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

Mr. Chairperson (Marcel Laurendeau): We are on resolution 1.(b)(1) on page 46.

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I wonder just at the onset whether the minister has any documentation he would like to table with respect to items that we raised last week, or should I just proceed with questions?

Hon. Eric Stefanson (Minister of Health): Mr. Chairman, no, I do not yet. I have two or three documents that have been prepared and are there for me to review with my staff, which I hope to be able to do today, or no later than tomorrow, so within the next day or so I should be able to table at least some of the preliminary information.

Mr. Chomiak: Mr. Chairperson, just at the onset, I want to indicate to the minister that in Question Period on Thursday, I indicated to the minister that, in fact, the minister had advised some individuals not to go to me because the issue was political. I was incorrect.

I reviewed my notes, and, in fact, the minister's colleague had advised the individuals not to go to me with respect to that issue. So the minister was correct. In my enthusiasm, I labelled the–it was not the minister who advised them not to talk to me to make it political, but, in fact, it was the minister's colleague. When I checked my notes, they advised me it was the minister's colleague in cabinet who had contacted him and said, well, do not go to the NDP Health critic. I just wanted to put that on the record with regard to that.

Now, my question to the minister is recently there was a $44,700 poll that was undertaken by the Department of Health to review the attitudes of the public as it respects health care. The minister indicated he would make that information public. Is the minister prepared to make that information public now?

Mr. Stefanson: Thank you very much, Mr. Chairman. First of all, on the first point that the member referred to from the previous Question Period, I thank him for correcting the record on that issue. In fact, I did have a chance to speak to one of the spouses of the LPNs, and Sue Hicks, the associate deputy minister, also had a chance to speak directly to one of the licensed practical nurses. I do thank him for correcting that.

I think, as the member knows, we have a poll release policy in place within our government, and, yes, we will be making that poll available.

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Mr. Chomiak: Is the minister indicating he will make it available to the committee members in Estimates, or he is going to make it available through some other course of action?

Mr. Stefanson: The poll that was done on behalf of the Department of Finance was just released basically publicly, I think, a few weeks ago, if I recall it correctly. I will certainly look into the nature of the release, but my expectation is just it will just become available on a given day and it will be readily available to members opposite and obviously anybody else who takes an interest in the polls. So I do not know–well, there is no process or requirement to bring it through the Estimates process, but I am sure the day it is released, a copy will and can be made available for the member opposite and, I am sure, others.

Mr. Chomiak: The government recently passed a bill with respect to the funding of clinics and other centres other than hospitals. The name of the bill escapes me, but it is the bill that provides for the funding essentially for private, noninstitutional hospital centres.

Now, given that this bill was brought about as a reaction to the penalty clause under the Canada Health Act that the federal government was imposing on the province and given that it was a relatively new procedure, I am wondering if the minister would table for us the amounts of money that have been expended with these facilities and the procedural arrangements, that is, the contracts that have been entered into, or, if the minister is not prepared to provide the contracts, at least the general information in terms of the procedures that are being contracted for by the provincial government to these various centres.

Just for clarification, I am not necessarily asking the minister to respond today. What I am basically asking for is can the minister provide that information at some future point in this committee?

Mr. Stefanson: I appreciate that clarification from the member, because we will return with information on basically what is covered, how much, what the expenditures are, any other information relative to the whole issue of these private clinics, Mr. Chairman.

Mr. Chomiak: I thank the minister for that response particularly, because it is a new process and a new procedure and it would be useful in order to determine the effect that the changes have had and the direction that the Department of Health is taking us in this area.

The minister may want to respond at a later date with more detail and may not be able to take this question today. I am, again, just looking for general information from the minister. With respect to the LPN program expansion that is supposed to take place at the Misericordia health centre, can the minister outline for me who is undertaking that particular education function?

Mr. Stefanson: The entire licensed practical nursing educational program is being run by Assiniboine Community College, so basically they run the two intakes at Misericordia. They have two intakes at Assiniboine Community College in Brandon. As the member I believe is aware from the day of the announcement, there will be two rotating sites again that will be administered by Assiniboine Community College. So really they run the entire program with satellite sites at Misericordia and at these two rotating locations yet to be determined.

Mr. Kevin Lamoureux (Inkster): I thank the member for Kildonan. I did have a question for the Minister of Health. A while ago, I guess it would be about a week and a half, ten days ago, I provided the Minister of Health a letter issuing some concerns in regard to the Misericordia Hospital, in particular some staff people there. I am wondering if he can just expand on any sort of response that he might have in regard to that particular issue.

Mr. Stefanson: Mr. Chairman, hopefully, the member saw a recent phone message from Sue Hicks, the associate deputy minister, calling his office. It was really a follow-up from discussions that he and I had had on this issue. Mrs. Hicks was going to run through the status of those individuals with the member for Inkster, so that would be the purpose of the message that you would have seen, hopefully, on Friday, I believe.

Mr. Lamoureux: I will not consume any more time. If the message was left on Friday on my voice mail, I will make some sort of connection with Ms. Hicks, possibly tomorrow morning, and we can continue to pursue it.

Mr. Chomiak: Just following up on the minister's response to my previous question, therefore, the entire program will be administered and operated out of Assiniboine Community College, administratively, though not physically. Do I understand that correctly?

Mr. Stefanson: The answer is, yes, Mr. Chairman.

Mr. Chomiak: Again, just in anticipation, I wonder if the minister will be able to provide us with data and information as to the training of nurses' aides in the province of Manitoba; that is, where the programs are offered; who is offering them and the number that are being trained. I am presuming that the government has a policy in this regard. Will the minister be able to provide us with that information during the course of these Estimates?

Mr. Stefanson: I will undertake to provide the information requested relative to the whole issue of training of nurses' aides, where the training can take place, and the numbers of individuals taking that kind of training and so on.

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Mr. Chomiak: Again, it is a general question. I appreciate we are not at this line in the Estimates, but I am wondering if the minister can, in a policy sense, outline for us what is happening with respect to the lab consolidation issue as it applies to Winnipeg, in particular, and to the province, where we are at in terms of the negotiations. The former minister during the last Estimates provided us with pretty much an update, and I am wondering if the minister might outline for us where we are at.

Mr. Stefanson: Mr. Chairman, there is a committee of representatives from the regional health authorities, the WHA and the RHAs across the province, that are in the process right now of putting together a proposal to put forward to myself relative to the issue of the consolidation of the public labs on the basis of a single program with more than one site.

We have been sharing information with that review committee. I am expecting that they will be in a position to be forwarding something to me fairly, fairly shortly, so in part, it was at the request of the RHAs to be a part of this review process for the public labs, and we have agreed with that. This committee has now been struck to put together a proposal for basically my review.

Mr. Chomiak: Can the minister therefore update us as to what the status is of the proposal whereby–and I do not know why the name is escaping me, but maybe I do know why it is escaping me [interjection]–the Toronto-based firm. MDS, what the status is of the MDS proposal, because as I understand it, last year the minister indicated that his department was reviewing the MDS proposal and had asked that the matter be reviewed.

Mr. Stefanson: That entire proposal is on hold pending this review with the involvement of the WHA and the RHAs.

Mr. Chomiak: Would I be correct in assuming that the public lab consolidation the minister is talking about seems to me to go back, seems to me to be a reconfiguration of the proposals that came out in 1995, when the entire lab system was reviewed and the lab study was undertaken by, and again the name escapes me, but perhaps the minister–in other words, we seem to have gotten off track from that overall plan. There was no movement on that plan. The MDS proposal came about. There was movement towards an MDS consolidation, but in terms of the overall provincial-wide plan, it seemed to be on the back track.

Is the minister now saying that the original planning or some variation of it that went into that original plan is now back in the running with the MDS decision now on hold? I am trying to get a sense of where we are at in terms of the lab system in general.

Mr. Stefanson: Basically what is happening–how best to make this clear? The RHAs and the WHA had indicated a desire and a willingness to put together a proposal for a single program with more than one site, and we agreed to that, so we had provided them with information that we had from the previous reviews.

I would expect that the '95 study would be something–if there was a '95, if that is the correct year of the lab report that was prepared a few years ago–would also be readily available to them. In fact, I am sure many of the people involved are quite familiar with that, so it is really on the basis of allowing that kind of a proposal to come forward that we are moving forward right now, and I have been told that we are expecting that in approximately a month's time, in terms of where they are today, in terms of that proposal back to us.

So it is really–as I say, we are providing the information, making them aware of issues, but it is really now in the stage of having the RHAs and the WHA put together their proposal.

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Mr. Chomiak: I thank the minister. That does answer the question I posed and helps me understand the situation.

Can the minister give us an update of the status of the breast clinic, vis-a-vis what is happening at the former site of the Misericordia and what is happening at 400 Tache and what the plans are in that regard? If the minister cannot provide it today, then by way of notice at some future point? Again, that may be too specific.

Mr. Stefanson: I will just touch on a few issues. Then I think what we will do is return with a status report for the member for Kildonan. I think, as he knows, back on November 6 the WHA and the Winnipeg Community and Long Term Care Authority jointly announced the implementation of the breast health program that he asked about. As he mentioned, it will be located at 400 Tache Avenue. The funding provides for the development of this new site and the rapid access diagnostic centre. It also provides for the consolidation of breast surgery from seven sites to three, I believe, and for the co-ordination of breast cancer treatment right across Winnipeg. WCA is working on developing the community components, including public education and wellness as well. The program director and manager and medical director are all in place. There are still elements that will remain at Misericordia relative to the breast screening, but the comprehensive breast health program, as he mentioned, will be moving to 400 Tache.

As to the current status of the space in terms of its renovations and the timing of the entire shift of the program, which has not occurred at this particular point in time, services are still being provided at Misericordia, I will return with the details of the timing and ultimate implementation.

Mr. Chomiak: I thank the minister for that response. During Question Period on Thursday, we touched on the issue of LPNs vis-a-vis acute care facilities. Is the minister in a position to give a policy statement which he alluded to on Thursday vis-a-vis the role and function of LPNs, both in an acute care hospital setting as well as their role and function in a tertiary care setting?

Mr. Stefanson: Again, as the member mentioned, he asked questions about this in Question Period last week. I had an opportunity on Friday morning to meet with the chairs and the CEOs of the Winnipeg hospitals. Amongst many other issues, this issue was raised by myself for discussion with them.

I think, as the member knows right now, decisions around staffing mix and requirements by and large are left with the employer and the individual facilities. We expressed at that meeting a view that LPNs can and should be playing an active role in our acute care facilities, along with obviously our long-term care facilities and our Home Care program.

Certainly, some of the facilities were immediately very positive, very interested in that, and what we intend to do is to continue to pursue those discussions with the WHA, the WCA and, in fact, ultimately all of the RHAs on the issue of the role of the LPNs right throughout our health care system, but certainly the specific question he asked is about the role in the acute care facilities.

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Mr. Chomiak: Mr. Chairperson, does the minister still have a nursing advisor? If the minister does, who is that person? If the minister does not, are there plans to fill that position? If not, what is the status of the nursing advisor position in general?

Mr. Stefanson: Mr. Chair, I am told that the functions performed by the former nursing adviser are now a part of the section on the organization chart that we discussed a few days ago under Workforce Policy and Planning. That division of the Department of Health has as its objectives to collect, analyze and evaluate data pertaining to workforce planning, adjustment, and training, to provide relevant policy and planning advice and recommendations, and it obviously goes through a listing of all of their activities and all of their expected results.

As well, within the regional structure, as the member would know, in the case of the WHA, I believe they have a vice-president responsible for nursing, Jan Currie, and obviously the RHAs have their own structures in place. So, as of right now, the functions previously performed by the nursing adviser are now being performed by the individuals who are part of the Workforce Policy and Planning Division.

Mr. Chomiak: Two questions. Firstly, I wonder if the minister could table the description of the role and function of the Workplace Policy and Planning, just for review. Secondly, will the new committee that has been set up to provide advice and various programs to retrain and bring back and increase the number of nurses in Manitoba, will they be reporting to the Workplace Policy and Planning Branch, or will they be reporting directly to the minister? I wonder if the minister might just clarify that, please.

Mr. Stefanson: On page 48 of the Departmental Expenditure Estimates is a summary of the Objectives, the Activity Identification, the Expected Results of the Workforce Policy and Planning that I referred to. On the second question, the nurse retention and recruitment committee, the six individuals we have talked about, with two individuals coming from the Manitoba Nurses' Union, two being appointed by the employer, and two being appointed by the government of Manitoba, that committee reports directly to the Minister of Health.

Mr. Chomiak: It goes without saying that the issue of inter- and intrafacility transport is fairly significant. I am wondering, as I understand it there has been a study and a review of the whole issue, and I am wondering if the minister might outline what the status is and what the government policy is as it affects interfacility transport.

Mr. Stefanson: This whole issue of interfacility transfers is really being reviewed in two different forums right now. One, and I am sure the member will have seen a copy or will have seen coverage through the media of a release done on May 13 from the City of Winnipeg, talking about the issue of interfacility and airport ambulance transfers here in the city of Winnipeg, where the Winnipeg Hospital Authority is working with the City of Winnipeg doing a complete review of those services with a view to have the Winnipeg Hospital Authority take over those services, purely the interfacility and airport ambulance; again, the view being to do that as efficiently and effectively as possible, recognizing we are not talking about people here who need the emergency ambulance care. That care would continue to be provided by the City of Winnipeg.

Outside of Winnipeg, the interfacility review was really a part of that entire review of emergency medical services, a question one of his colleagues asked today in Question Period. That review, I am expecting at a minimum a preliminary report, if not a full report, some time in June.

Mr. Chomiak: Notwithstanding both of those reviews, is there a government policy or a government initiative with respect to interfacility transport and the effect that movement of programs around–and I will use the city of Winnipeg as an example–the effect that program movement around the city of Winnipeg may have on an individual's access to service, and is there a government policy review or initiative in that regard?

Mr. Stefanson: Currently, if an individual is transferred from one facility to another and stays less than 24 hours, they do not pay for that ambulance service. If they are transferred purely as a result of a program shift, they do not pay for that ambulance service, but beyond those criteria, they do pay for the ambulance service. Really, both of these reviews–I have also requested that that entire issue be addressed as part of those reviews because the issue has certainly come up.

So, again, it is also a part of this review. While we are looking at how to do it as efficiently and effectively as we can, we should also be looking at how fair that policy is, Mr. Chairman.

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Mr. Chomiak: I thank the minister for that comment. I can anticipate a couple of replies the minister is going to be sending me to some letters I have written him in that regard. This is really a quite interesting and fundamental issue. The minister said that both of the reviews vis-a-vis transfers from facilities are reviewing this issue. Has the minister put out a directive or a terms of reference in terms of both the WHA in the city of Winnipeg and the RHAs to do the review as to what the parameters are? How has the minister directed these organizations that that is one of the issues that has to be reviewed and dealt with?

Mr. Stefanson: Mr. Chairman, when this issue first came to my attention some time ago in various ways, perhaps one of them was some letters I received from the member for Kildonan as well, I asked for assurance that this issue was under review. I am told that, yes, it definitely is that it forms a part of the review being done in both of these forums–the WHA review here in the city of Winnipeg and the EMS, Emergency Medical Services review, done outside of Winnipeg.

I am certainly prepared to follow up with obtaining the terms of reference and any additional communication that can confirm that to the member, but I was definitely told and confirmed here that that is the case, that both of those reviews are including that whole issue of what is a fair approach in terms of charging for interfacility transfers.

Mr. Chomiak: I thank the minister for that response. That is useful because during the review of the potential consolidation of services in the city of Winnipeg that was done in 1996 or so, it would appear to be a policy directive that mobility–and the words escape me, but the implication was that mobility was not a factor. We were always of the impression that it ought to be considered in the policy decisions that were being made to move programs. So I am encouraged by the minister's response, and we look forward to the receipt of those reports.

Last year in Estimates, it was indicated to us that we would be provided with flu statistics vis-a-vis the emergency rooms and the like, and I am wondering if we have those statistics at this point. The question was generally with the clogging of the waiting rooms. The general response was that flu season was amongst us, and it seemed to me that flu season was with us for a considerable period of time and the previous minister indicated he would provide the flu statistics. I, frankly, did not think I would get them. I do not think they are quite available, but having said that, I asked for them and I was assured I would get them. I wonder if it is possible if we can obtain those statistics that outlines the impact of flu vis-a-vis admissions to hospitals and emergency rooms.

Mr. Stefanson: Mr. Chairman, I will certainly provide the member what I can on this issue. I understand there is some information from Cadham Lab relative to the issue that I can share with him. There is also some information from the Centre for Health Policy and Evaluation relative to the utilization of our hospital system throughout the year based on age. I think there certainly is some information that he will find of use that will point to the flu certainly playing a role in terms of pressure on our hospital systems, which I think anybody who put on a television set or picked up a newspaper from outside of Manitoba back in January, February, would have seen that that really was the case right across Canada.

Now, I also recognize–and I am not a medical doctor–but I think in terms of the record keeping of why individuals are often in a health care facility, it can be any one of a number of medical requirements that are reflected on that individual's record. It does become somewhat difficult to potentially track each and every patient who is in specifically with the flu, although it certainly can be flu-related and flu can be an element of it.

So there is some information that I think the member will find both interesting and useful relative to the pressure that is put on our hospital system at certain times of the year, and, also, that certainly a good portion of that pressure is as a result of the flu.

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Mr. Chomiak: I look forward to receiving that information.

The minister, in reply to a question in the House last week, talked briefly about the status of the hepatitis C negotiations. Can the minister provide us with an update and/or any direction as to specifically the federal government offer and/or if there is going to be a follow-up meeting of ministers?

Mr. Stefanson: There are really the two issues. As the member knows full well, there is the issue of the 1986 to '90 individuals, people infected through the blood supply between 1986 and '90. I gather that final settlement of roughly $1.1 billion is close to being concluded. I believe the deputy is in regular discussion with other jurisdictions. I am told that is very close to being concluded.

The other issue is the individuals basically pre-1986 and after 1990. Again, in response to a question here in the House, I did indicate that we have been in negotiations with the federal government on concluding a memorandum of understanding with them for an allocation to the Province of Manitoba. The expectation is that the federal government has indicated that they will provide $300 million over anywhere from about a 15- to 20-year period, and Manitoba's share of that would be approximately $7.8 million.

We are also working with the WHA and the WCA and receiving advice on the utilization of the money here in the province of Manitoba, but some examples of services that are being looked at are additional clinics in the viral-hepatitis investigation unit at the Health Sciences Centre, some additional community-based nurses in the WCA to determine risk factors, monitor cases, counsel and provide education to minimize liver damage, some specialized diagnostic tests and some other treatment. So, again, I think when I answered that question a week or two ago, I said that we were close to concluding that memorandum of understanding, and I fully expect that we will be doing that very, very shortly.

There was a ministerial meeting set for May that was cancelled by the co-chairs. I am not sure if it was solely because of a quorum or participation of ministers. I know we were certainly prepared to participate, so it was not that we were not going to be there. But I think that was one of the issues; perhaps, there were others. So right now, there is not a ministerial meeting set. We did have one conference call some time ago, and this was certainly one of the issues that we discussed on that conference call to proceed expeditiously with concluding the memorandums with the federal government.

At this particular point in time, I think the next ministerial meeting is set for September, I believe, but there might well be–I mean, whether there is a need for conference call or any other communication. But, at this point in time, we are moving forward to conclude the memorandum with the federal government and start to access the cash, the money that they are making available to provide the services that I have outlined.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that response. I can indicate we will be getting into more details as we go through the course of the Estimates, but I appreciate the overall response and the information given to me by the minister.

During the recent issue that was raised by the Winnipeg Free Press with respect to the sterilization of medical equipment and the like, the minister indicated he would and he did, as I understand it, write to the federal Minister of Health. Can the minister provide us with an update as to what the status is of perhaps a meeting or an agreement or some kind of protocol that might be entered into on a national basis with respect to the safety issue?

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Mr. Stefanson: Mr. Chairman, I am sure the member for Kildonan (Mr. Chomiak) will recall that back in February just of this year we put a ban in place in terms of the whole issue of certain types of reusables in our health care system. At that time, Mr. Brian Postl forwarded a number of recommendations to myself, which were accepted, regarding the reuse of single-use medical devices. The RHAs right across the province were basically asked to ensure that their policies and practices were consistent with these recommendations, and I am told that that is, in fact, the case.

A provincial committee was established to review the issue of reuse and develop policies, protocols, quality assurance and monitoring systems, and they will report directly to myself. We are expecting that by August of this year. The committee is chaired by Dr. Brock Wright, Vice-President of Health Sciences Centre, and includes other RHA representation. Again, I think as the member knows, the reuse of single-use devices is very complex. It is anticipated that the ban on the reuse of these devices here in Manitoba will be extended until a national position is developed. Manitoba certainly wants to examine the national position prior to moving independently to set any guidelines.

Again, I think, as the member knows, the Canadian Healthcare Association has submitted a proposal for a feasibility study to explore options for implementing a policy for single-use medical devices in Canada. That was forwarded to the federal minister, the Honourable Allan Rock, and to myself as well. We, Manitoba Health and the WHA, support this proposal, and we are certainly willing to partner on a national basis with the CHA and other provinces to develop a national position and make recommendations on the reuse of single-use medical devices. So we certainly continue to pursue and support the need for a national position.

The member for Kildonan is also right. Very shortly after this issue was dealt with here in Manitoba, I did communicate with the federal minister on the issue. I believe there has been some communication between deputies on the issue. I certainly intend to continue to press to develop a national policy on the whole issue of reuse of single-use medical devices.

Mr. Chomiak: Just before we go on, I can indicate to the minister we had talked about where we are heading with respect to the Estimates. My guesstimate is that part of tomorrow will still entail some general questions. Then I think we will be moving line by line, and I anticipate relatively quickly hitting the section on Information Services wherein there will be a need to ask a number of questions. So my guess is we probably will not achieve the Information Services line when next we meet, which, I presume, will be tomorrow for a couple of hours. But, certainly very shortly thereafter, perhaps a subsequent meeting, we will hit the line Information Services, where we will have a fair amount of questions. So I can just inform the minister of that.

I am curious as to the status of the blood agency that has been set up. I wonder if the minister–he does not have to do it today, but if he can provide us with an update as to what the situation is here in Manitoba?

Mr. Stefanson: Mr. Chairman, I will provide the member with an update on Canadian Blood Services, both in terms of the building under construction here in Winnipeg and also the services that they are now providing to us.

Mr. Chomiak: I will also be asking further in the Estimates process an update on the palliative care program in terms of numbers served, et cetera. So just by way of telling the minister that we will be getting fairly specific on the palliative care program, and we will be asking a number of specific items there.

I have a specific question of the minister. Recently, the department, through Long Term Care, basically phased out the role of Level 1 and Level 2 care provided in personal care homes. Is that still the government policy? If not, can the minister outline for me what the government policy is?

Mr. Stefanson: No, we have not phased out Level 1 and Level 2 in the personal care homes but there is no doubt that there are more and more individuals who would be panelled as Level 3 and Level 4 in our personal care homes. Obviously a good number of the individuals who would be panelled as Level 1 or 2 are able to function independently through the Home Care program. Some are accessing the supportive housing programs that are in place, but Level 1 and Level 2 have not been phased out of our personal care home program.

Mr. Chomiak: Is the minister saying the funding for Level 1 through Level 4 has not changed and the various categories have not changed in the last two years?

Mr. Stefanson: Out of the over 9,000 personal care home beds in Manitoba, close to 2,000 are Level 1 or Level 2. So as I have indicated, that continues to be provided in our personal care home program. It the member is heading toward the whole issue of the levels of service that are required, those are taken into consideration when funding is provided to our personal care homes.

Mr. Chomiak: I will be getting to that. Just again, an anticipatory question, perhaps the minister can deal with it now, but we are going to be looking for some information with respect to the government's smoking policy, the number of convictions and the like. I would ask the minister to provide that data when we reach that particular line, the item in the supplementary Estimates.

Mr. Stefanson: Yes, I will provide that information to the member on the whole issue of the tobacco enforcement project and any other information relative to the smoking policies.

Mr. Chomiak: Reference was made in Question Period today to the $500,000 advertising campaign. Can the minister indicate where in the Supplementary Estimates that particular $500,000 figure came from?

Mr. Stefanson: Looking at the 1998 budget, the supplementary funding would have come out of Appropriation 21.5, Item C in the budget, Healthy Community Development.

Mr. Chairperson: Order, please. The hour being five o'clock, time for private members' hour.

Committee rise. Call in the Speaker.