4th-36th Vol. 36A-Committee of Supply-Health

When the committee last sat, it had been considering item 21.1 Administration and Finance (b) Executive Support (1) Salaries and Employee Benefits on page 71.

Hon. Darren Praznik (Minister of Health): Mr. Chair, I would like to introduce Dr. Brian Postl, who is the vice-president of Clinical Services for the Winnipeg Hospital Authority. He joins Mr. Gordon Webster, the CEO, and, of course, Ms. Sue Hicks, who is the associate deputy minister responsible for this area.

I just ask the member, Dr. Postl is available this morning, he is not available this afternoon, but we will bring him back to the committee. I know his colleagues, the members for Swan River (Ms. Wowchuk) and Osborne (Ms. McGifford) had a variety of questions around planning for the breast program. So I ask him, I hope that they will be able to join us this morning. If not, we will have to deal with that at another time.

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I cannot guarantee that the two members can join us this morning because of other committees that are sitting, but appreciate the fact that we will have to perhaps return to those items if we do not have a chance to deal with it this morning. Because Dr. Postl is only joining us for this morning, I am going to go right to the question that I posed when we last met, and by way of preamble, I am perplexed.

I want to understand how we get in a situation where we have a situation where a child can get surgery and surgery is cancelled and then surgery is bumped, and I am referring specifically to the Guffei child, the young three-month-old who needs surgery before the skull closes, so it is on a time line. Surgery had been scheduled for about a week and a half ago in Children's Hospital and was bumped because of lack of a bed. I assume it was lack of an ICU bed. Surgery was rescheduled for May. It has now been moved back to June.

To say that the family is concerned would be an understatement, and while we tend not to bring to the Legislature these kinds of specific issues, I do so for two reasons: First, I want to understand how this happens and what resolution can be put in place, and secondly, as part of a larger issue that I want to discuss here, it all goes back to the entire issue of when Children's Hospital services were amalgamated and there were guarantees made that resources would be offered on an expanding basis to take into consideration the amalgamation of services.

Since I am on a bit of a roll, I just want to advise you that I am well familiar with the issue, and I am well familiar with the fact that Dr. Postl took over operation of Children's Hospital and requested and I believe received permission to have block funding, which I think was of a positive nature, but, good heavens, the operating rooms at Children's still do not meet Canadian standards, and the operating rooms are in terrible shape. When we amalgamated services, it was guaranteed that these services would be provided.

Now if you go back--and I beg the indulgence of members here for this long-winded nature of the question--to the specific issue of this Guffei child, if there were alternative services available, perhaps the surgeon or surgeons in question could have conducted the surgery at some point previously at Victoria Hospital or at St. Boniface Hospital. But the fact is there is no ICU bed. The fact is there is difficulty slotting surgery for children. I have talked with the doctors at Children's; I have talked with some of the officials at Children's. The hospital is jammed up. Some kids have attended at adult wards. I do not know whether or not the step down unit has been put in place. This is not a new problem.

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So my question is twofold. Firstly: how do we deal with this child who needs surgery? Secondly: what are we doing on a systematic basis so that the McCorrister child does not have to go to the media to get their surgery and the Guffei child does not have to go to the media to get their surgery? What systematic changes are we putting in place to effect change? Those are my two basic questions.

Mr. Praznik: Mr. Chair, this is obviously a concern to us as well about issues around the Children's Hospital. I am going to ask Mr. Webster and Dr. Postl to update the member on their assessment of the problem and their plans or proposals that will be coming forward to correct it.

Mr. Brian Postl (Vice-President, Clinical Services, Winnipeg Hospital Authority): Around the issue of ICU use and surgery, for many years Children's Hospital has required or has needed to use ICU beds in a postoperative recovery process, so that the issue becomes one of trying to balance the schedule of surgery and the kinds of things being scheduled on a given day for surgery and the access to ICU beds, which is in part determined by what came in through the front door in the previous few days, whether that was motor vehicular accidents or trauma from other communities or a serious infectious illness or in certain seasons, of course, respiratory illness.

Now normally that balance works reasonably well. There are times when surgery is either deferred or otherwise delayed because ICU beds are unavailable, but it is a single site for ICU programming in the province for pediatrics. From time to time surgeons book cases against the advice of ICU and are determined to book cases. I think that sometimes those end up in disputes between the surgeon and the intensive care staff about what can be manageable in a scheduled way. I think that, in the cases that have occurred around the neurosurgical and plastics requirements of some children with skull defects that have the capacity to close, those are elective and can be scheduled in a way that is predictable. I think that is the most desirable approach to this problem as opposed to--in this last case, from what I understand, both were booked on a single day. There were two cases, similar cases, booked on a single day.

Around the amalgamation of services, I, of course, was not there at the time, but I think the intent and interest reflected a falling pediatric population and what the requirements would be for bed utilization. There was a period of time postamalgamation where beds were available that were not entirely used, and there were subsequent closures, postamalgamation, to beds at Children's Hospital. Then there have been intermittent expansions of bed use that have been consistent with epidemic illness in the community that has required additional beds.

One of the fallouts of the fact that through respiratory illness and I think through some of the successes of intensive care, that the intensive care unit in the last 12 months or so has been quite full in an ongoing way, is the whole concept that you mentioned of development of a step-down unit on a ward, and that process continues to be looked at from both a capital, a physical plant and a staffing set of requirements.

We think that likely can be achieved this spring and summer and should allow for the decanting of patients that now are in a PECU, which is adjacent to the PICU. That is an extended care unit and will allow the PECU beds to be used more consistently for intensive care in the event of these kinds of overflows. Ultimately there is a proposal in the works around the redevelopment of intensive care in Children's Hospital as part of a larger Health Sciences Centre redevelopment which will provide slight expansion but probably more importantly more flexibility and more space for the provision of some of these services.

Mr. Chomiak: So there is a proposal that is being formulated where--to do what in the interim period until the actual redevelopment of Health Sciences Centre and the adjacent Children's Hospital is redeveloped. What is the exact status of that proposal and what is the proposal for? Is it the step-down unit that we are talking about or is it some other--can I have more specifics on that?

Mr. Postl: It is a step-down unit. That discussion has ranged from the need for four to six beds to be available. I think right now the discussions are focused on four beds which would allow the decanting out of intensive care of children who, for example, would be ventilator dependent and require assisted technology to breathe and therefore survive but who are in a stable clinical condition that would allow them not to have to reside in the intensive care unit which occurs most frequently in the extended care part of the intensive care unit. So it would provide an expansion of function that would create some more flexibility around the issues of ICU use in a post-operative recovery mode.

Mr. Chomiak: So the discussion is for a four to six bed unit at some location to be staffed by a determined number of individuals, and is there a time line? You talked about the spring. I asked the minister previously whether or not there had been any proposal to the government with respect to a capital plan of this nature and he indicated the negative, so I am trying to get some time line on the extent of the--what exactly the proposal is and when we might see it?

Mr. Praznik: Just to clarify that the proposal that is now being discussed would be one that would have to come as an additional proposal to our capital program, over and above the--was it $70 million or $90 million expected reconstruction projects at Health Sciences Centre. Mr. Webster may wish to comment on it.

Mr. Gordon Webster (Chief Executive Officer, Winnipeg Hospital Authority): Mr. Chairperson, I think that the project that the minister makes reference to is a longer-term one which will call for the redevelopment of ICU at the Children's Hospital. The other project that Dr. Postl makes reference to, the four to six step-down units that Dr. Postl just indicated, is something that with approval to proceed could likely be put in place within a month.

Mr. Chomiak: So as I understand it, there is a proposal for a step-down unit. We are hoping that it has not gone to the provincial government. We are hoping that the proposal will go to the provincial government and that if all approvals should occur in a relatively short period of time, we could see the development of this unit in as little as 30 or, let us say, 30 to 60 days. Is that feasible?

Mr. Postl: Yes, I think that is feasible. The issues frankly will be likely that there are some capital requirements. Those are not extensive. The issues will relate more to operating dollars and finding staff, which has yet to be tested.

Mr. Chomiak: Just for my own edification, what kind of dollars are we talking about for something like this? Four to six beds, step down and staffing. What are we looking at?

Mr. Praznik: Capital and operating.

Mr. Chomiak: Capital and operating. Is this something that is in the hundreds of thousands, or are we into the millions on this?

Mr. Postl: It would be in the hundreds of thousands.

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Mr. Chomiak: Should this take place, would we be fairly confident that the issues surrounding--keeping in mind that there is scheduling difficulties but assuming that this takes some of the pressure off the ICU beds that are used for post-op, can we assume generally that situations like the McCorrister case and the Guffei case, all things being equal, would not tend to be regular occurrences? Is that a fair statement, because of the pressure taken off the ICU beds, which apparently is the major problem, keeping in mind the issue of the respiratory illnesses that occur on a regular basis, as well as, the issue of the people on life supports? If the family and the surgeons were here in the committee today, could they have assurances generally that that type of occurrence would be less likely to occur in the next 12 months?

Mr. Postl: I think the answer is yes, that once received, if the proposal were approved and put in place, it would reduce the frequency of these kinds of events.

Mr. Chomiak: I have never understood what portion of the capital development of the overall HSC program relates to Children's. Can I get a description of what is planned to take place at Children's as a result of the capital redevelopment of HSC?

Mr. Praznik: Mr. Chair, that program with the Health Sciences Centre has been in the works for some time; in fact, its estimated value has gone up. Some things have been added and changed. Ms. Bakken, out of the capital program--because it has been in the works as I said prior to the WHA taking over and their inheriting that process, if they would like to maybe give some sense of that today, but Ms. Bakken would be the one with the greatest degree of background and information to answer that question. If Mr. Webster would like to comment, that is certainly fine, but Ms. Bakken would be the one with the longest history in that particular plan. We can have her answer that question if the member wishes.

Mr. Webster: Dr. Postl may be able to give you a high-level overview of what the plans are at Children's Hospital.

Mr. Postl: The intent regarding the children's component of the HSC project includes a new emergency room with a capacity of something like 30,000 patient visits annually, a new suite of O.R.s in juxtaposition to the adult O.R.s for the Health Sciences Centre. That is, I believe, six in number, and a new pediatric intensive care unit would be close to, a change in position to be closer to O.R.s and adult intensive care and the new pediatric emergency suite.

Mr. Mervin Tweed, Acting Chairperson, in the Chair

Mr. Chomiak: Mr. Chairperson, I think generally my question with respect to capital has been answered. I was concerned about the operating rooms and the I.C. in particular, but I see that they are both going to be redesigned. I guess I have to assume between now and the actual completion date, whether it is 2003, as I read in the paper on the weekend, or whether it is sooner or later, my real concern then goes back to, will we have and do we have enough capacity in the interim period to carry out the activities that are required, and can I have stats on the occupancy levels of Children's Hospital beds, beds occupied, et cetera?

Mr. Frank DeCock (Deputy Minister of Health): Mr. Chair, we do not have the occupancies broken down in the information we have with us on each one of the centres at the Health Sciences Centre. We have the total occupancy for Health Sciences Centre. But that information could be obtained directly from the hospital, and we will obtain it from them.

Mr. Chomiak: Thank you. I will look forward to receiving that information when it is tabled.

Just to return back to the general question, are we confident between now and the redevelopment, whenever it occurs, that we have sufficient capacity at Children's Hospital? I will tell you why I pose that question. Because even if approval goes through and four to six step-down units are put in place, do we have sufficient resources? Are Dr. Postl and Mr. Webster confident that we have sufficient resources to take us through until the redevelopment takes place or are there other alternatives or other options that we might have to look at between now and the actual redevelopment to ensure that services to children are provided sufficiently?

Mr. Webster: As part of the 90-day planning process that our 13 clinical service teams got involved with early in the current year when they were put in place, we expect that those plans will be finalized within the next couple of weeks and brought forward to Manitoba Health for their consideration and approval. One of those plans will be related to child health, and that particular topic will be addressed in those recommendations.

Mr. Chomiak: So there is a 90-day plan that is going forward to the provincial government calling for a variety of--am I correct? There is a 90-day plan going forward from the W--[interjection] Okay, perhaps to be clarified.

Mr. Praznik: Mr. Chair, when the WHA began its full operations on the 1st of April, they had in place the program teams in each of the 13 program areas--and perhaps Mr. Webster would like to explain this in greater detail--and they embarked as teams in talking to doctors and nurses and allied health care workers in each of their program areas across the Winnipeg hospitals in a 90-day process to develop their planning and proposal for what changes that they see should take place to improve the operation of the Winnipeg hospital system, and when I say improve, that is not just to get good value for our expenditure, but that is to improve medical care for patients.

The results of that process are what Mr. Webster is talking about, so when the member said 90-day plan, it is a 90-day planning process. The plan comes at the end of the process, just to clarify in terms of procedure.

Mr. Chairperson in the Chair

Mr. Chomiak: Can I get a breakdown of the participants in the 13 clinical programs, and, in addition, when this process was undertaken previously, several years ago, there was a regular newsletter that went out that outlined the status of each of the 13 programs as they proceeded. It was not 13; it might have been 11 at that time. I am sure the minister knows what I am referring to. Will we have that information available on a regular basis as well?

Mr. Praznik: On behalf of the WHA, I am tabling this list of program team leaders.

Mr. Chomiak: Just in terms of the organizational structure, how does Dr. Postl as the V.P. of Clinical Services--is Dr. Postl responsible for each of the 13 related clinical programs? Is that how the organizational structure works?

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Mr. Webster: Mr. Chairperson, the organizational chart that I tabled on Tuesday indicated on the bottom left, there was the Vice-President of Clinical Services with Dr. Postl and his team of an associate vice-president, nursing, and an associate vice-president, allied health. The 13 teams report to that group.

Mr. Chomiak: So, okay, I see where child health--we have women's health, surgery and medicine, dialysis, critical care, emergency, diagnostic imaging, family medicine, geriatrics, mental health, laboratories, oncology, anesthesia. We have a nursing director, an administrative director, an allied health director and a medical director. These individuals are responsible, I assume, for the overall city-wide program, is that correct?

Mr. Webster: They are starting to assume responsibility for that program on a city-wide basis in conjunction with their counterparts within the individual hospitals where those services are provided.

Mr. Chomiak: Just so that I understand the process, if we look at emergency, for example, we have a nursing director, a medical director, an administrative and allied health director. They, as a team, are going to be responsible, together with who from each of the various facilities, for the provision of emergency services in the city.

Mr. Webster: Mr. Chairperson, along with their counterparts. So each of the hospitals who would have an emergency department would have senior staff within the hospital responsible for the emergency department functions, and they would interrelate with the city-wide emergency team.

Mr. Chomiak: Will each of those 13 functions have an envelope budget responsible for the activities in that particular area?

Mr. Webster: Eventually they will. We do not have the comparative financial data on a hospital-by-hospital basis to determine programmed funding as of yet, but as that information is developed, more and more of the hospital resources will be funded on a program basis so that services can be co-ordinated.

Mr. Chomiak: As part of this 90-day organizational exercise or process, are each of these teams putting together a needs assessment in their area?

Mr. Postl: We, in the beginning of the 90-day process, did a number of things. We asked them to use as a starting point in their deliberations the urban design team's recommendations of several years ago, recognizing that that was a large effort that had undertaken a large amount of review. So in each case that was the starting point of their deliberations. They then reviewed the existent data available around the program volume requirements, what kinds of services were being provided at which sites, and met with each of the hospitals, the counterparts in each of the hospitals, within those programs to determine what if any changes would be worth recommending to either improve efficiencies or improve services within the hospital sector.

Mr. Chomiak: So do we have, if I recall correctly, for example, are we going along the lines that HSC will be the trauma centre, that there will be surgeries of a tertiary care nature at both St. Boniface and HSC and neurology based on the Wade Bell's? Are all those considerations still on? Is that process still on or where are we at on that?

Mr. Postl: We have not yet received the final reports, but we are making the assumption that those were all starting points that are being considered in what they are arriving at in terms of a plan, so I would be surprised if there was any considerable alteration from those principles.

Mr. Chomiak: Some of the pressing issues, for example, of neurologists, neurosurgeons, oncologist and their losses in the city of Winnipeg, how is that being addressed?

Mr. Postl: Mr. Chairperson, I do not have a simple answer for that. I think that recruitment of physicians to Winnipeg is a remarkable difficult set of issues that is tied to the nature of Winnipeg, the nature of the programs we have, and the manpower base in the country that is available, so that I think in all cases those positions are being recruited for. There has been, I understand although I am not involved, some increased capacity within the Manitoba Cancer Treatment and Research Foundation to assist in recruitment. The issue of neurology is a difficult one, because the demand is high and the national supply is not particularly high, so that it is a difficult set of recruitments.

Mr. Praznik: For the benefit of members opposite with respect specifically to oncology, earlier in the year they may recall that we provided the Manitoba Cancer Treatment and Research Foundation, slightly under an additional $1 million to aid their recruitment efforts to recruit six additional oncologists and I think four oncology associates. They have been busy with that effort. I know they have had at least one potential recruit in to visit me, if I remember correctly, as part of the recruitment drive. I do not have those numbers and their success, but the dollars to fund those positions have been put in place some time.

As part of our retention, there was some effort I believe in agreement there on remuneration issues. So I do not want it to go without saying that--I think it was two or three years ago that in fact happened--we have not been putting more financial resources as a ministry and as a government into those areas. But with respect to oncology, for example, one of the real difficulties is actually finding the oncologists and being able to recruit them.

Mr. Chomiak: Is the Manitoba Cancer Treatment Centre underneath the auspices of this team? Where do they fit within this framework?

Mr. Webster: MCTRF are not funded as part of the Winnipeg Hospital Authority, but when we established our program teams they requested that their senior management group be considered a program team for planning purposes within the WHA, because they have to rely on the Winnipeg hospital system to such an extent for many of their programs. So they are not funded as part of the WHA, but at their request they are part of our program structure.

Mr. Chomiak: Has the WHA engaged any consultants or any other outside bodies to undertake additional consulting and/or organization work?

Mr. Webster: The only consultants that we have engaged to date are to help us in the development of a vision and strategy for a long-term strategic plan for a regionally integrated health information system based on approval that we received from the government last June.

Mr. Chomiak: Who were those consultants, and is it possible to get a copy of that report?

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Mr. Webster: Mr. Chairperson, the report is due the middle of June. There were two consulting firms engaged, Price-Waterhouse and INSI to carry out both the review or development of a strategy for the information system as well as to review all of the year 2000 compliance issues with the core computer systems within the nine Winnipeg hospitals.

Mr. Chomiak: With respect to this organizational structure, where did this come from, and is there a precedent or another jurisdiction or locale that this structure is based upon, or is it completely a creation arising out of the initial troika teams that were set up several years ago.

Mr. Webster: The original urban design planning partnership recommendations in 1995 recommended the clinical program management structure. The material that I received from Manitoba Health when I was appointed to this position had a recommended organizational structure as part of that material based on discussions that I had with other similar authorities that have been established in Canada. I then brought forward a recommendation to Manitoba Health for what I believe the structure should look like and received approval.

Mr. Chomiak: As part of this planning process--and if I am repeating this, you will have to forgive me because it is the first time I have seen this actual chart--am I assuming that each of the teams will come up with recommendations that will feed into the 90-day planning process, that it will then be forwarded to the government at the end or around this 90-day period. Is that how the process is working?

Mr. Webster: The planning process is well underway, and as I indicated, we would expect that within the next 30 days or even sooner the recommendations from those 13 planning teams will be submitted to Manitoba Health.

Mr. Chomiak: So the recommendations will go from the WHA board to Manitoba Health, and there will be recommended action in all 13 areas. That is a fair assumption?

Mr. Webster: Mr. Chairperson, that is correct.

Mr. Praznik: My expectation as minister, the reason why in fact they are coming to Manitoba Health for approval--as I call in the new processes, just as we have done in rural Manitoba, we have wanted to work very closely with RHAs in their initial period. As they get on track, that will be distanced somewhat as RHAs develop their own track records. But also too within those I expect there will be recommendations for consolidation of programming, moving programming around the system which will affect individual hospitals. I think that is a fair assessment. So obviously we want to know--there are likely to be some very significant changes within the system from the kind of preliminary information I have been receiving.

So I think it is important from an overall point of view that the ministry have a role in supporting or working out any perceived problems we see with the recommendations as they come forward. To date I can tell the member that in areas where we have asked the WHA to take on a role and develop programming--like for example, in dialysis, we asked them to intervene earlier than April 1--we have seen, I think, great success.

Mr. Chomiak: How will the public and how will the various caregivers have input into this process?

Mr. Webster: Mr. Chairperson, with respect to the 90-day process that we are involved with right now, the caregivers, the health care professionals have been providing input through their service teams within the individual hospitals. The public input will commence in June of this year when the community health assessment is undertaken jointly between the Winnipeg Community and Long Term Care Authority and the Winnipeg Hospital Authority, which is a requirement under The Regional Health Authorities Act, that we undertake a community health assessment during our first year of existence. We will be doing that jointly for the city of Winnipeg with the other authority.

By clarification, the health care providers that have been involved in this process are primarily the ones working in the hospitals right now through the hospital teams.

Mr. Chomiak: So if I understand it correctly, there is a process whereby the various teams have been liaisoning with the hospitals. They are going to bring forward recommendations to the WHA board that is going to go to the government, and then sometime in June a community assessment is going to be undertaken jointly with the Long Term Care Authority to do a needs assessment study in the city of Winnipeg. Is that correct?

Mr. Webster: The community health assessment is separate from the planning process, and it will involve, I would suspect, surveys, forums and questionnaires and public meetings to get public input into the public perception of what the health care requirements are within the city and in fact the province because of the very significant provincial responsibilities for two of our hospitals.

Mr. Chomiak: But, am I assuming correctly that there will be recommendations that will go in? The minister has already indicated that, and I am just looking for confirmation that recommendations go in. For example, if we look at surgery, let us say that it is assumed that there is a need for expanded surgery at some of the facilities that are underutilized, and of course Seven Oaks comes up as an example and other facilities, so the assumption would be that if recommendations may come in to expand surgery at various other centres, presumably that recommendation would come in, that would take place and then subsequent to that, a consultation process will still, as well, occur. Is that a fair analysis of what is happening?

Mr. Webster: The recommendations that are coming forward, as I indicated likely within the next 30 days from the individual teams, will be very specific in nature as to where services should be provided within the hospitals, where it is possible to consolidate or expand programs and certainly to start utilizing the operating room facilities within our Winnipeg hospital system that are currently underutilized. But there will be some very, very specific recommendations, along with where we have been able to in the short term indicate the resource requirements, both funding and staffing, that would be required to implement those recommendations.

Mr. Chomiak: I have had discussions with the minister on this. It is significant by its absence that we do not have a program team with respect to laboratories. The minister indicated that there is going to be some kind of developments with respect to labs relatively shortly, and I am just wondering why there is no team, as it were, for labs.

Mr. Praznik: Mr. Chair, an excellent question. The reason why that has not happened is the decision as to where we would be moving on labs in the province has remained with the Ministry of Health, rather than being assigned to the Winnipeg Hospital Authority at this particular time. The reason is that we purchase lab services from--or we have lab services coming from our own provincial labs like Cadham, labs within the existing hospitals, private labs which the member and I have discussed. We have the Westman Lab out in Brandon, so we really have a lot of issues.

As the member knows, we put the Winnipeg hospital lab system out to proposals. We had a number of proposals. The winner of that proposal call and to try to negotiate a contract was MDS, whose partners are, I think, the Manitoba Association of Health Care Professionals. We have been in negotiations with them for somewhere near a year now, and these are coming to an end.

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I do not have an answer for the member as to whether or not we have a deal with them or we are going to embark on a different initiative. That is a decision that cabinet will have to make, and I have not yet taken the matter to cabinet. We are still doing some final assessment before I do. But I can tell the member once we have made a decision on the future lab issue, then the next question will be who will be responsible or the body that will be there for administering labs. One question is: do we assign that to the WHA? Obviously if we just consolidate Winnipeg laboratories, that makes sense. If we opt for a province-wide model, then do we use the Ministry of Health? Do we use some other entity to be the host for that? Those are all kinds of issues that I am still working through with my staff and will take the options to cabinet at some particular point for decision. But until we have gone through that process, it would be premature to have a lab program group within the WHA.

Mr. Chomiak: Is any consideration being given to a bridge-funding arrangement for the WHA in some of this program area to take care of deficiencies in the system up until the various programs are up and running and delivering service? Let me give you an example.

We may dispute this, but I think it is pretty clear in terms of mental health programs that there is some major program deficiency, and there is probably a dispute as to whether that is in the institutions or whether that is in the community. I would presume that there is going to be some recommendations with respect to mental health programs and then there is going to be a needs assessment that is going to take place in June. Clearly, there is not going to be definitive answers for some period of time.

If one assumes--and I am using that as an example--there are deficiencies in program, would it not make sense to put in place a bridging arrangement for perhaps this and other program areas where there are obvious deficiencies, and is that under consideration?

Mr. Praznik: Yes, it does make sense. One of the things we have said to the WHA is they have a budget, and our experience rurally has been an interesting one because when all of--and they are a year ahead of us in this process, ahead of where Winnipeg is--but as many administrators have told me, until they have actually got into running facilities and programs and getting into the intricacies of the budget, which takes some time, they are able to find and discover a lot of things, better ways of doing things and getting value out of the system that was not there before.

So what we have said to the WHA--they are starting off with a budget for the facilities that are there, that is a known. It is going to take them some years to understand those budgets and get into them very deeply. As Mr. Webster says, you cannot move to envelope funding for programs overnight because many of the hospitals are not able to break down their expenditures by program, which is interesting. So that has to develop.

So what we are saying to them is they start off with that base. We expect them to, firstly, be able to--where they can find savings within their system in doing things better, to use those dollars first--and I do not expect they are going to find them all overnight--and where additional dollars are required to bridge a service, solve a particular problem, short term and long term, to come forward with those proposals in those areas and they will certainly be entertained by us.

If last year's experience is any indication, we added nearly a hundred million dollars during the course of the year to our budget, and I expect that if we need to add additional services and it can be justified, whether it be on a bridge basis or on a permanent change in a program, then we will want those proposals. I have never said to them do not come forward with them. We will deal with them on a case-by-case basis. I have said that at this committee, and we will go to Treasury Board appropriately.

But what I do not want to do is establish a $15-million, $20-million, $10-million bridge fund without having the justification for how that is going to be spent, and also, too, I think they have to recognize that if there are things that they can draw out of the system by way of savings, they should--just for example, the $2.5 million that was lost on subsidizing cafeterias. We have indicated to them I think already, and they are indicating to the hospitals, that that money is coming out of that hospital budget. It is available for other things within health care. It is not coming out in savings, but it is not a priority of the people of this province to subsidize cafeteria meals in hospitals. The $2.5 million that was doing that is not available carte blanche anymore, but that is the area where dollars can be found here or there. The first call for bridge money should be on those obvious things and then, secondly, would be new proposals that the Treasury Board would entertain.

So nothing that legitimately needs to be done will go for want of reasonable resources, but I think cases have to be made on a case-by-case basis as we move forward, and that is the way we have done it rurally, and it has worked reasonably well.

Mr. Chomiak: I guess I am asking directly of the WHA, is that consideration a part of the planning process and structure?

Mr. Webster: Mr. Chairperson, we have asked our teams as they look at the Winnipeg hospital system to break down their recommendations into two categories; first of all, the longer-term recommendations that are going to have long-term systemic impact on the system and the shorter-term recommendations that they believe could be implemented to take the pressure off the system in the shorter time frame until they say the long-term one is going to be implemented, and on the short-term recommendations, we have also asked them to indicate the transitional funding that would be required to implement those short-term recommendations.

Mr. Chomiak: The system is broken down into 13 clinical teams, although there is a subprogram under dialysis, which the minister indicated that the province specifically asked for. The minister also indicated that the province is retaining ownership, if I can put it in those terms, of the laboratory programs. Is there any other area--

Mr. Praznik: For a while.

Mr. Chomiak: For a while, on a temporary basis. Are there any other programs that the province has indicated that it is taking a particular interest in ownership of or has asked for fast tracking? Is there anything else that is an exception that is on this list that I am not aware of? I will re-pose the question if the minister is not clear.

The minister has indicated that there was special interest taken by the province with respect to the dialysis program and a subprogram was set up. The minister has also indicated that laboratories are going to be taken, at least on a temporary basis, under the auspices of the province while those issues are worked out. Are there any other programs in these 13 clinical programs that the province is taking a special interest in of that nature?

Mr. Praznik: Mr. Chair, just to go through that list, dialysis, our interest was because we identified after a very frustrating process on behalf of myself and the ministry that where decisions were being made and planning done for dialysis, we recognized, I think, that there were three or four decision-making points that were not all well-connected. So I said that I wanted the whole provincial program to be run by the WHA, so we could have one program team running the provincial dialysis program, and because the Winnipeg hospital system was so central to that program, that that was best housed in the WHA as opposed to in the Ministry of Health, and they would do it under contract for the province.

Mr. Peter Dyck, Acting Chairperson, in the Chair

We also indicated in that case--and it made imminently good sense; I think the member would agree--that having one group of professionals running the dialysis program for the province made a lot more sense than having someone in charge of dialysis in each regional health authority and a very broken program. You could not do good planning or make good decision making, so we said to the WHA you run it on a province-wide basis for the ministry. We will pull the necessary dollars out of other budgets where there were dialysis budgets, and then you will simply contract with the regional health authorities to purchase staff time or space for the rural components of the program, but at least there would be one central direction for dialysis in the province. So that is why that has developed in that form, and I think it makes sense.

The other area he mentioned was labs, and that it is really a temporary issue until we settle where we are going, and then we will make a decision where that will ultimately be housed. If it is done on a province-wide basis, it obviously has to have a little different dimension than on a regional basis, so that is an area in which we are looking.

The cancer area with the Manitoba Cancer Research and Treatment Foundation today is outside, although they are involved with the WHA for planning purposes and should be. There is a bit of a history and a tradition here, and until we kind of sort out a few issues, they very well may flow into the Winnipeg Hospital Authority at some time as well with the responsibility for the provincial program, but that is not quite yet determined. So those would be the three. There may be another. I cannot think of one. Perhaps Mr. Webster would add to it, but those are the three areas that I would identify today.

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Mr. Chomiak: The assumption under the Urban Partnership planning process was that--and, you know, I am wracking my brain for the exact terminology, but I will try to paraphrase, and I can be corrected, but the essence was that one of the planning assumptions made was that people are mobile and in the city of Winnipeg, people can access any facility in the city of Winnipeg because of their mobility. There was actually a terminology that was used during the planning process that was made very clear to both physicians and patients, that mobility is not a deterrent to the program development and operations. Is that still the planning assumption of the WHA with respect to these 13 clinical programs?

Mr. Praznik: Before I let the WHA answer, one comment I would make with respect to that statement, again, one of principle, one of the other changes in this delivery of medicine that I have come to observe, and I know the member for Kildonan, I am sure he would not disagree with me, is the practice of medicine. New technology has led to greater specialization and subspecialization, which at the end of the day has gotten better results, much better results for those being treated, but when you get to more specialized and subspecialized practice you have to have enough people to be able to support a well-practised team of professionals delivering that service.

Dr. Postl and I have had some discussion about this, about the history of health care delivery. Probably 50 years ago in rural Manitoba, or certainly in the 1950s, early '60s, probably the vast majority of health care services available to an individual would be available through their local hospital, local doctor pool. That was not to say that all the services were rural, but the level of medical care was such that the vast majority of services you would need in a lifetime you can get in a relatively unsophisticated facility compared to today because that was all there was in terms of medical practice. The number of very sophisticated, specialized services were probably far fewer than they are today. So they were for much less things that you would go to Winnipeg or Toronto, et cetera, for treatment.

In most cases you had the illness and you did not survive it or you were treated with the treatment of the day, et cetera, and that could happen rurally or in a small community facility with the best results of the day. But with greater specialization, subspecialization, the application of greater technologies and the requirement for having well-practised teams and large and very specialized care, and of course you need larger population groups to be able to support those specialties.

So today I know, just in a casual conversation, we talked about probably in a rural community, sort of the traditional nonspecialized facility, you might only be able to get 50 percent of your medical care there today. Not because the service is not there. It is just that it is so well refined and specialized that it is only available in places that service a much larger population group. The good thing for the public is that the results are far better than they were in 1950. That is part of the evolution of medical care.

So I just wanted to add that to the member's comments. I think it is an important point to have on the record. But for the answer to the question, I turn things over to Dr. Postl and Mr. Webster.

Mr. Webster: Mr. Chairperson, I think that as we are looking at where services should be provided in Winnipeg, we are certainly conscious of the fact that people are mobile, but our focus is still on patient care so that we are going to combine the ability to utilize the hospital facilities we have, particularly the ones that are underutilized today, and focusing on patient care, what is best for patient care across the city.

In looking at it from a staff perspective, there has also been discussion on the moving of people. We are not going to be, again, arbitrarily moving staff around the system. The key there is if programs happen to be consolidated or moved, we have to be in a position where the staff, particularly the qualified staff that are part of those programs, if they wish to, should have the ability to move with the programs. That does not mean we are going to tell people they have to move, but for those staff who would like to move with the programs, we believe they should be able to move for the benefit of citizens so that we do not lose the quality of training that they have.

Mr. Chairperson in the Chair

Mr. Chomiak: One of the major difficulties that the urban group planning process that took place several years ago fell into was the public concern about the removal of programs from the local community. The typical couple of examples were the family that moved near a hospital because they had an asthmatic child or the senior citizens who live in an area accessible to their local hospital, because they want that range of services for themselves or for their loved ones.

Is that concept--that is, the concept of the community, full range of hospital services--still within the planning assumption of the WHA and the 13 clinical programs? Is that question clear?

Mr. Webster: I will comment first, Mr. Chairperson, and maybe Dr. Postl would like to. We recognize that all--particularly when you get into the community hospitals around the perimeter area in Winnipeg, they do provide community services to their local community, and those services will continue. When you are looking at the consolidation or rationalization of services or combining them, you are starting to look at the more highly specialized services that have to be combined in a specific location, but the day-to-day community services required by communities will continue to be provided by community hospitals.

Mr. Postl: I think that we are assuming that there are a core set of services which will include emergency rooms in the community hospitals, which will include general medical, probably geriatric bed use, rehab use and some surgical use that will be the core part of all of the facilities.

Mr. Chomiak: With regard to the emergency services, there were a series of recommendations coming out of the Lerner report circa 1970--because there was a couple of Lerner reports, but I think it was about 1994. There were a series of recommendations which included, I assume, because the talk has been that HSC will be the trauma centre, a whole series of recommendations regarding emergency care and clinic facilities at HSC and the like. Are those recommendations still on or still under consideration? Where are we moving in terms of emergency services, I guess, is the question.

Mr. Postl: We are anticipating the continued use of four community hospital emergency rooms, two tertiary care emergency rooms at HSC and St. Boniface, and the likely use of Misericordia Hospital as an urgent care centre with extended hours. Within that context, there are several issues that we are exploring around bed mapping, triage, interhospital transfers that all come into some of the discussion the Lerner report has had. So some of that is still active in discussion.

Mr. Chomiak: I take it from your answer, then, that Grace, Victoria, Seven Oaks and Concordia will all maintain their emergency rooms. Is that correct?

Mr. Postl: Yes.

Mr. Chomiak: Are there acts of consideration being given to surgery, under the surgery program, to surgery in places other than the hospitals in the city of Winnipeg?

Mr. Postl: There has been no discussion within the planning exercise that I have been aware of, of discussion of use of surgery centres or private surgical centres, no.

Mr. Chomiak: Under the area of children's health, are recommendations from the--it is probably not a fair question--the excellent children's health report of 1994 part of the process, the overall recommendations?

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Mr. Postl: Some of the issues in that report, Mr. Chairperson, are being addressed by the child health team and continue to be part of discussions with Manitoba Health.

Mr. Chomiak: When Dr. Postl referred to the child's health team, is he referring to the child's health clinical team, or is he referring to another body?

Mr. Postl: Mr. Chairperson, the child health clinical team listed in front of you.

Mr. Chomiak: Is the child's health team, because of the nature of that report and because of the nature of the recommendations, are they bringing in within their gamut other governmental departments and agencies or are they strictly limited to the medical field?

Mr. Postl: I do not think that there is any limit to their potential for interactions with other government departments. I think within government there is an ongoing secretariat that is also serving to bridge roles that the child health team is working with and corresponding with around certain of the issues.

Mr. Chomiak: Just so that I understand the process and let us go to child health as an example. It is indicated that we are a year or two, or we may be some time away, sooner or later, from an envelope funding--what would the budget of the child health envelope look like? It would include Children's Hospital, presumably, plus what?

Mr. Postl: I do not know the answer to that, Mr. Chairperson.

Mr. Praznik: I may not understand the member's question correctly, but if we are talking about looking at a complete envelope of care within the system for children, I do not know if he is talking about WHA, WCA, but I gather it would take a great deal of work to break that out and be able to put it in an envelope what one spends on children's health, both in the institutional side and the noninstitutional side and in the fee-for-service medical care side. It probably could be done, but it would certainly be a very significant exercise. Within Dr. Postl's envelope of authority is really just the hospital system today. So I am not sure if that answers his question.

Mr. Chomiak: Yes, that does answer the question, because I was trying to get some understanding of the scope and the breadth of the extent of this Child Health Program, and given Dr. Postl's extensive experience in other areas, I was curious as to how that information might be put together and actually proceeded on.

This week, there was a very significant report that was released by the nurses. Will the WHA be undertaking--putting all the politics aside on the issue--will the WHA be taking this report and assessing it, given the relatively significant issues raised by a considerable amount of the workforce and staff who work in the WHA? What response will the WHA make to this particular report?

Mr. Webster: Mr. Chairperson, even before the report had been tabled, our associate vice-president of nursing, which is shown on the chart as one of Dr. Postl's groups, had already met with representatives of MNU and discussed the issues around nursing within the city of Winnipeg, and particularly the shortages and the issues around working conditions, the issues around part-time as opposed to full-time nursing. I have also talked to Vera Chernecki about the results of the report, and she and I will be getting together in the next two weeks to look at some of those recommendations.

But I do know that Vera Chernecki and Jan Currie have already had a number of meetings and are planning on having many more meetings to address that issue. Brian, I am not sure if you have--[interjection]

Mr. Chomiak: I have a myriad of questions, and I have not even got to my card index file, but my colleague is here and wanted to ask some specific questions. I just wanted to ask two small questions before my colleague raises some issues.

The first is the minister indicated at our previous meeting that he would come to this committee with statistics on the impact of flu, and the minister indicated they are still undertaking to get it. So that answers that question.

My second question is--and I go back to where I began--because I am going to have to leave this committee and go back to the family, the Guffei family whose child's surgery was delayed, set for May and now set for June. Is there any way or how do we go about ensuring that this surgery can be moved up or accommodated to take a good deal of stress off this family, and I am not just using this as one? There are lots of examples of this. How did they go about cutting through--and we have talked about that hopefully they will put in place some step-down beds that eliminate the problem in the future. Between now and then, how do they cut through this process?

Everyone here is sincere. I recognize that no one is trying to put roadblocks in the way, but there are roadblocks. How can they cut through this, so they do not have to phone me and they do not have to phone the minister, and there does not have to be a newspaper article? How can they do this to move up to surgery, unless the assumption is that this is--because it is elective surgery, and good heavens, most things are elective--that it can wait till June?

Mr. Postl: Mr. Chairperson, I think one of the things we need to do is work closely with the surgeons involved to try to convince them that these are not new issues, they have been around for a long period of time in terms of access to ICU, the need to book in collaboration with other people who use the ICU, and to ensure that the surgeons are not creating expectations in patients that are both unfair to patients and unfair to the system. I honestly believe that is part of this issue.

Secondly, I think I will personally go to Children's Hospital and try to sort out exactly what the delays in scheduling are and see whether there are other ways of moving this up.

Mr. Chomiak: I appreciate that response, and at least in the interim period I think it has to be solved. I just want to indicate that you are right. The system has not been able to deliver. I have talked with numerous surgeons who have talked and letters have been written. I actually phoned over and talked with the head of ICU. Certainly there was almost a planning assumption because of the plug up of beds that surgery was going to have to be delayed. I guess we have to get over this. We have lived with it for a while and we should not live with this. This is simply not fair.

Mr. Daryl Reid (Transcona): I have a few questions dealing with the Manitoba epilepsy clinic. I have had the opportunity to ask this question in Question Period of the minister dealing with this issue but was not satisfied with the outcome of those particular questions. I have also had the opportunity to sit in meetings with Dr. Postl and members of the public and family members of individuals who are suffering with epilepsy in the province here. So I have a number of questions with respect to that particular issue.

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When I asked my questions of the minister, it was dealing with Dr. Pillay, who was an epileptologist here in the province, and I believe the only remaining epileptologist who is now, from my understanding, going to be leaving Manitoba to continue his research in Alberta, I think in Calgary if I am not mistaken, which leaves Manitoba I think at a disadvantage in that Dr. Pillay is well regarded in this province with respect to the research that he was undertaking here on behalf of people suffering with epilepsy.

Can you tell me: what does the future hold for the Manitoba epilepsy clinic and for the research work that Dr. Pillay was undertaking with respect to his vagus nerve implant process that he, I believe, was pioneering here in western Canada?

Mr. Postl: Well, I think through the internal medicine team that they are attempting to recruit a neurologist, that there is a clear view and understanding that recruitment is required. I think it is recognized that is a difficult process and is going to take some time. In the interim, I think they are trying to explore ways of providing the required coverage to patients with epilepsy and with other neurologic illness. Vis-a-vis the potential for research around nerve implants, I think that is very hard to predict. It depends very much on who is recruited insofar that generally people come with their own research interests, and the likelihood of finding an epileptologist with a very similar interest in research may or may not be possible. I think it just depends who is out there in the marketplace.

Mr. Reid: If I recall correctly, in the meeting that I attended right at the very beginning of February this year, there was some discussion that took place at that particular meeting with respect to the recruitment of epileptologists or people with a specialty in pediatric neurology. It is my understanding that for a province the size of Manitoba, if we use even our neighbouring province to the west of us, Saskatchewan, I believe they have three people who specialize in this area. It is my understanding that that process has been underway for a long time, long before the Winnipeg Hospital Authority came into existence. There does not seem to be any progress in this matter. We have been going on for a significant period of time, and you have been unable to recruit.

So I am trying to get an understanding here. How is it that Calgary can recruit people that are well regarded--I am talking specialists here now--in our province away from us? What is lacking in our process, our health care system here where other jurisdictions can draw our specialists away from us? What is it that they are seeking that they do not find here in our province to allow them to remain here and to continue their careers and provide treatment to the, what, 23,000 or so people that are suffering with epilepsy in Manitoba?

Mr. Praznik: Two answers, money and weather. I do not mean to diminish the member's question, but in dealing with all our recruitment issues, provinces like Manitoba and Saskatchewan, and the Maritime provinces, for example, have not been able to compete with the salary levels that other provinces have been able to offer. If you notice in the recent settlement between the Alberta Medical Association and the government of Alberta, their salary levels, remuneration levels in Alberta are considerably higher than most other provinces. What is interesting to note in British Columbia, who claims to have the highest levels of remuneration in the country--and we have seen doctors move to both Alberta and British Columbia--they do not have a happy medical community. In fact, they are in a pitted battle with the provincial government there today. So salary becomes an important part, or remuneration, and wealthier provinces have the ability to pay more for their medical services than those provinces that do not have the same financial wherewithal. So that is part of it.

Secondly, lifestyle also becomes a part of it. The prairie provinces like Manitoba and Saskatchewan that have much harsher and longer winters are not as attractive as places like British Columbia and certainly Calgary. In fact, we have seen many more physicians who have left here for Alberta go to Calgary than Edmonton. That seems to be a perception I have had at least--because of weather, and that city versus Edmonton. So one is always competing with that. I know in issues of recruitment with the U.S., a number of physicians that I spoke to who decided to go to the United States, the amounts of money that are being offered are just astronomical, in some cases, compared to anywhere in Canada for certain individuals. We just do not have the wherewithal to compete with that.

Secondly, a number of those physicians--I know I had a doctor in Beausejour who left, and it was not even a money issue because the position that he accepted in a clinic I believe in South Carolina did not really produce a larger income for him, but what it did do was it gave him more regular hours. He was practising in a rural community. He told me that if he continued to practise--it was in Beausejour where he was a doctor in the community 24 hours a day, seven days a week. He was not practising that, but everywhere he went he was--and I will keep his name confidential--but he was Dr. so-and-so. He felt he had no privacy, he had no life and he told me quite bluntly--I was at his retirement party in his own--it was not really a retirement party, it was his departure party for him and his family. I was in his own rec room, and he told me that if he did not leave, he would probably be dead in five years because he could not keep up the pace and he just needed to have a life. He managed to secure a clinic position with a regular 40- or 50-hour week, and he wanted to dedicate the rest of his time to his family and enjoying life. He was very blunt. He wanted to be in a warmer climate. He just was tired of the winters.

So when you have a profession that is highly mobile and has lots of options, and particularly as the member flags the point that this is a very rare specialty, that there are not a lot of physicians with these skills and that they are probably in great demand, those places that can offer a better lifestyle, which often means a warmer climate and certainly British Columbia and Calgary have that ability, and offer a higher level of remuneration, that they ultimately find that very attractive, and it is more difficult for us to compete in those particular areas.

Now on the other side of the coin, those provinces only need so many of anyone, so once they have sort of filled their slate, it makes it easier for the Manitobas and the Saskatchewans and the New Brunswicks and the Nova Scotias to be able to compete for those physicians. But that is very much a real part of this.

I know in our recruitment drives in oncology, where we have had greater success, in talking with the people from the Manitoba Cancer Treatment and Research Foundation, our oncologists who are practising in areas like Northern Ontario, or even if they are in a bigger province, they are practising in areas where they are not close to a larger city and some of the oncologists we have spoken to--and one I visited with was in a Northern Ontario community, and for his family there were just more opportunities being in Winnipeg than there were in a Northern Ontario centre.

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The same rules apply everywhere. It does make it somewhat difficult, and I think that individual was coming out again with his family to explore Manitoba, and what was attractive to him was a larger centre and the opportunity for his spouse to find employment. If the family liked it here and the spouse could find employment, that physician was prepared to relocate to Manitoba and that was far more attractive than the location in Northern Ontario. So we are all involved in that kind of set of issues, and that is the reality of recruitment. Mr. Webster may in fact want to comment further. I see him looking at his microphone.

Mr. Reid: Just to let the minister know, and he was not at that particular meeting at the beginning of February, but Dr. Pillay never at any time, to me, at that meeting or in private conversation ever indicated that money and weather was an issue. He was leaving, I believe from conversations that occurred at that meeting, as a result of some internal problems, internal to the Health Sciences Centre operations, which leads me to my next question.

Because Dr. Pillay is, I believe, leaving at the end of May, may be seeing his last patient at the end of May and moving to Calgary, and money and weather was not the issue with him, that there did not appear to be a commitment from Manitoba Health Services or from the Health Sciences Centre itself, what internal problems were encountered in the hospital. Can you indicate what those problems were and what steps have been taken to resolve those issues to, hopefully, prevent other people with those specialties from leaving Manitoba and also to encourage people to come here? Because any specialist, anybody doing work in those areas, has to know that if you come into an area where you are not receiving support from the administration of the hospital or through the Manitoba Health Services, that you are going into a potentially career-ending move, and no one wants to do that, especially when you have specialty areas.

So I would like to know what problems were encountered in the Health Sciences Centre hospital to discourage Dr. Pillay from remaining here, because it was not money and weather, and also to find out in addition to what those problems were, whether or not they have been resolved.

Mr. Praznik: Mr. Chair, the member has certainly asked a fair question, and I am going to have these two gentlemen respond to it.

My answer was in a generality, and I just use for example the discussions out of Brandon with the two pediatricians there to make my point. And there are always exceptions, and the individual doctors, the member is very right--if they are working in an environment where they are not comfortable or there are problems with whom they are working with, that discourages them to leave. If it is not a good working environment, it is harder to recruit.

But I just know, in many, many cases of the difficulty in seeing doctors depart the province, or difficulty in recruiting doctors, and that is an issue that I have spoken with with ministers of Health across the country; we all share that same issue. I was speaking in generalities, making a general statement, and there are other issues that sometimes come up in specific instances. So I will have those gentlemen answer the specifics around this particular physician.

Mr. Postl: Mr. Chairperson, I do not have a huge grasp of the details, but there were also clearly rather intense interpersonal difficulties involving Dr. Pillay that may have contributed to his decision to leave the city.

Mr. Reid: How does the statement go, deja vu all over again? We have Dr. Seshia, for which I wrote to the Minister of Health sometime back last fall, I believe early last fall, and I believe for which I still have not received a response. Dr. Seshia, from my understanding, also encountered similar interpersonal difficulties from my understanding of that particular case. I understand that there are decisions to be made by the management of any organization in dealing with employees of a facility. I am not foolish enough to expect that those things would not occur from time to time, but now we have another doctor with a specialty working in the same area encountering interpersonal difficulties. So does that not raise any red flags with the department and with the hospital itself on how these matters are being handled, and whether or not there is someone else perhaps--I do not know for certain, but perhaps--beyond the doctors themselves that can be the stumbling block or the roadblock in a process of trying to keep our specialists in this particular field in Manitoba?

Mr. Praznik: Mr. Chair, I have some very bad news for the member for Transcona. I can tell him that interpersonal difficulties between physicians and administrations and physicians' colleagues are part of everyday life in Manitoba Health. These are not just two examples; there are probably hundreds out there.

An Honourable Member: Two in the same department?

Mr. Praznik: If the member may hear me out. I can tell him that we, on a regular basis, hear from our administrators, hear from other physicians and physicians privately making statements about other physicians and how they relate and how they get along. We probably need the skills that the member for Crescentwood (Mr. Sale) could offer from his days in the ministry to settle some of these disputes. I tell him this very sincerely that, yes, sometimes one finds when everyone in a department or in an organization is having trouble that, yes, maybe the problem is with an administrator. In some cases, it is relationships between physicians. I can tell him, being a rural MLA, where you get to hear a lot about relationships in clinics and organizations in your own constituency, happy days are never a term that come to mind. Relationships are tough and people are always getting out of relationships and into new ones in the medical profession and practising with people. Much of this does not become part of public record, but it is certainly there.

I know with respect to Dr. Seshia--the only difficulty I have with this conversation is that it is somewhat unfair to these people from the Winnipeg Hospital Authority. If Dr. Seshia would like to have his whole file put on the public record with relation to this matter, I would have no problem if he would grant that permission, but there are two sides to the coin. I do not know how much information the member has. I was in the same position as him when this issue came up, and I forwarded it for review.

I do understand though and I think I am comfortable in saying this and perhaps my colleagues who are more aware can advise me if I am off track, but I understand that Dr. Seshia did agree to a third-party process to deal with his dispute, if I remember correctly, and he did consent to that process. He just did not like the result. I have been lobbied with respect to this, and I will tell you as minister that I am not going to get involved in these particular situations.

Now the member asks a very right question, though, and I do not want to use this to put off his question. If one sees a continual pattern in a particular area, it does beg the question: Is it the individuals who are raising this, or is there a problem? Because administrators are not always clear.

I can tell the member, too, we have had situations where administrators have made life miserable for everybody, and boards have had to remove them. So I think the real question here--and I would ask Mr. Webster and Dr. Postl to comment on it because they are the managers of these programs--is really, in my view, what steps, what do they do when they see these kinds of personalities? What kind of investigations do they conduct to ensure that the right change in personnel is being made to ensure some period of clear sailing, as opposed to perhaps the wrong thing happening and people having to leave? If we can perhaps pursue it from that point of view--I know the member is as sensitive as I am to this. One has to be a little bit careful because there are issues--we would not want to see us in a defamation suit or we would not want to be hurting individuals--but there is a lot of information that is not public and, quite frankly, should not be as a personnel matter. But his question about how you handle this, I do not want to make light of because it really is an important question.

Mr. Webster: Mr. Chairperson, I, obviously, just having been an official authority for three weeks now, a lot of this happened before we took place, and individual appointments to hospitals and the medical staff level have been the mandate of the hospitals in the past. In an attempt to address this more on a system-wide basis in the future, as we swing over to program management and we start to take responsibility for the individual programs, one of the initiatives we are putting in place is the development of system-wide medical staff by-laws, which will allow us to become involved in management of the physician issues on a system-wide basis as opposed to a hospital-by-hospital basis.

That will enable us, when we are looking at credentialing and privileges, to address problems that may exist within individual hospitals. It will also enable us to develop a medical manpower plan for the city as a whole as opposed to a hospital-by-hospital basis. So we will be able to determine what the needs are, not just for the city of Winnipeg, but for the province, in the specialty areas on a systemic basis as opposed to a facility-by-facility basis.

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Mr. Reid: Well, when you talk about credentials, I mean, I am not in my comments here to follow, I am not trying to slight any of the doctors that are, I am sure, doing their best to provide services to the patients, but it is my understanding that we have a doctor--and I will not use the name here--working within that particular department that does not possess the credentials that I believe either Dr. Seshia or Dr. Pillay possessed. I do not know if that is part of the problem or not; but, if you are going to a credentials type of system here, one would think that you would want to start at that particular point right now and take a look at the people that you have working in there.

If that is part of the problem that you have got and there are some medical skills that others sense that may not be possessed by that person in that capacity, maybe that is part of the problem, and maybe that needs to be looked at. I am sure the minister knows, and I do not want to put the name of the doctor on the record because I do not think it would be fair to that person. If it is part of the problem, perhaps there needs to be a process here of saying that that particular doctor needs to obtain the training necessary to obtain the credentials for the job that he or she is fulfilling at this particular time.

You know, the minister obviously knows this issue. The meetings--we have talked about some time ago that there was a recruitment process ongoing. It has been ongoing, from my understanding, now for a few years. This is not just a short period of time here. We are losing people here, and the people that are calling me--my constituents are calling me--and saying: what does the future hold for the epilepsy clinic? If we cannot retain the doctors here in those professions, what happens to the clinic? What happens to the patients? It is my understanding that 40 percent of the epilepsy cases are intractable and that Dr. Pillay was handling a great number of those cases and has pioneered, through that nerve-implant process, which, we hope, is at least a part of the solution to allow people to lead more normal lifestyles.

So I need to know, what are we doing here to ensure that that clinic can survive and that the work that Dr. Pillay was doing is going to remain there to benefit or to help the people that are suffering with epilepsy? Is that nerve implant process going to fall by the wayside? Are we going to have to send our patients to Saskatoon or to Calgary to have that type of implant trial undertaken, because it is my understand it is still in the trial phase here? What plans do we have?

I mean, there is obviously a greater cost if our patients have to leave the province and travel to another jurisdiction to have the surgery done versus having it done in province here and in the city of Winnipeg, for that matter, where it has been occurring now. It is my understanding that the nerve implant process has been reasonably successful, but the patients, from the information that is brought to my attention, are wondering now themselves, because the staff in the hospitals do not know how to deal with it. They do not know that you have to pass, for an example, a magnet over this particular device to trigger it to shut down the seizure.

If Dr. Pillay leaves at the end of May and the hospital staff are not trained about this new technology, these new benefits for the patients, how are the patients to have any security or sense or comfort that their needs are going to be addressed? That is the question they are asking me and one for which I do not have an answer. If you have been through a recruiting process for two or three years, what is our plan? Do we have a plan on how we are going to help these people in the future? There are a significant number of people who are affected by this, and we are not just talking a handful here, we are talking thousands.

So I need to know what the plan is to help people suffering with epilepsy so that I might be able to provide that answer back to my constituents that ask me those questions.

Mr. Postl: I do not have a specific answer other than that they are recruiting, and I know the remaining neurologists are determining how they are going to provide coverage to whatever residual functions need to be covered. So the intent is to provide that coverage, but I can try to find out and provide more specific information in that regard.

Mr. Reid: Well, I would appreciate any information that you can bring back in that regard. Can you tell me, did Manitoba Health or the Winnipeg Hospital Authority, did we try to recruit or set up some type of an arrangement with the doctors working in this field in Saskatchewan? I believe Saskatoon is where the doctors are providing those patient services. Did we try to have those services come from Saskatchewan even on a part-time basis?

Mr. Postl: In reference to pediatric neurology, is that what you are referring to? Yes, we did have some discussions with neurologists in Saskatoon about providing kind of locum or interim or part-time coverage in terms of call and support. At least at that point in those discussions, they were not prepared to do that.

Mr. Reid: So we can have, if we have 2 percent of our population affected by epilepsy, which would be, what, 23,000 people, if 40 percent of those are intractable cases, I mean, just do the rough math here, and we know how many thousand people are involved here. I am sure that the province of Saskatchewan probably has a fair caseload themselves. I am not sure how or why they would want to have their physicians come here and walk away from their caseload there. Is there nothing that we can do? The minister talked about money and lifestyle. I am not sure doctors operate on that particular plain. I have always seen them as being professional people, so maybe I am naive in this. The minister shakes his head here. Maybe I am being naive, but I have always seen doctors--maybe I have them on a pedestal here, and maybe that is not right--but I have I always seen them want to be professionals, particularly people doing research, that they would want to continue with that.

Has the Premier (Mr. Filmon), for example, been involved in trying to encourage Dr. Pillay to remain in the province? Is there nothing that the Minister of Health cannot try? Is there something that he can try to encourage Dr. Pillay to remain here? Is there something in the research area that we are not providing for him because it is my understanding that he is having some difficulties getting access to the implant devices that bear an expense for health services? Is there something we can do to assist in that regard to allow him to continue the research because, if he can continue with that implant program, it will help Manitoba people without our people having to go out of the province to receive that service?

Mr. Praznik: Sometimes in the great bureaucracy that Health can be, particularly in an institution like the Health Sciences Centre, it does not surprise me from time to time when sometimes some innocuous funding arrangement or particular issue becomes a huge irritant to an individual in the system. It happens regularly, and it is the nature of the beast, I guess. One of my frustrations is sometimes things happen without thinking across government.

If there is a particular issue of that vein that is a concern to this particular doctor, then we would certainly want to know about it to correct it. If it is a matter of not being able to access through a budget some particular equipment or devices that he requires and he is just getting nowhere and a brick wall, we certainly want to know about it. So I am going to have Mr. Webster and his authority undertake to check that out and to find out if in fact that is the case with Dr. Pillay. There may be a lot of other things here that the member and I are not aware in terms of relationships.

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You know again, one of the things I have found as these things tend to unwind that, when you have people who are working on the leading edges of technology and in very intense environments, personal relationships either gel very well or they are very strained. The one thing no minister or no government can ever do is fix all those relationships. There may be things here that are just unfixable, but if it is a matter of some irritant in the way that we fund or his inability to access something they need and he has been hitting the regular bureaucratic wall that this cannot be done--and I share with members some of the frustrations of a physician who came to see me from Concordia who could install pacemakers at the Concordia operating rooms but had to do it at St. Boniface because the pacemakers themselves came out of the St. Boniface budget and that hospital insisted that the surgery be done in their hospital rather than outside because it was in their budget.

Consequently, with crowded surgery rooms, we were using them for something we did not need because hospitals were turf-fighting over where work would be done to keep patient numbers high. That is just what the Winnipeg Hospital Authority has been designed for; one of their prime purposes is to eliminate that kind of absolute nonsense.

I remember as well finding out that we would not allow use of certain kind of ultrasounds in community hospitals unless the doctor practised in that hospital, and that had to do with budgeting for hospitals and the way we budget. It was silly. Everybody is a taxpayer, and it is one system, but if you perpetuate these kind of institutional walls between, well, this is our hospital, and that is your hospital, and we have our independent board, and we are the providers of service, and you are the payers. I have heard that so many times in the last year and a half, it can make me ill, Mr. Chair, because at the end of the day the only people who are being hurt are the patients of Manitoba.

What I hear the member saying is, is there an effort that can be made to see if there is one of these types of irritants that our bureaucratic-paper, institutional-driven that has made it--if that is the root cause of this physician's desire to leave? By the way, I have seen that happen before. I would not downplay it. Sometimes you wonder why somebody is so angry over something, and it is everything else in the world. You sit down and, after digging, you find out that it is some silly little thing way down the line that nobody ever realized was preventing the person from doing the work, and it has added up over the years and come out in another form in that person's mind. If you can solve that, it makes a difference.

So I am just going to have Mr. Webster undertake to pursue this, keeping in mind, of course, that today the Health Sciences Centre still has its independent board and is the employer here, and we are only in the process of taking over that role, but certainly the WHA can endeavour to investigate this matter. I think Mr. Webster may want to give that undertaking.

Mr. Reid: Can you tell me what the waiting list is for diagnosis of people that suffer seizures? How many people would we have on the waiting list currently, and what are the historical values?

Mr. Postl: I have to find out the specific number. I think that it varies somewhat with the kind of illness that is associated with the seizures. In acute context, in terms of actually seeing a neurologist following an acute first event, I think the waiting list is quite short. In terms of the follow-up and maintenance needs of those patients, it would vary in terms of frequency of being seen between months and a year, I would guess, but I can get those numbers.

Mr. Reid: I would look forward to receiving that information to find out how long people have to wait to have some diagnosis of their situation, and whether or not they are a part of the 40 percent intractables versus those that can be treated through some other procedures or perhaps medications.

Can you tell me, for a province the size of Manitoba, how many neurologists should we have that would deal with seizures, with epilepsy? What would be the normal for the province of Manitoba? What would you expect? What would you want to have for our province in numbers? Dealing with epilepsy, I am talking about.

Ms. Sue Hicks (Associate Deputy Minister, External Programs and Operations): Mr. Chairperson, looking at neurologists in general for the province, we can get that information for you. As far as neurologists who are dealing specifically with epilepsy, I do not know that we would have that figure but, from a province-wide basis, I know there has been some work on looking at what we should have in this province. I can get those numbers for you.

Mr. Reid: I appreciate that undertaking. Would it be reasonable to say that we would need at least three people specializing in those areas for a province of this size? Because I think, if I am understanding correctly, Saskatchewan may have that number of people working and specializing in the epilepsy area. We are a similar population size, and I am just wondering if that would be what our expectation would be for this province as well?

Ms. Hicks: Mr. Chairperson, we do not really have a specific number there.

Mr. Reid: If you can, when you come back with your information with respect to the waiting lists and the number of people that would be required, could you give me an indication too of how long this recruitment process has been ongoing to find people specializing in this particular field so that we would be aware of what efforts have been made and how long you have been attempting to solve this? Perhaps this would be more directed towards the minister, because the Winnipeg Hospital Authority was not an entity at the time that this, hopefully, research was undertaken.

Mr. Webster: Mr. Chairperson, we can certainly undertake to get that information.

Mr. Tim Sale (Crescentwood): I just want to introduce an area in which we are going to have to reschedule, I believe probably for Monday, because I do not believe these gentlemen are with us this afternoon. I want to--sorry. [interjection] Clarification? Then we can certainly do some of this this afternoon. I will now just introduce it so that people have a chance, I guess, over lunch to think about the area that we want to explore.

I want to put on the record that it is our understanding and the understanding of Misericordia's board that the WHA has basically no responsibility for the decision that was made to change Misericordia to a long-term care facility with interim beds and a 24-hour walk-in centre, et cetera. This was a decision reached by government and communicated by letter, which I have a copy, to Misericordia Hospital and was the subject of a meeting on, I think, the Wednesday before the budget, which Dr. Postl and Mr. Fast attended.

Information was communicated to the board of Misericordia Hospital that this was a policy decision of government, it was not a WHA decision, and that it was not a decision that was up for any discussion. It was simply a position the government had reached and wished to communicate to Misericordia, that Misericordia was expected to respond either in agreement or not in agreement, but that the decision in any case had to be reached no later than 24 hours from the time of that meeting, in principle at least, and that was because the matter had, without Misericordia's awareness, been placed in the budget and was in the budget document. We had that debate in the House, and I think that is all a matter of record.

So the issues that we want to explore with the members of the WHA and the minister are matters of planning and policy, and, in particular, we want to know in very specific form what mechanisms are going to be used to ensure both the patients and the professional people, nurses and specialists and physicians, who have developed in Misericordia Hospital programs which might reasonably be called programs of excellence, at least according to the hospital and the physicians who have told us about them. Under the mandate, I might add, of the Minister of Health and his predecessors, which called--

Mr. Chairperson: Order, please. If this committee wishes to go a little bit further--

Mr. Praznik: If members would indulge a few moments because just by the member's comments, I met with Dr. Postl this Tuesday night with Misericordia, and I would like to update the committee on that and that Dr. Postl was involved in that meeting with Misericordia. He is not here this afternoon. I think he should have a chance to respond to the member.

Mr. Chairperson: Is it the wish of the committee to--

Mr. Praznik: Just a few minutes, five or 10 minutes.

Mr. Chairperson: Order, please--extend our sitting time right now, or you do not want that?

Mr. Praznik: Five or 10 minutes.

Mr. Sale: I think that our member's view, Mr. Chairperson--

Mr. Praznik: You have raised a matter involving Dr.--

Mr. Sale: Also, just note for the record that I did not cede the floor to the minister. I was interrupted, and it was not interruption on the point of order. It is not our view that we should extend at this time, that we should come back to this on Monday when Dr. Postl would be available.

Mr. Chairperson: Order, please. The time being 12 noon, I am interrupting proceedings, and the Committee of Supply will resume sitting this afternoon following the conclusion of Routine Proceedings.