages for 30 long-serving managers?
Hon. T. Lake: No, there have not.
J. Darcy: How many terminations of long-term managers have there been in the last year?
Hon. T. Lake: Some restructuring has occurred over the last year, but there have not been 30 long-term managers terminated in that process. My understanding is that between six and ten positions were affected over the last year as part of that restructuring.
J. Darcy: The minister said that the payouts were consistent with public service guidelines. My understanding is that that would be 18 months of pay plus benefits, in addition to their pensions — roughly $150,000. Does that reflect the minister's understanding?
Hon. T. Lake: I'm told that it would range from two months up to 18 months, depending on years of service.
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J. Darcy: Well, certainly, of course it depends on length of service. I understand that these were mainly or almost exclusively long-serving managers, which would mean that this cost was significantly higher.
The minister referred to restructuring. Does that mean that these positions were eliminated, or have they all been replaced? So how many positions were eliminated, and how many were replaced? Restructuring implies eliminated.
Hon. T. Lake: It's a combination of restructuring and terminations. As I mentioned, some people who are no longer there, either through restructuring or through termination, would have received compensation based on public sector guidelines. That would range from two months to 18 months.
The member is implying that all were long-serving members of the public service. I'm saying to the member that the compensation awarded ranged from two months to 18 months. Therefore, not all of them were long-serving members of the public service.
J. Darcy: Can the minister provide the amount? He said it wasn't 30; it was between six and ten. Can the minister provide the total amount of these compensation packages?
I understand that the individual agreements are confidential, that people sign non-disclosure agreements in order to get the payouts. Can the minister please provide information about the total amount that was paid out — how many positions and the total amount?
Hon. T. Lake: I already said that I would provide that information if I was authorized to provide it according to the Freedom of Information and Protection of Privacy Act. It is information we will have to accumulate and then ensure that we protect people's privacy at the same time.
The Chair: Member.
J. Darcy: …on the ambulance service.
M. Elmore: Thanks to the minister and staff for the opportunity to raise some questions that have come to my attention from a community organization called Sanctuary Health, who advocate on behalf of individuals who are undocumented, who have precarious immigration status.
We're seeing increasing numbers in B.C. and in our country, particularly with the recent changes last year to the federal government temporary foreign worker program — increasing numbers of folks who are in British Columbia without official status.
It was brought to my attention that…. Maybe I'll just read the background and present the situation. Currently under the Medicare Protection Act, MPA, the Medical Services Commission determines if babies are eligible for MSP. Procedurally, babies are granted MSP coverage if they are residents of B.C. and if they are the legal dependents of a resident of British Columbia who is also a beneficiary of MSP.
However, there's a roadblock if the applying parent has restricted or no access to MSP due to their precarious immigration status. The example is that when these parents apply for MSP for their babies, parents' identity and residence documentation is already required. This is problematic if the parents are undocumented.
Many of these parents want to apply for MSP for their babies but do not do so because they rightly fear being deported. These parents are concerned about providing the information to the Medical Services Commission out of fear that the commission will report them to the Canadian Border Services Agency or otherwise release the information. As a result, we are seeing — and it's being shared with me — that Canadian babies are being denied important health care that they need as infants.
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Some of the examples that have been brought forward, and I'll just put them on the record. Canadian babies, residents in British Columbia, who have restricted or no access to MSP due to the precarious nature and the criminalization of their parents immigration status include a baby of undocumented parents who was denied MSP because the parents were not eligible for MSP; also, a Canadian baby of undocumented parents does not have MSP because the parents are undocumented, and they're fearful of applying for MSP; and a Canadian baby of a temporary foreign worker was granted MSP but only till the expiry of the mother's work permit, rather than the longer term provided to all other beneficiaries of MSP.
It has been brought to my attention that this has been changed. It's either a regulatory change or a policy change. Previously if babies had been born, they were granted MSP. I was wondering if the minister is familiar with this issue — and also to address the important principle of babies being born in British Columbia being covered by MSP and having access to health care and medical services.
Hon. T. Lake: No policy has changed. If a baby is born in Canada, they are a Canadian citizen and immediately eligible for MSP.
M. Elmore: Thanks to the minister. Maybe I'll get some more information —there are specifics — and follow through with that. I think it may be a function, as well, that we're seeing more numbers, just in light of the federal changes bringing in the time limits, particularly for temporary foreign workers. We've seen that these numbers every day since last year have been increasing. So I can get some of the details and follow up directly. I think that would be helpful.
Also dealing with the increasing numbers of folks who are undocumented accessing medical services at hospitals, it has been raised that there is the experience of individuals who are undocumented, precarious immigration status, who go to a hospital for treatment, medical services. Their experience is that their information is transferred to Canada Border Services Agency. Particularly in the case, I believe, of Fraser Health, there were over 500 instances where individuals' immigration status was transferred to Canada Border Services Agency, resulting in some deportations, people being removed from British Columbia.
That has been raised as a concern in terms of the reluctance of individuals who have precarious immigration status to access health care if it's needed.
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I just wanted to raise that to the minister — if there's a policy on board with that. Or what steps are in place to ensure that individuals in British Columbia have access to health care if needed?
Hon. T. Lake: First of all, I want to make it clear to the member and anyone listening that medical services are never denied to someone needing medical services. Once the medical service is supplied, then, in some cases, if there doesn't appear to be coverage under MSP, the health authority needs to recover the costs.
In some cases — and this seemed to be a practice within some health authorities — they would contact CBSA to try to find out whether someone was resident or not and, therefore, how to collect the money owing. That has been discontinued. There are no health authorities that are contacting CBSA in that regard anymore. I know that was a concern of Sanctuary Health, and health authorities have discontinued that practice.
M. Elmore: Thank you to the minister for that clarification. I know that there had been reports to me that that was not the policy implemented in Vancouver Coastal. There were, I guess, different approaches amongst different health authorities. Certainly, that principle is appreciated.
The challenge is…. In terms of the increasing numbers of individuals without status in British Columbia, this is within the realm of responsibility of the federal government. There are discussions underway and initiatives from Vancouver city in terms of adopting the principles of a sanctuary city to ensure that individuals have access to services without fear of detention and deportation. So that's good news to hear that. I appreciate that.
Hon. T. Lake: I just wanted to clarify that they will not contact CBSA without the patient's consent. If the patient consents, then they might. But if the patient does not consent, then they will not.
M. Elmore: Thanks to the minister for that clarification. I'll convey that back to the organization and advocates. I'm sure they'll be very heartened to hear that news.
J. Darcy: I'd like to turn to the issue of Lyme disease.
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Back in 2010, the government commissioned a report — a confidential report, I understand — by a Brian Schmidt, who found that the incidence of Lyme disease is rising and likely to increase. This report also exposed what was referred to in the report as the woeful inadequacy of testing and treatment for Lyme disease in B.C. The author of the report stated clearly: "Doctors should be able to prescribe therapy unless that therapy poses a greater risk to patients."
This is an issue we've discussed in previous estimates. The Lyme patients who come to see me quite regularly, here in the Legislature, the Lyme foundation, as well as in my constituency office, remain very, very concerned about inadequate programs to support them, about wait-lists of two and three years in order to get appointments, much less treatment.
The complex chronic diseases program, CCDP, at Children's and Women's Hospital, as the minister knows, was created with a mandate for screening, diagnosis and treatment of various diseases, including chronic Lyme disease as well as patients with fibromyalgia and chronic fatigue syndrome.
Now, I know that a few weeks ago there was considerable concern amongst patients with Lyme disease, as well as Lyme disease advocacy organizations, that there had been information given to some Lyme patients that the clinic was not going to be treating patients with Lyme disease.
I also understand that since then, it's been said that that information was not, in fact, accurate. Either the decision has been changed, or the original information was not, in fact, accurate. I would just like the minister to clarify whether or not patients with Lyme disease are still considered one of the three key groups to be treated at the complex chronic diseases program?
Hon. T. Lake: I want to welcome Dr. Bonnie Henry, our deputy medical health officer, to support us today.
The Schmidt report that was produced in 2010 was a report that had a lot of information in it, obviously, and some recommendations — and some conclusions that certainly appeared alarming. But I think it's important to note that the B.C. Centre for Disease Control was not involved in the preparation of the report. The Schmidt report was not vetted or peer-reviewed by scientists or clinicians. It was a collection of perspectives regarding the needs of patients who have complex chronic diseases.
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The B.C. Centre for Disease Control has done its own reports and undertaken several studies over the last ten years. It has confirmed that there is a low, stable rate of Lyme disease in the province of British Columbia and that they do not expect to see large increases in the disease in this province.
The organism that causes Lyme disease is an organism called Borrelia burgdorferi, which is carried by some species of ticks, particularly deer ticks in British Columbia that appear west of the coastal mountain range. Less than 1 percent of ticks in B.C. that can carry Lyme are infected with that Borrelia organism.
Having said that, patients that are diagnosed with acute Lyme disease are treated by family physicians. They are well trained to recognize the clinical signs — the history of a tick bite, the bull's eye that appears on the skin and the other clinical signs — that are presented by someone with acute Lyme disease. They are certainly well within their practice scope to recognize and treat Lyme disease, which can be treated in the acute stage with a course of antibiotics and can be very effective in treatment.
The complex chronic diseases program provides care for people who suffer from a group of complex chronic diseases, which include but are not limited to myalgic encephalomyelitis, otherwise known as chronic fatigue syndrome, fibromyalgia syndrome and chronic Lyme disease. The acute stage of the disease is treated by primary care physicians, whereas more chronic complex forms of Lyme and other syndromes are treated at the complex chronic diseases program.
J. Darcy: I understand that there are differences of opinion, including amongst scientists and medical specialists on this area. Certainly, the Schmidt report pointed to a very real problem and one that Lyme disease patients say continues to exist.
When the CCDP was first established, it was supposed to offer more than what was at that time a very inadequate status quo for Lyme disease patients. Lyme disease patients say that they are now waiting almost three years to get into the program and that they are having their Lyme disease diagnoses overturned because of faulty blood tests. If they are actually lucky enough to receive a diagnosis of Lyme disease, they're only provided with a very limited course of antibiotics, which will not eradicate an entrenched infection.
What does the minister say to the Lyme patients who are raising these concerns? Why are people waiting as long as three years for an appointment?
Hon. T. Lake: Well, first of all, we don't know if they are Lyme patients or not. That is part of the conundrum of these complex chronic diseases.
The Schmidt report certainly, I would say, carried the view that many patients suffering from complex chronic diseases have. They want to know the cause of the problem and how to eradicate it. That is a natural tendency. I've spoken to patients on this and understand their frustration. It's a frustration that is shared by not just patients but by the medical and scientific community. There are some syndromes which are not easily explained.
The testing that is accepted by experts in both the Centre for Disease Control here in Vancouver and the Centers for Disease Control in Atlanta is not the same as some other testing laboratories which claim that their tests are more sensitive and more accurate and provide, I guess, what some people who suffer from chronic complex diseases want to hear — that they have Lyme disease.
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It is not as simple as that. The experts in diagnostics will tell you that those tests, which are often carried out in private for-profit laboratories, are in many ways misleading people into a false-positive diagnosis.
The complex chronic diseases clinic. Yes, it is busy. It was restructured to try to address some of the issues around the long wait times. Since November 2014, with the restructuring and with the recruitment of physicians and the team restructuring, new patient consultations and follow-up visits have increased significantly.
Are people getting in as quickly as they would like to? No. But there are, of course, other avenues. There are other people who will see people with these chronic complex problems. But the clinic in Vancouver certainly provides resources and supports that aren't available in many primary care settings.
I won't speak to the treatment modalities that are offered because I am not a physician that is working in that environment. I would leave those decisions to those people who are qualified to make them.
J. Darcy: Well, the minister says he's not a medical specialist, and I certainly don't pretend to be a medical specialist either. But the minister refers to chronic complex diseases. Lyme disease is an infection — right? — caused by a tick.
Hon. T. Lake: Acute Lyme disease is recognized to be a result of a Borrelia burgdorferi, which is a bacterium carried by a tick. When a tick bites a person — or, in my veterinary practice, bites a dog — it can release that organism into the bloodstream. That organism can cause an infection. Sometimes the body will be able to fight that infection. Sometimes it goes into a chronic stage and will settle out in joints, in kidneys, in neurological tissue.
But when it goes into those stages, it is not as easily diagnosed as it is in the early stages of the disease. In the acute stage, diagnosis is relatively straightforward. If someone is suffering from a chronic complex condition that they believe is Lyme, it can be extremely difficult to confirm that because the organism has moved past the stage where the current state of diagnostics is capable of corroborating that.
There are other immune-mediated and other chronic complex diseases that can mimic the chronic Lyme state, which makes it difficult to differentiate one condition from another. Of course, as technology and science make advances, we hope that we will be able to separate out and determine the cause of complex chronic conditions like fibromyalgia, like chronic fatigue syndrome, like chronic Lyme.
But at the level that we are at today, it is extremely difficult to do that. And to claim that there are tests out there that provide false hope is, I think, disingenuous and is not adhered to by the vast majority of the scientific community.
J. Darcy: What Lyme disease patients and advocates said to me, and the minister is aware…. The complex chronic diseases program acknowledges that the diagnosis of Lyme disease is supposed to be a clinical one. I gather that's because of what they see as concerns with the current blood tests. Yet, patients have to wait up to three years to get an appointment.
My understanding is also that the specialist, the infectious disease doctor at the CCDP, only works one day a month. So how are Lyme patients supposed to be able to get a diagnosis?
[1700]
Hon. T. Lake: I just had a great physiology and medical lesson from Dr. Henry. So just to review — see if I'll pass my mid-term — the acute stages of Lyme disease will show clinical signs. I mentioned the history of a tick bite, the bull's eye. Primary care physicians will see that and don't need to test. They will institute a course of antibiotics right away.
In someone that has the latent stages where the bacteria have disseminated through the body, ending up in other areas like the joints, for instance, the blood test will diagnose that. That can be done at the primary care physician's office as well.
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If that test comes back positive, these patients are put on a course of antibiotics. They may need to have a longer course because now it is in areas of the body where the bloodstream doesn't cross into the joint fluid as readily, so they may need a course of intravenous antibiotics. But that, once it's diagnosed, can be treated at the primary care physician's office as well.
Now we're left with people that believe they have Lyme disease, but they're negative for the test that is approved in Canada and by the CDC in the United States. They may have a positive test from one of these for-profit laboratories. They're often referred to as alternatively diagnosed chronic Lyme-like syndrome, and they will not respond to antibiotics.
The studies have shown that if you take the people that have the alternatively diagnosed chronic Lyme-like syndrome and put them on antibiotics…. In fact, four randomized controlled studies have shown that there is no benefit to antibiotics. In fact, there are serious side effects, including infections with C. difficile, for instance, as the bacteria wipe out the normal flora of the intestinal tract and C. difficile takes over. In fact, some deaths have resulted.
So there is no benefit, if there is not a positive test for Lyme disease using the test that is approved by the Centre for Disease Control, to long-term antibiotics, and there may be serious harms, which is why people that have not had a positive diagnosis with the approved test are not put on long-term antibiotics.
J. Darcy: I hope the minister and his staff will excuse my pronunciation of these terms.
Can the minister please explain what blood tests are used to pick up Borrelia hermsii and Borrelia miyamotoi? Do I have that right? What blood tests are being used at the clinic or in British Columbia to pick up these?
Hon. T. Lake: The Centre for Disease Control here in British Columbia employ tests that cover all of the species of Borrelia, including hermsii and miyamotoi.
J. Darcy: Are those blood tests offered through the CCDP?
Hon. T. Lake: Yes, they could be, but also available in the primary care setting as well, if they were suspected of having those organisms.
We have not found Borrelia miyamotoi in British Columbia. There is evidence of Borrelia hermsii in parts of the Okanagan. It causes a separate disease called relapsing fever, but again, blood testing is available for that organism.
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J. Darcy: I'm wondering if the minister can provide tick-infection rates in communities like Cultus Lake, Squamish and Coquitlam.
I understand that the ministry believes or the public health officers believe that the infection rate of what are referred to as black-legged Ixodes pacificus ticks is very low in B.C. — a maximum of one in 200 ticks being infected. But certainly the Lyme disease advocates, the Lyme patient advocates, that I've spoken with believe that surveillance by the Centre for Disease Control is picking up pockets of infected ticks in areas where the infection rate is much higher.
It would be very helpful…. Can the minister provide information, either here or subsequently, in writing, on what the infection rates have been in those specific areas in the past few years?
Hon. T. Lake: The deer tick Ixodes pacificus is the tick that is responsible for carrying the organism responsible for Lyme disease. The Centre for Disease Control and our public health officers created ecological niche modelling to look at the types of areas of the province where you would expect to find Ixodes pacificus and then went and field-tested in these areas for three summers in a row.
There were over 500 ticks that were found and tested. The prevalence of Borrelia in those ticks was one in 200, or about 0.5 percent, which is not higher than we've seen in the past. We also examined ticks that are submitted by veterinarians, by physicians, by citizens. Again, the prevalence of Borrelia in those ticks is within that same range.
In terms of the three communities listed, we will go back and see if we have specific data for those communities and provide those to the member.
J. Darcy: The minister will be aware, of course, that a couple of years ago a bill was passed in the Parliament of Canada calling for a national Lyme disease strategy. This bill, which was approved unanimously, I understand, in the federal parliament, was to include an action plan by every province and territory in the country.
Can the minister please speak to what his ministry is doing to put in place a comprehensive plan for Lyme disease patients in British Columbia? Specifically, what kind of consultation is happening with Lyme disease patients in developing this strategy?
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Hon. T. Lake: The national strategy is being developed. There's consultation that is beginning. In fact, on the 15th, 16th and 17th of this month, they will be meeting here in British Columbia.
Interjection.
Hon. T. Lake: Sorry, it's in Ottawa. Dr. Henry gets to go to that one. But at least it's a better time of year to go to Ottawa.
It is being led by public health officer Dr. Greg Taylor, the Association of Medical Microbiology and Infectious Diseases and a patient advocacy group. That is the first meeting that will bring all these groups together to discuss what provinces have learned, and we will look to see the results of that meeting next week.
J. Darcy: My next question was going to be about that conference, actually. So the Ministry of Health is participating? Or the public health officer's office is participating directly in that conference? That's a yes, I gather.
My question had been…. It was actually a question that I asked, I believe, two years ago, shortly after that bill was passed. Is the minister saying that there hasn't been a provincial strategy developed yet, flowing from that bill, and it's awaiting that national conference?
Hon. T. Lake: A national strategy does not mean that provinces have to do anything. A national strategy, particularly when it comes to health care, is to bring people together and look at best practices.
We are ahead of many provinces with the formation of the complex chronic disease clinic. It is one of a kind across the country, so I'm sure people at this meeting will be interested to hear about our experience.
We are participating in this conference. The member should not be under the illusion that the federal government has ordered provinces to do any particular work in this area, but we are sharing our knowledge and our experience with other partners at this conference in Ottawa. And yes, Dr. Bonnie Henry will be attending on behalf of the province of British Columbia.
J. Darcy: That concludes my questions on Lyme disease. Thank you to the minister and the staff.
I have a couple of other areas I would like to pursue, since we would appear to have a little bit of time left.
Interjection.
J. Darcy: What are they? Auditing of private clinics and walk-in clinics — and if we have time, MSP.
[1720]
J. Darcy: On October 30, 2014, the minister said that the government had and was currently auditing private-for-profit clinics that they felt had broken provincial and federal laws. The direct quote was: "….we are auditing and have audited some private clinics that we feel have broken the statutes of the Canada Health Act and, provincially, the Medicare Protection Act."
Does the minister have the results of these audits?
[1725]
Hon. T. Lake: The Cambie clinic is one of the clinics that we have been auditing and we continue to audit. Cooperation from the Cambie Surgery Centre and the Specialist Referral Clinic has not been the best, I would say. We have attempted to do on-site audits, and the cooperation by these organizations has been limited, which has made it difficult to carry out the auditing process.
As the member well knows, we are due in court in September on this issue. We continue to defend the government in this lawsuit and look forward to the opportunity to present all of that evidence in court in September.
J. Darcy: How much is British Columbia expecting to lose in Canada health transfer payments as a result of any extra billing that has been discovered to date?
Hon. T. Lake: I can go through the various years. The Canada Health Act says that if there are cases of extra billing, the amounts will be subtracted from the Canada health transfer by the federal government. In 2000-2001, that amounted to $4,610; 2002-2003, $72,464; 2003-2004, $29,018; 2004-2005, $114,850; 2005-2006, $42,509; 2006-2007, $66,194; 2007-2008, $73,925; 2008-2009, $75,136; 2009-2010, $33,219; 2010-2011, $280,019; 2011-2012, $224,568; 2012-2013, $241,637; 2013-2014, $204,145. I do not have figures past 2013-14.
[1730]
J. Darcy: There are certainly some significant numbers there. To the minister: what monitoring and enforcement measures will the government take to ensure that government funds are not, on an ongoing basis and in the future, being siphoned away via illegal extra billing by these for-profit clinics?
Hon. T. Lake: We are, of course, in court because of our actions that we have taken to recoup the results of extra billing through the auditing we have done. We are vigorously defending ourselves in that lawsuit that is brought forward.
I think we have demonstrated that we do not find it acceptable and that we will recoup those extra billings from clinics that carry this out. That's why we're in the situation we are, where we're defending ourselves in court. I understand the federal government has entered as an intervener or a participant in that court process as well.
J. Darcy: The minister mentioned the Cambie clinic, and the other was the surgical referral centre — the clinics that had been audited.
Hon. T. Lake: The Cambie Surgery Centre and the Specialist Referral Clinic have a common ownership group. For both of these facilities, we are undertaking audits, or attempting to undertake audits.
J. Darcy: What's the time period for which the ministry is attempting to audit those clinics?
Hon. T. Lake: Well, we go back to 2008 and 2009, when these clinics were notified of intent to audit. The first audit focused on Cambie Surgery Centre and the Specialist Referral Clinic. There were legal challenges that challenged the Medical Services Commission's power to undertake extra billing audits. The B.C. Court of Appeal rendered a decision on September 9, 2010, confirming the powers of the Medical Services Commission to conduct these audits, and the audits started on site in January 2011.
An interim report was presented in May of 2011. Further information was requested which warranted additional on-site work, and the final audit report at that time was July 2012 — when that was made public. It established extra billings totalling $500,000 in private charges and $70,000 in MSP claims out of a sample of 468 services covering, mainly, August 2008, December 2010 and January 2011.
The follow-up audits commenced in December 2012, and we continue to attempt to conclude those on-site audits. Obviously, with the legal challenges that have taken place, and there are roadblocks that have been put up to finishing those audits, time has gone on.
[1735]
There is, I guess, a tendency to look to the September date when the court case will commence, and hopefully, that will allow the completion of those audits once all the legal road blocks have been cleared.
J. Darcy: Have there been audits undertaken of any of the other private clinics?
Hon. T. Lake: There have been other clinics that have been brought to the attention of the audit and inspection committee. Our legal advice to date has been to proceed with the investigations, the audits, that we are doing and the court case that we're involved in to make sure that we have the reasonable grounds to continue on those audits.
We are acting upon legal advice to await the outcome of the legal proceedings that we have, hopefully culminating in September.
J. Darcy: Perhaps it's late in the day, and that's why I'm not understanding it.
Does that mean that the ministry does not believe — or the legal advice the ministry is being given is that there is not a reason for concern or suspicion — that there is illegal activity happening in any of those other clinics?
Hon. T. Lake: Our legal advice is that while we may have cause for concern that extra billing is going on, that while there is the legal case that was coming before the courts in September, it would be prudent to await the outcome of that case before proceeding with more audits.
That does not mean that we can't do those audits at that time and, of course, go back in time with those audits and recoup any extra billing that is determined through that auditing process.
J. Darcy: I have a couple of questions about walk-in clinics. The first one the minister may want to get back to me on, if he doesn't have the information at hand. Does the minister have any idea or, more importantly, any figures on the current numbers of how many British Columbians use walk-in clinics as their primary source of primary care?
Hon. T. Lake: We do not have those types of numbers, because the MSP billing codes, which we use to track health services obtained by British Columbians, doesn't differentiate between a walk-in clinic and any other type of primary care.
J. Darcy: There is one other question I want to ask, and I'm concerned we may run out of time if I don't have a chance to.
I know that the newly formed Walk-In Clinics of B.C. Association has been to the Legislature to meet the minister. They've met members on this side of the House as well. One of the issues…. In fact, on the front cover of their document, as the minister knows, they quote him as saying that walk-in clinics are "an important service." They were not aware that that was something you said in question period in response to a question that I asked, but whatever.
One of the things that the association is pressing for, as the minister knows, is a re-examination of the MSP cap that limits the number of patients that a GP may see. They are urging the province to change that so that in walk-in clinics, GPs can see more patients per day than the present MSP cap allows.
[1740]
What is the minister's response to that proposal?
Hon. T. Lake: My response is: not at this time.
J. Darcy: Okay, I'll ask one last question — or leave it with the minister — that is just a follow-up on the previous one. Does the minister not think that it would be valuable information — and important enough that we should look at it as far as MSP billing codes — to know how many British Columbians use walk-in clinics as their primary source of primary care?
Hon. T. Lake: Well, data is always useful, for sure, in health care planning. There may be other ways to get at that information — through surveys, for instance. I'm not aware of any that have been done, but as I say, the MSP billing codes don't differentiate between a walk-in clinic and any other type of primary care.
I would note, however, that the College of Physicians and Surgeons has made it very clear to all primary care practices that as soon as a patient walks in the door, you are responsible for that patient. There has been the notion that has been fostered over the years that if you attend a walk-in clinic, the clinic has no responsibility for your care. That is not the case, according to the College of Physicians and Surgeons.
I think that data that helps us manage the health care system — and that can be obtained through a number of different ways — is useful in planning. As I mentioned before, the issue of primary care is an ever-evolving one. There isn't one type of primary care that works for every British Columbian or works in every community, and the primary care model that is utilized throughout the province will continue to evolve.
Noting the hour, I move that the committee rise, report progress and seek leave to sit again.
Motion approved.
The committee rose at 5:42 p.m.
The House resumed; Madame Speaker in the chair.
Committee of Supply (Section B), having reported progress, was granted leave to sit again.
Committee of Supply (Section A), having reported progress, was granted leave to sit again.
Hon. T. Lake moved adjournment of the House.
Motion approved.
Madame Speaker: This House, at its rising, stands adjourned until 10 a.m. Monday, May 9. Safe travels, all.
The House adjourned at 5:43 p.m.
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