MR. SPEAKER: This being Private Members’ Day, the private member’s motion put forward by the hon. the Leader of the Opposition.

MR. KELVIN PARSONS: On a point of order, Mr. Speaker.

MR. SPEAKER: Is the hon. the Opposition House Leader rising on a point of order?

MR. KELVIN PARSONS: Yes.

MR. SPEAKER: The hon. the Opposition House Leader on a point of order, keeping in mind that it is 3:00 o’clock and it being Private Members’ Day.

MR. KELVIN PARSONS: In fact, Mr. Speaker, it relates to the motion that is before the House today, the private member’s motion. So I guess probably the more opportune time to do it would be once that motion is actually called for today.

Thank you.

MR. SPEAKER: The hon. the Member for the District of Cartwright-L’Anse au Clair.

The hon. the Opposition House Leader.

MR. KELVIN PARSONS: Sorry for the confusion, Mr. Speaker.

In regard to the motion put forward by the Leader of the Opposition, the Member for Cartwright-L’Anse au Clair, yesterday with regard to Medical Transportation Assistance Program, there have been some discussions by various persons, the Table Officers, the Government House Leader and myself, and it is felt that an amendment would be in order before we started the proceedings and debate on this motion, that I would on behalf of the Member for Cartwright-L’Anse au Clair - and I was the seconder to that motion as well - and that is in the last paragraph, the therefore be it resolved clause, it makes mention to the word "make" in the second sentence. We would ask that the word "make" be deleted, and we would insert in its place the words "consider making". That would, apparently, make the motion more palatable to all concerned. So we would move that amendment.

Thank you.

MR. SPEAKER: Does the hon. the Government House Leader want to respond to that particular amendment to the motion?

MS BURKE: Yes, Mr. Speaker, we were in consultation with the Opposition House Leader and the Table Officers regarding the motion that was put forward, because as it read indicated or called upon government to expend funds, which certainly would be what we probably felt was a motion that was out of order.

So with the changes, that would now say, "THEREFOR BE IT RESOLVED that the House of Assembly calls upon Government to consider making changes…" Certainly, they are asking government now for consideration, as opposed to a motion that requires government to spend money. So, from our perspective we have no problem with the amendment as put forward by the Opposition House Leader.

MR. SPEAKER: In order for a motion to be moved to amend a resolution, our Standing Order 55 states that it must be done at a previous sitting; but our House of Assembly not only makes but can change its own rulings and precedents. In order for the change to be made here today at the present sitting, it will have to be done by leave.

Does the hon. Opposition House Leader have leave to change the motion as put forward by the hon. the Leader of the Opposition?

MS BURKE: Yes, Mr. Speaker.

MR. SPEAKER: By leave?

MS BURKE: By leave.

MR. SPEAKER: The hon. the Member for Cartwright-L’Anse au Clair and Opposition Leader, by leave.

MS JONES: Thank you, Mr. Speaker.

It is a pleasure for me today to rise and speak to the motion that has been put forward as a part of our Private Members’ Day debate.

I would like to read the motion for the record, Mr. Speaker, just so members do not think I might have changed it since yesterday when I tabled it in the House of Assembly.

WHEREAS the Newfoundland and Labrador Medical Transportation Assistance Program assists residents financially in accessing medical services; and

WHEREAS the Medical Transportation Assistance Program’s current criteria do not sufficiently provide the financial support for its residents who must travel to avail of medical services in our Province; and

Mr. Speaker, we are bringing this motion forward today in light of the fact that we are on the eve of a Budget and realizing that this is an issue that affects many people - hundreds of people, thousands of people - across Newfoundland and Labrador. It is not new concerns; these concerns have been raised in the House of Assembly on many occasions over the past year and they have been raised in the public.

First of all, Mr. Speaker, for those who may not understand what the Medical Transportation Assistance Program is, it is a program that assists with the cost of air travel or bus service or taxi service or accommodations and meals in accessing medical treatment, but there are certain rules and regulations around those accessible costs that restrict a number of people in the Province from being able to use the program.

Mr. Speaker, this program was actually started in 1998. It has been ongoing in the Province for the last twelve years. It has helped thousands of Newfoundlanders and Labradorians at a time when they were financially unable to access health care. Yet, Mr. Speaker, in all that time we still only have something like 6 per cent of the population that are taking up the program.

Last year the budgeted amount of the program was $1.9 million, which is a relatively small amount when you look at the geography of Newfoundland and Labrador, when you look at the fact that we have only one tertiary care facility which happens to be based in St. John’s, and that you have most people in the Province being referred to either St. John’s or Corner Brook for different medical procedures and treatments.

Mr. Speaker, we have had many incidents come to our office from people all over Newfoundland and Labrador who have really fallen through the cracks of this program. Although it was intended to alleviate financial hardship on those who needed it, there are many who need it and are not able to access it, and I will give you some examples.

Mr. Speaker, for example, right now road mileage or reimbursement of road travel is not included in the program. Although the program says if you have to access a health care facility more than 200 kilometres away from your home that you are eligible for certain expenses, those expenses include whether you take an aircraft, whether you get a hotel or a hostel when you are there, and some of your meals; it does not include road travel.

As you know, many people in this Province are forced to access hospital facilities by road for a number of reasons. One, it costs more by air and they have to pay up front, so oftentimes they do not have the money for the airline ticket. In other cases, Mr. Speaker, they want to bring a family member, a spouse, a parent or someone else with them for care and for service while they are seeking medical appointments outside of their area. Therefore, to drive lowers the cost but mileage is not included.

Mr. Speaker, if you look at people who are on the Burin Peninsula, for example - because this is one of the areas where we have gotten a number of calls - if you live in Grand Bank or you live in Burin or in Lamaline, or any of those communities on the Burin Peninsula, you do not have the opportunity to take an aircraft to hospital in St. John’s. You have to drive. You have to drive the more than 400 kilometres each way to access that service. Right now, they are not able to claim any road assistance or road mileage under this program. For example, if you live on the West Coast of Newfoundland, if you are living in Burgeo, or if you are living in the Bay of Islands, or if you are living in Pasadena, or even Hampton, any of those places where they have come back and forth to St. John’s for treatment.

In fact, Mr. Speaker, I had a relative of mine who lives in the Sop’s Arm area who had to come back and forth to St. John’s at least half a dozen times in the last year for medical treatment, but they were not eligible to claim any of those expenses because they were travelling by road.

The same applies if you live on the Northern Peninsula, or if you live in Southern Labrador, or even now with the road opening into Goose Bay and Labrador City people have the option to drive to a health care facility, especially if they are going to be there for an extended period of time, or if they do not have the money up front to pay for an expensive airline ticket, oftentimes the gas is cheaper to travel by road.

Mr. Speaker, I had a case in my own district of a lady who suffered with cancer and spent two years making up to eight trips a year back and forth to St. John’s, to the Health Sciences Centre, and they drove all of those trips back and forth because she needed her husband to be with her when she came for her care. The cost of flying that many times throughout the year was basically the cost of their annual income, almost. If you are earning a fixed income of $1,200 or $1,500 a month and your airline ticket for both of you for that one trip to a hospital is costing nearly $2,000 a month, then you know you cannot afford those kinds of costs, so they had to drive. They made many, many trips for her care but were never eligible to claim those particular costs because they came by vehicle.

Mr. Speaker, I was in Labrador West a few weeks ago, an area where all people in that community are being referred to Goose Bay for a CT scan. Hopefully, in the Budget the minister will find CT scan equipment for Labrador West, because right now the cost that they are paying to subsidize flying everyone into Goose Bay to have this test done, surely it must be cheaper to put the equipment at the hospital in Lab West.

Having said that, Mr. Speaker, they can fly on a voucher subsidized by the government where the government will pay up to $700 in a subsidy – or probably more some days – to get that one person from Lab City to Goose Bay to have a CT scan done, which is excellent, no problem with it, but if that individual wanted to drive from Lab West to Goose Bay so they could take a family member with them, they would not be able to claim any expenses; yet, the cost of driving and their road claim would probably be a third of what the subsidy is on the airline.

So what I am saying to government is that by including road mileage, I do not think you are going to drive the cost of the program up. I think that you are going to see – and I am not saying that you are going to make the cost of it go down, either, but what I am saying is that you are giving people an option.

Today, if I was living in Baie Verte today, in King’s Point - the member for that area gave a statement today on the children in a school in King’s Point, the boy’s basketball team that won the medal this weekend. I happened to be at their game, I happened to watch their game, and I presented their medals to them. Mr. Speaker, he talked about them today in that community. Well, the people in that community today who have to go to hospital in St. John’s or some other part of the Province, they are not able to access any subsidy for their road travel, which I think is not fair. I think we need to start allowing for that kind of a program to be implemented, to try and relieve the financial burden that we are placing on people.

You have to realize, it is one thing for us to say we need a centre of excellence for health care in this Province, and I totally agree with that. I totally support it; I totally feel that we do need that. I think that we need to continue to build on our services, our tertiary care services in St. John’s and our specialist services, but if we are going to expect everyone else in the Province to come here to access those services, we have to make it a little bit more affordable for them to do so. That is the reason for my motion today, Mr. Speaker.

The other thing I am asking for is that – one time, originally when this program was implemented, if you came to St. John’s or went to Corner Brook or Goose Bay or wherever to a hospital and you stayed with a friend, you could actually claim your meals and your overnight lodging for private accommodations; something that we are still allowed to do as politicians. If I go into a community in this Province, if I go to Gander next week and I stay with someone I know, I am entitled to claim my meals and my private accommodations, but government cut that out of the medical travel program.

So, for patients who are sick and have to go to Gander because they are sick and end up staying with a friend or relative, they are not allowed to get private accommodation allowance or meals, but as a politician I am allowed to go and claim it. That is not acceptable; it is not fair. These people can least afford it. They are at the time when they are most ill. They are at a time when they need financial supports and you guys took that support from them. You cancelled that aspect of the program and you need to bring it back.

The other thing we are asking, Mr. Speaker, is that the $400 deductible for Island residents needs to be taken out. In Labrador now, how the program works - and it works very well I say, and I commend the former, former Minister of Health, the Member for Trinity North, Mr. Speaker, who actually took a sympathetic ear to what was happening in Labrador and did make a policy change in this program that allowed for people in Labrador to claim up to $1,000 a year in medical travel, and then anything over $1,000 they could claim 50 per cent of it. It works well, with a few exceptions like including road travel, like including the private accommodations and meals and those are the things I am talking about. The base amount, the floor amount, is a good effort and it has helped a lot of people.

On the Island portion of the Province, it is done very differently. There is no floor amount. For example, the first $400 you spend in a year you pay it out of your own pocket. The next $100 you spend, you can get reimbursed for it; then anything over $500 that you spend, you can get 50 per cent of it back. Well, we are saying: Do away with the deductible. Put it in at a $500 flat fee so that if you live anywhere on the Island of Newfoundland, if you are one of those people on the Burin Peninsula or the Port au Port Peninsula or the Bonavista Peninsula or the Baie Verte Peninsula, Mr. Speaker, the Northern Peninsula; then you will have the opportunity within a year to claim up to $500 of your medical expenses when you are required to travel outside of your area, over 200 kilometres one way to access medical services. We think that is fair, Mr. Speaker. Then, anything over that $500, people could claim up to 50 per cent back.

We are asking this because people are telling us that more and more they are being referred to hospitals outside of their area. For example, more and more we are getting a contingent of people on the West Coast of Newfoundland, on the Northern Peninsula region being referred to Corner Brook hospital. Most of them drive more than 200 kilometres each way to access that service. More and more we are getting people, Mr. Speaker, on the Burin Peninsula and in the Central Newfoundland area, being referred to St. John’s for speciality services, for cancer treatments in particular, and so on, and radiation treatments, and very specialized services. This is happening more -

MR. SPEAKER (T. Osborne): Order, please!

I remind the hon. member that her time for speaking has expired.

MS JONES: Thank you, Mr. Speaker.

I will have a chance to conclude my comments at the end, and I thank members for listening.

MR. SPEAKER: The hon. the Minister of Health and Community Services.

SOME HON. MEMBERS: Hear, hear!

MR. KENNEDY: Thank you, Mr. Speaker.

Thank you, Mr. Speaker, for the opportunity to speak to this private member’s motion. The Medical Transportation Assistance Program was introduced on April 1, 1998. To date, the program, it is my understanding, Mr. Speaker, is one of the most comprehensive programs in Canada in terms of scope of coverage. The program assists eligible residents who incur substantial costs when travelling for insured services not available within their immediate area or within the Province. The program is open to patients and family members who receive the appropriate referral from a physician, such as a general practitioner for in-province travel, and a specialist for out-of-province travel.

Our government, Mr. Speaker, has provided approximately $2 million in 2009-2010 for the Medical Transportation Assistance Program and is dedicated to providing a health care system where all residents have equitable access to essential medical treatment. This brings the total annual investment, Mr. Speaker, by this government, over the past three years, close to $5 million. The program provides assistance to residents or families on a cost-shared basis and may assist with medical travel expenses including: commercial air service, taxi services when used in conjunction with commercial air services, commercial ferry services, registered bussing services, purchased registered accommodations and meal per diems for each day of eligible accommodation.

Mr. Speaker, the program has helped a significant number of patients throughout the Province of Newfoundland and Labrador get the medical care they need. In 2007-2008, Mr. Speaker, 1,288 clients utilized the Medical Transportation Assistance Program; 1,530 clients in 2008-2009; and an estimated 1,311 clients for this current fiscal year. Our government, Mr. Speaker, is committed to providing patients with timely access to treatment and the Medical Transportation Assistance Program has ensured that approximately 4,100 individuals are receiving exactly that.

Mr. Speaker, in recent years we have continued efforts to provide a more responsive program to the client base it serves. On April 1, 2005, the $500 deductible for Labrador residents was eliminated. We also ensured, Mr. Speaker, that Labrador residents were reimbursed the first $500 of claimable expenses during a twelve-month period with a claimable balance cost-shared at 50 per cent. On May 1, 2007, Mr. Speaker, reimbursement of the first $500 of claimable expenses during a twelve-month period was increased to $1,000 with the claimable balance cost-shared at 50 per cent for those clients.

On February 1, 2006, Mr. Speaker, the program was enhanced to assist Labradorians and residents from the Island portion of our Province travelling via road for a distance of 200 kilometres or more one way and registered purchased accommodations in order to access insured services. In these instances, Mr. Speaker, the program assists with purchased registered accommodations and applicable meal per diems for each night of medically required purchased registered accommodations.

Mr. Speaker, on July 1, 2007 the purchased registered accommodations per diem increased from $75 to $125. The monthly cap on purchased registered accommodations claimable increased from $1,000 to $1,500. The monthly meal allowance claimable in conjunction with purchased registered accommodations increased from $600 to $700 and reimbursement of claimable expenses in excess of $5,000 during a twelve-month period increased from 50 per cent to 65 per cent. On July 1, 2007, Mr. Speaker, the $500 deductible was reduced to $400 for residents of the Island portion of the Province.

Mr. Speaker, we have made enormous strides in ensuring that the program provides an acceptable level of support for those requiring specialized medical treatment within and outside of our Province. However, this type of assistance, Mr. Speaker - it is important to emphasize this, that this type of assistance is only part of how our government is responding to patient needs. Our government, Mr. Speaker - as you heard the other day from the Throne Speech and also I think the Premier referred to this - has made enormous strides in ensuring that the program in rural Newfoundland and Labrador respond to the required needs of our population. What we are trying to do, Mr. Speaker, is to help decrease the need for residents having to travel to other parts of the Province to receive these medical diagnoses and treatments they require.

Obviously, Mr. Speaker, any patient who can access a required medical service in his or her own community or nearby will want to avail of that as opposed to travelling hundreds of kilometres, for example, from Corner Brook to St. John’s.

We have proven, Mr. Speaker, through these strategic investments, and that is what it has to be, strategic investments, because the reality is – and this is one of the things I am hoping to do later on this year is to go to various parts of the Province and hear from the people of the Province what they expect from their health care system. What we are trying to do is utilize the money we have, Mr. Speaker, to ensure efficient, effective service.

Mr. Speaker, I have used examples in the past of how when we spoke to the people of Flower’s Cove, we spoke to the people of Lewisporte, they were reasonable to deal with in terms of what they expected from our health care system. When you say to people, Mr. Speaker, this is what we have or this is what we can do, or what are your priorities, my experience, in the short time I have been Health Minister, is that people are willing to co-operate and that people do understand. In other words, Mr. Speaker, people are reasonable.

Our health care system, Mr. Speaker, by its very nature evokes emotional responses. That is one thing I realize, Mr. Speaker, with the e-mails I get on a daily basis, that when people have their loved ones who are affected, whether it be your parents, your children, your grandparents, that people want answers. Unfortunately, Mr. Speaker, we cannot solve every problem, but I certainly understand the emotion and the need for a response in terms of trying to solve the problem.

Mr. Speaker, what we are trying to do when we look at how we are going to put our medical services throughout the Province is look at our patients because as I repeated on numerous occasions, it is about the patients. It is about taking the money that we have and utilizing it as best we can. As a government, Mr. Speaker, we look at this rather big Province, the Island portion, and also Labrador and seeing how can we strategically place our investments to ensure the maximum use and the maximum benefit for all residents of our Province.

Mr. Speaker, certain pieces of equipment will be obviously located in bigger centres. Certain tests and procedures will have to be completed in St. John’s, and hopefully in places like Corner Brook or Gander. What we are trying to do is ensure that people can, wherever possible, receive their treatment closer to home.

Mr. Speaker, we recently announced that we will invest $500,000 to expand the hours of operation for the satellite dialysis unit in Clarenville. Effective March 31, 2010, Mr. Speaker, dialysis services will be offered an additional three days per week, effectively doubling the availability of services at that location. Our significant investment in new dialysis sites throughout the Province demonstrates our commitment to providing quality health care services.

My understanding, Mr. Speaker, is that dialysis patients can receive three treatments a week. I am not sure if it is more or less, it may depend on the severity of the illness, but if you are living in one place and have to travel hours on end to get to another place, that certainly is – it is more than inconvenient, Mr. Speaker. It is something that we have to, as a government, as best we can, avoid. Now, not in all circumstances can we do that in a Province that is geographically as large as ours with a significant rural component.

Mr. Speaker, since 2004 this government has established new dialysis sites, in Burin, Carbonear, Gander, St. Anthony, and Happy Valley-Goose Bay. The annual cost in 2008-2009 to operate all dialysis units throughout our Province was approximately $20 million, which is up 9 per cent from 2007-2008.

Budget 2009, Mr. Speaker, provided an investment of $50 million for funding new health equipment to be added across the Province. Investments included $3 million in laboratory equipment at the health facilities in St. John’s, Gander, Brookfield, Twillingate, Grand Falls-Windsor, Corner Brook, St. Anthony, Happy Valley-Goose Bay and Labrador City; $1.2 million for a nuclear medicine gamma camera in Corner Brook; $1 million to replace a CT scanner in Grand Falls-Windsor; $75,000 for an endoscopy unit in Stephenville; and $326,500 for ultrasound machines in Carbonear and Burin. With a recent investment, Mr. Speaker, of $10.9 million, our government has purchased twelve new mammography units, eleven of which have been installed in health care facilities in Carbonear, Burin, Clarenville, Corner Brook, Stephenville, Happy Valley-Goose Bay and Labrador City, as well as the breast screening centres in Corner Brook and St. John’s.

Now, Mr. Speaker, I am continuously reading out the names of these communities to dispel the myth that this government is only concerned about St. John’s or the Avalon Peninsula.

SOME HON. MEMBERS: Hear, hear!

MR. KENNEDY: Mr. Speaker, the numbers decry that proposition. What we are seeing, Mr. Speaker, is the taking of necessary equipment and putting it throughout the Province, because we care about the people of rural Newfoundland and Labrador, and we care about all the people of this Province.

Earlier today we had issues raised again in relation to the residents of Labrador. Mr. Speaker, we are addressing those needs. We have committed to the building of a new hospital in Lab West. There is a new college being built there. I am sure my colleague, the Minister of Labrador Affairs will tell me: How much is the cost of the Trans-Labrador Highway?

MR. HICKEY: One hundred and eighty-five million so far, and moving up.

MR. KENNEDY: So, Mr. Speaker, these are significant sums of money.

Mr. Speaker, we have also established, or there will be an additional mammography unit installed and operational at the Curtis Memorial Hospital in St. Anthony in November, 2010, once renovations to that facility are complete. These units complement those already in place in St. John’s, Gander and Grand Falls-Windsor, and bring the total number of digital mammography units in the Province to sixteen. Mr. Speaker, we have, it is my understanding, and I am trying to remember exactly where we are with the MRI unit in Gander, but we are moving ahead with that. We are moving ahead with all of this most technologically advanced and very expensive equipment. Mr. Speaker, we have to - and again the word is - strategically place these. So medical transportation is something that is obviously a key factor for us, but what we are also trying to do is decrease the distance that people have to travel in order to have their medical needs met.

Mr. Speaker, there have been investments in telemedicine and systems such as the Picture Archiving and Communications System commonly referred to as PACS, and physicians are able to provide care throughout different parts of the Province. As you can see, Mr. Speaker, we are making significant advancements toward enhancing health care in rural parts of the Province.

Mr. Speaker, I had a very interesting conversation with a number of psychiatrists shortly after I became Minister of Health on October 9 - although it seems so long ago - where we talked about tele-psychiatry. How we could, for example, take an individual in the Minister of Aboriginal Affairs district in Northern Labrador and receive the kind of advice where a social worker or someone working with an individual could receive advice through, whether it would be through the Internet, through Skype, through video cameras. All of the technology, Mr. Speaker, that is available today.

So this is how we have to move forward. We have to think outside the box in terms of trying to come up with solutions that benefit the people, especially of rural Newfoundland and Labrador. Mr. Speaker, even if you look at the minister, for example, my colleague the Minister of Environment. Her district, at the tip, is probably two hours to St. John’s. Now, Mr. Speaker, if you have to go for dialysis that is certainly a long haul. Now Carbonear has dialysis. It shortens it by half but it is still there, Mr. Speaker, that it is an improvement.

I think, Mr. Speaker, that the people of this Province know that not every place can have everything. One of the things I plan to do in the spring, or depending on when we are in and out of the House of Assembly, is have public discussion on this issue. What is it you are looking for and what do you expect?

I recently met with a council in the Minister of Environment’s district and I have to tell you, Mr. Speaker, we dealt with the issue of the lab, X-ray, the combined professionals that are very difficult to find these days. The council were very reasonable to deal with, but when we sat there and explained to them that it is a difficulty in finding the human resources, not from our end with providing resources.

Mr. Speaker, we are committed to enhancing health care in rural parts of our Province, not only through improvements in the Medical Transportation Assistance Program but in our many investments in the programs, services and medical equipment, and I look forward to the Budget on Monday in continuing that trend.

Thank you very much.

SOME HON. MEMBERS: Hear, hear!

MR. SPEAKER: The hon. the Member for The Straits & White Bay North.

MR. DEAN: Thank you, Mr. Speaker.

It is my pleasure to be able to take a few moments this afternoon to speak about the Medical Transportation Assistance Program as is mentioned in the private member’s motion.

Certainly, living in my district and so far removed from the services of the larger urban hospitals, I know all too well how important this program is and how burdensome it is on our residents as they have to travel, in particular to Corner Brook and St. John’s centres, to receive the medical attention that those living in the centres can kind of take for granted.

This motion before us today is very important. It was just last year in June when I experienced the true cost and financial burden that others experience all the time when my grandson, who was only four months old at the time, had a medical emergency and on a moment’s notice had to be brought to St. John’s. The expense of accompanying his mom and staying in the city for four or five days and having to stay in a hotel and the meals and so on, that by the time we got back home we had spent several hundreds of dollars. Actually, for us it was into the thousands of dollars. So going through that is not easy for any of us, and quite frankly, for some, for many in the Province it is virtually impossible to do that at a moment’s notice. It is a very important issue that we have in front of us and one that requires much attention, I believe.

The Canadian Cancer Society petition was presented here in the House back in December, 2008, by Ms Michael. It launched a campaign that was called Stand Up and Be Counted. There were several issues that were identified in this particular petition and a couple that I would like to take a few moments this afternoon and speak to as they impact and are very important in particular to the residents of my district.

Of course, the first issue that they mentioned was the reimbursement of mileage for use of their own personal vehicles. On the Northern Peninsula, in the District of The Straits & White Bay North, often the medical procedures and attention and so on that is required, require the patient to travel to Corner Brook. A trip to Corner Brook from St. Anthony is 1,000 kilometres and certainly a significant expense in terms of the gas and the cost of the vehicle and so on to go there. So the absence of reimbursement means a financial hardship and burden on individuals who do that. It was just a week or so ago that I had an e-mail from a particular resident of Savage Cove who is going back and forth for cancer treatment and actually having to cancel some of the scheduled times because she just cannot afford the financial output to be able to do the travelling.

So, I appreciate what the Minister of Health had to say about the investments that government has made. I acknowledge what government is doing, but at the same time we would certainly ask, as we put this private member’s motion forward, that great consideration is given to the request. It is a request that is put forward on behalf of the people of this Province, on behalf of the people of my district, and something that is very important to them.

Certainly, the ability to have a reimbursement based on mileage - there are other provinces that do it. It is not a new invention, the wheel is already there. It is a matter of establishing it. It is a matter of acknowledging the need for it and so on, and a matter of the willingness, I guess, and the commitment to make it work. It is something that should basically include a reasonable mileage allowance that really is based on the return distance, obviously, from the individual’s place of residence to the approved medical facility, wherever they might be going. As the Leader of the Opposition mentioned a while ago in her presentation, it certainly is easier at times, especially taking an escort or taking a family member along with you or a friend, it certainly is easier to travel to these medical facilities rather than to get on the aircraft at times and bear that expense of travelling and then getting there and not having transportation and so on. So, again, I would certainly ask that we give great consideration to the inclusion of a gas mileage rebate as requested in this private member’s motion.

The second issue that I would like to just speak to for a moment is the meal per diem, for staying with family members and friends and so on. Often, fortunately, because of how the people of the Province have, I guess, moved around and so on that not many of us today probably - we are lucky that we can come to St. John’s, or in particular the St. John’s capital centre, but also in Corner Brook as well. We are fortunate to have family members who live there or friends who live there. In those situations when we require this medical attention that causes us to be in these areas for extended periods of time, we are fortunate that we can have family members and friends who we can stay with; so that takes the burden away of having to pay for accommodations certainly. It is very difficult to stay there, and obviously, not be reimbursed for the cost of food and so on. So, the reimbursement, the ability to claim for meals, to have a per diem for staying with family members and friends and so on just increases that possibility again and helps really to relieve the true financial burden that is involved.

So again, we would ask that this would be reinstated. It is my understanding that this is something that was cut back in 2006 or so, I believe, under the current Administration. Certainly, we would ask that you would consider reinstating that and the necessity of it being very clear. It would still allow for some compensation for those who have to eat through, whether it is through generosity or just eating meals at the hospital and the cafeteria and so on. It is a legitimate expense and certainly would help in that whole process.

So that is really all that I would speak to at this moment, these two issues: the mileage reimbursement and the meal per diem. Again, many people, even as I am speaking right now, there are many here in the capital city from my district receiving cancer treatment, receiving medical attention for other things at the Health Sciences Complex, at the Janeway with children undergoing extensive financial burden, burden that in these tough economic times they find very difficult to really get through, and it is a stress that us as a government, us as leaders of this Province, have an obligation to do all that we can. So I would call upon government to certainly look closely at that.

Thank you.

MR. SPEAKER: The hon. the Member for the District of Ferryland.

SOME HON. MEMBERS: Hear, hear!

MR. HUTCHINGS: Mr. Speaker, it is good to stand to have an opportunity to speak to this motion. Indeed, as we know, health care is so important to all of us right across the Province, and this government has taken the lead certainly over the past number of years in terms of improving our health care system. Within that system there are an enormous amount of programs, service delivery and infrastructure, just to name a few of the entities that are involved in our health care system. Certainly, serving a province that is so vast, in terms of regionally and rural, in terms of the number of communities, harbours and coves, and trying to reach out and provide that service to all Newfoundlanders and Labradorians is indeed a challenge. We are certainly meeting that challenge and being innovative in terms of what we need to do.

This bill speaks to one of many programs, which is indeed a very important program, in terms of people having access to appropriate medical care, whether it is right next door to them in their community, whether it is regionally, within the Province, outside the Province, or somewhere around the country. It may be in a case where the service or expertise is not available here in this Province. So this is certainly a good program, and certainly allows people to access appropriate care and provide assistance through this Medical Transportation Assistance Program. Obviously, it is there to assist substantial out-of-pocket expenses that people incur, and try to reach that care, that this provides the assistance to them.

As I said, there are a number of referrals that can be made. It can be in-Province, it can be out-of-Province, across the country, or indeed outside of Canada if it is referred by a specialized physician recognizing that this care is required.

I know, as an MHA, and most hon. members in this House, in terms of the work we do, as Members of the House of Assembly, you go and you talk to people - health care is so important. It is a motherhood issue, no doubt, in terms of dealing with people’s families and loved ones. We deal almost every day in terms of health care issues coming up, in terms of inquiries people have, in terms of getting the care they need. Advocacy groups in terms of issues, they are important. We listen all the time, certainly, and try to advance their concerns. This government continues to do that and has done it since coming to power in terms of advancing health care, certainly listening to people in terms of groups and what they are advocating for, in terms of enhancements, and meeting those needs.

In fact, as we noticed, since 2003, our budget for health has increased almost a billion dollars – a billion dollars, Mr. Speaker, in terms of into all regions of this Province, into small communities, towns, urban centres, you name it. The emphasis this government has tried to make too is to invest in those regions and rural areas, to make sure the services where it can be are available, in Labrador and on the Island, so they are accessible, so people can get access to those services and do not have to travel as much, as often is required. So if we provide that service in particular areas that do cut down on the travel, but there are cases obviously where people do need to travel and that is why the importance of this program is so evident and is important to the people of Newfoundland and Labrador.

I talked about investment. I know in my district, in the District of Ferryland, there is an example. In the Southern Avalon, the Town of Trepassey, just recently, we provided upgrades to X-ray equipment, state-of-the-art, upgraded in the medical clinic in Trepassey, as well as upgrades to the laboratory equipment, to make sure the people on the Southern Avalon, and certainly on the Southern Shore, have access to those services in the region so they can access that and provide those services that they need there instead of having to travel long distances to access it. So that is just a basic example of this government investing in rural Newfoundland so we can have access to those services.

As well, Mr. Speaker, I have known first hand in terms of the broader scope of services needed to be provided in terms of our drug formula. We have made tremendous investment in that in terms of requirements of people advocating for various drugs over the past number of years. Certainly, we have done well in terms of answering their needs and increasing the number of drugs that are covered and the amount that are covered under the current drug formula, which again is the overall scope of health care improvement, health care delivery, and again this particular program supports that and is one that certainly is needed.

I just wanted to touch briefly on some of the eligibility criteria and the expenditures and what this type of program is for and what it is used for. It assists residents and families in terms of accessing care; commercial air service; taxi services; commercial ferry services; registered bussing services; purchased registered accommodations; and meal per diems for each day of eligible accommodations. So, very important in terms of we have sick loved ones, in terms of accessing appropriate medical care, that this is there for assistance for them so they can certainly access it.

I will just touch briefly, Mr. Speaker, on current assistance levels and the kind of thing we are talking about for those people out there that may not be too familiar in terms of what would be available with a program like this. There is a $400 family deductible for Newfoundland residents and families. The first $400 of eligible expenses in the twelve-month period is paid by the resident or their family. The next $100 of eligible expenses in that period is paid by the program. Each family member will be eligible. Expenses may be entitled to reimbursement of the first $100. Additional eligible expenses in the period up to $5,000 are cost-shared equally and 50 per cent by those that avail of that.

As well, Labrador residents, due to the uniqueness of the geography and in terms of accessing particular services, there is no deductible. The first $1,000 of eligible expenses in the twelve-month period is paid by the program. Additional eligible expenses in the period are cost-shared equally and all expenses in excess of $5,000 in the period are cost-shared by the resident family and the program, with the program paying 65 per cent of eligible expenses.

Now, Mr. Speaker, in terms of governing and looking each year, and as I said hearing from people in terms of what is important to them and changes in two particular programs, obviously this is one of many programs in the health care department that is looked at annually and in terms of the budgetary process. Over the past number of years this government has done that and has made changes to that.

I just wanted to speak briefly to some of those changes that have or enhancements that have been made to this Medical Transportation Assistance Program to meet the concerns and recognize where we need to invest and where we need to assist in programs.

For Labrador residents, April 1, 2005 the $500 deductible was eliminated. As well, in that same year Labrador residents were reimbursed the first $500 of claimable expenses during a twelve-month period with the claimable balance cost-shared at 50 per cent. That is obviously recognition of investments in the program, an enhancement to a program and certainly changes were made reflective of that.

Again in May of 2007, reimbursement of the first $500 of claimable expenses during a twelve-month period was increased to $1,000 with a claimable balance cost shared at 50 per cent. That was for Labrador residents.

In February, 2006, again we saw changes applicable to Labrador, and to the Island as well in terms of claims. The program was enhanced to assist residents travelling by road a distance of 200 kilometres or greater one way. We saw the eligibility criteria for patients travelling by road and requiring a minimum of fourteen consecutive day’s medical travel before becoming eligible for assistance, with accommodations and meals being eliminated. Once again, it is looking at the program. It is reviewing it on an annual basis and investing and trying to improve and make that program more beneficial to those in need.

In July of 2007, we saw enhancements to the program, certainly for Labrador and to the Island as well. Purchased registered accommodations per diem increased from $75 to $125. The monthly cap on purchased registered accommodation claims will increase from $1,000 to $1,500. Again, we saw an increase in the multi-meal allowance claimable. Reimbursement of claimable expenses in excess of $5,000 during a twelve-month period increased from 50 per cent to 65 per cent. So you have seen over those years, Mr. Speaker, that it was continually reviewed. The program is continually looked at, and once again, no doubt, possibly in this year it is being reviewed again and we will wait to see what happens in the coming days.

Mr. Speaker, a program like this, as I said, is part of a bigger comprehensive health care and program delivery in the Province, and one of many programs that need to be reviewed on an annual and often periodically -as I said, MHAs deal with a number of individuals, a number of groups. They bring forth their concerns and identify problems, and we certainly bring them forward.

I think the Minister of Health and Community Services referenced, when he spoke to this bill with regard to the Speech from the Throne, what was mentioned there overall in terms of the global picture, in terms of our expenditures in health. We have gone through a process of improving the health system in our Province, and certainly health care services in all regions of the Province. When we look, as I mentioned earlier, over a billion dollar increase since this government came to power. We look at some key investments, were mentioned actually in the Throne Speech, $17.9 million for mental health and addictions services; $112 million for health facilities, repairs and maintenance; $281 million to improve health infrastructure throughout the Province, and $177.9 million for new health care equipment.

So, Mr. Speaker, that certainly is enormous in terms of the investments in the Province in terms of health care and what we are doing to respond to the needs of health care, and no doubt the needs are great, as I said. Our Province geographically is certainly diverse in terms of our communities. Certainly, on the Island and in Labrador, but a comprehensive program where we are looking at service delivery, we are doing that and I think we are meeting many of the challenges that are required in terms of doing that.

Again, I said for my area - I know from dealing with other areas - we are investing. Community health, we look at resourcing in community health. We look at whether it is a clinic, whether it is equipment. There is a whole range of initiatives that we have looked at, and we are building on an overall scheme of health care.

Overall, we look at enhancing medical, health and addictions, improving long-term care and community supports, which is so important. We look at strengthening the health work force in terms of commitments we have made to those who work in the health care system and allowing them to provide the services; competitive wages, and as well, having the equipment and technology at their disposal that they need to do the type of job that they do so well.

Health care equipment, this government committed $200 million over four years in terms of health care investments. That is $50 million a year for a whole variety of equipment and technology that is so vital, not only in our urban centres but out around this Island and through Labrador in varied areas of the Province. So once again, it relates back to the whole issue of this program in terms of assistance for travel. If we can put more of that technology, more of that service into the regions and in communities, obviously it will reduce the amount of travel that is required. So it is a parallel program. We are putting investment into rural and regional areas in terms of the equipment and technology, human resource skills and, obviously, in some cases where travel is required, and this program is there to meet those needs.

Again, to conclude, this is a program that is reviewed. There have been continued investments in the program. I think it is a program that was initiated in the late 1990s I do believe, but since then it has been built on. It has been worked on to provide good additional funding in there, as this government is doing.

Mr. Speaker, with that I will conclude my comments on this bill. I certainly appreciate the comments of prior members and look forward to hearing additional debate by the hon. members.

Thank you, Mr. Speaker.

SOME HON. MEMBERS: Hear, hear!

MR. SPEAKER: The hon. the Member for Signal Hill-Quidi Vidi.

MS MICHAEL: Thank you very much, Mr. Speaker.

I am very happy to be able to stand and speak to this issue this afternoon, and I am very pleased that the Official Opposition has put this motion before us for discussion by the government and the Opposition parties. It is something that has been an issue for me, I know, for a long time, and I have spoken to this issue in the House on a number of occasions. The importance of relieving the financial stress on people when it comes to medical transportation is extremely important. People have enough to deal with when they are in poor health, and we know that when they are travelling for medical assistance in this Province, they are travelling because they have a serious condition.

Most conditions can be dealt with closer to home but it is because, of course, the size of our population, we have services, especially around cancer care that are quite centralized and people who are critically ill very often have to be involved in travelling to get the treatment that they need. Adding to that, burdens of finances is really something that we want to get rid of. If people are going to heal quickly, if their treatment is going to have benefits, then they need to have as less stress as possible on them. The stress of not being able to afford travel, having to use one’s savings in order to travel, and having to go in debt even for travel, is not something that we should want here in this Province. It is not something we should want in our country. We are a country that is beyond that, I would think, and yet we do not recognize adequately the role of medical transportation and the fact that having to travel for your treatment is part of your medical condition and the cost of medical transportation is a medical cost.

We, unfortunately, are behind a lot of the provinces in the way that we deal with this issue. For example, the reimbursement of gas and mileage for the use of personal vehicles is now happening in many provinces, and it is not beyond us or it is not something crazy for us to say this is something that should be happening here. The same way with meal per diems for those staying with family and friends, very often somebody coming in staying with a family or with a friend, they may be staying with somebody who themselves do not have a large income and the cost of having a couple of more people in the house – and sometimes people who are on very particular diets because of their conditions, that cost then becomes a burden for the family or friend that they are staying with, or for the person who is sick because they feel: well, I really do need to buy this food. I cannot have my family here in St. John’s - for example, if they are coming into St. John’s - carrying this cost. So we really do have to look at this issue of the per diems for meals. They get the per diem if they are staying outside of family, it is important that they also get the per diem if they are staying with family.

The coverage has to be large enough to really totally minimize the amount of stress on the individuals. So I am really glad that we are here discussing this issue and I am hoping that the government is open to voting, along with the Official Opposition and with myself as the leader of the Third Party, because I will be voting for this motion. I hope that government too will be voting for it so that we could all say in this House that we are all in agreement that we have to improve the medical transportation program in Newfoundland and Labrador, that we all care about the people of this Province, and that we all want to reduce the burden that is on people who have to travel for medical reasons.

Now, we talk about the issue being an issue mainly for rural Newfoundland and Labrador because it is people in the smaller communities who have to come into larger centres, and there is absolutely no doubt that the burden on rural Newfoundlanders and Labradorians is the heavier burden. I know that in a study that was done some years ago, and I cited this study here in the House in February of 2008, we know that one in three rural patients pay more than $200 per trip to see an oncologist, one in eleven pays more than $1,000, and some people pay up to $5,000 to come into St. John’s from a remote area and the amount of reimbursement they get does not balance out. When you are up to the thousands, the amount of reimbursement they get does not balance out what they are putting out.

The other thing that is a real burden is the fact that even when they are going to get reimbursed, people have to put the money out up front. They have to make the expenditure and then they get reimbursed. You know, that is fine when you have a good salary; you can probably manage that. That is fine when you are lucky enough to have some savings that are liquid, that you can go to a savings account where you keep several thousand dollars for use in emergency and you can take that and use it for an expenditure and then get reimbursed, but an awful lot of people who are coming into large centres for treatment are not people who are in a situation where they have $3,000 or $4,000 or $5,000 at their fingertips. Sometimes each trip can cost that, by the time you put in the cost of the air travel or the road travel, and you put in the cost of meals and the cost of accommodations, et cetera. Some trips can be into the thousands.

There really is a tremendous burden on people who are living in rural Newfoundland and Labrador. Rural Newfoundland and Labrador, as we know, does not have the same economy as, for example, St. John’s and the Northeast Avalon, or of Corner Brook, those two places in particular. Rural Newfoundland and Labrador, the income of people is lower, we have higher unemployment, and we have a large number of people involved in the fishery which is in dire straits.

We have to look at the burden on people in rural Newfoundland and Labrador, and I am really glad to see that the motion that is on the floor also asks the government to look at making changes with regard to the $400 deductible faced by those who live on the Island portion. I think that should be waived and I am glad that it is in the motion. I am really hoping, and I have some trust that the government will consider making that change. I think it is incumbent upon us to do so.

I also want to talk about not just rural Newfoundland and Labrador; I also want to talk about what people have to expend if they have to go outside of Newfoundland and Labrador. I am going to speak of the experience of one of my own constituents here in St. John’s, in the District of Signal Hill-Quidi Vidi, a woman whose doctor recommended that she travel to Ontario for surgery - recommended it. The doctor believed this is where she should go to have the surgery, and without any explanation from the government she was denied assistance under the Medical Transportation Assistance Program. She is aware of other people who had the same ailment that she has, which was urological in nature, who received funding but her application for funding was refused. This is a woman who is on her own, a woman who is a pensioner, and she could not get any help with the medical transportation. The thing is: not only was the expense going to be the expense of the travel, but she also had financial hardship with regard to finding accommodations that would not be too expensive. So, despite the clear recommendation of her doctor, the Province turned her down, and this woman has been through stress that she should not have had to go through.

So, when we talk about medical transportation, we of course are talking not just about the needs here in the Province, but we also have to look at the needs of people who have to go outside of the Province. We do have situations, and we all know them. I know that my colleagues in the House, many of them represent communities where, for example, communities have had to raise money for people so that they could bring either a child or another family member outside the Province for treatment; so that the parents of a child, for example, could travel to Halifax with them, or travel to Toronto and stay with them for an extended period of time, because no parent and no family wants to put a child in the children’s hospital in Halifax or the children’s hospital in Toronto and leave them on their own. They have to have family with them. It would be a terrible stress on family if they did not do that. Yet, we do know of communities where the whole community has to rise up and raise money to send a family away so that a member of the family can get treatment.

This is not good enough in this day and age. It is not acceptable. There are many stories like this. I know of another woman. This woman – and she has been in touch with us, both of the cases I am referring to, they have come to us and told us about their case - this woman was a breast cancer survivor in her fifties, and she lived in Labrador; she still does, of course. She was told that she had to go to Toronto for an MRI, and the appointment was set up. The MRI was of an urgent nature because of the nature of her condition, being breast cancer. All the flights were booked and she needed to get there, so she decided to drive to Toronto in her own car, and when she turned to government for reimbursement for her mileage she was denied.

Well, that is not good enough. We have to put a program in place so that people who have to travel outside the Province can get help with that travel. We have to recognize, too, the need for the mileage to be covered. People should be able to use their own car. It does not make any sense that somebody who has to come a two hour drive outside of St. John’s can get reimbursed if they are in a taxi or bus but cannot get mileage for their personal vehicle. So, we really do have to review the rules that we have in place so that, number one, a larger group of people can have this burden lifted from their shoulders and that, number two, besides increasing the numbers of people who can get reimbursement, that the reimbursement that is being offered is of a large enough nature that people are having to put in a minimum amount of money. It just makes sense to me that as a Province we do not want people to have to be stressed and to be burdened.

There was a study done at Memorial University in 2008 and the study was called: Closer to Home: The burden of out-of-pocket expenses in Newfoundland and Labrador. This study outlined how people are struggling to access health care in this Province. So the government does not even have to do the work to figure this one out, because we have such good research that is being done at Memorial University.

I want to just outline some of the things that they found in this study, something which I have already said but I will say it again. Rural patients - and by that we mean people who live more than an hour’s drive from where they go for their treatment - spend more than urban patients on care-related expenses. Well, people should not be punished because they are living in rural Newfoundland and Labrador - and they are being punished. People living one hour or more away from the nearest cancer clinic - and this is a cancer one - accounted for almost a fifth of the group spending $1,000 or more for a single visit.

So, you know, we have people who are sick, people who are in need, and they are carrying a heavy burden because at this point in time we are not adequately recognizing that medical transportation is a medical cost.

So, I am really encouraging all my colleagues in the House, especially my colleagues on the government side - I know the Official Opposition stand behind their motion - to look at this motion, to recognize the need of the people, to live up to what the Minister of Health and Community Services has been saying in this House when he says his first care is the patients, it is the people of the Province, and I really beg everybody in the House to vote for this motion when the time comes this afternoon.

Thank you, Mr. Speaker.

MR. SPEAKER (Kelly): The Chair recognizes the hon. the Minister of Labrador Affairs.

SOME HON. MEMBERS: Hear, hear!

MR. HICKEY: Thank you very much, Mr. Speaker.

Certainly, it is a pleasure to take this opportunity to speak for a few minutes, although many of the points that I will raise this afternoon have already been raised; but this is a very important issue, Mr. Speaker, as the previous speakers have indicated, certainly for the residents of our Province and indeed for the people of Labrador.

Of course, the further you are away from tertiary health care services the more it costs, particularly in these days in which we see tremendous cost for airfare and fuel. Certainly, transportation costs are something that people have to deal with.

Mr. Speaker, while their government, this government, has spent a tremendous amount of money over the last number of years on health care, one of the biggest issues that I deal with as an MHA in Lake Melville, serving the communities of Happy Valley-Goose Bay, Mud Lake, Northwest River, Sheshatshiu and Churchill Falls, is the issue of travel, particularly when it comes to people who are cancer patients, have to have tests done that cannot be done in Labrador; although I will say, Mr. Speaker, over the last number of years we have made great strides. We have made great strides in Labrador when it comes to health care, but still much needs to be done.

I just want to reiterate what the Minister of Health said earlier today, and I want to say to the people of Labrador West that our government is committed to building that hospital, and to providing the necessary services to the people of Labrador West and to those communities that are over in Western Labrador supporting the mining industry over there.

Mr. Speaker, this government has provided approximately $2 million in 2009-2010 for the Medical Transportation Assistance Program and is dedicated to providing a health care system where all residents have equitable access to essential medical treatment. This brings the total annual investment of this government under Premier Williams, just over the past three years, close on $5 million - unprecedented, Mr. Speaker.

I can tell you having lived in Labrador all of my life health care has always been a huge issue – a huge issue, not only in Central Labrador and Western Labrador but certainly Northern Labrador. Distance and geography is one of the main obstacles when it comes to getting access. As we will have further discussions in the days to come, I can tell you, Mr. Speaker, that over the last number of days and weeks I have received a number of e-mails from throughout Labrador talking about access, the air ambulance issue. The air ambulance issue is fully on the table of the Minister of Health and our government. I can tell you knowing our Minister of Health that he will deal with that expeditiously over the course of the next number of days and weeks.

Mr. Speaker, I do want to just take a couple of minutes to go over - and while the Member for Ferryland spoke of it earlier, I think it is important that we reiterate and reinforce some of the points that he made, particularly for Labrador, because sometimes people are not aware. We try our best, but certainly it is an opportunity for us today to speak about what we have done and the history of the Medical Transportation Assistance Program.

In April of 2005 the $500 deductible for Labrador residents was eliminated. We also ensured that Labrador residents were reimbursed the $500 of claimable expenses during a twelve-month period with the claimable balance cost-shared at 50 per cent on May 1, 2007. Reimbursement of the first $500 of claimable expenses during the twelve-month period was increased to $1,000, Mr. Speaker, with the claimable balance cost-shared with 50 per cent of the clients.

On February 1, 2006, Mr. Speaker, the program was enhanced to assist Labradorians and residents from the Island portion of the Province travelling by road for a distance of 200 kilometres or more one way, and required purchased, registered accommodations in order to access insured service.

In these instances, Mr. Speaker, the program assists with purchased registered accommodations and applicable meal per diems for each night of medically required purchased, registered accommodations. Mr. Speaker, on July 1 of 2007, the purchased, registered accommodations per diem increased, Mr. Speaker, from $75 to $125. The monthly cap on purchased, registered accommodations claimable increased from $1,000 to $1,500. The monthly meal allowance claimable in conjunction with purchased, registered accommodations increased from $600, Mr. Speaker, to $700, and reimbursement of claimable expenses in excess of $5,000 during a twelve-month period increased from 50 per cent to 65 per cent.

Our government has made significant investments in rural Newfoundland and Labrador to help decrease the need for residents having to travel to other parts of the Province to receive the medical diagnosis and treatment they require. I can only say to you, Mr. Speaker, we had the opportunity under the leadership of Premier Williams in 2004 – and I remember this well. There was certainly, in my District of Lake Melville, there was a cry for kidney dialysis units. At the time I was not a member of the Cabinet, I did serve as a parliamentary secretary to the minister of the day, but I want to say it was Premier Williams who called me – and it was one of these phone calls you like to receive, certainly, from the Premier, when he said: You can tell the people of Labrador, John, that I will personally be taking this issue to the Cabinet and I will call you back with a decision on Thursday afternoon. This was on a Tuesday morning. Well I can tell you what, there was no happier MHA when he gave me the call and said that the Cabinet had approved the kidney dialysis machine for Happy Valley-Goose Bay. I can tell you, Mr. Speaker, it has changed the lives of those that use it, and it is readily available. Not only did we do it in Happy Valley-Goose Bay, Mr. Speaker, but we did it in Burin, in Carbonear, in Gander, St. Anthony, and certainly we will be looking at other areas of the Province as we move forward.

Mr. Speaker, there is a tremendous amount of money we have spent on health care in Labrador, but there still needs much to be done. I want to say, as far as this particular motion here today, that certainly it is an important issue, not only for the members across here in this side of the House, but I believe certainly for all members of the House, because when we talk about health care, we never know when we are going to have the need to help a loved one. I can tell you, having dealt with many cancer patients and having lost certainly members, my dad, former spouse, to cancer, we do not know when these things are going to affect us. I can tell you the last thing we need to be worrying about really is how are we going to get treatment to the nearest hospital or to the nearest centre? That is something that we should not be thinking about. Those plans should always be there and perceived. We should be worrying about the care of our loved ones to ensure that they are living in comfort and that they are getting the very best medical treatment that they can for their illness.

So, Mr. Speaker, I do want to say that I applaud the Minister of Health for the good work that he is doing to try to keep our health care system on par. It is a tireless job and I believe that certainly the Minister of Health today is working hard and making great improvements when it comes to the health care system in our Province. There will be further changes for the better as we move forward with this year’s budget and certainly future year’s budgets as Premier Williams, as the Premier of this Province and at the helm, as we continue on to make improvements to health care.

I want to say to the people of Labrador West: The e-mails that you have sent me over the last number of days, I can tell you, I have been touched by some of the stories, and I can tell you with the Member for Labrador West and the Minister of Aboriginal Affairs, we will continue to work hard on these health care issues, along with our hon. colleague, the Minister of Health, and indeed our Cabinet colleagues.

Thank you very much, Mr. Speaker. With that, I will sit down.

SOME HON. MEMBERS: Hear, hear!

MR. SPEAKER: The Chair recognizes the hon. Member for Port de Grave.

MR. BUTLER: Thank you very much, Mr. Speaker.

I just want to take a few minutes to make a few comments with regard to this private member’s motion put forward by my hon. colleague, and there are just two or three issues in the part where it says THEREFORE BE IT RESOLVED that I will touch on, and one of them is the reimbursement of the gas mileage for the use of personal vehicles, the add meal per diems for those staying with family and friends, and the one with regard to – which is a very important issue – waive the $400 deductible faced by those living on this Island.

With regard to the gas mileage, and I know people in other areas, whether it is in Labrador or the far outreaching points on this Island of ours, if they have to come to St. John’s I know they find themselves in a greater difficulty than the people who reside in my district, but still there are cases that I can tell you of where people have difficulty, more so low-income families because it was only recently, there was one particular family who had to travel here to St. John’s, a lady had to come in for treatment for seven weeks in succession, five days per week and they were a very low-income family. You can only imagine the cost of what it was to even just travel back and forth, and it is only approximately 176 kilometres. Then again, some of them do not even have their own vehicle, and if it was put there that there was mileage used for personal vehicles, probably a family member, but many times they have to get someone who will just charge them an enormous fee, it could be $50 or $60 to come in if they do not have a vehicle. So I think we can save money with that part of it.

With regard to add meal per diems for those staying with families, many times someone has to travel with an individual, and just to come here in town before lunch - they are here for lunchtime and through the evening - it can be very costly. The individuals who they are taking in for treatments or assessments, they cannot afford to look after that. Usually this is fairly well identified, because the general practitioner usually will give a letter of consent that someone should travel with the individual and that would make a tremendous difference.

Mr. Speaker, the main issue that I want to touch on is the waiving of the $400 deductible. I have heard hon. members here in the House today, and I think everyone is in favour of what we are referring to here. All we are asking is to call upon government to consider making changes to the Medical Transportation Assistance Program. Mr. Speaker, this is not about saying that this is a bad program. We have heard the figures that are used throughout the Province that help individuals. We also know - we appreciate the changes that were made recently to the people in the Big Land, Labrador, where they are coming from and the tremendous costs that they have to encounter.

Mr. Speaker, we know that to be eligible for expenses, first of all it has to be reduced, and that is understandable by any private insurance plan but many people do not have a private insurance plan within our Province. Then we look at how the balance is calculated. We know, and I will just give an example. For instance, if the cost of someone to travel outside of this Province for an assessment or a transplant which cannot be done here in our Province and if it should cost in the vicinity of $2,000, we know that first thing to come off the top of that is the $400. Then they are reimbursed, they get the $100 upfront and then 50 per cent of the balance, which would be $750. So this family would get $850, and they appreciate that because it is some assistance to cover off on the cost of this particular trip that I am referring to that will cost $2,000. Mr. Speaker, if we waive the $400 that family would end up with $1,250 which is a tremendous amount to someone who is unable to afford to pay all of their own. They appreciate this program knowing that they can get 50 per cent.

The other key point - and I do not know if there is any way around it, Mr. Speaker, but all this has to be paid upfront. If a family has to travel outside of our Province they have to be able to arrange their airline tickets, they have to arrange a place to stay and have funds for their meals, and then on a monthly basis they can make this particular claim. That is all fine if you have the money to do that. I can honestly tell you, Mr. Speaker, I have been involved with different cases in my district; one individual who had to go away for a double lung transplant, and I happened to be on the committee that helped to raise funds to assist that family. The cost at that particular time was in excess of $30,000. Now, there is no doubt about it, they got their reimbursement back each month but in order to stay there, they just could not afford it, they had their apartment there. We even contacted friends we knew who looked after a high-rise apartment building in Toronto and furnished the apartment for them with furnishings that were left behind by residents when they left. That is what it entails, Mr. Speaker.

We know that here on the Island, the $500, I think the Leader of the Official Opposition mentioned for anyone who is outside the 200 kilometres. That is all fine, but I am referencing some cases where people have to travel to the mainland; the services are not provided here. They appreciate the amount that they are getting, as I said previously, but there are many people who travel. I would venture to say in my area each and every year there are four or five fundraisers for different families to help them to travel outside this Province, to help with the accommodations, towards their meals, and transportation to and from the facility that their loved one is attending. Also, here in the Province just travelling, like I said, 176 kilometres, what the cost would be to them.

Mr. Speaker, those are the only comments that I want to make. I stand in support of this private member’s motion and I hope that everyone in the hon. House - because this is not saying that government is doing nothing. It is only asking government to consider making changes so that it will be of better interest to the people in our Province, whether they travel to and from facilities here in the Province or outside of our Province.

Thank you, Mr. Speaker.

MR. SPEAKER: The Chair recognizes the hon. the Minister of Government Services.

SOME HON. MEMBERS: Hear, hear!

MR. O’BRIEN: Yes, Mr. Speaker, it gives me great pleasure to get up and speak in regard to the motion that was put forward by the Member for Cartwright-L’Anse au Clair in regard to the medical transportation issue in Newfoundland and Labrador, and also some of the things that we have been asked by that motion to consider in regard to the reimbursement of gas mileage and those kinds of things and the $400 deductible.

First, Mr. Speaker, I would like to just reflect in regard to how important it is to the people of Newfoundland and Labrador and how important it is, really, in the free world, how important your health and the provision of health services are to the people of this Province. It is the very foundation of society as we evolved over hundreds and hundreds and hundreds of years, the emphasis continued to be focused in regard to the provision of health care services. One of the only ones that I can think about in regard to importance would be education. Education to our young people would be probably equally important. In the overall, provision of health care and the provision of those services are the most important things to the people of this Province. Sometimes, in regard to your health, it can be plucked away in a second. I recognized that this weekend, a friend very close to me was taken away tragically and it brought back to my mind how important health care provision is to the people of Newfoundland and Labrador, especially in regard to another who was severely injured.

Also, Mr. Speaker, you can have health care issues in regard to not being totally plucked away. You have health in regard to various diseases in people that we have seen and family members we have seen battle through, and the provision of those health care services are so important. Also, Mr. Speaker, we can reflect on these things and we can reflect in regard to how important the amounts of money that we would put into the Medical Transportation Assistance Program, but the very important thing that we have to consider when we are doing that is the balance between the delivery of the health care services and also the transportation assistance program. We have to get that balance in regard to what happens. We have to be able to look at are we spending our money more wisely by investing in the best equipment? Which we have seen - this government do, time and time again. As a matter of fact, Gander was one of the first placements for a new digital mammography unit. One of the first in Eastern Canada, in the Atlantic Provinces, I believe, went into Gander about a year or so ago. I was very, very lucky that it was placed in Gander, it was placed in the region and provided that type of service to a lot of people. Not only from my own district, but out around Terra Nova, out around New-Wes-Valley and that area, Bonavista North, the Twillingate area too. It provides that health care service where they do not have to come to St. John’s.

One time, I remember back in my pharmacy days that most of the people requiring certain services had to travel to St. John’s to get that service. That is where they had to go. They had to travel a fairly long distance. Not only did they have to travel – don’t forget now, Gander is on the Trans-Canada Highway and probably now it is around three hours from St. John’s. Back then, it was probably more like three-and-a-half hours, because of the condition of the Trans-Canada Highway at the time. As we upgraded the Trans-Canada Highway, we thus decreased the time that was required in regard to driving to St. John’s.

Most of the people that were coming in for that type of service were coming in from rural Newfoundland and Labrador that had an extended period of time before they ever got to Gander, before they ever got to Clarenville, before they ever got to Corner Brook, before they ever got to Grand Falls-Windsor before they started to move to St. John’s. How important was the transportation assistance program back there that did not have near the amount of money invested in that program back then as it is today by this government?

More importantly, we got that balance, or we are looking for that balance, we are always investing in that balance. I reflect on my district, and also on the District of Grand Falls-Windsor, in regard to their central health care centre as well. We entered into a system back a number of years ago, in regard to shared service, and no duplication of service in Central Newfoundland and Labrador, because what was envisioned back then – and I cannot take credit for this because it was envision back then - that in order to provide the best quality health care system in Central Newfoundland that we possibly could, we could not have duplication of service. We could not have the duplication of services in Gander, as compared to Grand Falls-Windsor, and vice versa.

So they decided back then that certain services would be provided in Gander, certain services would be provided in Grand Falls-Windsor, and then people from the whole region could get that service in a reasonable period of time, but more importantly, they did not have to go to St. John’s to get it, which added another three or four hours onto their time and that kind of stuff - overnights, et cetera. Then, take in my district, as compared to Grand Falls-Windsor, well then most of the people, in regard to accessing that service could actually access it in one day and come back overnight and have that service. That is very important too.

When we reflect on this motion, even though we cannot downplay its importance, we also, as a government, have to be very, very wise in regard to our spending and also in regard to the placement of equipment, the placement of infrastructure before we actually start spending all kinds of money in regard to the travel assistance program as compared to - and then you do not have the money really to invest in the necessary equipment that the doctors and the specialists need to diagnose and treat. That is exactly what we have to do. That is very, very important too as we vote. Even though the spirit of this motion is good and well received, and I think it is very, very important, but I cannot get up here today and not reflect on the importance of the placement of the service itself.

Gander, back then, we had orthopaedic surgery, now it has really, really expanded. It is probably one of the best in Eastern Canada in regard to the services and the specialists that are there. I cannot say enough about them. They are absolutely fabulous. Then, when you get that type of service and placement in a hospital such as Gander - and it is centralized in Gander - then, you do not have the tug-of-war in regard to everybody trying to get the same specialist to come to their particular hospital which is only an hour away. Because you get that nucleus, I guess, then they start attracting other specialists, they attract each other and they all want to be with each other because they provide the call-ins, they provide the backup service that those particular doctors need because they work hard each and every day. So, taking that one in Gander, and then you take urology in Grand Falls-Windsor then the same thing happens because they attract themselves. Then, we, as a region, get the best service in a reasonable period of time.

I am not saying that we should not be providing the travel assistance program because it is very, very important. Sometimes people, and people from my district, have to travel to places outside of the Province because the particular procedure is not available or the best procedure is available somewhere else and it is warranted for them to travel. Then we provide service there as well for them to get from their place of residence into Ottawa and that kind of stuff.

We have seen investments in Central Newfoundland in the mammography units. We have seen an investment now in the MRI which is going to be placed in Gander. I think the target date for that to be up and running is going to be September of this year that it is going to be placed, then there is about a month of training and that kind of stuff to make sure that everything is working. It will be fully operational, I think, this October in this year. It is very, very important and it was not about where it was going to be placed. I never really, at any given time with regard to the consideration of the placement of that MRI, I do not think I spoke a word about it because for the simple reason, the bottom line, is that I wanted one. I wanted one in Central Newfoundland and that is all that I wanted. I wanted one in Central Newfoundland. I am proud and I am really pleased that it is in Gander. I am very pleased because the orthopaedic division is there and that kind of stuff, so it is very, very important.

The bottom line is that it is very, very important for all the people in that region because now in regard to having an MRI, and up until September of this year or October of this year, they would have to either go to St. John’s, nine chances out of ten St. John’s, but the only other place that they could go to get that service is Corner Brook which is just as far or an hour further away. That is a good example of placing a piece of equipment that would really complement the travel assistance program.

We have seen investments by this government in dialysis. I was one of the first actually - I think as a matter of fact in 2004-2005 Budget, the investment in regard to the dialysis that is now at the James Paton Memorial Hospital, which has also been expanded since then, was given the green light and given funding back in that Budget.

Then after that in 2005-2006 with the new cancer treatment centre placed in Grand Falls, I also got a cancer treatment center as well. I have been in it; it is absolutely fabulous, very aesthetic and very complementary. Probably in some ways - and I lost my mother to cancer so I know what I am talking about in regard to the trauma, not only to the patient but also the family, but I would think that those types of units and the design of those types of units actually give the family and the patient some comfort in their time of need.

These are the kinds of things that we do in regard to dialysis and we have a formula in regard to that kind of stuff as well, in regard to the placement of it. We cannot just go out there and put a dialysis unit or a cancer treatment centre in wherever it may be because they might have somebody with that particular disease and that kind of stuff. You have to have a balance in that too, as well, where you get the best, I suppose in a harsh way to say it, is the best bang for your dollar because you cannot – I cannot overemphasize that you have to, when it comes to health care, because it is such a huge aspect of our society and a huge cost to governments that we have to make sure each and every time we bring down a budget, each and every dollar that is spent in health care is spent in the best way we can possibly do. We rely on expertise out in the health care system; we rely on the expertise in the Department of Health and Community Services. We also rely on the expertise out in the boards themselves, we rely on the doctors, we rely on the nurses, we rely on people to tell us and give us information and advise us how we can best spend our dollars in health care, because that is very, very important.

I am not trying to take any emphasis in regard to how I am speaking here today, in regard to the importance of the motion put forward. That is equally important, but we cannot put all of our dollars in that, for the simple reason, that as we continue to put money and pour money into that, well then we will not have the money in regard to the pieces of equipment that are needed by our doctors and specialists out there in the field. Strategically, we have to place those pieces of equipment. That is the kind of things that we have to consider, and that is the word.

I understand that the motion was amended and is just asking government to consider - and I am positively sure, we absolutely will consider; absolutely. That is a part of the process, and we are all Newfoundlanders and Labradorians at the end. Here we are in this House, all as colleagues. We might be in different parties and that kind of stuff. You might be the Opposition, we are the government, whatever it may be, but when it comes down to health care we are all family. We are all Newfoundlanders and Labradorians. That is what is important, and that is why sometimes I am amazed or taken aback in regard to some of the criticisms on our health care system. We all try our best. I am sure governments in the past have tried their best. We have done some wonderful things in health care because this Premier, this government, has taken health care very, very seriously, and more importantly we have invested strategically. We have invested our money to get the best that we can possibly get in the dollars that we have spent, because it is not a bottomless pit. It is not a bottomless pit at all. We have money to spend. We have a budget there and we have to be very, very wise in regard to how we spend that budget.

Anyway, in conclusion, that motion is a very, very good motion and I am very happy to have had the time to get up here today and speak in regard to that motion, but I will leave you with the thought that we have to have balance. We have to consider other things before we put all our money into this program. We have to make sure that we invest strategically, invest in equipment and strategically place it so that it will reduce the time frame that somebody has to drive or travel to access that particular service, and that is very, very important as well. I would like to get them back each and every day to their own home.

MR. SPEAKER: The Chair reminds the hon. member his time has expired.

MR. O’BRIEN: Thank you, Mr. Speaker, and I will conclude.

As I said, I would like each and every Newfoundlander to be able to access health care in one day, not have to go away from home and their loved ones and this kind of thing. That is very important as well.

With that, Mr. Speaker, I conclude my remarks.

SOME HON. MEMBERS: Hear, hear!

MR. SPEAKER: The Chair recognizes the hon. the Leader of the Opposition, when she speaks now she will close debate.

MS JONES: Thank you very much, Mr. Speaker.

I would also like to take this opportunity to thank my colleagues on both sides of the House of Assembly for their contributions to the debate around this motion today, specifically the Member for Carbonear-Harbour Grace, the Member for The Straits &White Bay North, the Member for Ferryland, the Member for Signal Hill-Quidi Vidi, the Member for Lake Melville, the Member for Port de Grave, and the Member for Gander.

Mr. Speaker, this is a very important motion because it does affect thousands of Newfoundlanders and Labradorians who do have to seek health care in other parts of the Province, away from their home or even outside of the Province. We also know that they do so oftentimes at tremendous financial risk to themselves and their families. We also have heard of many cases, many situations where families have had to spend extended periods of time in the capital city in order to access health care services or in other parts of the Province to access health care services and outside of the Province. I can give you many examples just in my own family, where my family who lives in Labrador have had to spend times up to two months here in the city, and only recently since Christmas have spent nearly three months away from home near other hospitals in this Province.

So, when people have to do that to seek the medical services that they require, oftentimes, Mr. Speaker, they do so hoping that there is going to be some financial subsidy to help them and get them through this particular difficult time. What we have learned is that while there is a program there through the medical travel program that does reach out and give some assistance to Newfoundlanders and Labradorians, there are many who fall through the cracks in being able to access financial resources under that program.

When I opened debate today, I talked about many examples across the Province, and in Labrador, as it related to road travel and the inability to be able to claim mileage to access a hospital facility if you live more than 200 kilometres one way from that hospital facility. I talked about, as well when I opened debate, about having patients being eligible to claim private accommodations and meals. Something we enjoy doing as an MHA when we travel to other parts of the Province or to our district, but not something we have allowed under this program for patients in the Province who have to travel, say from the Burin Peninsula to St. John’s, or from Burgeo to Corner Brook, or Baie Verte to St. John’s. That should be there, it was there. In fact, it was in the program originally, because this program started in 1998, but it was the current government and the current Administration that took that out. We are asking them to consider putting that back into the program, as well.

The other issue, Mr. Speaker, that I spoke to when I opened debate, was the $400 deductable that now applies to all the patients on the Island portion of the Province. The first $400 in a year that you spend on accessing hospital facilities, you pay out of your own pocket, then after that you are eligible for a $100 rebate. Then after that $500 threshold, you are eligible for 50 per cent of what you spend. That applies to people who not only come to hospitals in St. John’s or other major centres in the Province, but that applies to people who go outside of the Province. I have gotten a lot of calls from people in Newfoundland and Labrador who have had to go to the Heart Institute in Ottawa for instance, who have had very complex heart surgeries. Two of my friends, actually, had to go there before Christmas. One of them spent nearly three months there, and their family, getting treatment and undergoing surgeries. Yet, Mr. Speaker, they had all of these medical bills wrapped up, they were on fixed income, and they could not claim hardly any money under this program, which was absolutely ridiculous.

There were fundraisers going on and family members putting together money to help them, yet these surgeries could not be provided in Newfoundland and Labrador. Most of these people, Mr. Speaker, who have to go outside of the Province for treatment to large hospitals and large centres like in Toronto or in Ottawa, most of these people have never left the Province before. Can you imagine, not just the idea of being very critically ill, having to be referred outside for a surgery that you cannot get done in the Province, but doing it in a large city where you have never been before, where the culture is very different, and trying to navigate your way through a much larger health care system to get the services that you need? You are doing all of this realizing that there is a tremendous amount of financial burden that you are incurred with as well, and huge bills that are going to come at the end of the day. Once you get your health dealt with, if you are fortunate enough to get it dealt with, you still know that at the end of the day you are going to worry about the big bill that you are going to have to pay.

Mr. Speaker, just this week in The Telegram, there was an article, the story of Mabel Janes, a lady – and I am not sure what part of the Province she is from, but I know they are fundraising in the Springdale area -

MR. SPEAKER: I remind the hon. member that her time has expired.

MS JONES: I am sorry. I have until 5:00 o’clock; I am closing debate.

MR. SPEAKER: My apologies.

MS JONES: It is 4:52 p.m.; I have until 5:00 o’clock.

MR. SPEAKER: My apologies; I was looking at the wrong clock.

MS JONES: Thank you very much.

We will have to get a few more clocks for the Legislature, obviously, and we will get some lessons in how to tell the time when we are at all that now. Anyway, Mr. Speaker, I get to speak until 5:00 o’clock and it is 4:53 p.m. on both clocks in the House of Assembly.

Mr. Speaker, before I was interrupted –

SOME HON. MEMBERS: Oh, oh!

MR. SPEAKER: Order, please!

MS JONES: - I was talking about the case of Mabel Janes, who is a lady who lives in this Province who needs a lung transplant, who has to be referred outside of the Province to Toronto to have that done within the next few days. Her life depends upon having this transplant done. Guess what is happening in places like Springdale, because that was one of the areas that were mentioned? They are putting cans on counters in stores to try and raise money to send this woman out so that her life can be saved.

That is not acceptable, Mr. Speaker. We live in a province today where we have a government who boasts consistently, Mr. Speaker, about the great wealth that we have, who boasts consistently about how rich we are as a province, who sticks their nose down at places like Ontario because they are on equalization.

Mr. Speaker, when you look at our situation in the context of the financial wealth that we have, why is it that when we have to send people to Ontario hospitals we cannot afford to do it and these people are struggling financially to access that health care system by having to go out and put cans on counters in grocery stores in small towns around this Province to raise money to access that health care?

Mr. Speaker, they are holding bingo games. They are having bake sales. They are going door-to-door. I have seen it in my own district so many times, not just in the case of Mabel Janes; there are many Mabel Janes out there. It just happens that this is the lady today that needs our help. Tomorrow, it will be someone else. Last week it was someone else. How many times have we seen people in our communities going door-to-door taking up money because of someone they love or a really good friend or neighbour has to be sent out of the Province for treatment?

What we are asking government to do is to have a look at the medical transportation program as it is today, look at how we can make changes to this program to reflect what the need is that people have and how we can make changes to better respond to the critical health care needs of people like Mabel. There are many out there that are like her.

Mr. Speaker, basically that is the premise of the motion that I have introduced to the floor of the House of Assembly today. It is a very important motion that affects many people. We are not doing this without recognizing the efforts that have already been made to enhance the medical transportation program in our Province over the last twelve years because consistently, since this program has been introduced, there have been changes and modifications reflecting what the need is. We are asking that there be more changes and more modifications based on the circumstances that we now find ourselves in. If we are going to continue to refer people to other hospitals where they have to drive, we need to be prepared to cover some of those expenses for them. If we are going to continue to refer people outside of the Province because that is the best health option for them, then we also need to be prepared to look at some of the financial burden that they take on as a result of that.

Mr. Speaker, I ask my colleagues today to respectfully show some support for the people who are in need and the people who depend upon this program, and I ask that you vote for the motion.

Thank you, Mr. Speaker.

MR. SPEAKER (Fitzgerald): Order, please!

Is the House ready for the question?

The motion is put forward by the hon. the Member for the District of Cartwright-L’Anse au Clair.

All those in favour, ‘aye’.

SOME HON. MEMBERS: Aye.

MR. SPEAKER: All those against, ‘nay’.

The motion is carried.

Motion carried.