Mr. Chairperson (Ben Sveinson): Order, please. Will the Committee of Supply please come to order. This afternoon, this section of Committee of Supply, meeting in Room 255 will resume consideration of the Estimates of the Department of Health. When the committee last sat, it had been considering item 21.1.(b)(1) on page 71 of the Estimates book. Shall the item pass?
Mr. Tim Sale (Crescentwood): I will just wrap up quickly the comments that I was making this morning to put a context around the issue we want to go into fairly thoroughly this afternoon, and that is the future of Misericordia Hospital. To summarize what I said this morning, it is my understanding that WHA did not have a policy role in the decision about the future of Misericordia, as indicated in a letter from the minister to Mr. Musick, the chair of the board, dated February 4, 1998, which lays out the government's role--sorry, the hospital's role as envisioned by the government in point form. I will not take the time to read that into the record because I know the minister is well aware of the letter, and I am sure Mr. Webster is as well.
I want to go really straight to the heart of the question, and that is the outline on page 2 of the new roll: 150 to 175 interim beds for paneled patients; 280 new personal care home beds; the walk-in 24-hour centre--walk-in clinic--the ophthalmology program, although it is not specified what that includes; the Manitoba Breast Screening Program, Winnipeg site, which is the provincial breast screening program and not the hospital program, I think it is important to underline; and the Health Links program. And then, to be more specific, the Misericordia General Hospital would no longer be a site for emergency services; critical care services; inpatient and outpatient surgery, except for ophthalmology inpatient medical services.
The difficulty I see with the decision as it is announced is what is not said. Let us put the context on this. When you have an ophthalmology program, one of the elements in that program is displaced retina, reattaching of retinas. That requires immobilizing the patient for a period of time, and requires some inpatient care in order to do that. So an ophthalmology program that does not include retinal reattachments is not a complete program. So that is the first question. If there is not to be general anaesthesia administered, and we are not to be able to do detached retinas there which require inpatient beds for at least a short stay, how is the ophthalmology program's integrity to be maintained?
Now let us start with that question, and I have a series of detailed questions about clinical aspects of the proposal.
Hon. Darren Praznik (Minister of Health): Mr. Chair, before we deal with that, I would like to deal with the member's comments by way of introduction because he has, I think, wanted to leave the impression on the record that the decisions around certain programming at the WHA or at Misericordia were made, are being made, solely by the Ministry of Health and that changes are solely our responsibility, and that the WHA, if but for us, would recommend other things. As well, I think he wanted to leave the impression that there was only a 24-hour period into which to make decisions, and this was rushed.
Now, granted the member may only operate on the information that is brought to him, and there is probably going to be a whole bunch of information brought to him, so I am prepared to provide him today with some letters that I think he would find most interesting, just to put this in perspective. First of all, Mr. Chair, I would like to provide him with a letter, my letter of November 6, 1997, to the Most Reverend Leonard Wall, Archbishop of Winnipeg, and Sister M.A. Plamondon of the corporate offices of Misericordia General Hospital, these representing the owners of the facility, as well as the acknowledgment from His Grace the Archbishop dated November 7, 1997, which acknowledges, because I know the member may doubt what I say, the fact that this process began actually in a meeting that Mr. Fast, chair of the Winnipeg Hospital Authority, and myself had with both on the 15th of October. So I provide that to members of the committee, and I think the member will see--I table that actually for the House and for the committee, so the committee may wish to--I think I have an extra copy for the Chair. I think it makes clear that we met on the 15th of October.
By the way, in planning for this internally within the ministry, this came about not only because of the long history of frustration I think in how the Misericordia fits into the Winnipeg hospital system--and it goes back 20 years over a number of governments, the realization that one did not need three acute care hospitals in essence in the downtown part of the city. The Misericordia had old infrastructure that would need to be upgraded. In fact, I can recall over the years decisions being made, because no one would come to grips with the Misericordia's role as a seventh acute care hospital in essence or one of seven acute care hospitals, that the existing acute care needs within the city of Winnipeg were spread among seven. I remember the argument being made very clearly, in doing that we made the viability of programming in the other six, particularly some of the community hospitals, less viable, less efficient. It removed the ability to develop certain centres of excellence, and that is not to take away from much of the good work that has been done in Misericordia where they have developed excellence, but it was the concept of spreading your acute care services on seven facilities.
Mr. Webster may want to talk about this, and I will ask him at some point to comment. In the preliminary work that he and his organization did after the appointment of Dr. Postl, this view of needing seven acute care facilities in a city the size of Winnipeg was reconfirmed to me by them in the discussions and planning that we had. The realization was there that if the WHA was going to be able to get on with its planning, some of these issues had to be dealt with, including the future role of the Misericordia. My own Capital people were saying we are at a point where we had to invest a million dollars, million and a half dollars in capital just to meet the fire and security upgrades in that facility, and what were we getting out of this. Was this a good use of capital without having the long-term role of the Misericordia moved forward?
In fairness to the Misericordia, I think every time they would argue that they have a long history of promises and commitments being made and not lived up to, and in the meeting I had with them on Tuesday evening with Dr. Postl, Neil Fast and myself, we--in discussing the history here, part of the problem is every time anyone in government even talked about a change in role for the Misericordia Hospital, Misericordia and its support community organized politically in the small "p" sense of the word to save the Misericordia, the yellow ribbons around the Misericordia, the whole bit, created enough political activity that no government of any stripe would really come to grips with the issue of where the Misericordia should be, even though those involved in the system from an objective point of view recognized that it was a problem, that the change in acute care services, how things were being dealt with across the city, really you had to come to grips with the Misericordia issue.
So people I think in government and in planning were continually met by this view that the Misericordia had to be saved. Of course, okay, people backed down, commitments were made, and in reality those commitments sometimes were very hard to live up to because they often did not make necessary sense. It was done around the reasons of saving the Misericordia in the politics of that part of the city.
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Having known that history, learned that history, having talked to our planners both in the ministry and particularly Mr. Webster and his team, it was recognized by the WHA board late last summer, early fall that we had to come to grips with this issue. The WHA had to get on with its planning in the Winnipeg hospital system, and the planning would be better if we knew exactly how many acute care hospitals we were dealing with and that the recommendation, the oral discussions that we had all pointed to a changing role for the Misericordia.
So we put together within the ministry, working with the WHA collaboratively, a plan for a new future for the Misericordia. That plan involved three functions: long-term care with the addition of 280 new beds, the conversion of the existing beds into the transitional unit for people panelled for personal care home beds and waiting for those beds of their choice, secondly, a 24-hour urgency primary care clinic concept to service the Wolseley and downtown area, and also add to the serviceability for the whole city, and thirdly, a role as a host for a number of essentially ambulatory programs where a downtown location would be more convenient for the users.
The Misericordia had a wonderful parkade with a great parking facility for a downtown location, and the bundle of things that would go into that would obviously have to make sense. The primary point I make is that Misericordia would no longer be an acute care hospital in the traditional sense. It would be a long-term care facility with the primary care function and as a host for a number of city and even province-wide ambulatory programs.
So those are the discussions we had with Sister Plamondon and His Grace the Archbishop as owners of the facility on the 15th of October. Both Neil Fast and I met with both of these individuals at the Catholic Centre on Pembina Highway, and they indicated a willingness to explore this. His Grace wanted us to commit into writing our concept that he could take to his board, which we did. By way of my letter of the 6th of November, his response on the 7th indicates it is going to take some time to work through it. After that particular period, between my deputy who I assigned to this project, the WHA, the concept was explored over a number of months. There was a lot of work done with their board, and it was done on a very confidential basis. The staff were not necessarily brought in by Misericordia. Their board was struggling with the principle and what this would mean. By the end of January or early February, I was able to then write to the chair of the board with really a more firm offer in terms of detail of what we were talking about. That is the letter of February 4, 1998.
There were still discussions that went on during that period and one has to come to the point of, do you fish or do you cut bait, and given the fact that in the budget, and I make no bones about that, we wanted to get on with making our capital announcements. We had to know whether the board of directors and the owners of the Misericordia hospital, who we had started talking with on the 15th of October, were prepared to accept in principle this new direction for the Misericordia Hospital which included a fair capital program. We said we had to know. This could not drag on for months, because if it was a no, too, for them, then the 280 beds--we had other sponsors ready to accept them. We wanted to get on with that, with our capital program and that is not unreasonable, nor is that rushed.
We let it be known to them that they had to come to a decision in principle, which they did. Once they did that at their board meeting, the week of the budget they indicated, which had been a planned meeting, I understand, and they had brought it to a decision at that point. They notified us the next morning, and they indicated that they would have to be advising their staff, because once they had done that we had to get into detailed planning and they wanted their staff to know. That made only good sense and hence that happened. So I wanted to make sure that history is on the record and the correspondence is here as to that history.
With respect to the specific bundle of ambulatory services, in the discussions that were made, I think we have referenced some in each letter, but in our letter or offer of the 4th of February, we indicate--I think there is a listing out of the discussions I have had--what kind of services would no longer be delivered on the site, what would be delivered on the site. Dr. Postl, who will be returning to this committee in a week, as minister, what I said to the WHA and I think Mr. Webster will confirm here today is that in that bundle of services, it had to make sense to the WHA in its planning, and the policy decision, yes, government will take responsibility for it. The policy decision that government made was to convert the Misericordia Hospital from an acute care facility, in the full sense of the word, to a long-term care facility with the primary clinic and with a certain number of ambulatory services for the city. Yes, that was a policy decision of government, and it was made with the advice of the Winnipeg Hospital Authority. I mean, we involved them in that planning. It was oral advice. We had discussion about it, and they indicated to us that made sense from the overall planning. But, yes, I will take responsibility for that.
Now the host of programs within the WHA that would be part of that, I have left to the WHA. In fact, I was lobbied by people on the Misericordia board to direct. I said, no, the WHA, who is responsible for delivering these programs, have to be comfortable with what goes into the Misericordia. If they indicated that this should happen at the Misericordia, then it should; if they indicated it should not, I was not going to overturn that. But the one thing we all agreed on right at the beginning is that the Misericordia Hospital was not to remain as an acute care hospital. That would defeat the whole purpose of the effort that was being made.
Now I have heard the same--and in fairness to the member for Crescentwood (Mr. Sale)--comments by certain members of the board, and I have spoken to Dr. Postl. I think the comments were that the WHA were saying their hands were tied to keep the breast program or something in whatever form Misericordia wanted to have it or whatever the story is, and that was different from the minister and there was some disagreement here. I heard those same comments that he has heard, so I know that they are coming from some in that community.
To ensure that there was no misunderstanding and that no one was passing the buck back and forth, Neil Fast, the chair of the WHA, and I convened a meeting with the executive committee or representatives of the board of Misericordia. Mr. Musick was there, as was the Archbishop's representative, Monseigneur Chartrand, as was Sister Plamondon, and both Dr. Postl and I--Dr. Postl was in attendance with Neil Fast--we met this Tuesday in my office, and if they had any sense of a difference of opinion, it was not there when we had that meeting. We were very clear.
Dr. Postl at that meeting explained the logic and planning around the breast program. He explained the issues around ophthalmology, that it was his belief that the ophthalmology program, despite some people who are now saying it cannot stay at Misericordia and should be moved elsewhere, from his work that was done in this planning, believes that that is a good place for the program and it can work. The detail that the member raises, I am going to ask him to defer that to when Dr. Postl is back in this committee, because I think the doctor will offer him the same explanation as he put to the board of Misericordia Hospital.
With respect to the breast program, we today I think have four sort of programs delivered in six different sites, and it is the intention of the WHA to actually make that a subprogram within their block of programming and to be able to have a team for the whole city that will give us a breast program delivered in the whole city. Obviously, there will be different sites for different things and different access points.
Now the member may laugh, but I think when he hears the explanation that Dr. Postl has given and he gave to members of the board of Misericordia, that is not to fracture the program, but I think when you get into the detail--and I will indicate to him. I am not qualified as a physician or a person who is involved in that program to describe it in the detail that I think it deserves to be described. I have to rely on the advice of Dr. Postl and his team in putting this together. But I think in fairness to this debate, they should have the opportunity to offer the same explanation to this committee that they have offered to myself and to members of the Misericordia board of directors.
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I think when the member has heard it, as I have, it is a very convincing plan and a very exciting one that will actually lead to an improvement across the city. I think he deserves that opportunity to put his case, and I would invite the member at this committee on the public record to ask his questions of Dr. Postl, because Dr. Postl should be able to defend the proposal that he and his group envision for this program. I also understand that a meeting was convened; another one will be coming up of all of the people involved in the breast program to get on with planning the detail of this program.
So, just to recap, the Misericordia had a great deal of time to consider this concept. A great deal of work was done to flesh out the details of which we were talking. The WHA planners, Dr. Postl and his group, have been intimately involved in the development of this proposal. I as a minister and we as a government, because we are funding capital, accept responsibility for this change in function and focus for the Misericordia Hospital. In fact, I would argue, and many do in the system, that it is long overdue, and I am very pleased to report to this committee that, after our meeting on Tuesday, the board of Misericordia and Monseigneur Chartrand, representing the Archdiocese of Winnipeg, made it very clear to us that they are accepting this proposal and change, and they want to get on with it.
We have a lot of planning work to do, and to be blunt, I think they are very excited overall with this new direction. Because of the planning and work that has gone on, the Misericordia Hospital will have another century of service in the city of Winnipeg. I think anyone who studied the Misericordia Hospital in great detail would recognize that its capital needs, its changing system of delivery of medicine meant that in the long run its capital needs would dictate a great amount of capital, and to expend that capital on that site to keep up the status quo I think the patients of Winnipeg overall would get much greater value to see those same dollars spent on the other six sites in expanding their services.
So, overall, I think this is going to be a very successful endeavour, one that is probably somewhat overdue. That is not to minimize some of the issues around specific programs that are there. But, if you sacrifice the overall objective for those programs--and again I want to underline that the planners who are working on this, whether it be plastics ophthalmology or the breast care program, believe, and have advised me that they believe, in the work that can be done, overall we will see improvements in those programs for the whole city. That is really what this is about.
I am going to say to the member: when Dr. Postl returns, he will be able to provide a much greater detailed discussion of how that will be done. I would invite members to put their questions to Dr. Postl who is the leading expert in this and is far more aware of the detail than I am and far more qualified than I am to discuss that detail.
Mr. Webster may wish to add something to this.
Mr. Sale: I just might observe, Mr. Chairperson, that in general, the longer the answer, the more defensive the respondent. That is an amazing defence of what in fact happened, and the minister in his defence essentially acknowledged that what in fact happened happened, and that is that the Misericordia Hospital board had not come to the conclusion that the government wished it to come to as of the week of the budget--with the item in the budget.
An Honourable Member: That is not true.
Mr. Sale: It is true; it is absolutely true. And that is why there was a meeting--[interjection] Mr. Chairperson, do I have the floor or does the minister?
Mr. Chairperson: You have been recognized.
Mr. Sale: Thank you, Mr. Chairperson. The meeting that was held is obviously one on the record. The evening, I believe it was a Wednesday during budget week, with Mr. Fast and Dr. Postl, Dr. Postl behaved in my view absolutely properly. He indicated that he was conveying a policy decision. He did not indicate agreement or disagreement with that decision. He operated as any civil servant ought to operate in that situation where he has been sent to convey a ministerial message. He conveyed the message accurately and clearly that this was not a matter for debate at this point, it was a matter of information, that the government required an answer. They required it by the next day and that the reason that it was required was that it was going to have to be announced in the budget, and that is why there was the hasty press conference in the minister's office at five o'clock on the day before the budget. This is a matter of public record. It is not a question of debate. It is not a question that can be I think countered, nor did I expect the minister to get into a long emotional defence of it, because it is simply a matter of public record. Not being critical of Dr. Postl, I am simply being critical of the process, and that is what I wanted to get into this afternoon. The minister seems to want to go back over years and years of history, some of it imaginary.
I had asked a question and that was: how is it possible to maintain the integrity of the ophthalmology program and not to be able to do general anesthesia and the immobilization of patients following surgery for some ophthalmological procedures which require immobilization, one of which is the reattaching of detached retinas? So I am just wondering how that is to be carried out in the new setting, wherever it is.
Mr. Praznik: Mr. Chair, the reason why I gave a long explanation is because the member implied in his statement earlier, at the end of this morning's session, that this was a 24-hour decision. Well, surely to goodness, any reasonable person saying when you start off with a proposal in principle and discuss it on the 15th of October, you provide it in writing in early November, you have discussions, it is formalized in a letter in February, that ultimately and all through that process Misericordia was aware through discussions with my deputy that at some point they had to make a decision. When would he have suggested they make a decision? In June, in May, October, whenever they like? At some point they had to say yes, we accept this, or no.
The process in putting that offer started with them on the 15th of October. It was not 24 hours, and that was the implication, perhaps I am wrong. Perhaps he will correct the record that that is not what he said, but that is what I believed he said this morning and I wanted to make sure it was clear, that this was not a walk-in, 24 hours to make a decision. The point of the matter was that Misericordia had a board meeting scheduled for that point in time and we needed an answer. It had gone on a long time, and if Misericordia was not going to accept this in principle, that was fine. We had other sponsors for those facilities and we wanted to get on in making the arrangements to put the personal care home beds in the ground. I could not have one organization hold up the process of building those long-term care beds. So either they had to accept it in principle and know we are marching down that path or not. It is the fish or cut bait, and it was not 24 hours in which they had to do that.
Now the reason why Dr. Postl was there the night before was because they had some questions around the programming and they requested that the WHA be present at that meeting, as I understand it, to answer those program questions, and that is what Dr. Postl did.
I also want to indicate that the decision around an acute care hospital or not was not made in isolation in my office or in the Ministry of Health. It was made in consultation with the WHA, of which Dr. Postl was a part. I will tell you, there was no happier person after our meeting on Tuesday in my office than Dr. Postl, because he has worked long and hard on this. Dr. Postl has, I think, the best interests of the patients in Manitoba and Winnipeg at heart. I use his advice regularly on planning. He is very good at what he does, and he has a lot of very good people working with him.
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Now, with respect to the specific question the member has asked, I am going to defer that question to when Dr. Postl arrives, when he is next with us because, quite frankly, he is able to offer that explanation in great detail around the programming recommendations. In fact, the ability to keep ophthalmology at that particular hospital was a recommendation of the WHA to me as minister. That is why it was in fact included in our letter of the 4th of February. The reason, as I said very clearly, that the bundle of ambulatory programs that would remain at Misericordia, and of course they wanted to have a sense of what would those programs include. I indicated that would be in the purview of the Winnipeg Hospital Authority. If they recommended something would work, then I would stand by that. If they said it would not work, I would stand by that. At one point, it was somewhat suggested that I should just overturn that, and I would not because I have asked them to plan and develop the system for the city of Winnipeg. So I think it is regrettable that we were not able to have Dr. Postl here with us this afternoon. I understand he is with patients--no, he is in other meetings and planning work that he has to do. He will be back. We are scheduling another time, and Mr. Webster will take this question back and ensure that he can answer it. I have heard the explanation to this a couple of occasions about how that program works, including last Tuesday when he explained it to the board of Misericordia--or a member of the board who had the same question. He is most able to answer it, and I look forward to having him here to answer that question.
Mr. Sale: It is interesting, Mr. Chairperson, that the minister has great difficulty just simply saying, as he alluded to but did not finally say, it was time to make the decision; we needed the decision by the next day. They had been talking about it for some time, but: we needed the decision by the next day. In fact, it was not 24 hours; it was actually 12 hours, because the meeting was in the evening and they needed the letter the next day. In fact, they got the letter the next day. So, when the government describes what has happened in other provinces, they have no difficulty saying B.C. closed Shaughnessy Hospital. They have no difficulty accusing Saskatchewan of closing hospitals which were converted, in fact, as this one is being converted, but they have no difficulty using the closure word when it is to describe other governments' actions. Somehow there is a great need to share the load here, and to say Dr. Postl is happy with this and I presume Mr. Webster is happy with us--in fact, to listen to the minister, lots of people are happy with this decision and he is just going along with the community joy of the closing of a hospital.
So I am simply asking him to do what he wants all of us to do when tough decisions are made elsewhere, to take responsibility for saying: I am closing this hospital as a government decision, with whatever advice. Governments rarely in my experience act independently of the advice they get, although sometimes they do. Of course they get advice, and of course he would ask Mr. Webster and Mr. Fast and Dr. Postl what their views on this were, but ultimately the decision was his and he has made it. He has made it with advice and probably against other advice, but he has nevertheless made the decision. All we are saying is, at the end of the day, as the minister himself described, he needed a decision and he needed it because they had put it in their budget. He did not want to have the embarrassment of a budget that had an item in it which was not in fact concluded, so he said, through his spokesperson, fish or cut bait, folks, because we have a budget coming up on Friday and we need your decision and we need it by tomorrow. That, in fact, was 12 hours after the meeting in the evening before.
Now that is what happened. It is a matter of record; it is not a matter of debate over the facts. The meeting was held. As the minister says, it was a scheduled meeting. The persons noted were in attendance. The decision that was required was made, and finally, as of Tuesday of this week, the minister was saying, with Sister Plamondon and others: the decision has now been confirmed. The problem is that Misericordia Hospital, following the mandate that it had been given by this government, not by some third party out in the woods somewhere but by this government--it was given a mandate to develop certain programs. It undertook, with knowledge of the government, to develop other programs. It has, for example, according to its own records, the most effective hip replacement program with the shortest stay and one of the highest volumes, if not the highest volume in the city of hip replacements. It has five surgeons, by far the largest breast surgery program in the city, five people assembled with great care over the past four years by Dr. Virginia Fraser to provide comprehensive one-centre care from the diagnostic, through confirmation, to surgery, to reconstruction, to physiotherapy, and if necessary, through other forms of oncology care. It boggles the mind that the government was prepared to say we are closing this hospital as an acute care hospital, but we have not the foggiest idea how we are going to maintain the integrity of programs which have developed a reputation for excellence and which are very specialized surgery and which could be maintained in fact with a very few short-term stay beds and the current surgical units that are there.
Seven of 11 plastic surgeons do most of their practice out of this hospital. Most of the routine local anaesthesia plastic surgery in the city is done out of Misericordia now, a great deal of carpal tunnel syndrome, a great deal of breast reconstruction, so this hospital--following what the government said it wanted to have happen which was the development of centres of excellence, focused programs of care, comprehensive care, high productivity I guess was one of the things Connie Curran was real keen on, very high productivity, short stays, low readmission rates--went to the trouble and in some cases to its own expense to put these programs in place. Now some of them were put in place at the government's urging, others with the government's agreement.
It seems to us that when the government makes a decision to close a hospital, it has some responsibility to be able to say at the time what is going to happen to the very good programs that are there and not to say, oh, well, there will be several sites around the city and women will once again get the privilege of going here for diagnosis, here for surgery, here for reconstruction, here for physiotherapy. The minister says it is not true. The minister does not know whether it is true or not because at the time of the meeting Dr. Postl and others have said there is no plan. We do not have a plan today to deal with the breast care question. We do not have a plan today to deal with reconstructive surgery. We do not know what we are going to do with the hip surgery program that has in fact helped to deal with one of the waiting list problems that this government had.
So you have taken something in the order of 200 acute care beds, 225 acute care beds. You are taking them out of the system. You are dispersing four programs for which the hospital had developed a national reputation of competence and excellence. You are dispersing the one cancer care program that gives people immediate access to surgery after diagnosis which is not the case in other centres, the one place where there is not a waiting list in Manitoba. You are saying, well, wait, we will come up with a plan some time before we actually move you. I do not know whether it seems as strange to the minister or does it seem just strange to us that four excellent programs are to be dispersed when in fact, if you talk to the surgeons, they could be maintained in that hospital with a very small number of short-stay beds with the surgery that is there without any additional significant amounts of capital expenditure, with the teams, with the support of the community that has developed that comprehensive breast care program.
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Has anybody asked whether it is possible or desirable to maintain this program, these programs in conjunction perhaps with the panelled beds that you are talking about? What canvassing of alternatives has actually been done involving the staff that are there now doing the surgeries now? Has anybody ever sat down with them and explored the feasibility of maintaining the integrity of those programs, or did you just say we will close the hospital, we will turn it into a long-term stay program, and when we get around to it, we will tell you what will happen to those four very good programs that were developed largely following the model that the minister's predecessor and pre-predecessor said. Let us develop integrated focus centres of excellence, let us mandate those and let us have them work for the benefit of all Manitobans.
This hospital did that, and now it is convenient because the minister screwed up in the 1995 election, the minister's predecessor, and announced a program that they had no intention of following through on, got themselves in the hole on personal care homes and desperately needed out. So they got out by closing a hospital and forcing an announcement without the foggiest idea of what they were going to do with what is in that hospital now. There was no plan. Those are the words of your staff, the words of your senior people. The only plan is convert. There is no plan to deal with what is in there now, and there is not today. There was not at the time, and the minister must be horribly embarrassed by that.
Mr. Praznik: Mr. Chair, the only interesting or I guess pleasurable part of the member's diatribe on this particular matter is that if we had done all the planning and all the detail today and then made the announcement, he would have probably accused us of not consulting with all of the people in the programs. So whatever we would have done would not have been acceptable to the member.
Now let us just look realistically at how these decisions happen. The Misericordia owners and their board of directors had to make a decision as to what they wanted their future to be. We gave them an option for their future. Now they could have gone and talked to all their staff. They chose not to, because once you do that then everything is out there and discussed in a public way without all the information detail. That was a choice they made, because we made them the offer and they asked us to keep it confidential while they considered it in principle. That is a choice the board made. Now that makes eminently good sense, because before you involve everybody in detailed planning about how things can happen and work and move, you ultimately want to know is that where I want to go. So their board of directors wanted to make a decision on the principle before they told their staff, before they told the doctors who worked in that facility, before they got into the detailed planning. So that is what happened.
Is that a good process? You bet it is, because now in all of the planning that can go on for the transition they will be involved. That is part of the work that Dr. Postl has undertaken. I think one of the first meetings was held with respect to the breast program for the city. There is another one coming up. So that planning work will go on, and it will involve people in there. In fact, if anything I would rather have it done by the people who are involved in those programs than planners in the Ministry of Health where we announce something a fait accompli with every question answered, as the member proposes.
The member talks about could we have saved the Misericordia. Here we come again, 20 years. Could we save the Misericordia as an acute care hospital? You know--
Mr. Chairperson: The honourable member for Crescentwood, on a point of order.
Mr. Sale: Mr. Chairperson, nowhere in the record will the minister find the words "save the Misericordia Hospital," nor will he find in any of my remarks that as the goal. Comments have been on the issue of what he is planning to do with the acute care elements of that program and with the process of making a decision to close the hospital. He will not find those words, and I would appreciate it if he would not put incorrect information on the record.
Mr. Chairperson: The honourable member for Crescentwood does not have a point of order. It is a dispute over the facts.
Mr. Praznik: Mr. Chair, then what the member is saying, I gather, is save those four programs at the Misericordia but not the Misericordia as an acute care hospital. So if that is what he is saying, that is fine. I will recognize that point that he is not arguing to save the Misericordia as an acute care hospital, that he recognizes the need for that conversion to take place. I will accept that.
Now with respect to those programs, here is the great dilemma in health care reform, and I know the New Democratic Party is struggling with it. I see it in their questions every day in the House from different members and from different statements. Fundamentally, are we going to continue the delivery of health care in the city of Winnipeg on the basis of individual programs operating out of their own facilities with independent facilities and boards making decisions and the Ministry of Health or its agent basically funding here or there or each other and doing it on the basis of contract, or are we going to have a centralized system of delivering programing for the 650,000 people in the city of Winnipeg and for the hundreds of thousands who use this facility in the rest of our province for many of their more critical care? That is a very fundamental issue. Once you accept the principle that you are going to operate on the basis of a system, that you are going to have that central planning direction control administration budgeting for programing across your system, then every program has to be looked at in the context of the whole.
I have listened to the member talk a great deal about the beauty of those programs at Misericordia. The bricks and mortar and where they operate is not what makes those programs what they are; it is the people who are part of them. It is the support that they get in the community. It is all of those things. The bricks and mortar is not what makes a plastics program; it is the plastic surgeon. It is the nurses who work with them. It is the support around that program that makes the program what it is. The Winnipeg Hospital Authority, that is not lost on the Winnipeg Hospital Authority. They are not there to destroy programs that work well. It is a matter of moving those programs into the larger system, in fact, taking the good things about those programs that you learn from how those programs are operating and making that the dominant theme of the whole program across the city. So it is not the bricks and mortar; it is the people.
What is absolutely critical, and I will accept this from the member--I mean the concern over those programs--what is absolutely critical to those programs is how we transition them into the larger area to make sure we preserve the good things about those programs and extend them across the city. That is what makes sense. That is what this is about.
When we talked about the planning for these things, Dr. Postl, the people he is working with--and the member criticizes we do not have a plan. Of course, we do not have a detailed plan today of how everything will work, nor could we because you want to involve the people who are in those programs. I know in the case of the plastic surgeons and the discussions that they have had with the WHA that have been reported to me, there is a group now saying, okay, which site do we want to go to. They are debating that amongst themselves, and they want input into that.
If you are going to get into decision making in a public forum, I think you have to sort of set out the parameters of what you are looking for and then you have to involve people in that. If you do the planning involving everyone at the beginning, you get such a public debate raging and interests and everyone getting into it you will never plan or be able to do anything, so you have to make some fundamental decisions about where you are going, what is it you are trying to achieve. In the case of Winnipeg, we made a fundamental decision that we want to operate on a regional basis. We want our programs to be centrally managed, determined, operated, planned for. Once you make that decision, you put the people in place to then go and do the detailed planning about how you make that work and that, of course, once you have made the decision it is public. People know what the parameters are, what direction you have given, and then you can get into the detailed planning, I think, in an open and public way.
My experience in public life has been such that if you are going to have debate around every issue--and we did have, by the way, a great deal of debate publicly about the concept of centralization some time ago. We made that decision and part of that is a rationalization of services. The board at the Misericordia Hospital, when we met with it, I remember the Archbishop was very clear to me. He wanted to keep this as a confidential matter until the board can make a decision on the principle and as owners we respected that. So if the member is going to be critical of me about the debate around the Misericordia as a whole should have been public, then appreciate that that criticism should also be with the Archbishop and their board who made that choice.
Now if we are talking about the programs, I am going to ask Mr. Webster to respond about the thinking of the WHA in those programs. I am going to indicate to the member, when Dr. Postl next joins us, and it is regrettable that we were not able to sit a few minutes longer for Dr. Postl to make some comment on this area, but I would invite the member to be here next when Dr. Postl is back at this committee to put these same detailed questions to him, because he is highly qualified to answer them and I think will allay many of the fears that the member has. I would ask Mr. Webster to address the WHA perspective of how they see these programs working and being managed within the overall system and the benefits that were attained by staff and teams at the Misericordia kept within the overall Winnipeg hospital system.
Mr. Gordon Webster(Chief Executive Officer, Winnipeg Hospital Authority): Mr. Chairman, I obviously am not qualified and will not try and touch on some of the clinical issues, but as far as the process that we have put in place to plan the transition--and I guess our time frame for a transition is not going to impact patient care, is likely somewhere in the range of a year and a half. Shortly after the announcement was made for the change in role of Misericordia, I along with Ted Bartman, who is the CEO of the hospital, sat down and put together a transition plan that could be released to the staff as soon as the board had authorized that. The transition team will be led by a steering committee which will be chaired by Ted Bartman as the CEO of Misericordia. It will involve myself, Marion Suski, the CEO of the Winnipeg Community and Long Term Care Authority, and also Frank DeCock as the representative for Manitoba Health.
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The six teams that we have assembled under that--the first team will have responsibility for dealing with human resource issues and to ensure that, as programs move, the very qualified staff within the facility can move with those programs. The second team has a responsibility for all the financial aspects of the transition. All of these teams have a representative from the WHA, Manitoba Health and the hospital on them. The third team will be responsible for looking at the programs that are there now and how they can transition out of that facility into other locations over, as I indicated, probably a year-and-a-half to two-year period. The fourth team will have representatives again from the hospital and the Winnipeg Community and Long Term Care Authority in developing the programs that will be moving in there. The fifth team will have responsibility for both internal and external communications, and the final team will have responsibility for the capital aspects of the transition, namely the redevelopment of the site.
As soon as the Misericordia board has authorized Ted Bartman to proceed with those transition plans, we are all ready to go.
Mr. Sale: Mr. Chairperson, I wonder if the minister and Mr. Webster are in possession of a letter dated March 20 from Dr. Kenneth Murray. I do not see cc's to anyone outside the hospital. Dr. Murray copied Dr. Lipson and Dr. Fraser, Dr. Waters, Dr. Crowson and sent the original to Mr. Musick. It is a detailed letter asking, I think, very important questions, many of which I am not competent to have any input on, but they are very critical questions about the proposal to try and maintain elements of the breast care program, the issue of the walk-in clinic, et cetera.
I am wondering whether the minister is aware of this letter or not.
Mr. Praznik: Mr. Chair, I am not aware that we have a copy of that particular letter.
Mr. Sale: Mr. Chairperson, I do not have another copy, but I will ask the clerk if they could provide copies. The letter, to summarize, sets out what I think might be talked about as the dilemma of partial pregnancy, that it is extremely difficult to be partially pregnant or for a light bulb to work a little bit. It either works or it does not work. The issues raised by Dr. Murray are that, in short, you cannot maintain any significant volume of day surgery without anesthesia. People who are anesthetists, anesthesiologists, are reluctant to stay in a facility where they are not challenged by anything other than the most routine performance of their duties, particularly when they are mostly local anesthetics and very rarely a general. You cannot do any general procedures if you do not have some acute care backup, because while surgery is a relatively low-risk event, it is not a no-risk event, and there needs to be the kind of ability to resuscitate and to deal with adverse reactions which cannot be predicted.
He makes the point, as Dr. Fraser has made to me, that it is highly unlikely that cancer care specialists would want to have their offices in a facility in which they cannot do surgery. So the notion of maintaining a breast program for which there is no surgical treatment and no oncological treatment, other than out-patient kinds of treatment, in the view of Dr. Fraser, Dr. Murray, Dr. Lipson and others is simply not feasible. It may be in the short run possible to do it, but it will not be feasible to maintain it because, in particular, anesthetists will not choose to be there, and they are a fairly scarce commodity as it is. We do not generally have an excess of competent anesthesiologists.
So what I am suggesting to the minister, I am not suggesting he should be able to read this letter and respond to it now, but I am suggesting that if this letter is not already in Dr. Postl's possession, he should examine carefully the arguments made by I presume a competent clinician and four other very competent clinicians with qualifications not unlike Dr. Postl's who are questioning seriously the possibility of maintaining what is being promised at that centre. They are by implication saying to the minister that you really should "fish or cut bait," in his own words, and tell the people at Misericordia and the women of Manitoba that this is going to be a personal care home with some transition beds, and whether or not there is a walk-in clinic Dr. Murray also questions, because he points out that there are no family practitioners currently at that hospital. So is somebody going to form a clinic and hire some new physicians?
The minister talks about duplication. Klinic with a K is two short blocks away--well, two long blocks away from Misericordia Hospital and has been short staffed, understaffed, asking for more resources for years. So would we set up a free-standing walk-in clinic at a hospital which is not going to have the diagnostic resources that it has now? It is going to have walk-in clinic level resources when the government has argued, this minister and others, against walk-in clinics for years on the basis that they are inefficient.
So Dr. Murray's letter, I think, is a very cogent, thoughtful, carefully argued letter, but it raises fundamentally the feasibility of doing what the government is doing or is planning to do just to maintain some services which the surgeons and doctors involved in are saying we do not think you can do this because we are not going to have our offices in one place, do our surgery in another and our reconstructive work in a third. It simply does not make sense from the point of view of how we use our time. So why not admit the obvious, or at least agree today that you will meet with Dr. Murray and his colleagues and have the serious discussion which his letter implies, and that is, this is a personal care home? That is what it is. Why do you not just say so and acknowledge that what you are proposing is probably, at least in the view of the physicians currently involved, not feasible?
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Mr. Praznik: Mr. Chair, before Mr. Webster responds, I just want to say to the member I have not had a chance to digest the letter, but in the bundle of services for Misericordia Hospital we indicated that the WHA would have to make sense with an overall planning. There are a lot of issues at play here with services from programs around the whole system, not just Misericordia, and the physicians would be involved in meetings with the WHA planning teams. Mr. Webster, I would like him to address that as well, so there is lots of opportunity to discuss these issues. I know some of the questions the member has raised were put in our meeting last Tuesday with Dr. Postl, and I think he was very articulate in expressing disagreement with some of these claims that were made and that is why I look forward to him coming here to put his case to the member, because ultimately these have to work within the WHA.
The other surprising comment with respect to the primary health centre is that I know Associate Deputy Ms. Hicks said we have had discussions with Klinic, and one thinks that they will complement each other, but in the meeting that I had with Misericordia, Mr. Bartman, their CEO, and their board seemed very excited about the primary clinic, urgency clinic. They thought it would serve a need and they saw great potential to develop that particular resource and argued in fact very strongly for it, so perhaps there is a disagreement going on within the Misericordia. But the sense I have from their board of directors and from their administration is that this is one of the things they feel very strongly about and believe services their community and believe will be highly successful.
So I am hearing today the New Democrats saying we should not have a primary care clinic in Wolseley in the Misericordia. I do not know. I do not know what they are saying. I know one doctor has raised some issues around it but I think the Misericordia people feel very strongly about that being a needed service in the area, and we believe that they have made some very strong argument about how they will make it work. That is why it became part of the role in the offer to the Misericordia about their new function. So perhaps the member might have to have a debate with Mr. Bartman about it, but Mr. Bartman believes very strongly in that particular clinic and has never expressed anything but great, I will not say support, he has been a great promoter of it, so I am a little perplexed. Mr. Webster, I would like him to respond on some more of the detail around these issues, because it is certainly within his bailiwick.
Mr. Webster: Mr Chairperson, I obviously cannot comment on some of the clinical issues in here, but I would like to pass this letter on to Dr. Postl, if I may. Following this letter though, and I have heard discussion around a lot of these issues, because on the evening of April 7, Neil Fast, our board chair, myself and Dr. Postl did meet with the surgeons at Misericordia Hospital and a number of these issues were raised. They got into areas that, I must admit, I had difficulty understanding, but they have agreed that as surgical components they are going to meet with Dr. Postl and his clinical services team to review them in detail. The first meeting was held last evening of physicians within the city involved in cancer care to look at how we should be going from having four breast programs in the city with surgery carried out at seven sites to probably one program with surgery performed at no more than three sites.
I know that Dr. Postl has also arranged to meet with the plastic surgeons early next week to talk about the consolidation of plastics around the city following a letter that we received last fall from the plastic surgeons indicating that they would like to operate out of no more than one community site. This is not just the surgeons, plastic surgeons operating at Misericordia. This is all of them have indicated they would like to operate out of one community site. As I recall, some of these issues here were discussed but I must admit I would not try and comment on the clinical issues of them.
Mr. Sale: Mr. Chairperson, I appreciate Mr. Webster's answer on this. I am glad that they are into those kinds of discussions. I just want to say in response to the minister, we obviously are in a political dialogue here to some extent, but it is not correct to say that I am suggesting that there should not be a critical care centre there or that there should be. I am questioning the feasibility and raising questions which I think need to be raised and obviously Mr. Webster agrees they need to be raised and I am glad they are being raised. The hospital would prefer, of course, to have an emergency care centre, as would the community, because there are so many people in that community that do not have cars, that do walk in at all hours of the day and night with varying levels of need and, in particular, as the minister well knows, mental health needs in that community are very acute, so the notion of having 24-hour availability of services is obviously attractive. The question that was being raised was the question being raised by Dr. Murray, and I am raising it on his behalf because I think it betrays the fact that there are many discussions that need to happen, and I am very pleased to hear that some of those discussions have started. I am also aware from Klinic that resources there need to be expanded, and if we are talking about 24-hour walk-in services within reasonable walking distance of the bulk of the people who use Misericordia Hospital, it is not immediately obvious that two sites are the best solution, although that may be the case. I am not in a position to judge that, but 24 hours certainly is appropriate.
The questions being raised, though, are can you have a truly comprehensive community walk-in clinic without having on site many of the kinds of facilities and services which approximate a kind of hospital that is not an acute care hospital in the old-fashioned sense of the word, but which provides specialty care of a variety of kinds with a small capacity to hold people for a short stay. That is the model that is being put forward as an alternative here, and I am not in a position to answer the question and would not put myself in that position. But I think it is a valid question to ask, because the minister wants to kind of have a black-and-white position about acute care hospitals.
I think he knows and we all know that an acute care hospital today takes many, many different forms in different communities, and so it is not a matter of, you know, this is an acute care hospital and this is not. There are many shades and many variations on that theme. Our concern is that the services this community needs and that have been developed by the hospital not be lost in the process. I hear the assurances around that. The difficulty is, and I am very frank about this, some of the things that Misericordia has developed have languished in the system in the past, so it is cold comfort to hear that they are being taken into account we hope for the future.
I guess the assurance I would want to have from the minister--and I do not think it is appropriate to ask for it from Mr. Webster; I think it is a policy issue, not an operational issue--is will the minister assure all of Manitobans and this committee that none of these programs will be moved and taken apart in the process, but the integrity of the programs will either be maintained or enhanced in the new settings, that is, not fractured, not fragmented, but we will get at least as good as we have now at Misericordia in whatever moves are made in the future.
Mr. Praznik: Mr. Chair, it is certainly our intention and the intention of the Winnipeg Hospital Authority--the reason why we do all these things is to improve service through our overall system, and I would hope and expect that the same will be the case in the programs that are delivered currently out of the Misericordia Hospital.
The member flagged the emergency urgency centre, and one of the issues my associate deputy just raised with me was that a good deal of the types of cases that come in in that particular city into that emergency room--and even the discussions we had with Misericordia Hospital and comments made to me by their administrator--are in the true sense of the word urgency matters, as opposed to emergency life-threatening trauma accident. Those happen, but they are urgency matters. Mental health issues is a big one that they flagged for us, and so part of the planning around this urgency centre, obviously, has to involve a mental health unit there on a 24-hour basis and many of those kinds of services that that community needs, and the member knows that community fairly well, being a neighbouring constituency.
So that is the intention of this plan. There is a lot of work that has to go into it in the next while, and I think that is why the Misericordia administration is very excited about it in terms of meeting need.
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Many an evening when I am in the city I like to go for a walk, and I have passed the Misericordia on many occasions. You know, it illustrates the point, when you are standing next to the Misericordia and you look down Sherbrook, you can see the lights of the Health Sciences Centre at the other end. If you go on the roof of the hospital you can see St. Boniface. So, in terms of location of hospitals, that facility--I will just share with him this story. When I was at a ministers of Health meeting in Toronto on blood issues, during one of our breaks we were standing looking out the window. We were on a high floor of a hotel where we were holding the meeting. The minister in Ontario pointed out I think 8 or 9 or 10 hospitals from that one window and sort of made the comment they were all built at a time when the population in Toronto was concentrated around that area. I believe the member for Crescentwood (Mr. Sale) was born in Ontario, grew up there?
Mr. Sale: No, I went to the University of Toronto.
Mr. Praznik: Went to the University of Toronto. So he knows, has a little familiarity with that city. In downtown Toronto they have more small hospitals than they need for what they are doing, and that is part of their dilemma. Winnipeg, you know, had that same problem. If the Victoria had not moved from its downtown location--I guess it was in the Osborne area at one time. When it was rebuilt, it moved to the suburbs. The old Concordia was closer to downtown. The old Grace was closer to downtown. I think there was a St. Joseph's Hospital at one time in the Burrows area.
In Manitoba, during the building boom, we in essence moved many of our downtown hospitals out to the suburbs. So there was a lot of forethought in that. We do not have five or six hospitals in the downtown area. We only have three in essence, Misericordia being the last one. The Misericordia has gone through a huge change in that community over a number of years and there are a lot of issues. So, compared to what has happened in other provinces where they have had to make decisions and choices like this, because of the foresight in planning with moving those other hospitals out years ago, we really only end up with sort of one situation to deal with.
The Sisters of Misericordia made the point about carrying on providing care to people in the Wolseley area, recognize the ambulatory, the walk-in part that had to be met, and that is where that planning is around. The Misericordia board, as I said, is very excited about the clinic; they think it can provide a great deal of service. We are, too. Some of those issues about how it interacts with other areas have to be worked out in the planning.
I can tell the member there are many other places that have very intensive health clinics and do not have acute care hospitals. In my constituency, Lac Du Bonnet, for example, has a health centre. It is not even open 24 hours a day. The nearest hospital, which they were part of the same regional system before regionalization, is Pinawa, which is still a 20-minute, 30-minute car ride, depending on where you are in the area. That particular facility has met, by and large, the health needs of that area. In fact, the community health assessment indicated that. The municipality was looking for hospital beds, but it was not supported by the health assessment for the area and the needs process. So there are many places where this has happened and can work.
I will agree with him, our definition of what is a hospital, an acute care hospital, is changing somewhat. There are issues of change around that that should not necessarily restrict one, but the planners, as we work through this, I think even in the last few weeks in terms of the calls to my office and the comments being made about some of these programs, as the people involved at the Misericordia are sitting down with the WHA and as more information gets shared about other options, I think a lot of these issues will start to go away. In fairness to this doctor and to the questions that the member raises, whenever you are going to make big change there are a hundred questions. A lot of people see all of the problems with it, but as you work it through those tend to dissipate as solutions come forward and other options that were not even thought of by people in that facility become available.
Mr. Webster, I think, may want to add something to my answer. Any detail?
Mr. Daryl Reid (Transcona): I wanted to pick up where I had left off this morning talking about people suffering with epilepsy and the services which would be leaving the province of Manitoba.
After listening to the comments by Dr. Postl and the minister this morning, I am in some consideration over the lunch period into the early afternoon, I am not sure that we have a plan--the province has a plan in place to deal with people suffering from epilepsy and ongoing research and treatments for those 5,000 patients or so that are intractable cases. I want to ask the minister: can he provide me--because I have a number of questions I would like to ask in this regard--a list of the practicing neurologists in the province of Manitoba, and do you have that here today?
Mr. Praznik: Mr. Chair, that information is available to the member from the College of Physicians and Surgeons. We can endeavour to get him that list, but it is a matter on the public record that they do make available.
Mr. Reid: I am not sure if the minister is aware or not, but that list that they have is dated by many months, and that there have been some significant changes with respect to that list. I was hoping that the minister's department would have some updated version, considering that some of the doctors that are on that current list have now left the province and that is still the list that the college is issuing.
Mr. Praznik: Mr. Chair, the registry of physicians in the province is kept by the college, so we do not keep a registry within the Ministry of Health of physicians. We use their list. He is asking for the list of that particular specialist in the province. The only repository of that list is the college. They update it from time to time, and I guess one could always phone every hospital--check admitting privileges or update that list, but it is the college who is the repository of that information, not the ministry.
Mr. Reid: I am somewhat confused here then. I hope that the department is developing some kind of a plan to deal with the exodus of doctors that provided treatment for people suffering with epilepsy. The minister says that the College of Physicians and Surgeons is the place to get that information, but the list that I have is not a current list. I am wondering here: how can the department develop a plan that is required to treat people suffering with epilepsy if you do not even know how many neurologists you have in the province of Manitoba? How can you develop a plan if you do not know what resources you have or have not available? Can you answer that for me?
Mr. Praznik: Mr. Chair, we have sat through hours in this committee discussing the process for the delivery of programs and care and within the Winnipeg Hospital Authority, the planning around providing service to people with epilepsy, whichever clinical program that falls into, rests with that program. Traditionally, that has rested with the hospitals and the ministry is involved from time to time, but the ministry is not specifically developing a care plan for any particular or most illness. I guess we do have some involvement in terms of cancer, the cancer treatment foundation, but the delivery of that specialized program rests with each regional health authority in terms of the array of services that they offer. The bulk of the care and treatment in this particular area, I suspect, comes from the Winnipeg Hospital Authority who have just taken over much of that program, from listening to the discussion with the member today, rests at the Health Sciences Centre. That particular department, the university is a partner in there, so there is a shared responsibility. Mr. Webster, I would invite him to comment on the WHA's intention in this particular area, but it is not within the ministry that that planning would be housed.
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Mr. Webster: Mr. Chairperson, the issue around recruitment of physicians up until, well, I guess, and still, until we have our final arrangements in place with individual hospitals, will still be the responsibility of the hospitals. But I can certainly get a question of how internal medicine intends to deal with that; I can get an answer to that question.
Mr. Reid: Can the minister tell me: is the Department of Health or the Winnipeg Hospital Authority providing any direction to the pediatric community, and I am talking doctors here, on what advice they should be giving to individuals or family members that may come to them for neurological services with respect to epilepsy? Are you providing any direction, because now that Dr. Pillay is leaving at the end of May, what direction--are you providing any direction since the Health Sciences Centre obviously may not be in a position to provide that type of service? Where are these patients now going to receive that service from?
Ms. Sue Hicks (Associate Deputy, External Programs and Operations Division): Mr. Chairperson, my understanding is from Dr. Postl this morning that the discussions are with the neurologists and that they are actually looking at planning and covering the existing cases while they are also endeavouring to look at a strategy to employ additional neurologists into the province.
Mr. Reid: Does the department know what the caseload is of the existing neurologists?
Ms. Hicks: At this time I do not know the exact caseload, no.
Mr. Reid: When Dr. Pillay leaves the province at the end of May, because I do not have a comfort level from the information I received this morning with respect to any attempt to try and retain him because he has already indicated I believe in writing that he is going to be terminating his services at the Health Sciences Centre at the end of May and moving to Calgary, and I believe Dr. Booth who--we will not refer to other matters dealing with the individual--is the only person going to be left in that particular facility. When Dr. Booth goes on vacation or Dr. Booth is sick or unable to attend to her duties, who is going to be on call, since Dr. Pillay was the one to fill in after that?
Mr. Praznik: Mr. Chair, these are administrative details that the individual program managers, whether they be at the Health Sciences Centre or as the WHA takes over, will have to ensure are looked after. We have never made it a habit as a ministry to interfere at that level of decision making, and I can tell you that those who are responsible for programs usually are always able to make those kinds of arrangements where necessary--I imagine there are probably a few exceptions--but generally speaking, have been able to arrange to alternate care providers. I know in the case of Brandon, with the pediatricians, that the Brandon Regional Health Authority made alternate arrangements while they are recruiting additional pediatricians. So it does happen from time to time. This is not the first time it has happened.
Mr. Chair, may I propose--Mr. Webster would like to respond--and then I would like to propose that we take a break for 10 minutes or so and come back to us. There is some information I would like to share privately with my colleagues the member for Transcona (Mr. Reid) and the member for Kildonan (Mr. Chomiak).
Mr. Webster: Mr. Chairperson, as you know, we are still in the process of transitioning our responsibilities from hospitals to clinical teams. Although our internal medicine team has not yet taken responsibility across the system, I will ask Dr. Postl to talk to them before he comes to the committee again so that he can respond to questions in this particular area.
Mr. Chairperson: Is it the will of the committee to take a 10-minute break? [agreed].
The committee recessed at 3:52 p.m.
The committee resumed at 4:05 p.m.
Mr. Chairperson: Order, please. We will resume consideration of the Estimates of the Department of Health.
Mr. Reid: Mr. Chairperson, my comments about the service of epileptologists in the province, I have pretty well all of my comments on the record to this point. My concern here is for the patients and their families, those who do not have a clear understanding of, first off, getting diagnosis of their particular illness and then being directed to the appropriate treatment areas, and of course, dealing with the long-term care for those intractable cases, 40 percent of the overall number I believe are intractable and require some further new initiatives that are being pioneered here by Dr. Pillay, but there may be other matters that are affecting Dr. Pillay's decision and the government's decision with respect to replacements or alternative types of treatment areas.
But I will leave that with the minister, and I hope that the department can come back with some information with respect to the questions that I have left with the department seeking some further clarification or some information with respect to numbers, in particular, so that I might have a clearer understanding on how I can provide some direction and some advice to my constituents who call me or the families who call me with these cases, as I have had over the last several months.
I want to move on to a letter that I just received in the mail yesterday from a constituent. When I read this letter from this constituent, who is a woman living in my community, I am quite distressed by what I read and it occurred with respect to services at the Concordia Hospital between the days of April 6 to 10 of this year, 1998. The individual was taken to hospital and spent all of those days in the hospital on a stretcher. Perhaps I can read this and explain to you the distress that the individual suffered as a result of her stay in Concordia Hospital.
The following, for Hansard's information, is a direct quote from the letter. I spent April 6 to 10, 1998, in Concordia Hospital. I went to the hospital with severe abdominal pain. The first night I spent in a treatment room that is meant to have four patients in it. There were seven of us on stretcher beds. The following morning I was to have some tests done. First I had to have an enema. Well, there are no bathroom facilities in the treatment room, so they brought me a commode chair, and there I was sitting on it with a curtain drawn around me while the others in the room ate their breakfast. Most humiliating for me, and I am sure very unpleasant for the others.
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They moved me from there to the hallway where I spent the next three nights. After some more tests, they found out I had acute pancreatitis brought on by gallstones. My pain eased some when they started treatment, but my back felt like it was breaking after that many days on a stretcher. I also developed diarrhea which meant I had to get off my stretcher, pull my I.V. and trot down to the washroom at the end of the hall. When you are not well, the sights and sounds in the emergency department are not welcome. I realize these are the people who should be treated and I had no business being there. I asked several times if there were no beds even in the observation ward. The answer was always no. This was an experience I hope never to have to go through again.
I can provide a copy for the minister if he wishes to have a copy of that.
This, I do not think any individual, anybody in this room would expect to go to a hospital and have this type of service. This is a question of dignity and respect for patients, in addition to the treatments, and from my understanding, this is not a period of time when flu was causing the problems within the hospital system, as the minister has said in Question Period, and I have listened to his responses to questions. This was an individual who had some difficulties in respect to privacy matters, and I personally would not want to be put into a situation like that and I would not expect to have anybody close to me or any other members of the public in situations like this.
How does the minister respond, how does the department, what do you say to patients, people from your community when we know that our health care system should not be that type of a system? What do we say to our patients, to the people of our communities when they have to be put into positions like this, where there is no dignity and no respect shown to them, that treats them in a manner such as this when we know that an individual if they are going to be in there for a period of time and we cannot diagnose their particular ailment or their illness, that we need to have the spaces available? I am not sure whether or not there was a responsibility on the part of the hospital to refer this individual to another facility that may have had room spaces or beds available. I do not know that and perhaps I should ask that as a question. I do not want to have this letter entered into the record in the sense of the name of the individual used, and I chose very carefully not to use the name, not to table this letter, but to provide that for the minister's information. Perhaps you can tell me, how do I respond to my constituent, and this is not the first case like this that I have been made aware of. How do I respond to individuals when they bring these matters to me and they tell me first-hand their real life's experiences of how the health care system has responded to them when they are in their most vulnerable moments?
Mr. Webster: Mr. Chairperson, I cannot disagree with anything that the member has said. Hopefully, as we start looking at our hospital system as one system as opposed to nine separate stand-alone organizations, we can start to implement some of the items he suggested, and particularly if we can get a Central Bed Registry, hospitals should be sharing with each other the information of whether or not there are beds available because we do know that at a time right now, particularly now that the flu season is behind us, that there are beds available within various facilities in the city and yet other hospitals have still got patients waiting admittance within the individual hospitals and those patients are not being transferred the way they should be.
Mr. Reid: Well, having been a member of this Legislature for a number of years now, you build up a recollection of events that have occurred, and there is a history that goes with that in the sense of you remember these issues being talked about in past, and if recollection serves me right, I remember the Central Bed Registry being talked about for a significant period of time now and I do not know if this is something that is going to occur because it has been talked about for some time. Would this have helped in this situation? Perhaps it would have. I do not know that for certain, but it did not occur and my constituent did not receive the care with the dignity and respect that she was entitled to. Obviously the individual, after the diagnosis was made with respect to the medical condition and treatment was started, started down the road to recovery. Having spoken with the individual on the weekend, I sensed that things are going along well now.
But with respect to the dignity and respect for the individual, that is the part that irritates me the most about the way this woman was treated in the hospital. There has to be a better way of doing things. If you do not have a diagnosis done and you know you have to keep the patient in for a period of time, and I am talking days here and perhaps weeks because this nearly extended to a week, that there is some way you have to find space somewhere so that the person can have some privacy for the medical procedures that are required by the hospital in the performance of the diagnosis of the condition. So by saying that you are going to have a Central Bed Registry, I am sorry if I say I have heard this before. Been there, done that. I have not seen any progress in that regard.
Mr. Webster: Well, Mr. Chairperson, if I can, I think that there is a quasi Central Bed Registry in place now, although it is on a phone-in basis as opposed to any organized one across the system. But once you have a Central Bed Registry in place, you also have to use it properly, which means you have to have an ability to move patients between hospitals into available beds without the receiving hospitals saying they are not prepared to take the patients. That is one of the difficulties we have had in the past. We do know that there are hospitals that have got beds that refuse to accept patients from other hospitals where they are waiting in the emergency departments.
Mr. Reid: So if I understand Mr. Webster correctly, what he is saying here is that my constituent or any other person living in the province of Manitoba goes to work, pays their taxes which support the health care system, and somebody in an administration somewhere is saying that you cannot come and use the hospital facilities because you did not get admitted to this particular facility. Am I understanding correctly what you are saying here?
Mr. Webster: Mr. Chairperson, that is basically what I am saying, yes.
Mr. Reid: The patient in question here is left in the position, then, or any other patient for that matter, of having to make an instant decision when they are stricken about which hospital they go to. How would a person like that know whether or not they should be going to St. Boniface Hospital versus Concordia or going to Health Sciences Centre or some other facility?
Mr. Webster: Mr. Chairperson, they should not have to make that decision. They should be able to go to the closest hospital and have the system such that they get admitted to the most available bed closest to the particular hospital that they go to, if that hospital cannot accommodate them.
Mr. Reid: Can you tell me, because there are dates on this letter, were there spaces available in the other city hospitals?
Mr. Webster: Mr. Chairperson, I do not know it right now, but we can certainly find out.
Mr. Praznik: Mr. Chair, you know, the member has hit upon an excellent case. It illustrates a problem and it certainly should be of concern to all of us, but one of the experiences I had as we were going through this system is I remember with the cancellation of elected surgery at HSC it freed up beds that would have been used for surgical purposes to be used for medical purposes.
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I think on one particular day, and I look to Ms. Hicks, but I remember on one particular day we had 20 or 25 beds available at Health Sciences Centre, something like that, and we had patients in the hallway at Grace. I could not believe this, and I said: have those patients been offered the beds at Health Sciences Centre? Now the result that I got back--I wanted the member to hear this, I know he is--with some notes. I wanted the member for Transcona (Mr. Reid) to hear this. I asked: had those people been offered the beds? The response we got back from Grace was: oh, yes, they have been offered the beds, but they wanted to stay at Grace even if it meant they were in the hallway. Now, true or not, that is what came back.
I think Mr. Webster's comment really illustrates the point. There are going to be times, and I do not want to make this sound like the panacea, when the whole system gets plugged. There have been those times. But also once the stress starts to come off and as we put more resources in, you are still going to have from time to time some facilities that have much greater stress and are plugged up while there is room in the overall system.
I am not raising this old article to get into a political debate with members opposite, but I wanted the member for Transcona just to have a look at this. I know he is making a few notes. It is from 1984 and it is: Health care crisis denied by Desjardins, hospitals forced to limit admissions.
I share it with the member because you can almost change the names today and it would be the same kind of stories, and the Free Press was running the hospitals in crisis at the particular time.
One of the things that amazed me in my experience has been if we have any pressure on the system, the first hospital we want to shut down is the Grace. I am reading this: Hospital forced to limit admissions, and I quote: faced with a capacity patient load, administrators at Grace General Hospital began limiting admissions yesterday for a 24-hour period.
Back in 1984, it was the first hospital to shut down. You ask yourself, well, what is going on here. Well, when you go out and you drive by the Grace, you realize that it is right next to the Courts of St. James. It becomes an easy access point to health care for literally thousands of people who go into those blocks, so if you are sick or not feeling well it is often more convenient to go to the Grace than it is to go to your own doctor in many circumstances. So the Grace has a pressure on it that maybe other hospitals do not have.
The point I get at, you cannot be putting more capacity necessarily in the Grace if you have underutilized capacity somewhere else. So the beauty of regionalization and building a single system--and it has taken a long time to get here; just to even get the consensus we should do it has taken some time--is that you can now operate on a systems-wide basis.
One difference between where we are today and where we were with the urban planning project--and I know when Minister Orchard was there and when Minister Desjardins was there, there were efforts made to get people working together co-operatively--is when you do not control the turf and you are expecting nine independent institutions to do what makes common sense, the turf walls get in the way and it does not get done.
What we have now with the Regional Health Authorities Act is the programming, the money, the direction come from the regional health authority, and we are ensuring that they are armed with the tools to do the job. If they do not have the right tools, we as a Legislature may have to give them all the tools they need to do the job, but there is no reason in my mind--and the member's comment I support a hundred percent. It is exactly the kind of comment I have made in the privacy of my office when I have seen these frustrations in the system--is they are all taxpayers of the city of Winnipeg. It is their health care system. The people fund it through their taxes, and they should expect that if they walk into the doors of Concordia Hospital or Grace Hospital and there is not room for them in that hospital and there is room at St. Boniface or HSC or whatever, that if they want that bed, to be in a bed as most of them would do, that the system should be able to facilitate that and get them into a bed as quickly as possible where that bed is available, because it is all the same taxpayers.
Now the irony, of course, is that everyone says, yes, that makes sense, but many of our independent boards--yes, we should do that; it makes sense. But when you come to setting up the system that will do that, you get all of these problems in place.
So it still does not take away from some of which we faced this winter when our whole system was at a capacity, and that is what we are trying to do, is increase our capacity to be able to handle that, but even when we do that, we are still from time to time going to have certain hospitals that get plugged and others have space. I guess the public look at all of us and they say, hey, it is our tax dollars, we pay for it. It is our health system; it is a small city, how come I cannot move? To be honest, I have no good answer to them about why they cannot. Some of the independent hospital boards, from time to time, give them a good reason, but in my mind that is nonsense. It is a public system; the public pay for it; the public should be able to access it.
I know there are times when we need more resources as a whole system, and that is what we are in the process of putting in with the additional PCH beds to take some pressure off in other things. But if the system cannot allocate the resources it has well, then we are in real trouble, and that is what we are trying to change. We will get Mr. Webster--we will endeavour to check on those specific dates for the member.
Mr. Reid: I am sure the minister will excuse me if I am somewhat doubtful. Having been here since 1990, I listened to Health Minister Orchard talk about a Central Bed Registry, and this is 1998 and my constituent did not receive any other treatment than probably would have occurred in 1992 when Minister Orchard talked about it. So I am skeptical that this process is even going to move forward. You say it is. You may be determined to see it move forward, but having heard of this now for going on six years, one would think that, yes, there would be a bit of organization involved in this, but after six years you would have expected to see some progress in these matters.
I guess you are guessing, because you say you do not know whether or not the other hospital facilities were or were not full and whether or not the patient could have been transferred to another facility. I guess then I have to ask the question: were there beds or other sections of that hospital where beds were not occupied? Why were the acute care beds for that particular facility not available for that woman in that part of her community? She lives in the northeast part of Winnipeg where Concordia is the service hospital, and now we are going to move that individual to another hospital where you say there may or may not have been beds available. That will take some research no doubt to find that out, but the overall system here I think is lacking in acute care beds. If there had been--you have beds that are shut down in hospitals here in the city of Winnipeg where patients can go. I know they are because I have nurses coming that work in those facilities and tell me. They live in my community. They tell me about beds that are closed in your hospital system and have been closed for some time.
So you have to know that there are beds that your government has closed over a period of time here. You have to get staff that is available for them. Of course, then, again, you have cut the number of nurses, going back, which causes me more concern. When I talk to my constituents about these matters, they say that the care that was provided by the hospital staff who were there, who were obviously stressed out, was as well as could be expected under the circumstances of the case because they were working under high-stress situations in that particular area with lack of resources available to them. That is the question they ask of me. The resources are lacking, and they have asked me to raise this with the minister and the department with respect to nursing staff in the hospitals and with the lack of available beds, acute care beds for people who come in with emergency cases such as this that have not been diagnosed and are forced to lay on stretchers in the hallway for up to a week, as is this case, which causes them more problems with respect to their recovery.
No one--having had my father in the hospital just a few weeks ago and seeing first-hand the circumstances of the St. Boniface Hospital where you have to spend days on stretchers in the hallway, there is no way an individual can make any kind of a decent recovery in a hallway, lying there 24 hours a day with all of the activity going on around you. That is the other issue that my constituent here is referring to, this woman is referring to. You cannot make a decent recovery and be expected to do well lying on a stretcher in the hallway, very uncomfortable, very unrecognizing of the dignity and respect that should be afforded to every individual in the system. You have to forgive me, Mr. Minister, when you talk about the Central Bed Registry. I have been here since '90. I have heard that from the previous, previous Minister of Health. I have heard it from the previous Minister of Health and now I am hearing it again, and I am somewhat suspect that this is ever indeed going to occur.
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Mr. Webster: Mr. Chairperson, I cannot even comment on the area around dignity and respect for individuals because I agree with you 100 percent on that. I also cannot deny that there are patients lying in stretchers in emergency departments that should not be there. But very honestly, if people are bringing it to your attention that there are hospital beds available within the system that are not being used, I really--sincerely, I would like to know where they are because it is my understanding they are using all of the available beds within the system at the present time.
The secret of a Central Bed Registry is not the fact that you have the registry. The secret is using it properly once you have it. Our system today, despite the fact that we know where beds are available, the beds are not being utilized the way they should be. Let me give you an example. When we brought in the temporary deferral of elective surgery requiring hospital admittance, within 24 hours, because of the nature of the patients that flow through, Health Sciences Centre had 25 empty beds. When I met with the CEOs at the end of that week, I was informed that there were some hospitals that still had patients lying in emergency on stretchers. I asked the question: well, why did you not transfer them? The question was the Health Sciences Centre had contacted the other hospitals and told them their availability, and the response they got back from the hospital that had the largest number of patients waiting for admittance, we wanted to keep our patients here until we could admit them into our own hospital. I could not overrule them.
Mr. Praznik: Mr. Chair, I do not take anything away from the member for Transcona (Mr. Reid) because the member for Transcona is dead-on in his line of questioning. If I sat in his shoes, I would be asking the same questions, but the story that Mr. Webster just described is exactly what is fundamentally wrong with our health care system and has been for 20 years. The only reason I share this article with him is not to say it happened when the New Democrats--it did happen with the New Democrats. It happened with the Tories. What happened?
Let us analyze why in 1984--it is good to sometimes put these in context. I quote this article. It says: doctors, nurses, administrators, union officials and hospital employees recently outlined a litany of problems affecting patient care. They include dangerously long waiting lists for surgery, aging equipment, high numbers of chronic care patients occupying valuable space in acute care hospital beds and four recent deaths at the Health Sciences Centre which may have been prevented if intensive care beds were available.
Of course this Dr. Gerry Bristow is quoted--and he was one of the many professionals who blamed problems on chronic severe underfunding. They said the situation will worsen if the government sticks to its 3 percent increase for '84-85. The reason why I just raise this is that you could take these lines, change the numbers and the names and have the same story again, before, and here the Free Press in the article has created a series, Hospitals in crisis, et cetera.
You ask yourself: why is it always this way? Well, there are a number of reasons. I think the nature of health care will always have people in it looking for more dollars for their particular programs, and if you are lobbying for dollars, you are never going to say I have enough. You always need more. That is the nature of the business. But secondly, why could any governments not, why could Mr. Desjardins not, why could Mr. Orchard not, why could Mr. McCrae not, and I think it was Wilson Parasiuk who was the last Health minister of the New Democratic government for a short time, why could they not get these simple common sense things, because what the member for Transcona (Mr. Reid) asks is simple common sense? If you have the beds, why can you not move them?
The reason why is we as a province, like every other province in Canada, left the delivery of health care in the hands of independent institutions. Now I am not saying that is the be-all and end-all. There will always be issues of financing. We can always debate that, but just to make simple movement decisions, when you have independent facilities making those decisions who are in essence the real deliverers of health care--we are just the funders under that system. We just send the money, and of course it is never enough. It was never enough when the New Democrats were in power. It is never enough when the Tories are in power. It will never be enough no matter who is in power.
But why can the common sense things not happen? It is because independent boards and their independent facilities, all relying on their tradition of service and their public community support, say, no, we must continue to provide health care. I was told by some of the faith-based chairs, for example, that Mr. Minister, the best way to provide care is let us continue to provide it. You just be the funder. We will be the provider. But people like you and I--and I say that to the member for Transcona--we have constituents who end up in hospitals where there is not a bed in their facility. I think the matter Mr. Webster referred to is the situation at the Grace--had the largest number I think at that time, it may have not been the Grace. It might have been another hospital--but we had 25 beds freed up at the Health Sciences Centre to take that capacity. People would not move them. They did not want to lose them out of their hospital.
Well, you know, you look at it and you shake your head. Do we have the power to order it? No, we do not. Do we have the power to make it happen? No, we did not. Ultimately, now I think the difference between Mr. Desjardins and Mr. Parasiuk and Mr. Orchard and Mr. McCrae and today is that none of those ministers had dealt with the fundamental issue at that stage. They did not have the legislative authority to regionalize and rationalize the system to provide central control.
I am fortunate that Minister McCrae brought in the legislation and left me with the concept of regionalization. I brought in the amendments with respect to Winnipeg, and we now have the power to set up one centralized system. Will it be the answer to every question? No, it will not. Will the system still need more money and probably ever-increasing amounts as new technology and the population ages and we deal with all those things? Yes, it will, and we will always be struggling to keep up with the growing cost of health care, and we will debate whether it is enough all the time. But if you do not have the tools to do at least the common-sense things in the system, this system is headed for its own demise.
At least I, with some pride, take credit that at least at this stage we have managed to get the tools in place to at least deal with the common-sense organizational issues in health care. We can debate needs back and forth in beds, and the member is right. We do have a demand for more acute care or medicine beds. That is why we are adding the personal care home beds that will take some pressure off, and I know there are discussions going on with Concordia now and that configuration about increasing their number of acute care beds for that part of the city rather significantly. Yes, we need to do that. We are doing it. We are putting those things in place.
But you know, if we still did it without having changed the basic way we run the system, at the end of the day we would have a little bit of temporary relief, but we still would be dealing with these ludicrous situations where we are not able to manage the flow of work around the system to get the best use out of what we have. You know, one never knows how long you are going to be Minister of Health. It is not a portfolio you want for your whole life. I can tell you this. But whoever succeeds me as Minister of Health at whatever day, at least I believe they are going to have some fundamental tools that none of my predecessors, including New Democrats, had to be able to deliver better quality care in the system.
One of the mistakes we have all made as politicians is we have got caught up in the battle with those independent authorities, and both parties, I think--depending on whether government or opposition can be accused of the same thing--we have got caught up in those battles when those independent agencies have been threatened or challenged to secede power, in essence, to the public to run their health care system. The arguments have come out, oh, we do it so well. We have a history. We have a tradition, et cetera. Yes, they do, I do not take that away from them, but the greater good of the public needs to be served and if it is not being, we have an obligation to make it happen. Whenever those debates--and I have seen it happen in this round. Perhaps, one reason after being in government for 10 years, we are doing it now, it is happening now, is because in the early days, first of all, you had to build a consensus to do it, and the opposition to make this kind of centralizing move is fierce.
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Part of the argument of what is coming out of the Misericordia--and I appreciate the member for Crescentwood correcting the record in that he did not oppose the fundamental change of function at the Misericordia, and I appreciate that correction on the record or that clarification or putting it on the record--is because there are many in that organization or around it who would say no, we must keep the Misericordia as it is in the status quo and they will mount a campaign. We have already seen copies of a document being circulated by someone from the Misericordia, in fact I would be pleased to put it on the record because I think it makes the point, if we have a copy of it. I saw it in Mr. DeCock's file and I would like the Clerk to make me a copy.
The save the Misericordia campaign: Dear Doctor (blank), In the save the Misericordia campaign, issues have included protests over the breast program, letters from surgical patients protesting the changes. I mean it is all the classic stuff of a group of individuals who want to go out and frighten the public, raise the issue, create a bunch of heat so that the change does not take place. Ministers of Health, including Mr. Desjardins, who have tried to make the change have been met with this kind of stuff because we have to save the status quo.
The status quo does not work but we still want to save it because--how does that help this individual? The member brings it back--and I am glad he does--right to the point. That member's constituent has a right to expect that those of us who are responsible for managing the system ensure that it is managed as well as possibly can be expected. Maintaining independent institutions that we are just the funders of is not the way to manage health care in these latter days of the 20th Century. That member also expects that we should be able to find a reasonable amount of resources to fund that system, and that will always be a debate because the costs of health care rise more rapidly than inflation, for many good reasons, new technology, aging population, greater need, but they continue to rise and I do not suspect you will ever see a day where everyone in health care says yes, we have all the money we need to do the perfect job. It will never be there, but do they have enough resources to do that job they have to do, that is the real question. Will there always be pressure on the system? Yes, but I think people should have the expectation that we can manage it reasonably well, get the best use out of our resources and that there is adequate funding to meet that need.
I say to that lady, I apologize on behalf of all of us that our system is run that way and that has to happen, and I tell you I am serious in that that has to be addressed and the only way to address it is to deal with fundamental need for change, which is taking over this system to run it as a central system. We can debate on amounts of money and we always will, and whoever is on what side of the House, but we are committed to doing that. The member has the right to ask why did it not happen earlier? It did not happen earlier, I believe, because you had to build a consensus, you had to build the support to do what we are doing. Even now with a general consensus to move to consolidation, to centralization of the administration of health in Winnipeg, we still have those who are out there fighting for the old system. And yes, you can fight for the old system and you can show a few good places where it really works, but at the end of the day the member for Transcona (Mr. Reid), the member for Kildonan (Mr. Chomiak), the member for Lac du Bonnet (Mr. Praznik) and all of us, the member for River East (Mrs. Mitchelson), the member for Niakwa (Mr. Reimer), and all of us who are in this committee in this Legislature have a responsibility to do what is right for the whole system, and that is what it is about.
I sometimes do not know where the New Democrats are on this issue, but I do appreciate the fact that you have not come out and opposed the whole centralization system. Because I think whoever is going to succeed me as Minister of Health needs that ability to better run the system, and if there is one failing we have all had collectively, going back to the days of Larry Desjardins, on both sides of the House and all parties in this Legislature, is we have been all afraid to do what health care administration has required us to do, which is to take over the system to run it for the people of Manitoba as opposed to just being the funder. We have all been in the shoes where we have seen the opposition from one group or another and we said oh, well, we have to let the thing continue on and yes, we recognize the history.
At the end of the day when you analyze it, we all have a responsibility for not making this happen, and if they can say one thing about Darren Praznik at the end of the day, you can argue about how much money I did or did not get for health care, the fact of the matter is by the time I leave this office as Minister of Health, I want to ensure that the operation of The Regional Health Authorities Act is in place and it is being delivered and that the efforts to make this system work have not been thwarted by any organization, group or individual who is trying to preserve an old system that does not work.
Mr. Dave Chomiak (Kildonan): Before I commence, I guess we should talk about where we are going to go and where I think we should go. I had planned to query both Mr. Webster and Ms. Hicks about some specific programs in their area, but we are running out of time today. I recognize that Ms. Hicks may not be available to the committee for the next little while, but we will have to deal with it. I am wondering if in terms of organization we should move towards--if this is possible, if perhaps next Monday we could go back to capital again and go back to USSC and try to deal with those.
Mr. Praznik: Monday?
Mr. Chomiak: Monday. If we could, and then Tuesday perhaps deal with--if we can get Ms. Suski in to deal with the long-term care issues.
Mr. Praznik: Personal care home or home care or both?
Mr. Chomiak: Both, if we could. Then Wednesday, we will go back to the WHA.
An Honourable Member: So we will not be doing bills on Wednesday?
Mr. Chomiak: Pardon me, Thursday. Thursday to deal with the WHA and related--something rough like that for next week might--[interjection]
Mr. Praznik: Can we do the breast program in the morning?
Mr. Chomiak: Yes, and there were reasons for not dealing with it today because of commitments of our members to other things. That is the reason. [interjection] Well, I am torn with 15 minutes left whether or not I take the bait and go into my dissertation or whether I pose a number of questions to utilize the time that staff are here. [interjection]
An Honourable Member: Call it six o'clock, or you can too.
Mr. Chomiak: No, that is one thing I will not be doing. What I think I will do is I will compromise to a certain extent and try to do both, deal with a little bit of what the minister had to say and then pose a few questions. I do not like going on for long periods of time when staff is available, but I will go for a short period of time.
I am always suspicious when we have a constant reference to newspaper articles back in 1983, fifteen years ago. When that becomes the reliance and that becomes the defence of a government's position, I have always thought that it is not a very good defence, particularly when it is held out as the be-all and the end-all, particularly when you have a government that has been in power for 10 years and promised so much in terms of reform and changes to the system and delivered so little in actual fact. I mean, let us look at it. The closure of 1,400 beds in the system, government figures. The report from 1990, they recommended the opening of 1,400 personal care home beds in Winnipeg, government figures. The government plan in 1995 to open those beds, government promise. A government plan to renege on the opening of those personal care home beds, government broken promise. The announcement in 1992 by Don Orchard of a Central Bed Registry as the be-all and the end-all, a government promise.
I mean the list goes on and on. The minister recalls when he was appointed as minister, and there was a, quote, crisis in the emergency beds, and he found cause to open beds. We have had those crises for the past years, ever since I have been critic, every single year. In fact, one year, the year previous to this new minister being appointed, the previous minister, we had to remind him of the Christmas rush and we had a requirement for open beds. The challenge from the present minister to myself, not I think a wise decision, to find beds in the system, and my proceeding to attend at some of the facilities and going up to the third floor of Misericordia and finding locked rooms with locked beds and saying to the people there, what is in these? Oh, there are beds in these rooms. What are they being used for? Oh, they have been converted to plastics. Now plastics is being shifted over to some other facility after a conversion. I mean, the list goes on and on and on.
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The fact that the minister, yes, found 25 beds. He had to cancel elective surgery in a system that already had the longest elective surgery lists in the country. Give me a break. That was somewhat predictable. The fact that we went to St. Boniface Hospital and I looked at the list. I looked at every single person on the 16-bed list of people waiting for a bed. Not one had the flu. Not one had the flu, and I confirmed it, and I went through it with both the physicians and the nurses attending. Find me the flu cases, find me the flu bug, and the Grace Hospital saying it is not the flu bug and every single institution. [interjection]
Well, the minister says that he is told by the CEO of Winnipeg Hospital Authority. Then give me the facts and the statistics because they are not there. Having visited every facility, having talked to individuals who are actually onsite, it could not be collaborated at all, and it was predictable. It was predictable. [interjection] Sure, there were some flu people, but the minister has yet to provide those statistics, and he knows it does not exist. The first excuse--I mean, I do not want to go on, because I will use up the entire time going down this road, and I tended not to want to do it.
The predictability of the crisis, the predictability of the bed shortage was there. There was an opportunity going in to deal with the issue, and it was not dealt with. I lay that directly on the desk of the Minister of Health. The Minister of Health can bring all of the articles he wants from 1983 to the table, but the fact was there was a failing on the part of the Department of Health to not only anticipate but adequately plan to deal with the crisis situation in Manitoba, and that has to be laid squarely on the shoulders and on the responsibility of the minister. It is not the collective responsibility of members.
I will not take the responsibility for it, because we stood up in the Legislature in the fall and advised both the minister and the government of the difficulties that they were going into, and we wrote a letter to the Premier (Mr. Filmon) on December 23 asking the Premier to do something. December 23 we wrote a letter to the Premier. That afternoon--interesting, coincidentally or not--the minister announced a short-term plan. [interjection] Well, the minister says it corresponded with his press conference. Regardless, the fact was there was an acknowledgement even then that we were actually in a crisis, and the entire issue could have been avoided and anticipated and dealt with and was not.
The reason that the woman was sitting in the hospital at Concordia was because the government did not adequately plan or attend to the situation, and the fact that the only response was to cancel elective surgery when we already had the longest waiting list in the country, to my view, certainly was an administrative response and it certainly was something that was necessitated, but it was quite predictable, but it was not necessary and it did not have to be done in that fashion.
Mr. Peter Dyck, Acting Chairperson, in the Chair
So I have taken my five minutes, and I do not want to go on, regardless whether it prompts debate or not. I wanted to put on the record a few comments with regard to this. I can indicate for the record, I could go on a lot more on this issue. But I did want to ask a couple of more questions, and it can be dealt with as the minister sees fit.
I am wondering if we could have any idea from the WHA as to what sorts of arrangements and what sort of budget or planning are going into interfacility transports as it relates to the system? Has there been earmarked or are they earmarking particular funding for interfacility transports to accommodate the shifts that may be necessitated by the new system that is being put in place?
Mr. Webster: I guess there are two components to it, because we are just in the midst of working with the city as they try to restructure the ambulance services. That is one component. The second one is looking at the whole issue of the pricing around interfacility transfers and the way they have been funded in the past and whether that is going to continue to be appropriate for funding in the future. That has just started.
Mr. Chomiak: I recognize there is a subcommittee looking at the--do we know when we might see some resolution to the issue in terms of the ambulance situation in Winnipeg? Do you know, what was their time frame on that? Are we looking at something this summer or the fall?
Mr. Webster: Mr. Chairperson, there are probably two time frames. There is the city's and there is ours. I would like to get it resolved before the end of June. Whether the city is prepared to move that quickly or not, I do not know.
Mr. Chomiak: Will the funding for the ambulance service be coming out of the Department of Health budget or will it be coming from the WHA in the future?
Mr. Webster: I have been informed, Mr. Chairperson, that the funding, which has flowed from Manitoba Health to the City of Winnipeg, in the future will be flowing through the WHA. In exchange for that, we have told the city that we want an operating agreement between the WHA and the city to outline some deliverables that we will expect in exchange for the funding.
Mr. Chomiak: Are there any guidelines that have been put in place with respect to the number of ambulances in the city of Winnipeg vis-a-vis the population?
Mr. Webster: Mr. Chairperson, there have not been any guidelines put in place, but as we talk to the city about what our expectations are, the numbers and the deployment of those vehicles will be one of the considerations.
Mr. Chomiak: I just briefly want to return to a couple of questions of Ms. Hicks as relates to her functions in her capacity. I note that she is responsible for the rural and northern task force of the aboriginal health strategy. Can I have an update on both of those, and if possible, tabled documentation in relation to both of those?
Ms. Hicks: Yes, Mr. Chair, the rural and northern task force, we have, in the process of reorganizing the department in order to reflect the needs and the change of the system, combined the rural and northern task forces along with the previous Winnipeg and rural operations. So they are all one unit right now, and they continue to support the functions of the rural and northern regional health authorities and are also responsible for supporting the development of the Winnipeg Hospital Authority and the Winnipeg Community and Long Term Care Authority. So they are all one unit now and are bridging the transition of the services being moved in Winnipeg and also dealing with some of the issues that are still cropping up in the rural areas.
The aboriginal area that we have is a program area, and we have consolidated all our programs under one unit also, of which the aboriginal unit is part of that. Ms. Arlene Wilgosh is responsible for the new implementation support services, health authority implementation, and we have also got health programs that is headed up by Ms. Marcia Thomson.
Mr. Chomiak: Structurally though, it is interesting that it says Rural Northern Task Force--
The Acting Chairperson (Mr. Dyck): Order, please.
Ms. Hicks: I have a correction. It is Regional Health--Regional Support Services. Sorry, Mr. Chair, I have forgotten the name of one of the major units in our department.
Mr. Chomiak: I am looking at the organization chart. It is interesting that it is Rural Northern Task Force. Why that nomenclature? Or is it just because it is the carry-over from the previous exercise, is that correct?
Ms. Hicks: Yes, it was a carry-over from the--we set up a task force when we first initially began the development of the regional health authorities. Now we are seeing that their role is far more support than it is actually a task force, so we have changed the nature of their function.
Mr. Chomiak: And the aboriginal health strategy headed up by Arlene Wilgosh. Is that specifically a program, a delivery of program support, and what is the status of it?
Ms. Hicks: Mr. Chairperson, the Regional Support Services are headed up by Ms. Wilgosh. That includes many of the members of the former task force plus the operations, former operations which were Winnipeg and rural operations. The aboriginal strategy has been rolled into health programs under Marcia Thomson and is considered to be a program within the department.
Mr. Chomiak: So we do not have a designated, or do we have a designated component area that is looking at the overall aboriginal issues as they relate to health?
Ms. Hicks: At this point, what we have in the department is we have a couple of individuals and one specifically within Ms. Marcia Thomson's area who is responsible for aboriginal health issues, and that is Ms. Loretta Bayer.
Mr. Chomiak: So an issue like, if we are to say hypothetically the issue of provision of home care services to aboriginal people, how is that handled in the department?
Ms. Hicks: Mr. Chairperson, we would take advice and there would be some communication through the program area which would be through Ms. Loretta Bayer and Ms. Marcia Thomson, but the issue that deals with home care on First Nations and other communities would be brought to our central management table and discussed as a policy issue, and then if there was an implementation component to that, then the implementation aspect would then be expected to be interpreted to the regional health authorities and to the First Nations through the program, but the policy decisions and the planning would be done at our executive management level and at the table with the minister.
The Acting Chairperson (Mr. Dyck): The hour being five o'clock, time for private members' hour. Committee rise.