BC Sessional Papers

Department of Health ANNUAL REPORT 1976 British Columbia. Legislative Assembly 1977

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Full Text

 PROVINCE OF BRITISH COLUMBIA
Department of Health
ANNUAL REPORT
1976
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1977
  To Colonel the Honourable Walter S. Owen, Q.C, LL.D.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned respectfully submits the Annual Report of the Department of
Health for the year 1976.
r. h. McClelland
Minister of Health
Office of the Minister of Health,
Victoria, B.C., January 31,1977.
 Department of Health, Victoria, B.C., January 31, 1977
The Honourable R. H. McClelland,
Minister of Health, Victoria, B.C.
Sir: I have the honour to submit the Annual Report of the Department of
Health for 1976.
J. W. MAINGUY
Deputy Minister of Health
 DEPARTMENT OF HEALTH
The Honourable R. H. McClelland, Minister of Health
J. W. Mainguy, Deputy Minister of Health
N. S. Wallace
Senior Financial Adviser
W. Diet?iker
Director of Data Processing
W. F. Locker
Director of Personnel
F. G. Tucker
Consultant in Mental Health
J. S. Bland
Consultant in Geriatrics
M. L. Chazottes1
Director of Health Education and Information
COMMUNITY HEALTH PROGRAMS
G. R. F. Elliot
Deputy Minister, Community Health Programs
J. H. Doughty
Acting Director of Administration
W. D. Burrowes
Acting Director, Division of Vital Statistics
H. J. Price
Comptroller
Public Health Programs
K. I. G. Benson
Associate Deputy Minister and Provincial Health Officer
W. Bailey
Director, Division of Environmental Engineering
L. M. Crane
Director, Division of Public Health Nursing
A. A. Larsen
Director, Division of Epidemiology
F. McCombie
Director, Division of Dental Health Services
R. G. Scott
Director,  Division of Public Health Inspection
P. Wolczuk
Director, Division of Community Nutrition
G. D. Zink
Director, Division of Speech and Hearing
Special Health Services
J. H. Smith
Director, Bureau of Special Health Services
W. J. Bowmer
Director, Division of Laboratories
C. E. Bradbury
Director, Division for Aid to Handicapped
H. K. Kennedy
Director,  Division  of  Venereal  Disease
Control
L. D. Kornder
Director, Division of Occupational Health
F. D. Mackenzie
Director, Division of Tuberculosis Control
1 Appointment effective August 16, 1976.
 Mental Health Programs
A. Porteous
Associate Deputy Minister
H. W. Bridges
Co-ordinator of Adult Psychiatric Services
F. A. Matheson3
Comptroller
M. M. Lonergan
Consultant in Nursing
Mrs. F. Ireland
Co-ordinator of Boarding-homes
R. S. McInnes
Co-ordinator of Mental Health Centres
A. G. Devries
Consultant in Psychology
J. B. Farry
Consultant in Social Work
D. Fernandez4
Planning and Research Officer
British Columbia Youth Development Centre
P. H. Adilman, Director, Residential and Day Unit
D. C Shalman, Director, Psychological Education Clinic
Greater Vancouver Mental Health Services
J. D. Kyle, Executive Director
Burnaby Mental Health Services
W. C Holt, Director
Victoria's Integrated Services for Child and Family Development
A. Kerr, Acting Director
MEDICAL AND HOSPITAL PROGRAMS
W. J. Lyle
Deputy Minister, Medical and Hospital Programs
Hospital Programs
J. G. Glenwright
Associate Deputy Minister
P. M. Breel
Senior Director
C. F. Ballam
Senior Medical Consultant
A. C. Laugharne-5
Director, Hospital Finance Division
J. D. Herbert
Director, Administrative Services
2 Resigned effective September 15, 1976.
s Retired effective October 31, 1976.
* Appointment effective January 15, 1976.
5 Appointment effective October 12, 1976.
6 Appointment effective May 1, 1976.
H. R. McGanng
Director,  Hospital  Consultation  and Inspection Division
R. H. Goodacre
Director, Research Division
G. F. Fisher
Director, Hospital Construction and Planning Division
 Medical Services
D. H. Weir
Chairman (pro tern.)
D. M. Bolton
Senior Medical Consultant
G. A. Stewart t
Chairman
A. W. Brown
Executive Manager, Plan Administration
R. A. Munro
Director of Financial Services
Commissions, Etc.
H. F. Hoskin
Chairman, Alcohol and Drug Commission
of British Columbia
D. H. Weir
Chairman,   Emergency   Health   Services
Commission
P. Ransford
Executive   Director,   Emergency   Health
Services Commission
F. G. Tucker
Chairman, Forensic Psychiatric Services
Commission
J. Duffy
Executive Director,  Forensic Psychiatric
Services Commission
J. Bainbridge
Director of Government Health Institutions
A. A. Larsen
Chairman, Provincial Adult Care Facilities
Licensing Board
M. Dahl
Chairman, Provincial Child Care Facilities
Licensing Board
t On retirement leave effective June 4, 1976.
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 TABLE OF CONTENTS
The Year in Review..
Demographic Features.
Page
15
19
COMMUNITY HEALTH PROGRAMS
Public Health Programs
Introduction	
Public Health Program Highlights	
Communicable and Reportable Disease	
Health and Our Environment	
Specialized Community Health Programs	
Community Public Health Nursing Services.
Home Care Programs	
Dental Health Services	
Health Education and Information..
  23
  24
  25
  29
  36
  42
  44
  46
  47
Nutrition Services  48
Vital Statistics  50
Aid to Handicapped  5 2
Laboratory Services  5 3
Community Human Resources and Health Centres  57
Action B.C  58
Council of Practical Nurses  59
Voluntary Health Agencies  60
Tables—
1—Reported Communicable Diseases, British Columbia, 1972-76  61
2—Reported Infectious Syphilis  and Gonorrhoea,  British  Columbia,
1946, 1951, 1956, 1961, and 1966-76  61
3—Selected Activities of Provincial Public Health Nurses, September
1975 to August 1976  62
4—Patients Admitted to Home Care Programs and Nursing Visits Carried
Out, 1975 t  63
5—Patients Discharged From Home Care Programs, by Age-group and
Classification, 1975  63
6—Selected Activities of Provincial Public Health Inspection, 1972-76 64
7—Registrations, Certificates, and Other Documents Processed by the
Division of Vital Statistics, 1975 and 1976  65
8—Case Load of Division of Aid to the Handicapped, 1976  66
9—Tests Performed by Division of Laboratories, 1975 and 1976  67
10—Licensing of Practical Nurses  68
11—Number of Cases Referred for Hearing Assessment, by Source,
Division of Speech and Hearing, 1976  68
12—Number of Cases Referred for Hearing Assessment, by Type of
Evaluation, Division of Speech and Hearing, 1976  68
13—Hearing-impaired Cases, by Degree and Type of Impairment, Division of Speech and Hearing, 1976  68
 Page
Mental Health Programs
Introduction  69
Mental Health Program Highlights  70
Community Mental Health Centres  70
Greater Vancouver Mental Health Service...  76
Burnaby Mental Health Services  76
Victoria's Integrated Services for Child and Family Development  77
British Columbia Youth Development Centre  78
Boarding Home Program  80
Consultants  82
Tables—
14—Patient Movement Trends, Mental Health Facilities, 1973-76     88
15—Patient Movement Data, Mental Health Facilities, 1976     89
MEDICAL AND HOSPITAL PROGRAMS
Hospital Programs
Introduction  93
Hospital Program Highlights  94
British Columbia Regional Hospital Districts Act  94
British Columbia Regional Hospital Districts Financing Authority Act  95
Hospital Insurance Act  95
Hospital Act  9 6
Hospital Rate Board and Methods of Payment to Hospitals  96
Hospital Consultation and Inspection Division  98
Research Division  98
Hospital Finance Division  99
Hospital Construction and Planning Division  101
Medical Consultation Division  106
Administrative Services Division  108
Approved Hospitals  109
Statistical Data  111
Tables—
16—Patients Separated and Proportion Covered by Hospital Programs,
British Columbia Public General Hospitals Only (Excluding Federal, Private, Extended-care, and Out-of-Province Hospitalization)  112
17—Total Patient-days and Proportion Covered by Hospital Programs,
British Columbia Public General Hospitals Only (Excluding Federal, Private, Extended-care, and Out-of-Province Hospitalization)  113
18—Patients Separated, Total Patient-days and Average Length of Stay,
According to Type and Location of Hospital for Hospital Programs
Patients Only, and Days of Care per 1,000 of Covered Population 113
19—Summary of the Number of Hospital Programs In-patients and
Out-patients, 1971-76  114
10
 Page
20—Summary of Hospital Programs Out-patient Treatments by Category,
1971-76 ,,  114
21—Patients Separated, Total Days' Stay, and Average Length of Stay
in British Columbia Public Hospitals for Hospital Programs Patients
Only, Grouped According to Bed Capacity, 1976 (Excluding
Extended-care Hospitals)	
22—Percentage Distribution of Patients Separated and Patient-days for
Hospital Programs Patients Only, in British Columbia Public
Hospitals, Grouped According to Bed Capacity, 1976 (Excluding
Extended-care Hospitals)	
Charts-
I—Percentage Distribution of Days of Care by Major Diagnostic
Groups, Hospital Programs, 1975	
II—Percentage Age Distribution of Male and Female Hospital Cases
and Days of Care, Hospital Programs, 1975	
III—Percentage Distribution of Hospital Cases by Type of Clinical Service, Hospital Programs, 1975	
IV—Percentage Distribution of Hospital Days by Type of Clinical Service, Hospital Programs, 1975	
-Average Length of Stay of Cases in Hospitals in British Columbia,
by Major Diagnostic Groups, Hospital Programs, 1975 (Excluding
Newborns)	
114
115
116
117
118
119
120
Medical Services Commission
Introduction	
Medical Services Commission Highlights..
Benefits Under the Plan	
Services Excluded Under the Plan.
Premium Rates and Assistance	
Laboratory Approval	
Professional Review Committees.
Salaried and Sessional	
Statistical Tables	
121
122
122
124
125
125
125
126
126
Tables—
23-
-Registration and Persons Covered by Premium Subsidy Level at
March 31,1976 ,  127
24—Persons Covered by Age-group at March 31, 1976  127
25—Coverage by Family Size at March 31, 1976  128
26—Distribution  of  Fee-for-service  Payments  for  Medical  Services
(Shareable)  129
27—Distribution of Medical Fee-for-service Payments and Type of Service  130
28—Average Fee-for-service Payments by Type of Practice  131
29—Distribution of Fee-for-service Payments for Insured Services, Non-
shareable Additional Benefits	
131
11
 Page
30—Average Fee-for-service Payments by Type of Practice, Nonshare-
able Additional Benefits  132
31—Summary of Expenditures, 1969/70 to 1975/76  132
Government Health Institutions  134
Emergency Health Services Commission .  140
Forensic Psychiatric Services Commission  146
Alcohol and Drug Commission  148
DEPARTMENT OF HEALTH EXPENDITURES, 1975/76
Financial Tables and Chart
Tables—
32—Statement of Operations and Surplus (Deficit), Emergency Health
Services Commission  142
33—Statement of Financial Position, Emergency Health Services Commission  143
34—Expenditure by Principal Categories in the Department of Health
for the Fiscal Year 1975/76  154
35-—Detailed Expenditure by Principal Categories in the Department of
Health for the Fiscal Year 1975/76  155
36—Statement of Working Capital and Financial Position as at March
31, 1976, of the Medical Services Plan of British Columbia  157
37—Statement of Operations for the Year Ended March 31, 1976, of
the Medical Services Plan of British Columbia  158
38—Statement of Changes in Cash Position for the Year Ended March
31, 1976, of the Medical Services Plan of British Columbia  159
Chart—
VI—Expenditure by Principal Categories in the Department of Health
for the Fiscal Year 1975/76  154
12
   THE YEAR IN  REVIEW
The year was one in which federal-provincial discussions paved the way for
marked changes in the funding arrangements for medical and hospital care in
Canada. In June, the Prime Minister of Canada presented a proposal to the
provinces which offered annual cash payments and the transfer of tax revenue
potential to the provinces, in lieu of Federal Government sharing of 50 per cent of
the cost of medical and hospital programs in Canada. Under the proposed arrangement, federal funding would no longer be directly related to program cost.
In presenting the federal proposal, the Prime Minister pointed to some basic
general conditions which provinces would have to meet to qualify for the federal
funding, but emphasized that the arrangement would give provinces more flexibility
in planning and in administering programs to meet their individual needs. However, it was clear to the provinces that the Federal Government would be transferring to them more financial risk should medical and hospital costs rise much
faster than the growth of the economy.
By the year-end, the Federal Government and the provinces had concluded
their discussions along the following lines: All provinces would agree to cancellation of their sharing agreements under the Hospital Insurance and Diagnostic
Services Act. These agreements would otherwise have continued until 1980. The
new system for financing medicare and hospital insurance would commence April 1,
1977. The federal contribution would be made up of approximately 50 per cent
tax revenue potential and 50 per cent cash transfer. Under the cash portion, equal
per capita grants based on federal contributions in 1975/76 would be escalated
thereafter by a three-year moving average of the gross national expenditure per
capita.
This new arrangement will bring to an end the form of sharing hospital care
which has been in existence since 1958 and the sharing of physician services which
started in 1968.
In addition to the above, the federal offer regarding sharing of costs for certain
low-cost alternatives to high-cost care, which have been under discussion for some
time, was replaced at the end of 1976 with a proposal to provide lump sums for
this purpose in the block payments under the new financing formula. Services such
as personal care, intermediate care, home care, and certain forms of ambulatory
services were included in this proposal. Other aspects of health care could continue to be shared under the Canada Assistance Plan or other similar social service
legislation.   Discussions on this option were still under way at the year-end.
In the face of the economic pressures of rising health costs, the Government
of British Columbia announced the first increase in medical insurance premiums
since the beginning of the plan in 1965. Following the inauguration of the federal-
provincial sharing arrangements in 1968, the medical plan had been able to build
up reserves. In recent years these reserves had been depleted and additional funding was being required from consolidated revenue. The monthly premiums Of $5,
$10, and $12.50 for single persons, couples, and families respectively' were
increased to $7.50, $15, and $18.75. The rates of premium subsidy continued as
before for those unable to pay full premiums.
Co-insurance charges for hospital care were increased for the first time since
1954, with a charge of $4 per day replacing the previous levy of $1 per day.
Extended-care patients under 19 years of age were to continue on the $l-per-day
co-insurance arrangement.
There were significant developments in the field of medical teaching. A future
increase in the output of the medical school at The University of British Columbia
15
 J  16 DEPARTMENT OF HEALTH REPORT,  1976
was announced. In connection with this development, the Minister of Health and
the Minister of Education outlined a plan for the development of medical teaching
facilities. In addition to a new 240-bed hospital on the campus, it was stated that
more than $5 million will be spent on extra space for teaching medical sciences at
the university and more than $ 13 million will go to provide interim teaching facilities at four Vancouver hospitals—Vancouver General Hospital, St. Paul's Hospital,
Shaughnessy Hospital, and the new paediatrics-maternity complex.
Administrative arrangements were set up to foster rapid completion of these
facilities, both at the university and at downtown teaching hospitals. It was indicated that further funding would be provided in the future for teaching space at the
downtown hospitals. This would be used for facilities forming part of the long-
range planning of those hospitals.
A new financing approach was established whereby the Department of Education will contribute substantial funds to medical teaching facilities, both on the
campus and downtown. Hitherto, such funds have been provided by the Department of Health and from the federal Health Resources Fund.
The campus hospital is to be a relatively unspecialized unit which will concentrate on teaching facilities for first- and second-year medical students.
The Minister of Health indicated in November that, after considerable
review, new referral units for the Province for paediatrics and for maternity should
be provided side-by-side on the site of Shaughnessy Hospital. This project would
consist of 200 pediatric beds and 90 maternity beds. The units would be operated
by the New Children's Hospital Society and the Salvation Army Grace Hospital
respectively. The facilities would phase out the existing Children's Hospital, the
Health Centre for Children at the Vancouver General Hospital, the Grace Hospital,
and certain maternity beds at other hospitals.
Evaluation of the Community Human Resources and Health Centres at
Houston, Granisle, James Bay (Victoria), and the Queen Charlotte Islands was
commenced during the year. These centres, operating under local boards, seek to
integrate and provide under a single administration a wide range of basic services,
including social service, public health nursing, and primary medical care. The
evaluation is to determine whether this form of organization is likely to provide
results superior to the more traditional arrangement.
The audit committee is composed of six representatives drawn from the B.C.
Association of Social Workers, British Columbia Medical Association, Registered
Nurses' Association of British Columbia, The University of British Columbia,
Department of Human Resources, and the Department of Health. The results of
the audit will be completed for review in 1977.
To facilitate provision of integrated service, the Department has also assisted
in developing small structures to house physicians and staff of various agencies
providing health and social services. During 1976, units were completed at
Lumby, Pender Harbour, and Mayne Island.
The approval of structures for the integrated housing of health and social
service personnel was announced for Terrace, Prince George, Vernon, and Kamloops.
There was an expansion in the program and activities of the Forensic Psychiatric Services Commission during the year. In May a forensic clinic opened in
Victoria, housed at the Victoria Mental Health Centre. Initially this is to serve
southern Vancouver Island. In August a new forensic clinic opened in Vancouver
to serve the Lower Mainland. This clinic incorporates the former unit situated at
the Vancouver General Hospital.   Both new units provide assessment, treatment,
 YEAR IN REVIEW
J 17
consultation, and follow-up for the mentally ill offender who can be handled on
an out-patient basis.
The hearing conservation program was expanded to cover 10 more centres
in the Province, and this brings the number of areas now covered by the program
to 15.
A vision care task force was established in September to plan for a coordinated vision care system for the population.
At the year-end, Government approval had been given for a program which
will bring improvement in air ambulance service for patients who need it, and an
extended training program for ambulance crews. The policy set out would include
new ambulance fee schedules. One effect of the new ambulance policy will be
to greatly reduce long-distance patient transfers by road and make air ambulance
service available between the more remote areas of the Province and major treatment centres without heavy cost to the patient.
The new arrangement called for a Provincial dispatch office to be established
at Victoria to co-ordinate and arrange all long-distance patient moves within the
Province, whether by air or road ambulance. Decisions as to the most suitable
means of transport will be made by the patient's physician in consultation with
the Provincial dispatch centre. They will operate in co-operation with the existing Rescue Co-ordination Centre, which will continue to be involved in emergency
mercy flights.
The year under review was the first in which Government-operated hospitals
had functioned under the new organizational structure. There was a review of the
roles of these hospitals with particular attention being directed to Riverview Hospital. The staff of Government hospitals have responded with gratifying results to the
administrative changes, and senior staff are confident that administrative improvement will continue. Working arrangements between the hospitals and the
Department of Public Works have been improved immensely over the past year.
On July 15, 1976, the Education Centre at Riverview Hospital was transferred
to Douglas College, New Westminster. As more educational activities have been
transferred from hospitals to educational institutions, centres such as this have
tended to become under-utilized. It is expected that the transfer will provide
Douglas College with badly needed facilities and at the same time provide a
stimulating and co-operative arrangement between the hospital and the college.
Two organizational changes should be noted within the Department. Increased emphasis on health education and the dissemination of health information
were reflected in the creation of a new Division of Health Education and Information in the Departmental, support services. The new division incorporates the
former Division of Public Health Education of Community Health Programs and
the various information services in the Department.
As part of the general Government reorganization, the agency, Action B.C.,
was moved from having its primary contact with the Department of Health to a
more direct relationship with the Department of Recreation and Conservation.
This organization had considerable success in promoting the awareness of good
health through activity and sound nutrition. It is expected that, notwithstanding
the new organizational arrangement, the Department of Health will continue to
work in close co-operation with Action B.C.
At the end of 1975 the Alcohol and Drug Commission had been transferred
to the Department of Health from the Department of Human Resources. There
were a number of developments relating to the Commission in 1976. In July
the Narcotic Addiction Services, the Alcohol and Drug Counselling Services, and
 J  18 DEPARTMENT OF HEALTH REPORT,  1976
the Youth and Family Counselling Services were transferred from the Vancouver
Resources Board .to the Alcohol and Drug Commission.
Government approval was given for a 30-bed residential treatment centre
for the Lower Fraser Valley to provide an intensive therapy program.
A detoxification unit was approved for Maple Cottage on the Woodlands
School site to serve South Burnaby, New Westminster, Surrey, Richmond, Delta,
and Coquitlam. The initial capacity of this unit will be 20 beds with a potential
for expansion to 35 or 40 beds.
Eighteen major hospital programs were completed or substantially completed
in 1976, involving about $33.5 million in capital cost. At the year-end there were
4,320 extended-care beds with about 1,570 additional beds under planning or
construction.   Of these, about 500 new beds are expected to open early in 1977.
The number of days of care paid in public hospitals in British Columbia by
Hospital Programs was reduced somewhat over 1975. In all, the estimated days
of care were 3,371,036, a decrease of 42,594 days from the actual 1975 figure.
The reduction in the days of care was in part the result of increased use of the
Home Care Program, but another factor was a withdrawal of services from seven
major hospitals by the Hospital Employees' Union, Local 180. The work stoppage in these hospitals ranged from a few hours to 16 days. Final resolution of
the differences between the hospitals and the union was brought about by the
passage of the Hospital Services Collective Agreement Act (Bill 75), on June 9,
1976.
The increasing use of the community mental health teams appears to have
had a direct relationship with the lessening pressure of admissions to Government-
operated mental hospitals.
With the exception of an increased incidence of gonorrhoea, there were no
serious outbreaks of communicable disease in 1976, nor were there any major
outbreaks of food poisoning. In the case of gonorrhoea, it was reported that a
penicillin-resistant strain has been identified in this Province. This strain has been
reported in three provinces of Canada so far and in a total of 11 countries.
The world-wide increase in malaria affected the Province and some 200 cases
were diagnosed. For the most part, those affected were new immigrants or
returning residents who had travelled to tropical countries.
Immunization programs against the so-called swine influenza were much in the
public eye during the year. These programs arose out of concern over an outbreak
of influenza in the United States in which a strain of swine influenza virus similar to
that which caused the 1918/19 pandemic of influenza appeared to be indicated.
The Federal Government arranged the purchase of vaccine from a number of
countries.
Two types were purchased—a vaccine to provide protection against both the
more common A/Victoria strain, as well as the A/New Jersey 76 (Swine Flu)
strain; and a vaccine which would provide protection against A/New Jersey only.
The policy in British Columbia was to proceed immediately upon receipt of the
dual-purpose vaccine to immunize persons with chronic illnesses, as well as the
aged. Commencement of the program for swine flu alone was to await confirmation
of a further case of swine flu anywhere else in the world.
At the year-end the situation was as follows: The dual-purpose program had
been carried out for the chronically ill and the elderly. It was halted pending
investigation cf a higher than normal incidence of Guillain-Barre syndrome (paralysis) in the United States, which the Surgeon-General there suggested might be
linked to the flu vaccine.
 YEAR IN REVIEW
J  19
The routine use of smallpox vaccine has been discontinued as this disease
appears to have been brought under world-wide control.
The two leading causes of death both showed increases in mortality during the
year. For heart disease, the deathrate was 262 per 100,000 population compared
to 258 in 1975. Despite the increase, the 1976 rate is still well below the rates
being recorded five or more years ago. The cancer death rate was at its highest for
some years in 1976, a rate of 160 per 100,000 population being recorded. This
was above the figure of 156 for 1975 and well above most rates of recent years.
While accidental deaths continued at a high level, an encouraging decline was
shown in 1976. The rate was 74 per 100,000 population, down from 78 in 1975
and 86 in 1974. Within this category, 36 per cent of deaths resulted from motor-
vehicle accidents, down from 39 per cent the previous year. The infant mortality
rate in 1976 was down to 14.4 per 1,000 from a figure of 15.4 in 1975.
DEMOGRAPHIC FEATURES
The preliminary population count for the Province according to the 1976
Census was 2,406,212. This is subject to some slight upward adjustment when
people enumerated at temporary addresses and living outside the country are added
to the population counts at their usual place of residence. The final census population will still be somewhat below the estimated count for the Province and this will
necessitate adjustment of the population figures for the inter-censal period 1972 to
1975. In turn, this will require recalculation of the vital statistics rates which will
have been somewhat understated by the use of the higher population estimates.
On the basis of the preliminary 1976 census population count and revised
estimates of the population from 1972 to 1975, the birthrate reached a low of
15.1 per 1,000 population in 1973 and has since increased to 15.4 in 1976. The
1973 rate represented the end of a period of almost unbroken declines in the birthrate, commencing in 1958, and was over 40 per cent below the record high of 26.1
for 1957. The 1976 rate was an increase over the figure of 15.1 for 1975.
From 1971 to 1975 the marriage rate per 1,000 population was unchanged at
9.3. However in 1976 there was a slight decline to 9.1. While this is still a relatively high rate compared to figures for the late 1950's and early 1960's, it is below
most of the rates recorded in the 1940 decade.
The deathrate in recent years has fluctuated within very narrow limits after
some fairly marked declines from the mid-sixties to 1970. It reached a record low
of 7.9 per 1,000 population in 1973 and, after a rise to 8.2 in 1974 and a decline
to 8.0 in 1975, there was a further decline this year to the low rate of 7.9.
The two leading causes of death both showed increases in mortality this year.
For heart disease, the deathrate was 262 per 100,000 population compared to 258
in 1975. Despite the increase, the 1976 rate is still well below the rates being
recorded five or more years ago. The cancer deathrate was at its highest point for
some years in 1976, a rate of 160 per 100,000 population being recorded. This
was above the figure of 156 for 1975 and well above most of the rates of recent
years.
The gradual downward trend of the deathrate for cerebrovascular diseases
continued in 1976, there being 79 deaths from this cause for each 100,000 population. This is well below the 1975 rate of 86, and also well below the rate of most
recent years.
While accidental deaths continued at an excessively high level, the rate for
1976 showed an encouraging decline to 67 per 100,000 population from 78 in
 J 20 DEPARTMENT OF HEALTH REPORT,  1976
1975 and 86 in. 1974. Within this category, 38 per cent of the deaths resulted from
motor-vehicle accidents, down from 39 per cent the previous year. The proportion
due to falls was up to 19 per cent from 16 the previous year, while for drownings
the proportion was down to 8 per cent from 9 in 1975. Poisonings and burns
accounted for 10 per cent and 6 per cent respectively of all accidental deaths, the
former figure being up from that for 1975, while the latter was unchanged.
The suicide rate was slightly lower at 16 per 100,000 population, an improvement over the higher rates of recent years.
The infant mortality rate in 1976 was down to 14.4 per 1,000 live births from
the 1975 figure of 15.4. The most substantial decline was registered for infants
from 1 day to 1 week old, but infants at ages from 1 week on also shared in the
improved mortality rate.
 •§«
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COMMUNITY HEALTH
PROGRAMS
  Public Health Programs
Public health legislation in British Columbia dates back to 1869
when statutory authorization was given for a Provincial Board of
Health. However, active administration of public health services in
the Province by the Board did not get under way until the last decade
of the 19th century. By 1946 the services had developed to the point
where full departmental rank was warranted and in that year the
Department of Health and Welfare was established.
Public Health Programs is now one of the two major administrative subdivisions of Community Health Programs (the other being
Mental Health Programs) and is charged with providing a wide
range of preventive, treatment, and environmental control services and
with promoting positive health. These services are made available to
the public through certain centralized facilities and a network of 17
local health units covering the non-metropolitan areas of the Province.
Greater Vancouver and the Capital Regional District have their own
health organizations, which are not under the jurisdiction of the Provincial Health Department, but which receive certain consultative
and specialized services together with financial assistance from the
Provincial Government. These two administrations collaborate very
closely with the Provincial Health Department in disease prevention
and control, and in program implementation.
Statutory support for the operation of Public Health Programs
comes mainly via the Health Act, and pursuant regulations, and the
Public Schools Act. These statutes confer powers on the Minister of
Health, the local Medical Health Officer, and the local board of
health for dealing with matters of public health. The local board of
health may be either a municipal council (covering municipal areas
which may also draw up add-itional public health by-laws), or a union
of municipalities and school districts, to administer relevant sections
of the Health Act or pursuant regulations in areas outside municipalities.
A review of the activities of Public Health Programs is presented
on the following pages:
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 J 24 DEPARTMENT OF HEALTH REPORT, 1976
PUBLIC HEALTH  PROGRAM HIGHLIGHTS
• Increased emphasis on health education and the dissemination of health information was reflected in the creation of a new Division of Health Education and
Information in the Departmental support services. The new division, which
incorporates the former Division of Public Health Education of the Community
Health Branch, was given an immediate mandate to consolidate existing information services in the Department and to carry out a Province-wide study of health
education needs.
• With the exception of an increased incidence of gonorrhoea, there were no serious
outbreaks of communicable disease this year, nor were there any major outbreaks
of food poisoning.
• The world-wide increase in malaria affected the Province, and some 200 cases
were diagnosed. For the most part those affected were new immigrants or
returning residents who had travelled to tropical countries.
• Arising out of concern over an outbreak of influenza in the United States caused
by a strain of swine influenza virus similar to that which is thought to have caused
the 1918/19 pandemic of influenza, a large-scale public program of immunization
against influenza took place in the Province in the fall. Because of the limited
supply of vaccine, it was offered only to chronically ill persons of all ages and to
persons over 65.
• The routine use of smallpox vaccine has been discontinued as this disease appears
to have been brought under world-wide control.
While about 500,000 immunizations were carried out among the population
during the year, some indications of a decline in immunization level point up the
need for continuing promotional effort to maintain the general level of immunity
to such diseases as diphtheria, tetanus, pertussis, rubella, rebeola, and poliomyelitis.
The incidence of venereal disease continued at a high rate and it has been necessary to increase the activity related to contact tracing.
• In the field of environmental engineering, nine regions were established to replace
the five regions in which service was previously based. Regional engineers were
appointed in each region, thus increasing the service provided to the local health
units.
• A publication, Waterworks Systems Guidelines, was issued during the year for
the information of water system designers.
• In view of the increasing use of radiation-emitting equipment in the healing arts,
the Division of Occupational Health intensified its surveillance of such equipment
to ensure that radiation exposures are kept at safe levels.
• The introduction of disposable artificial kidneys makes it possible to reduce
markedly the amount of time patients requiring kidney dialysis must spend on
this procedure. Also, the quality of the equipment in use has been improved by
the introduction of electronic components.
• About 15,000 expectant parents attended 685 series of evening or day-time
classes provided by Provincial public health staff. Over 75 per cent of the
classes had enrolment by both parents compared to 62 per cent in 1974.
•
•
 COMMUNITY HEALTH PROGRAMS I 25
• Integration of the services provided by the Victorian Order of Nurses in the
Province with the public health nursing service was made complete during the
year with the assumption of responsibility for VON nursing service in the Vancouver area by the Greater Vancouver Metropolitan Health Services.
• Home visits by public health nursing staff to persons over 65 years of age increased
by 25 per cent in 1976.
• Home care programs continued to be available to over 90 per cent of the
Province's population.
• Service from the expanded role of public health nurses was extended to a number
of remote areas of the Province which lack full medical facilities.
• A reorganization of the former combined Fraser Valley and Skeena dental region
into two separate regions resulted in better service being provided in these areas.
• In the field of nutrition information, special emphasis was placed on maternal and
infant nutrition with the production of the Infant Nutrition Guide for professionals, a first in Canada.
• Substantial progress was made in computerization of the Division of Vital Statistics data processing operation and a terminal was installed to provide direct
access to the Transport and Communications Department computer.
• Program plans for the health promotion-prevention focus of the community human
resources and health centres were initiated during the year. An all-centre workshop and conference was held in the fall at Granisle for 40 board and staff representatives. An evaluation process has been implemented using a variety of
approaches to monitor service.
• A vision care task force was established in the Province in September 1976 to
plan for a co-ordinated vision care system for the population.
• An important addition was made during the year to the program of the Division
for Aid to Handicapped. This involved the development of a work adjustment
program at the Vancouver General Hospital to provide vocational assessment and
work adjustment service to selected disabled out-patients at the hospital.
• Negotiations between the Department of Health and the Department of Education
were concluded during the year and approval was given for co-ordination of
service by speech therapists in the schools.
• An extension of the hearing conservation program to 10 more centres in the
Province in 1976 brings the number of areas covered by the program to 15.
• New community health clinics were opened in Lumby, Pender Harbour, and
Mayne Island in 1976.
COMMUNICABLE AND REPORTABLE DISEASE
Except for gonorrhoea, for which the reported incidence continued to increase,
there were no serious outbreaks of communicable disease during the year. Only
11 cases of diphtheria were reported, compared with 51, 69, and 22 during the
preceding three years. Also, no major outbreaks of food poisoning were reported
during the year.
Infectious hepatitis, which is a highly cyclical disease, was at a low ebb this
year, with only 745 cases reported, compared to over 1,800 cases five years ago.
 J 26
DEPARTMENT OF HEALTH REPORT,  1976
Measles dropped from 1,149 cases in 1975 to 181 cases this year, and rubella from
476 reported cases in 1975 to 69 cases in 1976,
Almost 200 cases of malaria were diagnosed this year. Most of those affected
were newly arrived immigrants or persons returning from visits to tropical countries.
This is a reflection of the world-wide increase in malaria and serves to emphasize
the fact that with increasing travel we are increasingly vulnerable to diseases that do
not normally occur in this Province.
INFLUENZA IMMUNIZATION
Influenza vaccine first became generally available about 1960 and has since
then been given routinely by many physicians to elderly persons and to patients
with chronic illnesses.
This year, for the first time, British Columbia, in common with all the other
Canadian provinces, planned for a large-scale public program of immunization
against influenza because of an incident in the United States in the spring.
An extensive outbreak of influenza occurred at an army recruit camp in New
Jersey. Although most of those who became ill were infected with the current
A/Victoria strain of influenza virus, a small number were found to be infected with
a type of influenza virus that is normally only found in swine.
Since there is good circumstantial evidence that a strain of swine influenza
virus was the cause of the world-wide pandemic of influenza that took so many lives
in 1918/19, the United States Government decided to offer immunization against
swine influenza to everyone in the United States, at public expense.
The four American manufacturers, who normally also supply the Canadian
market, were not able to manufacture enough vaccine to meet even their Government's order, which meant that no influenza vaccine was available for export to
Canada this year.
The Federal Government approached other companies producing influenza
vaccine in all parts of the world and were able to obtain about 13 million doses
of unfinished vaccine in bulk form from Australia, Holland, France, Germany, and
England. Two types of vaccine were purchased—one offering protection against
the current A/Victoria strain of influenza virus, and the other against the A/New
Jersey (Swine) influenza virus.
This imported vaccine was tested and made ready for use by the Connaught
Laboratories in Toronto and the Armand Frappier Institute in Montreal, but
because of the many technical difficulties that arose it was not ready for use at
public clinics until mid-November.
Each province adopted a somewhat different approach to the use of these
vaccines. British Columbia's program, which was generally the same as that in
the other western provinces and Quebec, was to offer a combined or bivalent
vaccine (A/Victoria and A/New Jersey (Swine)) only to chronically ill persons
of all ages and to persons over the age of 65. A/New Jersey (Swine) influenza
vaccine was also purchased and stored in Vancouver. The program called for this
to be offered to healthy persons in the 20 to 65-year age-group if evidence developed that the A/New Jersey (Swine) type of influenza was recurring.
Both the American and Canadian manufacturers experienced a great deal of
difficulty in producing a satisfactory vaccine for chronically ill children and no
vaccine suitable for use in children was available in Canada during 1976.
About mid-December, American Public Health officials noticed that an unusual number of cases of Guillain-Barre syndrome seemed to be occurring in
persons who had recently been vaccinated against influenza and the U.S. Public
 COMMUNITY HEALTH PROGRAMS J 27
Health Service temporarily suspended their national immunization program, while
the significance of this observation was investigated and evaluated.
Although there did not appear to be a similar problem in Canada, several
Canadian provinces, including British Columbia, also decided to temporarily suspend their vaccination program until more information became available from the
United States.
TUBERCULOSIS CONTROL
The number of new active cases of tuberculosis again declined in 1976. Preliminary data indicate that 390 such cases were diagnosed during the year compared
with 440 in 1975 and 464 in 1974. Approximately 80 per cent of these new cases
were pulmonary tuberculosis, the remaining 20 per cent being divided among other
systems of the body. The incidence of the disease continues to be higher in individuals born outside Canada and also in certain ethnic groups.
The number of beds available for the treatment of tuberculosis has again been
reduced, reflecting the aims of the division to treat as many patients as possible at
home if the situation is suitable and to discharge hospitalized patients when they
cease to be infectious. These objectives have become feasible due to the availability
of the new and effective anti-tuberculosis drugs.
During the year a great many of the stationary miniature X-ray machines
located in health units have been taken out of operation. While these have been a
convenience to the public, their productivity in discovering previously unknown
cases of tuberculosis has fallen to a very low level. These machines also are quite
old and, in some cases, the radiation levels have become unacceptable. Increasingly, the efforts of the division to further reduce the incidence of tuberculosis must
be concentrated on ensuring good treatment of known cases and thorough investigation of contacts of these cases in order to prevent further dissemination of tuberculosis. For this, the division remains very dependent upon the local health units
throughout the Province.
Some adjustments are being made in the relative responsibility of caring for
Indian tuberculosis patients as between this division and the federal medical services in an effort to improve the treatment and follow-up of this group.
VENEREAL DISEASE CONTROL
Infections usually transmitted by sexual contact are called "sexually transmitted diseases" or STD. There are two different manifestations of these diseases,
usually referred to as signs and symptoms. The first is a discharge, either from
the male or female, the second is a skin lesion, or sore.
The discharges are by far the commonest signs and symptoms. The most
prevalent infection in the male is non-gonococcal urethritis or NGU. The disease
may have a long incubation period of one to four weeks, there being a serous
urethral discharge. Unfortunately, the disease cannot be treated by penicillin. It
is at least twice as common as gonorrhoea. Formerly, it was thought that the female
was a symptomless carrier, but there is increasing concern that the infection can
cause cervicitis and pelvic inflammatory disease, and may result in eye infections
and bronchitis in newborn infants. As the causal organism has not been clearly
established, there is no specific control program other than to offer treatment to the
patient and to his sexual contacts.
Gonorrhoea, or infections of the urethra with the gonococcus organism, is the
second commonest STD causing a discharge in the male. The incubation period is
usually four or five days, starting with a burning pain on urination, followed a
 J 28 DEPARTMENT OF HEALTH REPORT,  1976
day later with a urethral discharge. The methods of control have been to establish
clinics in large centres, to require reporting of cases diagnosed by physicians and
laboratories, and to offer contact tracing services. Although these were effective in
the past, the current less-restrictive sexual morality prevalent in young single adults
has resulted in more cases of this infection developing than can be dealt with by the
available control procedures.
The more recent control concept has been to identify promiscuous females,
and as the infection seldom produces symptoms in women, to examine them on a
routine basis and provide treatment where indicated. Although this procedure may
help to retard the spread of the infection, it too is inadequate.
Of the many control procedures that have been recommended, three deserve
mention. Firstly, physicians are required to report infections they become aware
of. However, as this offends the confidential doctor-patient relationship, such
reporting is inadequate. The physician can avail himself of assistance in contact
tracing from trained Health Department staff if he needs it. The second control
method is to establish acceptable clinics for social diseases, mostly sexually transmitted diseases, and for the prevention of unwanted pregnancy, in major centres
throughout the Province. This solves a problem whereby some people who find it
difficult to go to their physician with a social problem will accept the anonymity of
a special clinic, whether it is a V.D. clinic, a planned parenthood clinic, a street
clinic, or a women's clinic. The third method is to establish diagnostic facilities
readily available to every physician. Ideally this would mean doing a screening
test for venereal disease on every woman having a pelvic examination, especially
young single women age 15 to 30. This would result in the asymptomatic carriers
being found and brought to treatment.
Other methods of control have been tried and found wanting. For example,
a Zenith information telephone line for free calling in the Province has had few
inquiries, and many of these are by pranksters.
Discharges in the female are also caused by yeast or monilia, a very difficult
infection to treat, and also by infectious trichomonas. Both these infections may
cause severe itching and they are more difficult to treat because of the current fashion of wearing tightly fitting clothes.
Syphilis is a common infection in the male homosexual group. The ease of
travel between West Coast cities, and the organized methods allowing easy sexual
contact, has allowed this infection to persist, whereas it has been well suppressed
in the heterosexual population. The methods of control are the provision of diagnostic and treatment facilities in the larger centres, contact tracing and treatment
of contacts, and the establishment of a good relationship of trust and confidentiality
with both the patients and physicians who see many of these patients. There is an
excellent screening program of blood tests on pregnant women, and anyone having
a physical examination. Active male homosexuals are encouraged to have routine
blood tests.
Many improvements have occurred in the division's operations. A third male
nurse and a physician have been employed in the Vancouver clinic and a health
educator has been taken on staff to assist in preparing educational materials to
improve the dissemination of information about sexually transmitted diseases. The
Vancouver clinic operates until 7.30 p.m., Mondays and Fridays, and is open from
10 a.m. to 1 p.m. on Saturdays. The Pine clinic and Water Street clinic are supported through the Vancouver City Health Department. Other clinics are located
in New Westminster, Victoria, Kelowna, Kamloops, Prince George, Prince Rupert,
Dawson Creek, and Fort St. John.
 COMMUNITY HEALTH PROGRAMS
I 29
THE PUBLIC HEALTH NURSE AND DISEASE CONTROL
Both communicable and noncommunicable disease control received attention
from public health nursing staff:
• Routine smallpox vaccinations were discontinued as this disease was
brought under world-wide control.
• Immunization for diphtheria, tetanus, pertussis, rubella, rubeola, and poliomyelitis continued at the same level as the previous year; however, the
general level of immunity in most areas decreased slightly.
• A promotional effort is required to increase immunity levels and to make
people more aware of the continuing need for immunization protection.
• Approximately 500,000 immunizations and tests were given by public health
nurses.
• An increasing amount of time was spent in contact tracing, and treating
persons with venereal diseases.
• The amount of public health nurses' time required for tuberculosis control
and for other communicable diseases decreased slightly.
• Cancer, along with diseases of the heart and circulatory systems, were the
major illnesses of patients receiving nursing service on the home care
program.
HEALTH AND OUR ENVIRONMENT
ENVIRONMENTAL ENGINEERING
The Division of Environmental Engineering employs 15 staff members; Director, Assistant Director, nine Regional Engineers, one technician, two full-time and
one part-time stenographers. Five of the Regional Engineers are located in local
health unit offices at Ladysmith, Cloverdale, Vernon, Prince George, and Cranbrook.
This specialized group of engineers is responsible for the approval of all waterworks used for domestic purposes, all swimming-pools except for backyard pools,
and some small sewage-disposal systems. They provide engineering advice to the
Medical Health Officers and their staff throughout the Province in connection with
problems arising from water supplies, swimming-pools, sewage disposal, solid
wastes, etc. They also offer their expertise to other Governmental agencies and
municipalities, especially in the area of operator training and instruction.
Field Services
The team concept, whereby each field engineer related directly to an engineer
at headquarters, which was started in 1974, has enabled the field engineers to
become fully experienced in their duties and responsibilities. This concept was
reviewed in 1976 and as a result of the study it was decided toward the end of the
year to make a further administrative change and to assign every engineer in the
division to a specific region of the Province. Nine regions were created from the
five regions under the previous arrangement. The term "District Engineer" given
to the five engineers located in the field was discarded and all nine working-level
engineers were named as "Regional Engineers".
 J 30 DEPARTMENT OF HEALTH REPORT,  1976
This new approach reduced the geographical area for all but two of the
engineers. This meant that the health units were able to receive more time from
their Regional Engineer. The Regional Engineers based in Victoria established a
schedule of regular visits to their assigned health units and thus met the general
needs for their field services.
Top priority was given to compilation of information concerning waterworks
systems and obtaining samples of drinking-water for chemical analysis. The results
of the chemical analysis were put into a data processing system for storage and
retrieval. The Regional Engineers also gave a good portion of their time to visiting
and assisting the operators of waterworks, sewage works, and swimming-pools; to
site inspections of installations; and to consulting with municipal officials.
Description of Functions
A brief description of the basic functions of the division is as follows:
• Waterworks—Reviews for approval, submitted plans and specifications for
domestic water systems, including private systems, utilities, improvement
districts, and municipalities. Certificates of approval from the Department
of Health are required before construction proceeds. This division has 859
recorded waterworks systems in the Province, up 99 from 1975. There
were 710 certificates of approval issued in 1976, up 71 from 1975.
• Sewage works—Reviews for approval, submitted plans for public systems
with flows under 5,000 gallons per day and not discharging into a watercourse. There were only two certificates issued in 1976, an indication of the
relatively minor nature of this function.
• Swimming-pools—Reviews for approval, submitted plans, and specifications
for all swimming-pools and auxiliary facilities to be built in British Columbia, except backyard pools to serve individual families. In general, compliance with the regulations ensures that physical safety and sanitation
standards will be met. Once the construction of the pool has been completed, the jurisdiction for conformance with the regulations transfers to the
local Medical Health Officer who is responsible for the issuance of an
annual operating permit. There were 83 certificates for construction issued
in 1976, a slight increase over 1975.
• Sanitation—Offers technical support to the Division of Public Health Inspection in the areas of septic-tank construction, tile for disposal fields, and
package sewage-treatment plants.
• Pollution control permits to discharge—An inherent feature of the Pollution
Control Act, 1965 is the requirement that four other Government agencies
review the applications for discharges prior to the issuance of a permit.
The Environmental Engineering Division, on behalf of the Minister of
Health, receives all applications for discharges to land and water, solicits
comments from the local health authorities, and formulates a Departmental
reply. Applications for permits to discharge solid wastes are also reviewed
by the division.
• Operator training (sewage-treatment facilities)—As Co-ordinator of Operator Training for British Columbia, the Assistant Director of the division
actively participates in the preparation and implementation of operator
training and certification programs in British Columbia. The delivery system for operator training was available through the three following avenues:
 COMMUNITY HEALTH PROGRAMS
J 31
(1) Preparatory training of eight months' duration is offered at Malaspina College in Nanaimo. A staff member of the division was a member
of the College Advisory Committee.
(2) Workshops, seminars, and schools are offered through the Education Chairman of the B.C. Section, American Waterworks Association,
who was also a staff member of the division. A five-day water and waste
school for operators, co-ordinated by the division, was held in May 1976
and attended by 154 operators.
(3) Correspondence courses are available from other areas for wastewater personnel in British Columbia.
• Operator certification—Trained sewage-plant operators have been able to
participate in the voluntary certification program established in 1966. This
program has continued to be effectively handled through the Environmental
Engineering Division.
• Other training—A one-day cross-connection control seminar was held in
Kamloops to familiarize plumbers, water purveyors, and public health personnel with the hazards of cross-connections and the devices which are
available to protect water supplies from these hazards. The usual large-
scale training program for pool operators was not provided by the division
this year. However, some health units offered a one-day course and used
Regional Engineers to assist with lectures. Booklets on swimming-pool
operation, prepared by the division, were distributed to those in attendance
and are available on request.
In addition to their regular assigned duties, the staff offered assistance to a
wide variety of other Government agencies and actively participated in specialized
groups and committees.
Special Projects
Following a careful review of accepted waterworks standards, the division
printed and distributed a publication entitled Waterworks Systems Guidelines.
This publication is primarily useful to designers of waterworks systems who submit
plans and specifications to the division for approval. Copies are available on
request.
All fluoridation installations in the Province were reviewed by the division's
technician or Regional Engineers. Reports have been made as a basis for future
annual inspections.
Separate lists of approved prefabricated septic tanks and package sewage-
treatment plants were compiled and distributed to all health units for their use as
required by the Sewage Disposal Regulations.
Short Courses and Conferences
Members of the division attended a number of short courses and conferences
which were helpful in their professional training and continuing education; staff
members also co-operated in the provision of various short courses.
Annual Conference
The Engineering Division held its third annual three-day conference on
October 6 to 8, 1976, to evaluate its program and priorities. Professional staff
were given the opportunity to exchange information, discuss policy, regulations,
procedures, and other matters of organization and operation.
 J 32
DEPARTMENT OF HEALTH REPORT,  1976
PUBLIC HEALTH INSPECTION
The Division of TPublic Health Inspection plays a very active role in a wide
range of activities in the field of environmental health.
Food Safety
The safety and protection of food served to the public continues to be one of
the major concerns of Public Health Inspectors. The Food Premises Regulations
are continuously under review for improvements; however, the major thrust has
not been in the field of enforcement but rather to assist in improving the skills of
food service workers through educational programs. Most of these activities have
been concentrated on the Lower Mainland in co-operation with the Canadian
Restaurant Association, and employees of both large and small operations have
participated. The investigation of food-borne outbreaks has been updated by
improved methods of reporting and through close co-operation with the Provincial
Laboratory. The surveillance of microwave ovens in restaurants throughout the
Province has continued with assistance from the Division of Occupational Health.
Regulations
The Mobile Home Park Regulations were rescinded by Order in Council,
having served a very useful purpose prior to the formation of regional districts.
The Department of Health still has authority under the Sewage Regulations and
Health Act to control sewage and water installations.
Land Use
Involvement with the issuing of permits for private sewage-disposal systems
and subdivision inspections are taking up 90 per cent of Public Health Inspector's
time in several health units. In order to assist with this heavy demand for service,
the Sewage Disposal Regulations were amended to permit Union Boards of Health
to charge and collect fees for sewage disposal permits. The money collected will
be used by the union boards to hire additional Public Health Inspectors. Four
union boards, namely, South Okanagan, Central Fraser, Coast Garibaldi, and
Central Vancouver Island, will participate as a pilot project.
The demand for housing is opening up many new subdivisions on Crown and
privately owned land. The Public Health Inspectors' continued involvement in
assessing land for both on-site sewage disposal and water supply is considered
essential as a preventive health program.
Educational Activities
The Division of Public Health Inspection, in co-operation with the British
Columbia Institute of Technology, completed the third and final module of a course
on law for Public Health Inspectors. The course was very well received and tapes
of the various lectures have been circulated to those who were unable to attend.
A four-day seminar for Public Health Inspectors was held in Prince George
in February and included those from Skeena, Peace River, Northern Interior, and
Cariboo Health Units. Both the Director and consultant from the division as well
as a solicitor from the Attorney-General's Department and a representative from
the Provincial Laboratory participated in the program.
The Department supported the National Educational Conference of the Canadian Institute of Public Health Inspectors in Vancouver by sponsoring the attendance
of 16 Public Health Inspectors.
 COMMUNITY HEALTH PROGRAMS
I 33
Personnel
This division has suffered an unusually high turnover of staff and it has been
difficult to recruit suitable candidates for northern and Interior vacancies.
A/general shortage of Public Health Inspectors appears to prevail throughout
Canada. However, some improvement is anticipated inasmuch as the Public Health
Inspectors' course at British Columbia Institute of Technology enrolled a first-year
class of over 40 persons in 1976.
The Director of the Division of Public Health Inspection is one of the representatives for the Deputy Minister of Community Health Programs on the Advisory
Committee for the Public Health Inspectors' course at the British Columbia Institute
of Technology. He is also the Deputy Minister's representative on the Board of
Certification of the Canadian Public Health Association and responsible for supervising the oral examination for those candidates wishing to become Public Health
Inspectors.
The student training program of Public Health Inspectors has been extended
from three to six months and the students are now required to submit five written
reports to the Board of Certification, which accounts for 40 per cent of the students'
marks.
DIVISION OF OCCUPATIONAL HEALTH
The Occupational Health Division provides a multi-disciplinary, comprehensive employee health service for public servants, acts as a consultative and advisory
group to all departments of Government, performs certain services required of the
employer by the Workers' Compensation Board (audiometric surveillance), monitors the use of ionizing radiation, conducts an extensive alcoholism rehabilitation
program for public servants, and conducts a physical fitness program for public
servants in the Victoria area. This division has five specialized areas of expertise,
namely, medical, nursing, radiation surveillance, alcoholism rehabilitation, and
physical fitness.
The medical team consists of four physicians, all of whom possess special
training. Physicians in this division provide some direct medical care, but the
major activities involve assessment of medical problems of employees with difficulty
in performing their job, advising employing departments of the best rehabilitation
or retraining program, and acting as liaison between attending physicians and
employers. It should be emphasized that occupational physicians direct their
efforts to the well-being of the individual employee and are neither labour nor
management oriented.
Advice on any particular health problem is made after a thorough medical
examination, consultation with the employer, other medical attendants, and other
involved parties such as the Workers' Compensation Board.
It is important that physicians continue to upgrade their basic knowledge and
all physicians in this division have availed themselves of postgraduate training
opportunities in 1975 in areas of specialty: industrial toxicology, aviation medicine,
cardiac monitoring, and business administration.
Nurses in this division work closely with physicians in assessing employees with
health problems. As well, they are intimately involved in the continuing follow-up
of individuals referred to this division. It is a responsibility of the nursing staff to
review the approximately 200 sick reports received weekly and to consult with the
employer and private physicians if it appears a health problem might be job-related
or job-aggravated. Also, the nurses are responsible for a good deal of the employee
counselling on a wide variety of subjects, as well as conducting immunization pro-
 J 34
DEPARTMENT OF HEALTH REPORT,  1976
grams, audiometric screening, pre-employment health screening, and health education. They also work closely with the alcoholism counsellors in the ongoing care
of some employees with alcoholism difficulties.
The use of radiation in the healing arts continues to increase despite the paradox
that the population is becoming more aware and concerned with various aspects of
radiation and its potential to cause harm to man and his environment. This increase
is most dramatically illustrated in the increase in dental X-ray tube heads, the
number of which has doubled in the last three years. It has been noted that during
the last two years there has been a marked improvement in the reduction of skin
exposure to X-rays by patients during a dental examination. The primary cause
is the dentist's awareness and a change in technical operating factors.
Commercial microwave ovens
were checked for defects as part of
the Radiation Protection Service's
responsibilities.
The Radiation Protection Service carried out a survey of all photofluorographic
(miniature) chest X-ray units in this Province in order to ensure that they meet
present standards of operation.
The possibility of harmful effects to man exposed for extended periods of time
to low-level microwave radiation is receiving increased attention. This concern
does not apply to the occasional use of an in-the-home microwave oven, but rather
to the commercial use of microwaves. The microwave survey program conducted by
this Department covered 265 commercial units of which 10 per cent were leaking
radiation well above recommended levels and 20 per cent were borderline or had
other mechanical or electrical faults.
The activities of the Radiation Protection Service during 1976 are summarized
as follows:
Radiation surveys   (X-ray,  radioisotopes,  and microwave)   1,018
Consultations and visits     388
Talks and lectures        25
Radiation leak tests      511
Water samples checked for radioactivity        95
Air samples checked for radioactivity        68
 COMMUNITY HEALTH PROGRAMS
J 35
The purpose of the Employee Development Services in this division is to provide a comprehensive Province-wide interdepartmental program to identify, diagnose, motivate, and refer for treatment troubled employees (problem drinkers) of
the Public Service, in order to rehabilitate and return them to effective job
proficiency.
This service has three closely related functions:
A. Counselling the troubled employee and (or) the family.
Alcohol and related problems identified—
Employees referred  109
Employees returned to satisfactory job proficiency     95
Other problems (drugs, marital, etc.)—
Employees referred     25
Employees returned to satisfactory job proficiency     25
B. Training for managerial, supervisory, and shop steward staff in the identification and referral of troubled employees (based on job performance). These
seminars are usually a full day's program. An attempt is made to include the
appropriate shop stewards.
Managerial, supervisory seminars—
Number of seminars        77
Number of attendees  1,503
Personnel Officer seminars—
Number of seminars	
Number of attendees	
  3
        90
Safety rally talks (2-3 hours)—
Number of employees attending  2,443
Number of sessions        12
General staff training—
Pearson Hospital employees       268
Number of sessions (ongoing)        21
Promotional talks (to acquaint the private sector with our
Government program)—
Number of talks  6
Number of attendees       386
Consultation services in order to promote the program within
the Government Service where the program is
little known or to help it function more smoothly
where it is already in operation. This also involves
liaison with community treatment services.
Number of discussions        25
Number of attendees        60
The total number of Government employees interviewed this year was 4,690
or over one tenth of the Public Service. The estimated cost-saving through employees returned to satisfactory job performance is $237,000 (based on a minimum
inefficiency rate of 25 per cent of personal earned income).
C. Research services—An attempt is being made to monitor the effectiveness
of this program and to determine actual case penetration.    It is too early in the
 J 36 DEPARTMENT OF HEALTH REPORT,  1976
program to report actual data, but trends are appearing and they are highly
encouraging.
The employee fitness program, now in its second year of operation, is staffed
by a full-time Fitness Director, half-time nutritionist, and seven part-time exercise
leaders. The program is designed to cater to the fitness and nutrition needs of
Provincial Government employees in the Greater Victoria area. Educational and
motivational information is provided, testing and counselling sessions are carried
out, and individual and group exercise classes are available.
The physical activity centre in Victoria, opened in January 1976, and catered
to 150 participants on a regular basis. Eight group exercise classes offered at other
locations attracted another 150 people. Administrative assistance was provided to
employee groups in the formation of inner-tube water polo, hiking, and weight-
training clubs. These three clubs catered to 60 members. Fifteen to 20 people
received nutrition counselling on a weekly basis, while a further 15 individuals had
fitness testing and exercise counselling each month. Health and bicycle maintenance seminars are available on an ongoing basis. The bi-monthly newsletter and
health fitness library are both available to Government employees throughout the
Province. New services and activities in the fall of 1976 include strength fitness
and aquatic fitness classes, a recreational activity group, and fitness testing. Plans
for the near future include small exercise programs in three offices on an experimental basis and a dietary modification program for obesity control.
SPECIALIZED COMMUNITY HEALTH  PROGRAMS
MEDICAL SUPPLY SERVICE
The Medical Supply Service operates a home care program for patients requiring special equipment. This includes patients with end-stage renal failure, haemophilia, and Crohn's disease.
The number of patients with end-stage renal failure has stabilized at about 90
home patients. These patients are relatively well except that they require dialysis
on a regular basis. This service provides the necessary equipment, supplies, and
drugs to maintain the patients at home. There were 75 patients on blood dialysis
at the end of 1976.
Two major improvements were made in the dialysis program during the past
year. Disposable artificial kidneys which can be used an average of four times were
introduced. They reduce the time on dialysis from an average of eight hours to an
average of five hours, three times a week. The second change was in the quality of
equipment, which was markedly improved with the introduction of electronic components. One patient has been provided with a portable machine so that he can
travel as his job requires. The Kidney Foundation has purchased a motor home
so that patients may take a holiday, taking their equipment with them, and the
Medical Supply Service provides the supplies for patients using this home.
There were 15 patients on peritoneal dialysis at the end of the year and there
have also been marked improvements in this service. Two patients were placed on
automatic machines and five patients were placed on automatic cyclers. As peritoneal dialysis requires about 40 hours of dialysis a week, this automatic apparatus
allows the patient to sleep during the process and therefore reduced the waking-
time necessary for this treatment.
 COMMUNITY HEALTH PROGRAMS
J 37
■a.
Disposable artificial kidneys are being used by increasing numbers of patients
needing dialysis.
There were approximately 30 patients with Factor 8 haemophilia on a home-
treatment program in which the Red Cross supplies the cryoprecipitate while the
Medical Supply Service supplies the intravenous administration materials. It has
been found necessary to supply one patient with Factor 8 concentrate or "Hemo-
phil". Although this is a very expensive procedure it is a way of controlling the
disease when no other possibility exists. A program has been introduced to treat
children up to their third birthday with "Hemophil" concentrate because the slow
administration of plasma is very difficult for a baby.
There are approximately five patients with Factor 9 haemophilia. This service
previously supplied a concentrate for the use of these patients, but the Red Cross
is now able to provide a concentrate prepared by Connaught Laboratories. As this
does not come as a complete packaged unit it is still necessary for this service to
supply the intravenous materials for its administration.
There are six patients with Crohn's disease who are provided with intravenous
materials from this service. The treatment of this disease by intravenous feeding is
a relatively new development and has not yet been adequately standardized. Some
patients are fed through peripheral blood vessels and must use very dilute solutions.
Other patients are fed by a centrally placed catheter into a blood vessel and can
receive much more concentrated solutions. At the present time it is necessary to
use sugar, protein, and fat solutions to which is added a variety of minerals and
vitamins. This is a difficult procedure for a home patient as sterility must be maintained. Progress is being made toward the establishment of standardized procedures and solutions and, once this is accomplished, then most patients should be
able to carry out this treatment at home.
Children on dialysis are not able to absorb sufficient food and therefore have
inadequate caloric intake.  A program was developed of supplying these children
 J 38 DEPARTMENT OF HEALTH REPORT, 1976
with food supplements which must be low in protein, potassium, and sodium. This
program has been extended during the past year to include children not yet on
dialysis who also have this difficulty. It has been found that providing these food
supplements before dialysis begins will likely improve their stature.
The major development that occurred in this service during the past year was
the opening of a limited-care unit in the Willow Chest Centre in Vancouver.
Patients who cannot dialyse at home because of lack of space or of someone to
assist them can be dialysed in these limited-care facilities, provided they have the
capability of assisting themselves. As the hospital renal units have continued to fill
up it has been imperative to find alternative methods of getting patients out of the
hospital. The number of home patients cannot be increased and these limited-care
facilities have the capability of taking patients who could not otherwise go home.
Once this capability is established as a method of increasing the facilities of these
patients, then additional limited-care units will be opened throughout the Province.
MERCY FLIGHTS
The Department again arranged for "mercy flights" to transport seriously ill
or injured persons by air to a hospital or other treatment centre. When such flights
become necessary, available aircraft from a variety of sources may be called upon,
including the Provincial Government, the Canadian Armed Forces, the Canadian
Coast Guard, and, in special circumstances, the United States Coast Guard and
British Columbia Forest Products Ltd. In each case a medical assessment of the
need is made by a senior medical officer of Public Health Programs who also acts
in a co-ordinating capacity between the patient's physician, the providers of the
aircraft, and the receiving hospital.
In 1976, 387 mercy flights were made, an increase of 8 per cent over the 357
such flights in 1975 and an increase of 59 per cent over the 244 flights in 1974.
COMMUNITY CARE FACILITIES LICENSING BOARDS
Although the Minister of Health is ultimately responsible for the quality of
care given in licensed care facilities for both children and adults, senior staff from
the Departments of Health, Human Resources, and Education have for many years
administered the Community Care Facilities Licensing Act for the Minister through
the Community Care Facilities Licensing Board. This year a number of changes
which have been planned for many years took place.
Two boards have been formed, a child care licensing board and an adult care
licensing board, and are now meeting monthly.
The Ministers of the three departments involved have each appointed a community representative to each board.
Toward the end of the year new adult care regulations were adopted which
reflect more fully the quality of care which the Government wishes the elderly people
in the Province to have. New child care regulations are under preparation and
will be ready next year.
The adult care board has been given the additional responsibility of developing
proposals for long-term care (personal and intermediate care in the home or in a
residence built for the purpose).
At the close of the year there were 514 adult care facilities and 1,249 child
care facilities licensed, and applications have been received and are outstanding for
19 adult care facilities and 62 child care facilities.
 COMMUNITY HEALTH PROGRAMS J 39
The Provincial Adult Care Facilities Licensing Board has set up a pilot project
to give basic St. John Ambulance Society training courses to certain operators and
staff of adult care facilities.
A community care facilities nursing consultant has been added to the board's
staff in Victoria.
The consultants made 17 visits to field offices in 1976 for consultation and
workshops.
SPEECH THERAPY
Twenty speech pathologists are currently serving the needs of communicatively
handicapped individuals in 18 local health units in British Columbia. While demands
for such service exceed existing staff capabilities, emphasis has been placed on
delivering quality treatment programs for speech and language handicapped clients.
Each health unit program has provided service to communicatively handicapped
clients within a framework of standardized guidelines to assure effectiveness. While
they are standardized, local health unit programs reflect the most pressing needs
of local populations with respect to
(a) identification of handicapped population;
(b) evaluation and assessment;
(c) treatment;
(d) reporting;
(e) dismissal; and
(/)   public information and education.
Extensive program data have been maintained at the Division of Speech and
Hearing's central office covering referrals, assessment and treatment, case disposition, and treatment time.
An average of eight clients per month or 96 per year are referred to speech
clinics in each health unit. Speech pathologists maintain an average of 32 clients
on an active therapy case load providing 20 to 24 hours of treatment time per week.
The number of client therapy sessions vary from one to three per week. When
appropriate, other treatment procedures are used, such as home programs, parent/
teacher programs, etc.
On the average there are about 42 children on the waiting-list for assessment,
with seven awaiting treatment.
Speech pathologists in local health units have presented a variety of public
information programs utilizing radio, television, and local interest groups. As well,
they have provided in-service training with co-operating professionals.
During the year, negotiations between the Department of Health and the
Department of Education were concluded and approval was given for co-ordination
of service provided by speech therapists in the schools. Formerly, service was
provided separately by the two departments and the new arrangement will result
in more effective treatment.
HEARING CONSERVATION PROGRAM
During the past year the division's system of service delivery has been closely
evaluated.   The system demonstrated a high degree of success.
The audiology centres not only fit hearing-aids but deliver comprehensive
hearing conservation services which range from the identification and rehabilitation
of newborns with hearing impairment to the rehabilitation of senior and other
 J 40
DEPARTMENT OF HEALTH REPORT, 1976
persons in need of hearing-aids. Persons who have been in need of services for
years are now being identified and are receiving assistance. The results of a patient
survey indicate a high degree of satisfaction with the service.
Contributing factors to this success are
(1) a high level of community and medical input through local advisory
committees;
(2) co-ordination of services with public health  personnel,  schools,
hospitals, and community organizations;
(3) low Governmental expenditure due to
(a) strict quality control of equipment and hearing instruments,
(b) standardization of critical systems procedures and reliance
on scientific principles,
(c) ability to identify problems, and
(d) effective problem remediation.
Approval has been obtained for expansion of the program from the five centres
presently in operation to 15. This will make possible considerable wider coverage
of the Province when staffing is completed.
The audiology centres provide a comprehensive program aimed at preventing
or overcoming hearing disabilities utilizing a team of health professionals. As a
result, the public in five Provincial areas where the services are offered have become aware of the fact that hearing disability can be remediated. An important
feature of the program is strict adherence to an accountable systems approach for
Province-wide calibration of audiometers was one of the numerous responsibilities
of the Division of Speech and Hearing services.
 COMMUNITY HEALTH PROGRAMS
J 41
each of the procedures from identification through remediation and prevention.
While the establishment of such an approach is initially difficult, it provides the
information needed to make adjustments which may be required in the program.
Reliance on established methods, principles, and recognized international
standards are fundamental to the program and experience has shown that the
systems and methods employed are successful and inexpensive in effectively servicing
the hearing impaired.
VISION SERVICES
The purpose of the vision screening program is to enable children to have
optimal visual function and maintain the ability to use their eyes together, comfortably and efficiently.
The pre-school years are critical ones in the development of a child's eyes.
Visual defects such as strabismus and amblyopia (occurring in 4.5 per cent of
children) can lead to permanent loss of vision in the affected eye if not corrected
and treated at an early age, preferably before age 6 or 7. The importance of early
detection and treatment of vision defects in this young age-group cannot be overemphasized.
Routinely, tests for visual acuity and stereopsis are being administered to all
pupils enrolled in kindergarten or Grade I. As many pre-schoolers as possible are
also being tested for visual acuity and stereopsis. This screening is carried out in
day-care centres, nursery and playschools, and at health unit offices. Visual acuity
testing is also carried out on pupils in special classes and those in Grades III, V,
VII, and X as time permits.
The responsibility for ensuring an acceptable standard of care in the vision
screening, referral, and follow-up of these children rests with the local public health
nurses because of their specialized knowledge.
Consultative services are provided by a Provincial orthoptist to assist health
unit staff in evaluating the vision program. This past year visits were made by the
orthoptist to 10 health units and 11 branch offices involving nearly 200 public
health nurses, health unit aides, and others assisting in the testing.
Each health unit has been sent a "learning module" for vision screening. The
purpose of this module is to provide public health nurses with information required
to carry out parts of the vision screening program relevant to their case loads.
In September 1976 a significant event in the field of vision care for the people
of the Province was the establishment of a vision care task force. The task force,
made up of ophthalmologists, optometrists, physicians, and educators will attempt
to prepare plans for a co-ordinated vision care system for the people of British
Columbia. This task force will examine the functions of various vision care personnel and vision care requirements on a regional basis. The co-ordination of
vision services has the potential to improve quality, comprehensiveness, accessibility, efficiency, and economy of the entire system.
COMMUNITY HEALTH CLINICS
Community health clinics are designed to house a number of Government
agencies such as health unit services, Human Resources facilities, and probation
services in one building to assist the public in obtaining easier access to social
services. This innovative approach is now being considered in any new building
projects undertaken in local communities by the Department of Health.
 J 42 DEPARTMENT OF HEALTH REPORT,  1976
During 1976, new community health clinics were opened in Lumby, Pender Harbour, and Mayne Island. Construction of such facilities at Terrace, Prince George,
Valemount, Vernon, and North Kamloops is planned to be commenced in 1977.
COMMUNITY PUBLIC HEALTH  NURSING SERVICES
Many disciplines make up the public health team which provides services to
people in their homes, their places of work, their schools, and their communities.
However, the one discipline usually most visible and the one which works most
directly with the majority of the residents is the community health nurse—the
public health nurse and the home care nurse. She is a primary health care worker
concerned with people of all ages, in all social and economic levels, with all types
of health needs in every community of the Province. She is concerned with individuals and communities in health and in illness.
Through her, many of the consultant services of other public health specialists
such as the health educator, the nutritionist, and the audiologist are delivered and
interpreted directly to people in their own homes. Emphasis is on health promotion, early identification of potential health hazards or problems, referral for treatment, and then follow up, rehabilitation, and promotion of individual or family
responsibility for care. Services are family centred with each individual being
considered in the context of his family and community life and relationships. Participation in voluntary health and other agency activities, in total health planning
for the community, in promotion of projects related to changing life-styles and
improved health and social services are all a part of the community nurse's normal
activities.
The year 1976 has been a difficult one for public health nurses, who faced
increasing demands from the public for more of the public health services which
have been helpful to them. There has been a complete re-examination of programs
in all areas, a review of priorities and modifications in the methods of delivery in
order to maintain high-quality care while still providing services to meet major
public health needs. Statistics reflect these changes and although certain programs
show a reduced service, most areas of the Province have maintained and even
extended services to high-risk, high-priority groups in perinatal, infant, pre-school,
and geriatric programs.
In line with a redefinition of health needs in rural areas, some nurses are now
working an expanded role in certain areas of the Province which have limited
medical facilities.
Integration of the service formerly provided in the Province by the Victorian
Order of Nurses was made complete in 1976 with assumption of responsibility for
VON nursing service in the Vancouver area by the Greater Vancouver Metropolitan
Health Services.
MATERNAL AND CHILD HEALTH
Perinatal
A high level of interest in perinatal education has been built up over a number
of years through the persistent efforts of public health staff working in conjunction
with physicians and other concerned groups and individuals.
• Expectant-parent education is reaching more people every year.
• Approximately 15,000 expectant parents attended 685 series of five or six
evening or day-time classes provided by Provincial public health staff, and
requests for further classes could not be met.
 COMMUNITY HEALTH PROGRAMS
J 43
• Classes consisting of discussion and exercises were attended by expectant
mothers and fathers, single parents and adopting parents, each concerned
regarding his and her future family.
• Over 75 per cent of the series had both parents enrolled as compared to 62
per cent last year.
• Over 41 per cent of all expectant mothers attended classes and a large per
cent of the remaining group had attended classes during previous pregnancies.
• Public health nurses presented prenatal education on television programs
and on home visits in an attempt to reach more expectant parents.
• Many volunteers, both professional and nonprofessional, were used to
assist the nurses with large classes.
• Enthusiastic new parents in many areas returned following the births of
their babies for further group sessions in postnatal care and infant growth
and development.
Infant and Pre-school
Emphasis was continued on programs related to infants and pre-school children.
Home and clinic visits, health appraisals, screening procedures, and health protection
measures were used to identify potential or early health problems, to promote
physical and emotional health and good nutrition patterns, and to facilitate treatment where required.
• Approximately 99 per cent of all newborn babies were seen at least once
in their own homes for general health assessment and parent counselling.
• Over 82 per cent of all new infants attended child health conferences.
• Home visits and special services, e.g., screening tests, physical appraisals,
etc., for pre-school children increased slightly from the previous year.
• Many pre-schoolers were seen in nursery schools and day-care centres where
public health nurses gave health supervision to children and consultation
to operators.
School
Identification of health hazards and individual problems and a strong program
of health promotion continued in schools.
• The public health nurses worked closely with teachers and special school
personnel to identify at-risk children and provide assistance to children with
special needs.
• A high concentration of time was spent with kindergarten pupils in order
to prevent later health problems from developing.
• Hearing, vision, and developmental screening programs were carried out at
appropriate grade levels and on all children referred or those with special
needs.
• Individual student counselling assumes a more important and time-consuming role each year, especially in secondary schools.
• Group discussions on a variety of topics provided contact with students of
all ages and opportunities for productive health promotion.
• The public health nurses continued to provide liaison between the homes and
the schools and worked with families and teachers where continuing care and
assistance was required.
 I 44 DEPARTMENT OF HEALTH REPORT, 1976
FAMILY, ADULT, AND GERIATRIC SERVICES
Public health nurses continued to provide a wide range of family health services, including health supervision, general counselling, care for those with special
illnesses or problems, health promotion, and programs to meet the special needs of
the elderly.
• Adults with special conditions, e.g., diabetes, cardiac or kidney ailments,
arthritis, received special attention from both home care and public health
nurses.
• Geriatric clinics for the elderly provided assessment and supervision opportunities as well as a social outlet.
• Home supervision of many elderly was provided and arrangements for additional care were made when required.
• Group discussions involved many adults in health education activities
related to obesity, fitness and exercise, nutrition, smoking, accident prevention, and other health subjects.
• Home visits to persons over 65 years of age increased by 25 per cent to
152,227, excluding home care visits.
• Special adult clinics were held routinely in all areas to provide injections
and immunizations for those requiring them.
• Personal care and boarding-homes were visited regularly providing consultative help to operators and supervision for residents.
• Mental health was emphasized and promoted in all contacts with individuals
and families and as part of every program being offered.
• Follow up of attempted suicides, group work with "Parents in Crisis," work
with individuals under emotional or mental stresses, etc., was carried out
by public health nurses.
• Over 12,000 visits involved mental illness and 1,545 visits were made to
retarded children or adults.
HOME CARE PROGRAMS
The home care program provides treatment and care in the homes to persons
who would otherwise be in acute hospitals, other institutions, or would be inadequately cared for at home. The needs of the patient are assessed by the Home Care
Co-ordinator with the patient's physician and the services required are supplied by
public health nurses, home care nurses, and physiotherapists, or purchased or
obtained from other community agencies by the public health unit. These latter
services include homemaker, dietitians, social workers, medication, equipment, and
transportation.
• Patients are admitted to a home care program on referral from their
physicians.
• Services, in some areas more comprehensive than others, are available to
over 90 per cent of the Province's population.
• Full "hospital replacement services" in home care are available in 22 areas
(serving approximately 80 per cent of the population) and provide at no
 COMMUNITY HEALTH PROGRAMS
J 45
cost to the patient all the services required by him during the period he
would otherwise have been in hospital.
• These costs as well as all nursing and some physiotherapy services to all
home care patients are paid by the public health programs of the Department of Health.
• All home care program costs in the Greater Vancouver Metropolitan area
are paid completely by public health programs.
• The home care services of the Victorian Order of Nurses in the Greater
Vancouver metropolitan areas were taken over by the official health departments in those areas on October 1, 1976. For the most part the former
VON staff transferred to these agencies.
• Approximately 35,000 patients were admitted to the home care programs in the Province in 1975.1 This was an increase of 43 per cent
over the number for 1974 and there was an increase of 45 per cent
in the number of nursing visits.
• In addition to homemaker, physiotherapy, nutrition, meals-on-wheels,
social work, medication, and other services, these patients received
almost 500,000 professional nursing visits.
• The average cost per patient-day for patients receiving home care in
lieu of hospitalization in 1975 was $16.42. On the average, patients
were included in the program for 9.7 days for a total average cost of
about$160.
COMMUNITY PHYSIOTHERAPY SERVICES
Physiotherapy service was available during 1976 in 10 Provincial health units.
This service was provided by the equivalent of 11 full-time physiotherapists and
included both preventive and treatment services.
The community physiotherapy services are being developed in the health units
to provide a full range of physiotherapy and associated services relative to the needs
of the area. The program has four major features:
(1) Treatment service—Provided under the home care program to
patients in their home setting.
(2) Consultative/advisory service—For patients, families, physicians,
community health nurses, and the community at large. Under this
aspect of the program, service is offered in the form of general
assistance and referral in such matters as diagnosis and treatment,
provision of equipment, and establishment of community health
programs.
(3) Preventive services—Wherein the physiotherapist participates in
community programs such as scoliosis screening, homemaker training programs, and physical fitness in schools.
(4) Maintenance and follow-up—Provides an ongoing audit of the
patient's level of independence and function within the community.
During 1976, about 10,500 direct physiotherapy treatment services were given
under the home care program. Some 2,000 of these treatments were rendered
under the comprehensive hospital replacement day home care program, which
covers a full range of support and professional services to the patient.
1 Home care program statistics tor 1976 are not yet available.
 J 46 DEPARTMENT OF HEALTH REPORT,  1976
DENTAL HEALTH SERVICES
By year-end the staffing of this division had greatly improved and comprised
eight dental officers, 14 dental hygienists, and 25 dental assistants. Also during the
the year it was possible to reorganize the heavily populated former combined Fraser
Valley and Skeena dental region into two separate regions called Fraser Valley and
Boundary and Skeena regions, each now having populations rather similar to the
other four dental regions of this Province. However, it must be recorded that the
present staff of dental auxiliaries is only approximately half that required to provide
effective dental health programs in all school districts served by the Provincial
health units. Therefore, it is the current policy to carry out effective programs in
selected school districts or parts of them, rather than to have ineffective programs
with a larger geographical coverage. To recruit and train competent staff to provide
total coverage is expected to take several more years.
The effectiveness of these programs has been well documented by results in the
Okanagan region, where such programs were first initiated. For example, in this
region during the period 1967/74 the dental decay rate of permanent teeth was
lowered by approximately 20 per cent and the average number of permanent teeth
prematurely extracted for the 15-year-olds had been cut by approximately one third.
To upgrade the competence of all staff engaged in these programs the second
Dental Health Institute, a one-week in-service training program,was held during
the past year. Topics presented and freely discussed included program planning,
personnel management stressing job descriptions and appraisals, classroom instruction, and standardization of dental inspections. A new feature this year was a
presentation by each regional team of an effective innovation to the dental health
programs developed by themselves.
The three-year-old birthday card dental programs continued to operate in 46
of the 66 school districts served by the Provincial health units. By this program
some 9,000 young children received from their family dentist an examination and
counselling at no direct cost to the parents. These children represented 56 per cent
of all those to whom cards were mailed by the local health unit. Acceptance was
highest in the Okanagan region at 84 per cent, where there is a good ratio of dentists
to population and experienced staff to carry out telephone follow-up for non-
responders. The lowest in acceptance rate was in the Kootenays at 45 per cent,
where neither of these conditions pertained.
In the school dental health programs carried out by the dental hygienists and
dental assistants, close to 90,000 children received dental hygiene instruction in the
classroom and, of these, some 50,000 took part in one or two lessons on tooth-
brushing, using a specially prescribed fluoride paste. Each received as a present
a new toothbrush used during their participation.
Dental health programs in schools and health units of Greater Vancouver and
of the Capital Regional District continue to operate effective dental health programs,
assisted by grants-in-aid from this Department. In addition these past three years,
the Department has funded a summer dental clinic at the Dental School of the
University of British Columbia. Patients are pupils of Greater Vancouver and the
Lower Mainland requiring much needed and extensive dental care. Treatment and
counselling is provided by senior dental students and dental hygiene students under
the supervision of members of the Faculty of Dentistry. This summer, 1,275 children
benefited from this clinic. The value of the services provided is conservatively
estimated as more than twice that of the grant provided.
During the year the fleet of mobile dental clinics was again increased by two,
to a total of six. The dentists staffing these units visited 33 communities without a
 COMMUNITY HEALTH PROGRAMS
J 47
resident dentist and completed treatment for over 4,000 patients on a fee-for-service
basis. The Prince Rupert dental facility was leased to a new dentist, approximately
1,800 patients having been treated in this facility during the past year. In addition,
the College of Dental Surgeons of British Columbia has provided and equipped
a dental clinic at Kaslo, and engaged a dentist for this grossly under-serviced area;
this is in addition to the facilities they continue to operate at Masset, Queen Charlotte
City, and Mackenzie, the latter now having the services of two dentists. It is a
pleasure also to be able to report a considerable increase this past year in the total
number of dentists located in the Kootenay region, which now has a ratio of one
dentist to every 2,543 persons there resident.
However, there are wide disparities in the dentist-to-population ratio in the
Province, with the ratio being as low as one dentist to every 1,280 people in the
Greater Vancouver area, although it is likely that many other residents of the Lower
Mainland also utilize the services of these dentists. For the total population of
British Columbia the ratio is one dentist to every 1,620 residents, an annual improvement having been evident the past eight years. However, in recent years there
has been a very marked increase in the number of persons in this Province covered
by group dental insurance plans. It is currently estimated that approximately 35
per cent of British Columbians now so benefit and in addition there are certain
categories of welfare recipients along with armed services personnel and native
Indians for whom dental services are provided. In some communities this situation
has resulted in a severe strain on the available dental services.
The oral cytology program has operated since 1969 with the co-operation of
the British Columbia Cancer Institute and the College of Dental Surgeons of British
Columbia, who issue cancer diagnostic kits to each dentist newly registering in this
Province. In the period 1969-75, a total of 1,896 smears was submitted to the
institute for diagnosis. No less than 34 cases, a ratio of 1:56, were confirmed as
having been derived from early cancerous lesions.
To evaluate the dental health status of the children of British Columbia,
Province-wide dental surveys have been conducted in the years 1958—74 and have
demonstrated a steady improvement in the dental health of those children. This
past year a new, more sophisticated and computerized methodology has been developed in co-operation with the Research Section of the Division of Vital Statistics.
It is planned that in 1977 this methodology will be carried out Province-wide on a
random sample of all children of specific age-groups and in sufficient number to
provide statistically significant results.
HEALTH  EDUCATION AND INFORMATION
Prior to the development of this new division in the summer of 1976, health
education had been the responsibility of Public Health Programs, and information
service functions had been performed by various individuals throughout the Department. In the interest of efficiency and expanded operation, the decision was made
to combine both functions into a Departmental service, and the Division of Health
Education and Information was formed in August with the appointment of Maurice
Chazottes as Director. Administrative reorganization of staffing and equipment to
meet the division's new responsibilities was well under way at the close of the
calendar year. In the summer, considerable progress was made in the reorganization by the division of the Department's various library facilities for books, periodicals, and films. The division planned to work in close collaboration with the
Legislative Library and the Library Development Commission to establish a compre-
 J 48 DEPARTMENT OF HEALTH REPORT,  1976
hensive central library for the Department as a whole, providing one of the major
sources of reference in public health specifically, and health care in general. The
central library will be located in the new health services building in Victoria.
Division staff continued to provide a basic audiovisual service, with slide-tape
packages, videotape dubbing, and literature and colour photography being produced
throughout the period of transition. The third series of 13 "Senior Chef" programs
for television was completed by the end of the year, employing an improved format
of linked 15-minute segments instead of half-hour shows. This major project was
undertaken in conjunction with the staff of the Nutrition Division.
Audiovisual workshops were conducted by division staff in various health
units, and at BCIT for second-year students in the Environmental Health class.
In public relations, the division was actively associated with several projects.
Among the most significant were the influenza immunization campaign and publicity
relative to the expanded program for medical students. The division has acted in
a consultative role in the preparation of several manuals and handbooks for various
sections of the Department of Health and associated commissions.
NUTRITION SERVICES
The science of nutrition is an evolving one, so priorities in nutrition must
constantly be evaluated.
Throughout the past year the nutrition consultants endeavoured to provide
public health nurses, teachers, and other professionals involved in nutrition education with up-to-date, pertinent nutrition information and teaching materials.
In the field of maternal nutrition, a slide-tape series containing two slide tapes
suitable for prenatal classes and a third for updating professional knowledge was
introduced through nutrition workshops. A major accomplishment was the completion of the Infant Nutrition Guide for health professionals and an adaptation of
this guide for parents. A 16-mm film, "Why Nutrition," was produced to stimulate
pre-school teachers to include nutrition education activities in their programs.
Class plans entitled "Having a Happy Heart" and stressing the role of nutrition in
the prevention of obesity and cardiovascular disease were developed for teachers
of all grades. The much demanded pamphlet How to be a Good Loser has been
revised to become The Fat Fighters Handbook and now emphasizes increased
physical activity, change in life-style, as well as calorie restriction in weight reduction.
Sound nutrition information has been made available to the general public
through such methods as the Nutrition Buyline column, now carried by 50 newspapers throughout the Province. Television will be used again to reach senior
citizens with the filming of a new 13-program series of the "Senior Chef." A new
cookbook will also accompany the series.
In-service nutrition education programs for public health nurses were presented
at the local level. The consultant staff presented 11 individualized workshops,
primarily in health units where nutritionists are not located. Often these health
unit visits included meetings and workshops with such groups as physicians, home
economics teachers, pre-school teachers, and dieticians.
In the six health units with nutritionists on staff, public health nurses received
nutrition education on a regular basis. Even though in some instances the community nutritionist's position has been in existence for less than two years, her role
as an educator is well established. Medical associations, community colleges, adult
education groups, schools, recreation centres, weight-reduction groups, for example,
rely on her assistance.   The community has also quickly learned that she is a source
 COMMUNITY HEALTH PROGRAMS
J 49
Production and Nutrition Division staff discuss culinary details for opening sequence
of new series of "Senior Chef" TV shows.
of reliable nutrition information. She often appears on local radio and television
programs and is asked to submit newspaper articles. Libraries and bookstores seek
her advice before purchasing nutrition publications.
A major portion of the nutritionist's duties involves participation in ongoing
health unit programs. These include assisting nurses in prenatal and infant nutrition
classes, counselling at-risk pregnant women, helping patients to follow their
therapeutic diets at home, and assisting community care facility operators with
their food service.
Highlights of specific programs in the six health units with nutritionists are
listed below. These demonstrate the nutritionist's role in providing nutrition information and education, and her participation as a member of the preventive health
team.
Boundary Health Unit
There was establishment of a good liaison between the health unit and local
physicians and hospital dieticians. Increased referrals of at-risk pregnant women
were noted so that nutrition counselling was given to an average of 25 women per
month.
Central Fraser Valley Health Unit
A nutrition education program was developed for use in pre-school and day
care centres. As a member of the local pre-school nutrition committee, the nutritionist had direct contact with parents and teachers who influence children's food
habits at this early age.
Simon Fraser Health Unit
A nutrition component was provided at clinics for 3-year-old children. The
objectives of the nutrition component are to assess the child's weight for height,
evaluate the child's food intake, and to provide supportive information to the
parents so that the child can develop positive food habits.
 J 50 DEPARTMENT OF HEALTH REPORT,  1976
South Okanagan Health Unit
The unit was involved in school feeding programs. Non-nutritious foods have
been replaced with nutritious foods in vending-machines and school canteens in
the Kelowna area. A nutrition education program for students and meetings with
teachers, principals, school board officials, and vending-machine suppliers were
required to bring about this change.
South Central Health Unit
This unit organized and implemented adult nutrition education programs.
This includes a seven-lecture series on nutrition and physical fitness to be offered
to the general public by the local community college. Other sessions designed for
specific groups, such as occupational health nurses, job trainees, hospital staff, and
employees of local industries have been offered.
Cariboo Health Unit
Participation in health programs was offered to native Indians, which includes
classes in prenatal and infant nutrition and assistance in planning meals, snacks,
and nutrition activities for the day care centre. Resource material was also supplied to the medical service nurse.
VITAL STATISTICS
The Division of Vital Statistics continued to administer the Vital Statistics Act,
the Marriage Act, the Change of Name Act, and the Wills Act (Part II), as well
as to provide a centralized statistical service to community health programs and
certain voluntary health agencies.
REGISTRATION SERVICES
There was a further substantial increase during 1976 in the volume of all types
of certificates issued by the division.
The total number of registrations also increased substantially. While registrations of births and deaths showed an increase, marriages declined slightly.
There was a substantial increase in the number of divorce orders registered.
The sharp increase in numbers of adoption orders registered was due in part
to late registration of orders made in the previous year.
Registrations of wills notices maintained their long-continued upward trend,
reflecting the increasing use of the facilitative provisions of Part II of the Wills Act.
Table 7 shows the numbers of main types of events registered and documents
issued under the specified Acts in 1975 and 1976.
BIOSTATISTICAL SERVICES
Substantial further progress was made in the major task of computerizing the
division's entire data processing operation, which was commenced in 1974 by the
Computing and Consulting Services Branch, Department of Transport and Communications. A terminal linked with the central installation was installed in this
division in the fall. The operation of the terminal will replace the use of the
division's obsolescent IBM unit record equipment as rapidly as the necessary computer systems can be designed and programmed.
 COMMUNITY HEALTH PROGRAMS
J 51
The Health Surveillance Registry (previously the Registry for Handicapped
Children and Adults) received 11,816 reports of disabilities, congenital anomalies,
and genetic disorders during 1976 from numerous sources of ascertainment. From
these, 8,786 new cases were recorded, and 3,030 reports provided additional information concerning cases previously on file. This was a substantial increase in
ascertainment over previous years and was due in most part to the co-operation
of the Department of Human Resources in providing for the registration of handicapped adults through its Health Care Division.
Computer systems and programming of registry records, with the exception
of the Cancer Register, were completed in 1976, an analysis of the case load to
year-end 1974 was developed and reported from statistics and data supplied
through use of computer facilities.
For several years, follow-up information on the condition, activity, and special
needs of register cases has been obtained by means of annual surveys of registered
children aged 7 and 14 years. The results of these surveys provide a basis for
estimating the Province's rehabilitation needs.
Several research papers based on registry data were accepted for publication.
Research staff provided the statistical services to registry consultants and also to
nondepartmental researchers and agencies in connection with health related studies.
During the year the registry's medical and genetic consultants were active in
international committees and symposia on subjects related to the work of the
registry. These included conferences on such topics as the epidemiology and
etiology of birth defects, psychological and social implications of developmental
disabilities, comparison of teratogenesis, mutagenesis, and carcinogenesis; the classification and taxonomy of syndromes, monitoring systems, and the use of registers
in morbidity studies.
The Cancer Register is a specialized unit within the framework of the Health
Surveillance Registry. The register receives notifications of live cases of malignant
neoplasms from hospital pathology laboratories, private physicians and the Cancer
Control Agency, while information on cases of cancer ascertained at death is
derived mainly from the Division of Vital Statistics registration system.
The Cancer Register provides a definitive source of annual Province-wide
statistical data on the incidence of malignant neoplasms.
The registry's cancer consultant rendered invaluable assistance in interpreting
pathology reports and determining their diagnostic classifications as well as in maintaining contact with hospital pathology departments.
Close collaboration was maintained with the Cancer Control Agency of British
Columbia, and also with the British Columbia Cancer Society and The University
of British Columbia's Department of Health Care and Epidemiology.
A statistical report on cancer incidence, prevalence, and mortality in British
Columbia, 1969 to -1973, was completed with the help of a grant from the Cancer
Control Agency.
Statistics of the 1974 case load of women screened under the cytology screening program of the Cancer Control Agency of British Columbia were analysed.
The division continued to be actively involved in the work of the perinatal
program of British Columbia. Two research officers of the division, one as a member of the Program Executive Committee and one as the consultant, contributed
special reports and statistical advice to the medical members of the committee.
Statistical advice and data processing services were provided to the Division
of Dental Health Services.   Dental surveys were undertaken in two Greater Victoria
 J 52 DEPARTMENT OF HEALTH REPORT, 1976
public schools to assess the reliability and validity of the newly revised criteria and
examination techniques for recording dental health.
The division continued to share in the responsibility for processing mental
health statistics. Pending completion of the new information system which is in
process of development, patient records are being processed through the use of
SPSS (Statistical Package for Social Sciences).
One of the division's research officers continued to represent community health
programs on the Provincial Metric Conversion Co-ordinating Committee. A metric
conversion committee for community health programs was formed during the year
for the purpose of overseeing and co-ordinating the implementation of metric
conversion as it affects various divisions of the Public Health and Mental Health
Branches.
Development work continued on the computerized record linkage program
which was recently initiated by the division. The project involves the linkage of
British Columbia vital and health records into individual and family histories, to
provide data for health research.
The division's research section became increasingly involved in health program
evaluation. The evaluation of the parent study group behavioural program in the
Courtenay area, initiated in 1975, was completed in the fall of this year, and the
results presented in one of the division's special report series.
Evaluation of a smoking education program for Grade VI and VII students
undertaken by the South Okanagan Health Unit was initiated, and data collection
was completed before the end of the year. Data collection for the evaluation of the
family asthma program in Kelowna was also initiated in the spring and will be
completed in 1977. This program is sponsored jointly by the Health Department,
the B.C. Tuberculosis Christmas Seal Society, and the Kelowna General Hospital.
The division continued to co-operate with the Department of National Health
and Welfare in the maintenance of a National Surveillance System of Congenital
Anomalies. Lists of congenital anomalies ascertained from physician's notice of
births and from death and stillbirth registrations were submitted to Ottawa throughout the year, and assistance was given in the critical examination of the resulting data.
The division maintains a register of all known cases of tuberculosis and
selected nontuberculosis chest diseases, as well as files of new active TB cases and
contacts to these cases. The computerization of these files was completed, and the
tables required for the annual report on tuberculosis were generated by computer,
using the Statistical Package for Social Sciences.
Assistance was given to the Division of Speech and Hearing in designing and undertaking a pilot project for the collection and processing of speech and hearing data.
Services were provided to the Divisions of Epidemiology, Venereal Disease
Control, Environmental Engineering, Public Health Nursing, Public Health Inspection, and to the G. F. Strong Rehabilitation Centre, in the mechanical processing of
records and statistical consultation.
AID TO HANDICAPPED
The Division for Aid to Handicapped conducts a service which includes a wide
variety of rehabilitation measures mainly designed to assist the handicapped to
become competitively employable. These services are provided under the terms of
the Vocational Rehabilitation of Disabled Persons Act (Canada) and Agreement,
through which the Federal Government reimburses the Province for 50 per cent of
the costs incurred.  The major types of service are medical and vocational assess-
 COMMUNITY HEALTH PROGRAMS
J 53
ment and, subsequently, the provision of such items as prostheses and wheel-chairs,
and of academic and vocational training programs designed to help prepare the
handicapped person for gainful employment.
During 1976 an important addition was made to the program of the division.
The development of a work adjustment program was initiated at the Vancouver
General Hospital through which vocational assessment and work adjustment services are provided to selected disabled out-patients of the hospital. The program
is under the direction of a Program Co-ordinator and counsellor who, with the
co-operation of the hospital management, the union concerned, and the staff of the
hospital, have made it possible for accepted patients to engage in actual, useful work
in the hospital, under direction. The division not only participated in the planning
and development of the program but also made available a substantial part of the
salaries of the two professional staff members.
It is gratifying to report that the vocational orientation for the deaf program,
which was put into motion three years ago with the assistance and co-operation of
the personnel of Vancouver Community College, Manpower, and the Department
of Education, continues to be highly successful in preparing and training the deaf
and hard of hearing for gainful employment. This program continues to be the
only one of its kind in Canada. The possibility of developing a somewhat similar
program for the blind, who have some special and unique needs that have never
adequately been met in Canada, is being explored.
Plans for maintaining active liaison with the resource boards and areas of
Vancouver are in an advanced stage and it is anticipated that this will result in a
substantial improvement in services to the handicapped in the Vancouver Metropolitan region.
There were some problems during the year associated with recruiting adequately trained staff for vacancies created by retirements and resignations. This is
a reflection of the fact that, to date in Canada, there are no full-time courses at the
university level to train vocational rehabilitation personnel. Over the past several
years the division has recruited staff from applicants with relevant, associated
training and experience and has then given them intensive in-service training under
senior supervision in the Vancouver office of the division. All newly recruited
professional personnel are required to complete a minimum six-month in-service
training program before being permitted to undertake responsibility of an area or
region in the field. This necessity to provide in-service training initially causes
delays in filling field vacancies.
The division wishes to acknowledge the valued co-operation of other Provincial Government departments such as the Department of Education and the
Department of Human Resources, the Federal Department of Manpower and
Immigration, and the many voluntary agencies in the Province.
LABORATORY SERVICES
The role of the Division of Laboratories is to provide public health laboratory
services for the diagnosis, investigation, and control of community diseases and for
amelioration of the environment. These services to physicians, hospitals, and other
branches of Government include bacteriology, environmental microbiology mycology, parasitology (and tropical medicine), virology, and related immunology and
serology with quality control. To maintain the necessary skills in these fields, the
Provincial Laboratories are constantly involved in clinical, research, and teaching
commitments.
 J 54
DEPARTMENT OF HEALTH REPORT, 1976
Volume of tests performed by the Provincial Laboratories totalled 638,800 in 1976,
compared with 637,300 the previous year.
In addition to performing routine laboratory procedures, the Provincial Laboratories act as the medical microbiology reference and referral centre for British
Columbia, provide consultative services for physicians and agencies, and collate
and report laboratory information on the epidemiology of incidents of community
disease.
The work load of the Division of Laboratories increased less than 1 per cent
between 1975 and 1976. In Table 9, the numbers of tests performed in 1976 at
the main laboratories and the branch laboratories in Nelson and in Victoria are
compared with the corresponding numbers for 1975. Increases in work performed occurred in examinations for intestinal parasites (21 per cent) and
virological investigations (3 per cent). A decrease occurred in enteric bacteriology (9 per cent).
BACTERIOLOGY SERVICE
Diphtheria
Between 1956 and 1967, only 15 cases of diphtheria were identified in laboratories in British Columbia. From 1968, diphtheria became resurgent, reaching a
peak in 1974 with 355 laboratory-diagnosed cases. The number of cases declined
to 83 in 1976.
Enteric Diseases
The number of specimens submitted for culture for Salmonella, Shigella, and
enteropathogenic Escherichia coli (ECC) decreased by 9 per cent. First isolates
from 807 persons included Salmonella, 388; Shigella, 168; EEC, 301. The 338
strains of Salmonella belonged to 43 types. The most common isolated from
human sources were S. typhimurium and S. typhimurium var. Copenhagen (85),
 COMMUNITY HEALTH PROGRAMS
J 55
S. san diego (53), S. heidelberg (38), S. saint paul (30), S. infantis (20), and
S. thompson (18). S. mbandaka, S. Stanleyville, and S. Indiana were isolated for
the first time in British Columbia. Six cases of typhoid fever were confirmed bac-
teriologically. During 1976, Salmonella was isolated or confirmed from 100
nonhuman sources, including chickens, turkeys, cattle, horses, dogs, pigs, lobster,
duck, iguana, horned toad, fish, fish meal, environmental swabs, and cooked ham
and turkey. Of the 21 types identified, the most common were S. typhimurium
and S. typhimurium var. Copenhagen (23), S. infantis (16), S. saint paul (16),
S. san diego (7), S. thompson (6), and S. agona (6).
The 168 strains of Shigella included Sh. sonnei (85), Sh. flexneri (73), Sh.
boydii (5), and Sh. dysenteria. (5). The most common enteropathogenic E. coli
(EEC) were 026:K60 (B6), 56; 0128:K67 (B12), 41; 018:K77 (B21), 39;
0126:K71 (B16), 33; 0111:K58 (B4), 31; 0125:K70 (B15), 25; and 055:K59
(B5), 22.
Food Poisoning
During the investigation of 167 incidents of suspected food poisoning, 242
specimens were cultured. Food poisoning organisms were isolated in 18 incidents:
Staphylococcus aureus, 11; Salmonella, 4; (5. san diego (2), S. saint paul, and
S. typhimurium); Clostridum perfringens; Bacillus cereus; and Bacillus subtilis.
One incident of clinically diagnosed paralytic shellfish poisoning occurred in
Kitimat when four persons fell ill with nausea, vomiting, cramps, and muscle
weakness after eating fresh cockles. In two incidents, strychnine was demonstrated
by the Vancouver City Analyst in a bottle of rye whiskey and heavy metal was
detected by the Federal Food Laboratory in canned orange and grapefruit juice.
Immunofluorescence
In 1976 the direct immunofluorescence test was introduced for confirming
the identification of cultures of Neisseria gonorrhoea. Immunofluorescence tests
were also used for confirming the diagnosis of syphilis, toxoplasmosis, and streptococcal infections.
Mycology
Dermatophytes were isolated from 460 specimens of skin: Microsporum, 79;
Trichophyton, 336; Epidermophyton, 45. The three most common dermatophytes
were T. rubrum, 232; T. mentagraphytes, 87; and M. canis, 77.
Tuberculosis
In 1976 the number of tests relating to the diagnosis and control of tuberculosis remained much the same as in 1975. At the request of the Division of Tuberculosis Control, strains of Mycobacterium tuberculosis were tested for their susceptibility to rifampin as well as to streptomycin, isoniazid, and ethambutol.
WATER MICROBIOLOGY
In the spring the Department of Environment and the Department of Health
introduced a new service for the chemical and bacteriological analyses of private
water supplies to determine their suitability for domestic use. In five months,
coliform tests were carried out on 211 water samples. In consultation with the
Computing and Consulting Services Branch and the Environmental Laboratory,
Water Resources Branch, a new computerized laboratory requisition and report
form was developed for use in recording, storing, and retrieving the results of tests
on public water supplies.
 J 56 DEPARTMENT OF HEALTH REPORT, 1976
TROPICAL AND PARASITIC DISEASES SERVICE
The Tropical and Parasitic Diseases Service provided advice on the diagnosis
and treatment of tropical and parasitic diseases acquired by travellers and immigrants returning to or entering Canada.
INTESTINAL PARASITES
The number of faecal specimens examined for parasites increased by 20 per
cent from 18,318 in 1975 to 22,001 in 1976. The numbers of helminthic and
protozoan parasites identified showed a dramatic increase from 1,300 in the five-
year period 1956-60 to 20,400 in the five-year period 1971-75. This increase
reflected the exposure of Canadian travellers to parasites and to increased immigration from tropical countries.
Malaria
The number of blood films examined microscopically for malaria parasites
increased from 194 in 1975 to 440 in 1976. Of the 177 patients with malaria
parasites in peripheral blood films, 165 (94 per cent) were identified as Plasmodium
vivax, five as P. malaria;, and five as P. falciparum
Serology
Specimens from 862 patients were sent to reference laboratories for serological
diagnosis of a variety of communicable diseases. In 20 per cent of the tests,
positive results were obtained, including visceral larva migrans (18), amcebiasis
(13), filariasis (12), echinococcosis (8), schistosomiasis (7), trichinosis (3),
malaria (3), and trypanosomiasis.
Exotic drugs, not available commercially in Canada, were supplied for
treating 53 patients with trichuriasis, filariasis, malaria, schistosomiasis, amcebiasis,
and trypanosomiasis.
VIROLOGY SERVICE
The 368 viruses isolated or identified serologically were influenza, parainfluenza, and respiratory syncytial viruses, 93; adenoviruses, 8; mumps and measles
viruses, 11; rubella virus, 18; enteroviruses, 20; herpesvirus, 212; mycoplasma, 5;
not yet identified, 1.
Herpes Simplex
Herpes virus was isolated from many patients with genital lesions. With
current sexual freedom, an increasing number of these infections were seen in VD
clinics and by family physicians. Although usually self-limiting, herpes virus may
cause congenital anomalies or foetal death in pregnancy.
Influenza
Epidemic influenza appeared in January 1976. Most cases were caused by
influenza virus type A/Victoria; a number of localized outbreaks were, however,
caused by influenza virus type B.
RETIREMENT
Miss M. C. Reid retired after a lengthy and satisfying career. She was supervisor in bacteriology sections from 1948 to 1976.
 COMMUNITY HEALTH PROGRAMS
J 57
BRANCH LABORATORIES
Following the death of Miss Marjorie D. Petavel, Technician-in-Charge,
Nelson Branch Laboratory, the laboratory was closed pending the appointment
of a suitable replacement. Miss Petavel worked for 31 years in the Division of
Laboratories and from 1955 to 1976 in Nelson, where she became known for her
outstanding service to the community and to public health workers in the Kootenays.
The Victoria Branch Laboratory at Royal Jubilee Hospital continued to
provide good service on contract to the Capital Regional District.
DELIVERY SERVICE
With the introduction of a delivery service in January 1976, first to five health
units, then to 14 and, finally, to all units outside the Lower Mainland, the transportation of specimens to the main laboratory and the return of reports was
speeded up, leaving few areas in the Province without overnight public health
laboratory service.
COMMUNITY HUMAN RESOURCES AND
HEALTH CENTRES
The community human resources and health centres project is jointly supported
and financed by the Department of Human Resources and the Department of
Health. The development group, responsible to the Minister of Health and the
Minister of Human Resources, provides a link between the two departments and
the four community human resources and health centres. The six group members,
functioning as an interdisciplinary team, are responsible for providing consultation
and information to the two Ministers and their departments, regarding policy and its
implementation, and management and monitoring services to the centres to assist
them in meeting their objectives.
The over-all objectives of the project are to provide community involvement,
integration of services, and a health promotion and prevention focus.
1. Community Involvement
The four centres (James Bay (Victoria), Houston, Granisle, and Queen
Charlotte Islands) each have an elected board of 10 to 15 members. The boards
have statutory responsibility for providing social services, public health nursing
services, and mental health services in their respective communities. Each board
has hired a co-ordinator to administer the centre and together the board and
co-ordinator have been successful in providing facilities and staff to meet their
responsibility.
The total operating budget for the centres' 1976/77 fiscal year was $1,179,474,
and the Department of Health portion was $926,693. Each board and co-ordinator
negotiate with the development group their budget based on their core services and
the centre's priorities.
2. Integration of Services
The community's public health nursing and human resources staff, employed
by their respective departments, have been seconded to the centre. The exceptions
are James Bay and Granisle, where the public health nursing staff are "attached."
 J 58
DEPARTMENT OF HEALTH REPORT, 1976
Of the total staff, approximately one third have been seconded and the rest board-
hired. Integration in each centre provides a common administration for all staff,
responsibility to one board, and common objectives for multidisciplinary team
functioning.
The basic services integrated in each centre include s6cial and public health
nursing services and primary medical care. Each centre has also included services
to meet their community's particular needs and interests, e.g., in
Houston—Psychological services, manpower, and volunteer services have
been integrated.
Granisle—Continued attempts to obtain dental services.
James Bay—Community school, volunteer services, Manpower outreach,
probation, and homemaker services are included.
Queen Charlotte Islands—Four separate service locations, dental services, physiotherapy, senior citizen visiting, and meals-on-wheels are
provided.
3. Health Promotion and Prevention Focus
Each centre has been busy initiating program plans with this focus. An all-
centre workshop-conference, with 40 board and staff representatives, was held in
Houston/Granisle in the fall of 1976. Participation in sessions focused on "health
promotion," "volunteerism," "team functioning," and "management."
Granisle is involved with environmental concerns in Topley Landing; Houston
initiated a health fair; James Bay works with day care, family life programs, a drug
program, and experience in human life-styling; and the Queen Charlotte Islands
are working on youth preventive programs and alcoholism.
Evaluation
An evaluation process with a four-pronged approach has been implemented:
(1) Audit Committee of six representatives from the British Columbia
Association of Social Workers, British Columbia Medical Association, Department of Human Resources, Department of Health, Registered Nurses Association of British Columbia, and University of
British Columbia, School of Business Administration:
(2) Data from the project's information system and other agencies and
institutions:
(3) Consumer and community survey:
(4) Service monitoring by the Department of Health, Department of
Human Resources, and development group.
ACTION B.C.
During 1976, Action B.C. again took major strides toward its goal of promoting awareness of good health through activity and sound nutrition.
At the Pacific National Exhibition over 9,000 men, women, and children
participated at the Department of Health display. To supplement the Canadian
Home Fitness Test and the children's obstacle course at this display, a new and
important component was introduced, namely, the computerized nutritional analysis. Based on a 24-hour recall of food intake, in less than five minutes an individual
received a print-out telling him the adequacies or inadequacies of his daily diet.
 COMMUNITY HEALTH PROGRAMS
J 59
Nutritionists were on hand to counsel and recommend on the results. This pilot
project, both popular and worth while, has led Action B.C. to do the necessary work
to extend the program to large numbers of people and cover a time period up to
one week for an in-depth study of the public's diet habits.
The daily physical education program which was started in two schools in
Prince George was increased to 17 schools in that district and Action B.C. has
initiated or has given support to similar projects in Revelstoke, Nanaimo, Dawson
Creek, and Abbotsford. Other school districts are becoming actively interested
and are making plans to use Action B.C.'s experience in developing their own
programs. The testing program for the Lower Mainland schools, started last year,
continued under the guidance of Action B.C.
Acting as a catalyst and motivator on the industrial scene is a main concern.
Advanced activity leadership training with a select volunteer group of Cominco
employees will ensure the longevity of that project. Many hospitals throughout the
Province have sought assistance in initiating fitness and recreational activities for
their staff. Another step toward personal well-being for health professionals has
been the Royal Columbian School of Nursing activity program run by Action B.C.
as a regular and mandatory part of the students' curriculum.
Health units and their staff continue to be a very important link between
Action B.C. and the public they serve throughout the Province. It is hoped that
the in-service training and testing with presentations of activity and meal planning
will expand to include all units in the forthcoming year.
In addition to the specific programs outlined above, Action B.C. has participated in a great many community events and conferences which have provided a
forum to bring a message of position life-style change to thousands of people, both
public and professional.
COUNCIL OF PRACTICAL NURSES
The British Columbia Council of Practical Nurses, under the authority of the
Practical Nurses Act, has completed 12 years of its mandate under this Act. The
10 members of the Council are appointed by Order of the Lieutenant-Governor in
Council on the basis of nominations by the
• Minister of Health (two members);
• College of Physicians and Surgeons of B.C. (one member);
• Registered Nurses' Association of B.C. (two members);
• Minister of Education (one member);
• British Columbia Health Association (one member);
• Licensed Practical Nurses' Association of B.C. (three members).
Since its inception, 85 general meetings of the council were held, as well as a
great many standing and special committee meetings. During council meetings
over the years, 13,465 applications for licensure were received; the disposition of
these is given in Table 10. Consideration was given to graduates of college and
hospital programs in the Province and to a large number of applicants from outside
British Columbia and Canada. Of these, licences were issued to 381 British Columbia graduates and to 256 applicants trained outside the Province.
While the responsibility for the preparation, administration, and marking of
Provincial practical nurse examinations was transferred to the council in 1975, a
further step was taken in 1976 with completion of a contractual agreement with the
 J 60 DEPARTMENT OF HEALTH REPORT, 1976
Canadian Nurses' Association testing service for the use in British Columbia of their
national examinations. This will make it possible to use regularly updated examinations and increase the "portability" for licences to other provinces in Canada.
This year council accepted the first year of the nursing program at Douglas
College as being equivalent training to that given in other colleges for practical
nurses. This now makes it possible for students in their program to take advantage
of a progressive or "ladder" approach to nursing training.
VOLUNTARY HEALTH AGENCIES
The Ministry of Health continued to give financial support to a wide range of
voluntary health agencies. In general, these agencies cater to persons suffering
from chronic debilitating conditions who have special needs beyond the scope of
health services routinely available, and to certain disadvantaged socioeconomic
groups in the population. Over $2.5 million in grants was awarded to these
agencies for the 1976/77 fiscal year.
 COMMUNITY HEALTH PROGRAMS
J 61
Table 1—Reported Communicable Diseases, British Columbia, 1972—76
(Rate per 100,000 population)
1972
1973
1974
1975
1976
Number
Number
Number
Number
Number
of
Rate
of
Rate
of
Rate
of
Rate
of
Rate
Cases
Cases
Cases
Cases
Cases
Amcebiasis	
1
0.1
2
0.1
1
0.1
1
0.1
Brucellosis	
	
1
0.1
Diarrhcea  of  the  newborn
(E. coli)	
60
11
2.7
0.5
29
51
1.3
2.2
52
69
2.2
2.9
49
22
2.0
0.9
52
11
2.1
Diphtheria 	
0.5
Dysentery, type unspecified
72
3.2
34
1.5
91
3.8
97
3.9
93
3.8
Food infection—
Salmonellosis —	
415
18.5
320
13.9
302
12.6
456
18.6
321
13.2
Unspecified  	
73
3.2
36
1.6
7
0.3
33
1.3
3
0.1
Food intoxication—
16
0.7
25
1.1
Botulism _	
5
0.2
	
2
0.1
Hepatitis—
Infectious 	
1,894
84.3
1,755
75.8
1,381
57.7
962
39.2
745
30.7
26
1.2
25
1
1.1
0.1
11
0.5
	
10
1
0.4
0.1
12
0.5
Meningitis—
Bacterial 	
34
1.5
47
2.0
43
1.8
33
1.3
47
1.9
Viral  _	
22
1.0
20
0.9
12
0.5
16
0.7
11
0.5
Pertussis	
102
4.5
102
4.4
66
2.8
49
2.0
77
3.2
Poliomyelitis  	
	
1
0.1
Q. fever	
1
0.1
Rubella	
84
3.7
77
3.3
342
14.3
476
19.4
69
2.8
Rubeola -	
97
4.3
158
6.8
573
23.9
1,149
46.8
181
7.4
Shigellosis _	
202
9.0
212
9.2
203
8.5
184
7.5
120
4.9
Streptococcal  throat  infec-
454
20.2
836
36.1
789
32.9
739
30.1
698
2
28.7
Tetanus 	
0.1
Trichinosis	
	
1
0.1
	
Tularaemia	
	
1
0.1
	
	
Typhoid   and   paratyphoid
fever	
13
0.6
3
0.1
6
0.3
8
0.3
7
0.3
Western equine encephalitis.
7
0,3
—
	
	
Totals	
3,587
159.7
3,734
161.3
3,951
165.0
4,286
174.4
2,450
100.8
Table 2—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946,1951,1956,1961, and 1966-76
Year
Infectious Syphilis
Gonorrhoea
Number
Ratel
Number
Ratel
1946    	
834
36
11
64
71
72
68
45
76
73
98
101
146
174
121
83.0
3.1
0.8
3.9
3.8
3.7
3.4
2.2
3.6
3.4
4.4
4.4
6.1
7.1
4.8
4,618
3,336
3,425
3,670
5,415
4,706
4,179
4,780
6,070
7,116
7,921
8,955
9,284
9,793
9,870
460.4
1951   	
286.4
1956	
1961	
244.9
225.3
1966         	
1967   	
290.8
242.0
1968  	
208.6
1969 _	
1970                     	
232.0
285.2
1971	
325.7
1972                        ..-..   .
352.5
1973 	
1974 _	
1975                 	
386.6
387.6
398.6
19762	
396.2
1 Rate per 100,000 population.        2 Preliminary.
 J 62
DEPARTMENT OF HEALTH REPORT,  1976
Table 3—Selected Activities of Public Health Nurses,
September 1975 to August 19761
Maternal and child care—
Expectant parent series enrolment:
Mothers   9,161
Fathers  -■- 5,707
Total class attendance (685 series)   51,285
Prenatals—number of home visits       6,460
Postnatals and new infants—number of home visits     21,285
Infants—
Number of visits to Child Health Conference     58,134
Number of home visits     40,155
Pre-school—
Number of visits to Child Health Conference  69,810
Number of home visits  27,902
Special assessments—infant and pre-school  17,638
School—
Screening tests (assistance by auxiliaries)  _•_  292,855
Follow up      26,010
Conferences with students     25,955
Conferences with staff     80,736
Home visits     33,194
Family, adult, and geriatric (excluding home care program)—
Adult (ages 19-64 years)—number of visits  128,066
Adult (ages 65 and over)—number of visits  152,227
Geriatric clinic attendance	
Family planning clinic	
  482
  732
Community care facilities—number of visits  5,795
Mental retardation—number of home visits	
  1,545
Mental health (preventive counselling)—number of home visits  5,576
Mental illness—number of home visits  5,593
Family problems—number of home visits  8,242
Disease control—
Immunizations—number given  405,781
Tests (tuberculosis, diphtheria, and other)   32,518
Venereal disease—number of visits  7,386
Tuberculosis—number of visits  7,475
Infectious hepatitis—number of visits  1,702
Chronic disease—number of visits  12,923
Total home visits
274,972
Total professional services by telephone  257,982
i Statistics provided are for activities of Provincial public health nurses only and do not include public
health nurses employed by Greater Vancouver, New Westminster City, or the Capital Regional District.
 COMMUNITY HEALTH PROGRAMS
J 63
Table 4-
-Patients Admitted to Home Care Programs and Nursing Visits
Carried Out, 1975
Area or Program
Number of
Patients
Number of
Nursing Visits
8,341
3,070
3,018
7,731
12,461
149,047
55,500
39,739
133,618
Hospital replacement program	
118,294
Totals	
34,621
496,198
Table 5—Patients Discharged From Home Care Programs, by Age-group
and Classification,1 1975
Age-group
Hospital Replacement
NonThospital Replacement
Number
Per Cent
Number
Per Cent
0-19	
20-44
1,541
4,111
3,108
1,866
1,835
12.4
33.0
24.9
15.0
14.7
394
1        2,481
J
1        5,466
/
4.7
29 8
45-64                       	
65-74	
75 and over.	
65.5
Totals	
12,461
100
8,341
100
i The hospital replacement program provides all services required except medical at no cost to the patient,
e.g., nursing, physiotherapy, homemaker, social work, medication, laboratory, nutrition, supplies, etc., whereas
other patients on the home care program (nonhospital replacement) receive nursing and some physiotherapy at
no cost but are required to pay for other services required.
 J 64 DEPARTMENT OF HEALTH REPORT,  1976
Table 6—Selected Activities of Provincial Public Health Inspection, 1972—76
Type of Inspection or Activity
1972
1973
1974
1975
1976
(Estimate)
Inspection—
Food premises—
5,022
1,622
775
337
260
1,703
498
212
1,741
1,566
1,718
454
384
345
366
1,298
1,343
449
797
1,305
4,975
2,042
2,551
1,003
17,554
438
399
6,307
10,685
3,376
1,963
2,524
338
1,234
3,109
9,668
1,962
1,064
437
280
2,442
546
274
1,603
1,946
1,567
418
365
387
318
1,801
1,516
518
917
1,516
5,716
2,431
2,692
1,543
22,585
528
772
5,395
11,719
3,440
1,370
2,740
314
1,535
3,225
10,051
2,553
1,512
561
305
3,139
1,013
300
1,672
2,199
1,344
600
370
400
352
2,094
1,153
430
890
1,496
5,370
2,665
3,717
563
26,251
430
686
6,140
14,786
3,361
2,107
2,776
541
1,479
3,330
11,107
2,392
2,045
343
317
3,013
544
266
1,653
2,015
1,249
666
396
367
388
2,613
1,791
445
720
1,915
6,663
2,953
3,179
722
24,367
384
1,518
5,259
14,208
3,350
1,769
2,763
813
1,284
3,226
12,817
3,177
Other              	
1,925
185
377
2,224
Schools	
613
400
Housing	
1,641
1,301
1,315
541
564
336
Parks and beaches  —	
Water and waste investigation—
Swimming-pools—
468
2,737
2,266
460
689
Public water supplies-
2,145
9,308
Private water supplies—
Inspection	
Samples  —
Pollution and survey samples	
Private sewage disposal	
3,159
3,993
600
27,744
380
2,140
Land use investigation—
Subdivisions	
6,185
12,820
Nuisance investigation—
3,521
Garbage and refuse	
1,845
2,808
680
1,287
Meetings	
3,127
i Includes boarding homes, youth hostels, day care centres, hospitals, and other institutions
 COMMUNITY HEALTH PROGRAMS J 65
Table 7—Registrations, Certificates, and Other Documents Processed by
Division of Vital Statistics, 1975 and 1976
Registrations accepted under Vital Statistics Act—                      1975 1976
Birth registrations     35,573 37,810!
Death registrations      18,862 19,410!
Marriage registrations     21,572 20.6201
Stillbirth registrations          414 3401
Adoption orders       1,637 2,260!
Divorce orders       7,250 9,350!
Delayed registrations of birth          375 289
Registrations of wills notices accepted under Wills Act     37,295 40,877
Total registrations accepted  122,978 130,956
Legitimations of birth effected under Vital Statistics Act	
Alterations of given name effected under Vital Statistics Act
Changes of name under Change of Name Act	
Materials issued by the Central Office—
Birth certificates	
Death certificates	
Marriage certificates	
Baptismal certificates 	
Change of name certificates	
Divorce certificates	
Photographic copies	
Wilis notice certification
Total items issued  122,484
175
298
247
275
2,280
2,052
79,340
89,120
8,969
9,527
8,601
10,141
17
7
1,995
2,095
225
319
10,806
12,007
12,531
12,663
135,879
Nonrevenue searches for Government departments by the
Central Office     11,203 15,531
Total revenue  $534,895      $515,510!
i Preliminary.
 J 66 DEPARTMENT OF HEALTH REPORT,  1976
Table 8—Case Load of Division for Aid to Handicapped, 1976
Cases under assessment or receiving services, January 1, 1976  1,305
New cases—
Referred to Aid to Handicapped Committees in Vancouver Metropolitan Region and North Fraser Region (12 committees)  563
Referred to Aid to Handicapped Committee outside Vancouver
Metropolitan Region (37 committees)   798
Referred from other sources       2
Total new cases  1,363
Cases reopened (all regions)       257
Total cases provided with service in 1976  2,925
Cases Closed During 1976
Rehabilitated—
Employment placement made by—
Canada Manpower     58
Aid to Handicapped     18
Self  237
Other  110
Total placed in employment  423
Job placements not feasible, restorative services completed  414
Not rehabilitated—
Severity of disability  232
Unable to locate clients .  121
Other  461
Total not rehabilitated  814
Other reason—
No disability  5
No vocational handicap  16
Deceased  n  10
Total other reasons     31
Total cases closed in 1976  1,682
Cases remaining in assessment or receiving services, December 31, 1976  1,243
 COMMUNITY HEALTH PROGRAMS J 67
Table 9—Tests Performed by Division of Laboratories, 1975 and 1976
Item
1975
1976
Main
Nelson
Victoria
Main
Nelson1
Victoria2
Bacteriology Service
Enteric Section—
Cultures—
14,391
3,500
246
4,047
4,393
25,636
3,528
16,988
101,798
308
31,807
24,588
1,050
313
604
18,318
1,156
261
4,653
1,365
31
3,295
1
13
13,022
3,236
242
2,938
4,018
20,158
3,661
28,201
96,893
4,526
178
35,058
25,373
1,010
326
618
22,001
1,138
440
32,178
2,963
6,809
8
3,113
4
186,246
13,890
7,284
4,398
2,266
467
3,531
243
1,271
325
51,707
4,553
7,866
3,796
184
167
4,785
1,333
	
34
Miscellaneous Section—
Cultures—
25
184
273
15
87
53
3,025
Haemolytic Staph./Strep	
129
12
N. gonorrhoea;	
128
2,692
8,865
1,713
157
2,174
	
8,320
1,782
Immunofluorescence—N. gonorrhoea:.
	
20
2,154
1,768
  1
Tuberculosis Section—
1,894
4
	
1,575
....
1
3
3,004
1
Parasites—
Fasces  	
2,907
Pinworm swabs  _	
61
	
29
Malaria blood film	
Water Microbiology Section—
Presumptive/Confirmed coliform test	
32,113
2,214
7,959
113
2,931
2
182,225
12,739
8,196
4,971
3,784
306
4,418
660
619
6
51,783
2,804
7,198
521
104
3,361
490
3,695
602
379
2,212
304
4,170
891
414
  |   	
Serology Section—
Syphilis—
18,096
4,3492
ASTO	
968
864
893
951
Toxoplasmosis	
Virology Service
Virus isolation—
Rubella	
Serological identification—
Haemagglutination inhibition—
Rubella
—
Totals       	
578,337
7,479
51,489
596,139
5,1981
638,801
37,464
637,305
1 Nelson Branch Laboratory was closed for two months.
2 Victoria Branch Laboratory transferred syphilis serology to main laboratory.
 J 68
DEPARTMENT OF HEALTH REPORT,  1976
Table 10—Licensing of Practical Nurses
(Disposition of applications received since inception of program in 1965 to October 31,
Received	
Approved—
On the basis of formal training  8,093
On the basis of experience only—
Full licence  396
Partial licence   876
  1,272
  9,365
1976)
13,465
Rejected _  1,871
Deferred pending further training, etc.  1,739
Deferred pending receipt of further information from applicants  397
Awaiting assessment at October 31, 1976  93
Number of licences issued to October 31, 1976	
Number of practical nurses holding currently valid licences at October
31,1976 	
13,465
8,650
6,420
Table 11—Number of Cases Referred for Hearing Assessment, by Source,
Division of Speech and Hearing, 1976
Referral Source
Physician
Public Health
Nurse
Otheri
Total
3,055
504
142
3,701
1 High-risk hearing register, public health clinics, etc.
Table 12—Number of Cases Referred for Hearing Assessment, by Type of
Evaluation, Division of Speech and Hearing, 1976
Type of Evaluation
Initial
Assessment
Reassessment
Hearing-aid Evaluation
and Rehabilitative
Audiology
Total
2,034
i
575              1                     1.092
3,701
Table 13—Hearing-impaired Cases, by Degree and Type of Impairment,
Division of Speech and Hearing, 1976
Type of Impairment
Degree of Impairment
Total of
Mild
Moderate
Severe
Profound
Each Type
492
622
45
144
707
120
1
13          |                                       649
458                    228                    2,015
92         |            30          |            287
1,159
971            I           563           I           258           I           2.951
 Mental Health Programs
On October 12, 1872, just 14 months after British Columbia's
entry into Confederation, Mental Health Programs had its beginnings
when the Royal Hospital in Victoria was designated as the Provincial
Asylum. The management of the institution was placed under the
jurisdiction of Mental Health Services in the Provincial Secretary's
Department, where it remained until 1959, at which time it was
transferred to the Department of Health and Welfare and became
known as the Mental Health Branch.
With the change in name to Mental Health Programs in 1975,
as part of the reorganization of the Department of Health, the branch
transferred the operation of the various mental health institutions to
the Division of Government Health Institutions, and became solely
responsible for the development of mental health services at the community level.
A review of the year's operations of the various community
services throughout the Province appears on the following pages:
69
 J 70 DEPARTMENT OF HEALTH REPORT,  1976
MENTAL HEALTH  PROGRAM  HIGHLIGHTS
• There were 9,000 new admissions to service in the Province's 30 mental health
centres and, additionally, 4,000 persons were carried for treatment from the
previous year's case load. In addition to direct treatment the professional staff
in mental health centres also provided consultative services to a variety of community agencies.
• The patient load of the Greater Vancouver Mental Health Service for October
1976 was 2,716, a substantial increase over the previous year's case load of
2,116. The October case load for 1974 was 949.
• During the year the administration of the boarding home program was decentralized to the community mental health centres. This move permitted the central
staff to expand their consultative role to the centres in the development of
new resources, the licensing of boarding homes, and in terms of management
problems.
• Rapidly increasing case loads in the north and south community teams of the
Burnaby Mental Health Services necessitated recruitment of additional nursing
personnel for those teams. The north team moved to new offices in May, vastly
improving working conditions for a busy staff and providing much more satisfactory facilities for patient care, teaching, and community preventive activities.
Out-patient and day program personnel worked closely with Canadian Mental
Health Association to develop a badly needed sheltered workshop program in
Burnaby. Continued rapid growth and development in the Lougheed Mall area
suggested the need for an additional out-patient team to provide service there.
COMMUNITY MENTAL HEALTH CENTRES
Mental health centres have been established in 30 British Columbia communities. The function of each centre is to develop, in co-operation with existing
resources within the community, a variety of services designed to meet the specific
mental health requirements of the area served.
Mental health centres are located in the following communities: Abbotsford,
Burnaby, Chilliwack, Courtenay, Cranbrook, Duncan, Fort St. John, Kamloops,
Kelowna, Langley, Maple Ridge, Nanaimo, Nelson, New Westminster, Penticton,
Port Alberni, Port Coquitlam, Powell River, Prince George, Prince Rupert, Saanich, Sechelt, Squamish, Surrey, Terrace, Trail, Vernon, Victoria, Whalley, and
Williams Lake.
A centre is staffed by a team of experts in mental health and may include a
psychiatrist, a psychologist, psychiatric social workers, mental health nurses, and
other professional personnel.
The majority of the centres provide the following services in varying proportions :
• Direct treatment services for adults and children.
• Consultative services to physicians, health, welfare, educational, and correctional agencies.
• Educational programs, both professional and nonprofessional.
• Special programs such as the supervision of the long-term patient, preventive programs, boarding home care, special group homes, etc.
 COMMUNITY HEALTH PROGRAMS
J 71
Members of a mental health centre may make periodic visits to outlying districts of the area served by the centre, primarily to provide diagnostic assessment,
consultation, and referral services. This travelling clinic usually utilizes facilities
provided by the local health units, and on an appointment basis sees patients who
have been referred by the family doctor or the district public health or welfare
services. When necessary, after seeing the patient, the clinic may refer the patient
back to the family doctor, in some cases to school authorities, or on occasion may
recommend admission to a residential treatment facility. Treatment by the clinic
team is usually given in close co-operation with the family doctor, the health unit,
or other agency.
During 1976, emphasis was placed on making Community Mental Health
Programs as efficient as possible, both through internal streamlining and externally
through better co-ordination with various community agencies. Staff worked very
hard to attempt to meet community demand for services.
Regional reports of the community mental health centres follow:
VANCOUVER ISLAND REGION
Community Mental Health Programs teams in Victoria, Saanich, Duncan,
Nanaimo, Port Alberni, Courtenay, and Powell River constitute the Vancouver
Island Region. Over 2,500 patients were treated in 1976 by these teams. Such
direct services to patients accounted for two thirds of staff time. Another major
service was consultation to various community agencies dealing with emotionally
disturbed clients. During the year the Victoria integrated services project for children and families was added to Mental Health Programs administrative responsibility (see page 77). The functions of Integrated Services and the two mental
health centres in the Capital Region area were closely co-ordinated with other
agencies such as the Capital Regional District Health Services and the Department
of Human Resources.
A sampling of some of the special projects of note from mental health teams
in the region follows:
In Courtenay, the centre conducted training programs for a wide variety of
community agencies in group techniques, behaviour management, and counselling.
A pilot project in which migraine headaches were treated by biofeedback techniques
showed very promising results. Volunteers learned to raise their body temperature
in their extremities, usually their hands, and in so doing were able to reduce or
eliminate the pain associated with migraine headaches.
The Duncan Mental Health Centre was involved in periodic meetings with
Human Resources, public health, probation, Indian services, and school district
staff to co-ordinate their services to children. These conferences prevented duplication of services and effected a more creative system of providing services to
children.
In Nanaimo, the centre was instrumental in developing a multi-purpose residential and day program centre for a wide spectrum of mental health clients.
The Powell River centre materially assisted in bringing together, for planning
and consultation, most of the voluntary and Government agencies in their area, and
the occupational health section of the local mill.
In the Greater Victoria area, the Victoria and Saanich centres joined forces to
make the community nurse follow-up program more effective with the Eric Martin
Institute and private practitioners of medicine who admit patients to that facility.
Regular consultation meetings were held with a number of these physicians.
 J 72
DEPARTMENT OF HEALTH REPORT,  1976
Supervised by a qualified art therapist, emotionally disturbed patients are encouraged to
paint and draw as part of diagnosis and treatment at Victoria Mental Health Centre.
LOWER MAINLAND REGION
Mental health centres located at Sechelt, Squamish, New Westminster, Whalley, Surrey, Langley, Port Coquitlam, Maple Ridge, Abbotsford, and Chilliwack
make up the Lower Mainland Region. Approximately 3,000 patients were treated
during the year. Direct services to patients took more than two thirds of the time
of the mental health teams. In addition to those services, the centres provided
consultation to various community agencies serving emotionally disturbed clients.
In the provision of services of all types, staff worked closely with local physicians;
personnel from Public Health Programs, the Department of Human Resources,
schools, the local hospital, probation and the courts; and various other local professional and lay groups. Examples of special activities for these centres include
the following:
In Abbotsford the adult development program, jointly sponsored with Fraser
Valley College, which offers a variety of short workshops, seminars, and group-
learning experiences, added several new workshops and recruited a number of additional community people as group leaders.
The Chilliwack centre, marking the completion of a decade of service, was
occupied with a full program of direct services to clients.
In Langley, two adolescent group sessions, one made up of Grade IX and X
boys and the other a mixture of Grade VIII boys and girls, were held during
regular school hours. The students were taken by bus to the centre by a special
services person employed by the Department of Human Resources and seconded
to the school's Special Services Division.
 COMMUNITY HEALTH PROGRAMS
J 73
In Maple Ridge the centre was consulting during the year on the planning of
the psychiatric unit of the Maple Ridge Hospital, currently in the architectural
planning stage.
In Sechelt the centre assisted with the establishment of a group home for
emotionally disturbed adolescents, and continued to provide them with consulting
services.
The Surrey centre developed a joint program with the public health unit for
patients requiring injectable psychotropic medication. A special workshop on
psychotropic drugs was held in conjunction with this clinic.
OKANAGAN-THOMPSON REGION
Regular visits to the Kamloops, Vernon, Kelowna, and Penticton Mental
Health Centres was undertaken by the acting Regional Program Director during
the year. This new function enabled headquarters personnel to develop better
channels of communication with field personnel regarding policy matters, program
development, and other activities which pertain to mental health centre operations
within the Okanagan-Thompson Region.
A total of 2,016 persons was referred for direct services through mental health
centres within the region in 1976, representing an increase of 24 per cent over the
previous year's figure of 1,531. The Kamloops centre showed the largest single
increase with 38 per cent; Kelowna, 36 per cent; Penticton, 20 per cent; and
Vernon, 9 per cent. Direct patient services, i.e., treatment of individuals, families,
and groups, accounted for approximately 60 per cent of the professional time of
personnel throughout the region. The balance was devoted to agency consultation,
the school system, hospitals, and a variety of educational activities directed toward
specialized groups or the community at large.
The surrounding communities of Merritt, Ashcroft, Revelstoke, Keremeos,
Salmon Arm, Cawston, Osoyoos, and Hedley continued to be served by way of
travelling clinics from each of the centres. The particular mental health requirements of Salmon Arm were under study at year-end by a joint working group
representing Hospital Programs and Mental Health Programs. The objective was
to provide a less costly but perhaps more appropriate and effective alternative to
the erection of a 10-bed psychiatric unit within the Shuswap Lake General Hospital
complex.
Kamloop's drop-in centre program for long-range psychiatric patients was
expanded this year from one to two afternoons per week. In addition, an intensive
staff development program was inaugurated for in-service personnel at the mental
health centre together with a 30-week course in abnormal psychology for some 50
registrants from the professional community at large, comprising teachers, medical
and nursing staff, Department of Human Resources personnel, etc. In conjunction
with the YM-YWCA, the Kamloops Mental Health Centre also sponsored a short-
term course for 25 parents seeking help with interpersonal communication and
child-raising problems.
The Vernon centre continued to support the largest single complement of
chronic patients (300) through the boarding home program. With a view toward
fostering more independent life-style opportunities for this large chronic-patient
group, the boarding home staff were successful in establishing a new independent
living home for selected persons from this group. Staff also contributed toward the
development of a crisis line for Vernon and district.
A part-time pharmacist was added to the Kelowna centre staff during the year,
eliminating a hospital-based dispensing program which had proven costly and ad-
 J 74 DEPARTMENT OF HEALTH REPORT,  1976
ministratively awkward. Through CMHA sponsorship of an LIP grant, the Kelowna
centre staff was instrumental in the development of a winter-activity program for
young chronic boarding home patients. In terms of other new activities, the
Kelowna centre embarked upon an intensive group and conjoint marital therapy
program in order to cope with the large increase in referrals (36 per cent) over
last year and to reduce the time span between initial referral and therapeutic contact.
In 1976 the Penticton centre was instrumental in the development of a unique
drop-in program for chronic emotionally ill young adults. This program was geared
largely to help those residents of boarding and group homes who were not functioning as independently as their assessed potential would suggest. This drop-in program, largely assisted by community volunteers, combined both recreational and
work activities with the result that a number were fully employed in regular work
situations at year-end.
With funding support from New Horizons, centre staff also contributed toward
the design and implementation of three workshops to train volunteers who work
with senior citizens.  Approximately 50 persons attended each of these workshops.
KOOTENAY REGION
The Kootenay Region is served by mental health centres located in Cranbrook,
Trail, and Nelson. Services to the surrounding communities of Golden, Fernie,
Sparwood, Kimberley, Creston, Castlegar, Salmo, Nakusp, New Denver, Riondel,
Grand Forks, and Rossland are provided through travelling clinics and frequent
consultation to local professionals. The total population of this area, based on
Hospital Programs estimates, was over 127,000 in 1976.
During the year the centre had a total of 10 full-time and five sessional professional staff, and four support staff. They provided direct therapeutic services to
over 2,200 clients. The month-end case load for the centres averaged over 1,000
cases. While direct therapy with adults, children, and families occupied the bulk
of staff time, consultation and support services continued to be offered to community agencies, including Human Resources, public health, and school services.
Staff from the three centres were active in community education. Child-rearing
workshops and volunteer training were continued by the Cranbrook staff. Staff from
the Nelson centre were involved in many in-service education programs for community groups, including a three-day children's resource workshop, child-care
courses, and nurse-training programs. As well as community education activities,
staff from Trail conducted an extensive community awareness and mental health
attitude study. The results from that study confirmed the high visibility and acceptance of the Trail centre in the community.
The boarding home program continued to grow in the region, and it was hoped
that the decentralization of the program would allow better co-ordination between
the centres and the boarding homes.
Community development work was also undertaken in the Kootenay Region
during the year. Staff participated on interagency co-ordinating committees, and
in the development of proposals for needed community resources. For example, in
Nelson, efforts to establish an alcoholism treatment centre looked promising at year-
end, primarily due to the Chemical Dependency Committee, which had mental
health centre representation.
Data on the types of problems and required services in the communities served
by the centre were collected and related to population subgroups. These data, along
with similar data from other regions, would form the basis for program development.
 COMMUNITY HEALTH PROGRAMS
J 75
The major problem facing mental health services in the Kootenay Region was
the increasing demand for direct therapy services. Last year the region, as a part
of the Okanagan-Thompson-Kootenay Region, reported 2,576 cases seen in direct
service. This year the Kootenay Region alone had over 2,200 cases. This increase
in service demand was reflected across the whole of Mental Health Programs, as
evidenced by the 27-per-cent increase in case load over the past three years.
NORTHERN BRITISH COLUMBIA REGION
The Northern British Columbia Region comprises the area north of Kamloops
and includes the catchment areas of community mental health centres in Williams
Lake, Terrace, Prince Rupert, Prince George, and Fort St. John. For the first
time since the centres were opened in the region it was possible during the year to
fill all vacant positions. However, many of the areas that did not yet have an
established mental health centre received only limited mental health services from
travelling clinics.
In addition to staffing problems, the services provided by these clinics were
also affected by the long distances and the frequent inclement weather conditions.
Communities which travelling clinics visit on a more regular basis included Masset,
Bella Coola, 100 Mile House, Quesnel, Hazelton, Dawson Creek, and Fort Nelson.
A full-time mental health worker was providing services in Kitimat.
Local mental health services in the Northern Region were augmented by visits
of personnel from mental health centres in the Lower Mainland, Riverview Hospital,
and the UBC Health Sciences hospital. Professionals from these facilities provided a variety of consultation services. In addition, both the Riverview Hospital
and the Health Sciences hospital continued to accept referrals from the north.
The awareness of the residents that mental health affects all aspects of their
lives greatly increased during the year, and, consequently, more demands for
specific services related to mental health were being made. In general, services
were aimed at four groups of people—young children, adolescents, adults, and
special groups or groups with special needs.
General services provided by mental health centres were designed to deal with
the total range of problems related to mental health. Assessment and diagnostic
services included those for the assessment of specific types of mental health problems. Client consultation services were provided for other professionals who
desired general or specific case consultation. A somewhat related program included
community and agency support services, in which workshops and other training
and information services were provided, upon request, for other agencies and for
the community at large.
Counselling services were aimed at clients who require specific information or
general counselling. Rehabilitation services assisted people with their reintegration
into a normal life situation. Research and evaluation services included surveys of
community needs, the analysis of services which are needed to deal with these
needs, and the documentation of existing services. Also included were the evaluation of program effectiveness, and the definition of service options and their objectives. The volunteer and self-help groups programs provided support for citizens
who wanted to participate in mental health activities, and for self-help groups who
focused on specific group needs.
 J 76 DEPARTMENT OF HEALTH REPORT,  1976
GREATER VANCOUVER MENTAL HEALTH  SERVICES
The Greater Vancouver Mental Health Service (GVMHS) completed its
fourth year of operation in the summer of 1976, and has become an integral part
of the mental health delivery system for the area. The service is responsible for
the operation of seven community care teams and the Broadway Clinic, providing
direct patient care to approximately 2,800 patients. Additionally, the service
operates the short-stay residence, Vista, a halfway house for men and women, and
Blenheim House, which is a treatment facility for pre-school children and their
families.
The primary mandate of the GVMHS is to treat the moderate to seriously ill
patient in the community, and to provide limited service to families and children
within available resources. The effectiveness of the service has been confirmed by
a series of evaluative studies conducted by the Evaluation and Research Planning
Department. The implementation of a management information system, which
was in the initial phase of development by year-end, will provide additional evaluative and planning data. The development of performance standards for each team
and facility will be possible when the management information system has been
fully activated.
Each community care team was working to capacity with 250—350 patients
on its case load. The community care teams have been very successful in establishing good relations with other agencies working in their community, especially public
health, Human Resources, local hospitals, and police. Increasingly, the teams are
utilizing community resources and programs which are available in many areas of
the city. During the year the GVMHS enjoyed excellent relations and support
from Mental Health Programs and the city and municipal health departments.
While there are some components of the mental health delivery system still to be
developed, there is a much higher quality of patient services available to Greater
Vancouver than in the past. When the necessary support services are provided,
Vancouver will have a system of mental health delivery unequalled in Canada.
BURNABY MENTAL HEALTH SERVICES
Burnaby Mental Health Services during 1976 continued to offer the Province's
only regionalized, decentralized, integrated, and comprehensive program of psychiatric resources for adults, families, and children resident in this community.
In-patient unit—The 25-bed acute psychiatric in-patient unit maintained high
occupancy and activity, treating large numbers of seriously disturbed patients efficiently and effectively in their own community. Only occasionally was it necessary
to call upon the resources of the Riverview Intensive Care Unit for back-up with
grossly assaultive or dangerous patients.
A detailed study by the nursing staff of the ward environment and staff behaviour toward patients, aimed at minimizing patient dependency and regression, has
been carried out, and an ongoing ward environment committee established to monitor and regulate these conditions.
Adult day programs—Two separate adult day programs are offered by Burnaby Mental Health Services—one is an intensive five-day-per-week milieu program
designed to produce major behavioural changes, the other a part-time more gradual
re-educative and socially rehabilitative program. Close co-operation with the outpatient teams resulted in establishing a number of new activity groups of different
types during the year.
 COMMUNITY HEALTH PROGRAMS J 77
The day hospital programs sponsored a one-day workshop on psychiatric day
programs, attended by representatives from all such programs in the Province.
Response to this innovation was so enthusiastic it is expected to become an annual
Provincial event with rotating sponsorship.
Adult out-patient services—Rapidly increasing case loads in the north and
south community teams necessitated recruitment of additional nursing personnel
for those teams. The north team moved to new offices in May, vastly improving
working conditions for a busy staff and providing much more satisfactory facilities
for patient care, teaching, and community preventive activities. Out-patient and
day program personnel worked closely with the Canadian Mental Health Association to develop a badly needed sheltered workshop program in Burnaby. Continued rapid growth and development in the Lougheed Mall area suggested the
need for an additional out-patient team to provide service there.
Children's out-patient services—The Children's Out-patient Department continued to provide consultation services to Burnaby schools and out-patient assessment and treatment services to children and families from Burnaby. Addition of a
part-time speech therapist improved these services. The pre-school and out-patient
staff combined to offer a one-day workshop for children's day care workers in
Burnaby, covering topics from normal growth and development to working with
families.
Consultation and education services—Increasingly, Burnaby staff have been
asked to consult in a variety of forms to community groups and organizations such
as the Canadian Mental Health Association, the Burnaby Health Department, Burnaby pre-schools, Burnaby General Hospital, Dogwood Lodge, and L'Arch Vanier
Home. Staff continued to provide educational placements for students in nursing,
psychology, social work, and occupational therapy, as well as to physicians serving
a rotating internship. An active in-service education program was augmented with
two major workshops—one workshop on family therapy was held in the spring,
and in the fall a workshop on goal attainment scaling was offered. Members of the
staff also attended various professional meetings, workshops, courses, and seminars
to develop and improve their knowledge and skills.
VICTORIA'S INTEGRATED SERVICES FOR
CHILD AND  FAMILY DEVELOPMENT
As of August I, 1976, the administration of Victoria's Integrated Services
became the responsibility of the Department of Health, through Community Mental
Health Programs. It had previously reported directly to the Ministers of Health,
Education, and Human Resources. Staff provided to the project by the Department of Human Resources were seconded for the remainder of the fiscal year and
then would become Department of Health staff. Mental retardation services,
formerly the responsibility of Integrated Services, were transferred to /the Department of Human Resources.
Integrated Services provides clinical services to families whose children have
difficulties in the following areas:
• Learning disability.
• Brain injury.
• Developmental delay (0—5 years).
• Social-behavioural disorders.
• Severe emotional disturbance.
 J 78
DEPARTMENT OF HEALTH REPORT,  1976
The early childhood team provides assessment services to children and their
families, with treatment services available primarily to those children with socio-
behavioural difficulties. A number of education programs for parents of infants and
pre-schoolers have also been developed.
The school-age team provides assessment services to children and their families, with treatment services available to selected children in all problem areas who
are between 6-11 years of age.
During the summer of 1975, Integrated Services entered into a one-year contractual relationship with School District 61, involving the clinical development of
a special two-classroom facility located at George Jay Elementary School. Staff
from School District 61, Human Resources, and Integrated Services developed a
short-term therapeutic classroom experience for behaviourally disturbed children.
The program included follow-up services to the children, as they returned to their
regular classrooms and family involvement, as required. The contractual relationship with School District 61 proved to be successful and could be considered a
demonstration of the viability of co-operative ventures between mental health and
educational resources.
Members of the school-age team were also involved in providing direct and
consultative services to the Learning Assistance Centre in School District 61, which
was an attempt to integrate special educational services available to children in
School Districts 61, 62, and 63.
BRITISH COLUMBIA YOUTH  DEVELOPMENT CENTRE
The British Columbia Youth Development Centre, referred to as "The
Maples," is located in Burnaby, and provides a variety of services, all of which are
part of the comprehensive consultation and treatment program dealing with psychological, social, and learning problems in children and adolescents under the age of
17 years.
After an initial screening, each child is interviewed and assessed at the centre.
It is here that the treatment program for each individual is developed. In most
cases the family of the disturbed child will participate in the assessment, treatment,
and educational process. The program that is offered may include out-patient
attendance, a day program, or living-in accommodation.
These services are provided by two units, each with its own professional staff
and Director—the psychological education clinic, providing special services for
children with learning problems, and the residential unit, which provides living-in
accommodation for 45 boys and girls in separate residences.
The staff of The Maples is comprised of professional workers, including psychiatrists, psychologists, child care counsellors, teachers, nurses, and others who
are trained in the mental health field.
A report of the two units follows:
RESIDENTIAL AND DAY CENTRE TREATMENT UNIT
The residential and day centre programs provide a variety of services, which
include comprehensive consultation, assessment and treatment of psychological,
social, and learning problems in adolescents, from the ages of 12 up to 17. There
are three self-contained residential cottages which provide living accommodations,
in separate wings, for boys and girls who require intensive treatment on a round-
the-clock basis.    Treatment in the cottage is carried out in a warm, homelike
 COMMUNITY HEALTH PROGRAMS
J 79
atmosphere by a team of child care counsellors, supported by a psychiatrist and
social worker.
The day centre program provides treatment for boys and girls from 14 to 17
years of age who require support and counselling, yet are able to live either at
home or in other suitable community facilities. They attend the centre on a daily
basis. In addition, the centre serves as a transitional stage of treatment for some
adolescents in the move from cottage to community. It also provides an extended,
intensive assessment for some adolescents prior to admission to the cottages. The
day centre treats those adolescents who require less structure in their daily life and
can assume more responsibility than those in the residence.
All adolescents in the residential cottages and day centre attend the special
school, where the educational staff work closely with cottage and day centre staff
to ensure that therapeutic and educational goals are co-ordinated and complement
one another. When indicated, some adolescents attend classes in nearby community schools. A major goal is to equip all adolescents with the skills necessary
to re-enter the regular school system, vocational training courses, or to achieve job
placement.
A gymnasium, swimming-pool, and arts and crafts centre are located on
grounds. Special individualized programs such as art and dance therapy, drama,
gymnastics, and swimming are designed to improve motor and expressive skills.
Socialization is an important goal in the activity's program. Camping, ski-ing,
movies, social events, and regular outings promote and develop social skills by
bringing the adolescents into contact with the community.
Residential and day centre programs insure high standards of clinical practice
by providing an ongoing, in-service training program leading to a diploma in child
care. The planning and implementation of this program is under the direction of
a training co-ordinator who works with the unit psychiatrists, social workers,
psychologists, and child care counsellors in developing a curriculum which stresses
an integrated approach to the treatment of adolescents.
The in-service training program aims at skill development in child care and
includes the following: Milieu, family, individual, and group therapy; interpersonal
and group dynamics; assessment, supervision, cottage management, and administration; and personality growth and development. The unit is also affiliated with
The University of British Columbia and provides field training to students from
the University of Victoria and Douglas College. Field placement training is provided to psychiatric residents and students in social work, child care counselling,
nursing, psychology, education, and recreational therapy.
To meet the increasing need and demand for personnel to work more effectively
with adolescents, the residential unit sponsored a three-day workshop in June 1976
for workers in the field throughout the Province. The response to this seminar was
excellent. Some 200 applications for the course were received, but, because of
space limitation, only 75 participants could be included in the seminar. Topics
such as family therapy, individual therapy, depression and aggression in the adolescent, psychological testing, and interactional techniques were discussed. The need
for repeated seminars of this nature was expressed and a future conference is
planned for 1977.
Private physicians, psychiatrists, school counsellors, probation officers, and
those working in mental health centres refer their clients to the residential and day
centre programs. Referral is usually made through local Department of Human
Resources offices. The referrals are assigned to an interdisciplinary team for assessment and diagnostic recommendation.    Staff continued to concentrate on treating
 J 80 DEPARTMENT OF HEALTH REPORT,  1976
the more seriously disturbed adolescent and his or her family. During 1976, 150
adolescents were referred for residential treatment. This was a 15-per-cent increase
over the previous year's referral rate.
PSYCHOLOGICAL EDUCATION CLINIC
The Psychological Education Clinic continues to operate a program for children and their families in the hope that most of the problems can be resolved,
permitting the child to remain in the regular school system. Staff provide a consultation service to supplement the special services that the schools normally provide.
The clinic can also provide special assessment services such as neuropsychological
evaluations.
During the year a clinical service continued to be offered to the northwestern
communities of British Columbia where psychological services are nonexistent.
A staff psychologist visited Prince Rupert, Ocean Falls, the Queen Charlotte Islands,
Lower Post, and Cassiar. These trips were generally initiated by a request from
the local schools for assistance with problem children, although the lack of any
mental health personnel in some of the remote communities frequently results in a
wide range of community and (or) family problems being investigated. Workshops
for parents and teachers, as well as some direct clinical intervention, comprise the
bulk of the travelling clinic work.
During the year some graduate students were hired on a research grant from
the Non-Medical Use of Drugs Directorate in Ottawa, to do a study of the incidence
of drug-related problems in three remote company towns (Tasu, Ocean Falls, and
Cassiar). Feedback from the communities indicated that the travelling services
being offered were badly needed and very much appreciated.
When a child has deteriorated to the point that prevention is no longer possible
and the only viable alternative is removal from the school system, the clinic has a
well-equipped school in Burnaby that accommodates 50 children. To complement
the staff of eight teachers, there is a support staff of five psychologists and a part-
time speech therapist. The teachers provide a highly technical learning assistance
program designed to embrace both academic learning and successful therapy.
Within this program the child is assigned academic tasks adjusted to his level
of cognitive and emotional functioning. It is a success-oriented program which
minimizes and counteracts failure of the past by emphasizing success in the present.
The teachers are also aware that much learning is provided outside of the classroom,
and provide field trips and several camping experiences to complement the educational program.
Another service that is provided is to assist the Department of Education in its
in-service training of teachers who are already in the field in classroom management.
Four teachers spend one month at the clinic, during which time they receive a
didactic and practical experience. Most of the teachers have been teaching for
several years, and are from communities located in fairly remote areas around the
Province. In addition, the clinic provides a training of one-year duration for three
teachers from the Burnaby area.
BOARDING HOME PROGRAM
During 1976, there was approximately 585 placements (or replacements)
made to 306 boarding homes in the Province. The over-all case load of the program at December 31, 1976, was 1,992, compared to a figure of 1,886 at December
31, 1975. This small increase in over-all case load reflected the gradual change in
 COMMUNITY HEALTH PROGRAMS
J 81
the type of person receiving the service. About two thirds of referrals received for
placement were persons resident in the community, rather than persons who had
been hospitalized for many years in centralized mental health institutions. Generally
they were younger, more acutely disturbed, and more active, but following treatment
required shorter boarding home stay. Further, a greater number of persons who
had many years in boarding home care were being helped to move to more independent forms of living. The total number of persons rehabilitated in this way
during the year was approximately 244. During the year, approximately 133
persons were readmitted either to the psychiatric ward of a general hospital or to a
mental health institution for varying periods of time during the year.
A major decentralization of the program became effective June 1 when administrative responsibility was transferred to local community mental health centres.
This move was part of a long-range plan which enabled the Boarding Home Coordinator to expand her consultation role to the mental health centres, while continuing to provide co-ordination at headquarters levels with other departments of
Government.
There continued to be a need for the development of resources able to provide
a more specialized type of program or service for specific groups of mental health
clients. Such resources are generally described as providing an intermediate type
of care, and are most frequently developed and sponsored by nonprofit societies.
The types of client requiring specialized program or service are the young, psychi-
atrically disabled person; the young behaviourly disturbed retarded person; and
persons of all ages who are physically disabled as well as mentally disordered.
A good activities program for boarding home residents, provided by occupational therapists and activity workers, continued throughout the year. The major
goal of this program is, through the development of self-direction and self-confidence
in the residents, to involve them eventually in normal recreational, educational,
vocational, and employment resources in the community. To this end, activity personnel were involved in the development of sheltered workshops, activities centres,
and adult education courses, as steps in the process of rehabilitation. They assisted
in the development of co-operative group-living homes (unsupervised) which is a
new, most promising arrangement for housing the mentally disabled person in the
community.
Additionally, the activity personnel initiated many imaginative and innovative
programs for both individuals and groups designed to improve awareness of
self and others. For example, eight district baseball teams were formed which
compete with each other for a championship trophy. Gym, tennis, hikes, ski-ing,
and bowling were promoted as participatory sports. Cultural and educational
activities included attendance at adult education courses, restaurant dining, trips
to Gastown, Chinatown, the Kelowna Regatta, and the Calgary Stampede.
Several workshops were arranged by local program staff for boarding home
operators. These workshops covered a variety of topics and were designed to
enhance the operators' skills in the management of their resident groups, and to
increase their understanding of the residents' behaviour and problems. Additionally,
the staff enrolled in workshops and continuing education opportunities provided by
Mental Health Programs and other sources, in order to enhance their own skills
and knowledge.
Several licensed boarding homes closed down during the year. These closures
took place for a variety of reasons which did not indicate any particular trend and
the program was able to absorb the loss of beds. However, the closure of a specialized resource on Vancouver Island for 18 young male psychiatrically handicapped
 J 82 DEPARTMENT OF HEALTH REPORT,  1976
persons was of significant concern because of the difficulty of replacing the valuable
service offered in this facility.
The approximate distribution of placements made and case load of the boarding home program in 1976 were as follows:
Placemen's Made Case Load
1976 December 31, 1976
Region 1 (Kootenays)      23 113
Region 2 (Okanagan-Thompson)  186 671
Region 3 (Fraser Valley)   176 825
Region 4 (Skeena)      31 21
Region 5 (Greater Vancouver)1     25 91
Region 6 (Cariboo-Peace River)        3 14
Region 7 (Georgia Strait)  102 164
Region 8 (South Vancouver Island)      39 93
Totals   578 1,992
i Burnaby and North Vancouver were the only municipalities of the Greater Vancouver area where placements were made through the mental health boarding home program.
CONSULTANTS
The senior administrative offices of Mental Health Programs are located in
Victoria, and the staff consists primarily of consultants in the various mental health
disciplines. Their varied responsibilities include the provision of consulting services
to the field staffs; conducting studies regarding the Province's need in terms of
facilities, programs, and treatment services; maintaining liaison with other Governmental, community, and nonprofit agencies; co-ordinating the recruitment of professional personnel; the provision of continuing educational seminars and workshops; and involvement in research projects.
A brief report of the work undertaken by each of the disciplines during the
year follows:
NURSING CONSULTATION SERVICES
The year under review was characterized by a considerable widening of the
scope of the Nursing Consultants' responsibilities. This was formally identified as
the provision of consultative services to community mental health programs, Government hospitals, psychiatric nursing education programs, general hospital psychiatric services, and other Government departments.
In this regard, reports were developed on the role of nurses in community
settings and the status of psychiatric nursing education in the Province. Among
the former were critiques of classification systems proposals for broad-banding
various categories of community nurses and, also, several categories of ancillary
hospital workers.
The designing of local community systems to ensure continuity of psychiatric
nursing care to patients and clients was a promising development, and favourable
results were evident in the Victoria, Duncan, and Surrey communities. A different
aspect of the same focus on continuity materialized in a one-year trial project for
collaboration between community mental health nursing and community college
nursing education, with anticipated gains for both programs in Surrey Municipality.
The nursing component of Mental Health Programs was provided by community mental health and psychiatric nurses.   It was necessary to apportion con-
 COMMUNITY HEALTH PROGRAMS
J 83
siderable time to nursing education and psychiatric nursing education matters,
through work on five advisory committees to various levels of nursing and psychiatric nursing education programs, and two task committees on continuing education. As well, all of these commitments enabled the Consultant to keep abreast
of the Provincial scene regarding the academic preparation of nurses for psychiatric
mental health nursing practice. Similarly, the chairmanship of the Mental Health
Nursing Liaison Committee, which provided an opportunity for senior nurses in a
variety of health care agencies to meet, provided an overview of current activities
in the Province.
In this regard, the first half of the year saw the completion of input into the
B.C. Medical Centre Nursing Manpower Committee, and the chairmanship of the
Post Basic Clinical Education Committee. Three reports emanated from the latter
and should prove useful in the development of plans for staffing nursing services
for nurses equipped with specialized skills.
Consultative work concerning hospitals included the provision of information
on staffing patterns to out-of-Province hospitals; participation in considerations of
the role of Riverview Hospital; liaison with Directors of Nursing; a visit to the
federal psychiatric centre at Matsqui, and review of an intermediate care facility's
nursing services.
During the year the Consultant collaborated with the Registered Psychiatric
Nurses' Association on a number of projects, as follows:
(a) development of data and recommendations to the Provincial Manpower Commitee on nurses qualified for psychiatric nursing practice;
(b) development of standards for practice for psychiatric nurses; and
(c) development of a format and mechanism for approving psychiatric
nursing education programs.
Riverview Hospital makes extensive use of video tape recording equipment to train
psychiatric aides and nursing staff.
 J 84
DEPARTMENT OF HEALTH REPORT, 1976
A specific added dimension to the Nursing Consultant's responsibilities, at
the request of the Registered Nurses' Association, was twofold in nature. First,
a study of the' need for consultative services by psychiatric units of general hospitals,
was under way at year-end. The second, to provide nursing consultation to general
hospitals on request, resulted in consultation visits to three hospitals. Professional
responsibilities were also carried out through participation in the work of the
Registered Nurses' Association Nursing Practice Committee.
A difficult and time-consuming responsibility during the year was the transferring of the Education Centre, Essondale, from the Department of Health to the
Department of Education, and its residences to Riverview Hospital. It marked the
end of 17 years of administrative responsibility for this facility.
SOCIAL WORK CONSULTATION SERVICES
New responsibilities during the year for the Consultant in Social Work included
serving as Co-ordinator for Continuing Education for Mental Health Programs and
acting as Regional Program Director for the Okanagan centres.
The work of the Series Review Study Committee, begun in the previous year,
was completed in May 1976. The committee's findings encompassed the entire
classification series for psychiatric social workers, and made major recommendations designed to bring about more professional accountability, more career potential
at the service delivery level, more recognition for individual professional achievement, and the introduction to an appropriate licensing mechanism for clerical
practitioners. At year-end the committee was waiting upon the Public Service
Commission for endorsement of these recommendations.
With the objective of providing more flexibility in the hiring of clinical social
workers, especially in rural areas where shortages of professional personnel are
felt most keenly, a special committee was formed during the year to study the
benefits of extending the "sessional appointment" mechanism for psychiatric social
workers.   It was expected that the report would be completed by year-end.
The inappropriateness of the curriculum and practicum models of the two
University Schools of Social Work, in terms of community mental health priorities,
continued to be of concern to the administration, as well as to psychiatric social
workers throughout the Province.
This growing discrepancy between the requirements of the field versus the
product of the schools prompted the establishment of a Committee on Social Work
Education to engage in an ongoing constructive dialogue with the training institutions in Vancouver and Victoria, with more collaborative approaches to curriculum
planning and field work practice.
As a member of the Child Care Facilities Licensing Board, the Consultant in
Social Work was active in a number of special studies dealing with the appropriate
utilization of facilities in Victora and the Lower Mainland. At year-end the Child
Care Board was involved in the formulation of regulations for child care facilities.
The Consultant was active on a number of committees throughout the year,
including the Program Advisory Committee; the Planning Committee for Mental
Health Programs; the Advisory Committee to the School of Social Work, University
of Victoria; the B.C. Conference on the Family; and the Committee on Special
Needs for Special Children.
As chairman of the newly formed Continuing Education Committee, the
Consultant worked with field and headquarters personnel in an effort to develop
a comprehensive continuing education program for mental health personnel throughout the Province.    The committee was successful in assisting most of the mental
 COMMUNITY HEALTH PROGRAMS
J 85
health centres to commence local programs of in-service education and staff development, shared by other agency personnel within their respective communities.
The second annual Western Inter-provincial Conference on Rural Mental
Health convened at Naramata under the chairmanship of the Consultant. Approximately 160 lay and professional delegates from the four western provinces attended
the three-day conference. The format for this conference emphasized the need for
a better understanding of how a variety of rural communities can come to grips
with the development of mental health services. Using community simulation
techniques, participants had occasion to experience real community issues in
process, to react to pressure groups, and to come to know at first hand the special
problems and resources unique to "have" versus "have not" communities, in terms
of their availability of human services.
PSYCHOLOGY CONSULTATION SERVICES
Areas of special emphasis during the year included providing consultation on
mental health policy, planning, implementation, administration, research, and evaluation. The over-all determination of policy and planning was done in conjunction
with a Program Advisory Committee, composed of program personnel, representatives from different mental health regions in the Province, and people representing
the various mental health disciplines.
Research and evaluation are important aspects of the administration of Mental
Health Programs, especially the documentation of related needs to mental health of
British Columbia communities and the necessary services required to deal with
these needs. .
Generally, there are four groups for whom specific mental health services are
provided. These include young children, adolescents, adults, and special groups
or groups of people with special needs. The total range of mental health services
includes an assessment and diagnostic program, a client consultation program, a
group-therapy program, a one-to-one therapy program, a rehabilitation program, a
research and evaluation program, a community and agency support program, a
counselling program, and a volunteer and self-help program.
During the year an area of concern was the maintenance of standards of providing psychological services. This concern was shared by the British Columbia
Psychological Association.
In 1976 the Consultant in Psychology continued his responsibilities of acting
Regional Director for northern British Columbia.
The result of increasing public awareness in mental health was reflected in the
concern of many communities about mental health problems, and the focusing of
what can be done by both the communities themselves and the Government to
alleviate these problems. A number of requests to meet with various community
groups to discuss these concerns were received by the Consultant in Psychology.
Several communities themselves initiated the documentation of local needs, and
such information was of great assistance in determining not only the types of
services most needed but also in being able to utilize available resources most
effectively.
Special responsibilities of the Consultant included services to various crisis
intervention centres in the Greater Vancouver region, assistance to a number of
centres in documenting community mental health profiles, and to the Integrated
Services for Family and Children Centre in Victoria.
Through the support of the Community Care Services Society, it was possible
to finish a health study of British Columbia communities with 50 or more residents.
 J 86 DEPARTMENT OF HEALTH REPORT, 1976
In the first part of the study a survey was made of people working in the four main
industries in British Columbia. In addition, residents of various communities and
personnel from Government agencies were surveyed in an attempt to determine the
type of general physical and mental health problems which existed in the various
areas. This resulted in nine general categories which either directly or indirectly
were thought to affect physical and mental health. The categories were composed
of demographic, health, education, housing, employment, economic activity, basic
services, environmental, and recreational variables.
The second part of the study consisted of collecting as much objective information as could be obtained pertaining to these variables, and this was used to provide
profiles for the various communities in British Columbia. The study was initiated
by the Government to assist in the planning of needed services.
MANAGEMENT ANALYST CONSULTATION SERVICES
Management analyst consultation services continued to be available to both
Mental Health Programs and the Government health institutions, with the emphasis
in 1976 on services to the mental health centres.
The response of mental health centre personnel to the proposed information
system was enthusiastic and a project team, composed of both field and head office
representatives, was formed. The team completed its work in May and presented
its recommendations to the Program Advisory Committee in July. By the end of
the year the procedures and programs required to collect and process data on
mental health centre clients was completed and preparations were made to begin
implementation in the centres.
With the assistance of the Medical Records Consultant, and the co-operation
of the Division of Vital Statistics, modifications were made to data collection and
processing.
During the year the Management Analyst assumed responsibility for the
design of new forms and procedures for several areas requesting this service. Assistance was provided, for example, in the development of a system to evaluate two
sheltered housing projects in Vancouver, and advice was frequently given on the
design of the records system for the Forensic Psychiatric Institute.
The Management Analyst served on the Planning Committee, the Program
Advisory Committee, and the Department of Health Metric Conversion Committee,
and continued to represent Mental Health Programs in dealings with the Division
of Vital Statistics, Computer and Consulting Services, and the Queen's Printer.
RESEARCH AND PLANNING SERVICES
The Research and Planning Section is a newly developed component of
Mental Health Programs. At the beginning of the year the vacated position of
Consultant in Sociology was converted to that of Research and Planning Officer
and Dr. D. Fernandez was appointed to the position on January 15.
Initial efforts in this area were concentrated on program development. An
"after-the-fact" planning model was developed, in close consultation with field staff,
in order to organize the array of current services provided from mental health
centres into a program format. Work in this endeavour proceeded well and was
expected to be complete toward the end of the year.
Other activities involved exploring avenues of research grant funding, since no
budget currently exists for research purposes. Contact was established with National Health and Welfare, and the Medical Research Council, regarding types of
research funded.
 COMMUNITY HEALTH PROGRAMS
J 87
There was direct consultation with field staff involved in research projects, and
recent publications of research in the field of mental health were regularly summarized and distributed to field staff through mental health centre administrators.
Projects under way at year-end included the development of a treatment goal
attainment scaling component of the new client information system, evaluation of
a pilot program involving a community mental health nurse in a general hospital,
comparison of mental health worker/population ratios of British Columbia and
the other provinces, participation in the evaluation of medical care for boarding
home residents, and studies regarding community awareness of mental health
services.
It was hoped that activities in research could be increased through the acquisition of a federally funded national health scientist attached to Mental Health
Programs.
STATISTICS AND MEDICAL RECORDS
After the major efforts of the past few years to computerize patient data, it was
necessary during 1976 to carry out extensive editing of both patient records and
computer programs in order that the data system could achieve greater accuracy
and efficiency. The task of processing all computer programs was assumed by the
statisticians, thus relieving the pressure on the Division of Vital Statistics and
providing a faster, more direct service for both routine and special requests.
Statistical Forms and Routine Reports
The volume of statistical forms verified by this section again increased. As of
March 1, 1976, the centres assumed the responsibility for coding all items on the
statistical forms. In August the administration of Victoria Integrated Services for
Child and Family Development was returned to Mental Health Programs, and their
case load was added to the statistical system. In October the case load of the
mental health workers who were formerly part of the Boundary Community Human
Resources and Health Centre at Grand Forks was added to the statistical system as a
new unit, administered by Trail Mental Health Centre.
A number of routine statistical reports were generated during the year, including the Monthly Statistical Bulletin, the Statistical Canada Outpatient Monthly
Report, the Annual Statistics Canada Preliminary Report from Institutions, and the
Annual Statistical Report for 1975. Two routine reports were discontinued, the
Preliminary Patient Movement Report and the Annual Statistics Canada Return
from Outpatient Programs.
A variety of research projects was undertaken during the year, such as a survey
of clients admitted to mental health facilities with alcohol or drug addiction problems, the preparation of summary information packages on all Provincial in-patient
and out-patient mental health facilities, and a survey of pharmacy services.
Close liaison with the Division of Vital Statistics and Statistics Canada was
maintained throughout the year.
Medical Records
The transfer of the Medical Records Consultant position to Victoria greatly
facilitated intra-departmental communications. As a result of the Consultant's visit
to 28 mental health centres, a report on the record keeping system was prepared.
One recommendation from this report, the formation of a Clinical Records Committee to encompass Mental Health Programs and Greater Vancouver Mental
Health Services, had been implemented by year-end. This committee will be respon-
 J 88 DEPARTMENT OF HEALTH REPORT,  1976
sible for policies and procedures of the client file system. Time was spent in orientating a number of new clerical staff in the centres, and a program of in-service education was set up specifically for the clerical staff.
Table 14—Patient Movement Trends, Mental Health Facilities, 1973-76
Yearly Sum of Entries* From—
Resident or Case Load
Mental Health Facilities
Oct. 1973
to
Sept. 1974
Oct. 1974
to
Sept. 1975
Oct. 1975
to
Sept. 1976
End of
Sept. 1974
End of
Sept. 1975
End cf
Sept. 1976
13,901
2,024
2,024
505
413
72
20
11,372
153
110
43
15,691
1,950
1,950
438
332
88
18
13,303
352
301
51
45
16
12,890
9,904
226
1,015
344
246
297
349
314
253
377
226
415
356
358
200
294
417
377
222
159
293
287
147
87
360
308
218
779
442
16,056
1,690
1,690
427
302
97
28
13,939
676
319
45
269
43
13,263
10,151
241
975
258
298
254
330
178
380
426
326
394
319
457
228
381
403
388
205
267
178
396
133
55
345
333
246
784
435
30
463
75
3,112
63
388
260
280
202
156
252
453
397
426
185
15,234
1,643
1,643
987
645
174
168
12,604
27
10
17
17,347
1,381
1,381
980
645
178
157
14,986
46
18
28
8
7
14,925
12,267
305
1,002
334
338
224
486
492
352
787
348
737
411
1,013
231
379
298
265
302
286
134
555
109
104
614
146
304
760
447
430
74
2,537
76
659
293
185
214
48
210
325
248
279
121
17,622
1,244
1,244
930
609
177
144
15,448
Total in-patients -.	
61
17
BCYDC                    	
30
8
Vista (August 1975 )2           	
11,219
9,295
253
807
412
243
117
291
107
350
464
235
398
327
419
222
261
482
319
259
188
234
242
128
69
278
401
194
759
535
285
16
1,772
12,577
10,821
231
776
333
281
63
523
199
392
634
210
768
447
672
258
260
286
230
366
257
149
512
74
58
535
202
225
1,097
374
398
11
1,652
709
156
150
145
6
15,387
12,480
350
Burnaby 	
1,253
469
344
237
401
762
496
Kelowna	
696
277
783
Nanaimo 	
Nelson	
372
266
273
508
214
306
256
396
96
548
100
59
727
279
Trail                          	
372
701
452
VISC (August 1976)2	
Whalley                                	
181
467
71
2,834
95
420
349
340
187
53
26
542
198
424
152
1
387
100
All community care teams	
Blenheim House (July 1974)2 _	
2,907
80
492
215
279
185
692
286
214
Richmond  - -—	
Secure (April 1975)2 __	
South Vancouver (July 1974)2	
Strathcona	
248
83
203
178
274
149
152
142
247
103
104
365
281
West Side                          	
354
BCYDC (out-patients)	
101
1 For the residential facilities this includes permanent transfers, admissions from community, and returns
from leave and escapes.
2 Month centre/team commenced reporting.
 COMMUNITY HEALTH PROGRAMS J 89
Table 15—Patient Movement Data,1 Mental Health Facilities, 1976
Entries
Exits
Mental Health
Facilities
Total
a
_o
tt  -r,
81
.a-3
a<
>
CPJ
§2
U  tr
| o
rr ">
E i
O.P.
Total
Vi
c
rt
5
>
rn
u
I-I
PU It
If
E c
u cpj
Q> l-p
BL.H
M
tC
<S
6
0
15,155
558
558
418
286
104
28
14,179
670
308
44
276
42
15,831
1,287
1,287
396
265
104
27
14,148
639
304
44
268
23
293
271
271
21
21
1
1
1
31
1
1
30
30
3
8
19
15,559
1,606
1,606
457
307
108
42
13,486
640
271
46
279
44
14,311
779
779
80
56
8
16
13,452
596
259
43
263
31
878
749
749
115
112
3
14
14
11
3
34
3
3
1
1
30
30
1
16
13
336
75
75
261
139
Dellview  -	
96
26
Total in-patients.....	
BCYDC                   	
Vista (August 1975)2
13,509
10,424
348
975
282
354
279
327
175
384
502
219
389
325
504
229
404
378
408
228
166
198
440
150
37
363
370
233
725
435
60
452
85
2,852
46
402
272
281
193
147
274
625
258
354
233
12,856
10,027
356
816
121
360
305
478
91
199
320
293
365
301
1,361
159
226
476
204
265
68
210
495
171
69
166
214
132
807
423
102
438
36
2,596
32
414
298
228
171
108
252
600
200
293
233
Fort St. John .,	
Kamloops _	
New Westminster —
Saanich.-  	
Sechelt	
Squamish „	
Trail  	
Vernon , -
VISC (August 1976)2	
Whalley 	
All community care teams 	
Blenheim House (July 1974)2.
Kitsilano 	
Mount Pleasant	
Richmond	
Secure (April 1975)2 	
South Vancouver (July 1974)2
Strathcona _ 	
West End 	
West Side	
BCYDC (out-patient)	
1 Table compiled from actual data through September 1976, and projected for the remainder of the year.
(Note—In case of centres/teams opened in 1976, table compiled on basis of available data for 1976.)
2 Month centre/team commenced reporting.
  MEDICAL AND
HOSPITAL PROGRAMS
  <
O
Hospital Programs
Prior to the introduction of the British Columbia Hospital
Insurance Service on January 1, 1949, the Province had been interested
in developing a comprehensive program for many years. In 1932
the findings of a Royal Commission had recommended that a compulsory health insurance maternity plan be considered, and in 1936
a Health Insurance Act had been placed on the statutes but never
proclaimed. In 1937, British Columbians voted in favour of health
insurance in a referendum held in conjunction with a Provincial
general election. Finally, in 1948, the Hospital Insurance Act was
passed, establishing a Hospital Insurance Service which when implemented on January 1, 1949, provided coverage for acute care in
approved general hospitals.
The funding of the operating costs of the service (Hospital
Programs) was a 100-per-cent responsibility of the Province until
1958 when the Federal Government agreed to share on a Canada-wide
basis approximately 50 per cent of the approved cost of certain hospital
services.
In March 1975 the name of the service was changed to Hospital
Programs as part of a reorganization of the Department of Health.
The following pages contain individual reports of the divisions
which comprise the administrative structure of Hospital Programs,
and brief reviews of pertinent legislation and statistical data.
a.
O
x
93
 J 94
DEPARTMENT OF HEALTH REPORT,  1976
HOSPITAL PROGRAM HIGHLIGHTS
• Gross operating expenditure for public general, rehabilitation, and extended-
care hospitals for the calendar year 1976 amounted to $520 million.
• A total of 395,706 adult and child B.C. Hospital Program patients was discharged in 1976, a decrease of 2,573 or 0.65 per cent less than in 1975; 95.7
per cent of all patients discharged were covered by Hospital Programs.
• Hospital Programs was responsible for 3,371,036 days of care for adults and
children in public hospitals, a decrease of 42,594 days or 1.25 per cent less
than 1975.  The average length of stay was 8.52 days.
• In 1976, 18 major hospital projects were completed, involving an estimated
$33.5 million. Two special unit projects were the Acupuncture Clinic and the
installation of the brain scanner, both at the Vancouver General Hospital.
• At year-end there were 4,320 extended-care beds in the Province and there were
approximately 1,670 additional extended-care beds under construction or in
planning stages; of these about 500 additional beds were expected to come into
operation early in 1977.
• During 1976 the regional hospital districts debenture sales to the B.C. Regional
Hospital Districts Financing Authority amounted to $67 million.
• Grants totalling $7.5 million were approved toward purchases of movable and
fixed technical equipment amounting to approximately $12.5 million. Over
7,200 applications for such grants were received from hospitals.
• Over 2,000 patient accounts and 2,600 emergency-service and minor-surgery
accounts were processed daily by Hospital Programs.
• Over 750 out-of-Province hospital accounts were processed each month, resulting in an estimated total expenditure of over $8 million.
BRITISH COLUMBIA REGIONAL HOSPITAL
DISTRICTS ACT
This Act, which is primarily related to the capital cost of hospital buildings
and equipment, provides for the division of the Province into large districts to
enable regional planning, development, and financing of hospital projects to be
carried out under a formula which provides substantial financial assistance from
the Provincial Government.
Each regional hospital district, subject to the requirements of the Act, is able
to pass capital expense proposal by-laws authorizing debentures to be issued covering the total cost of one or more hospital projects. When approval has been
obtained from the Minister of Health, the district is able to raise any funds
immediately required by temporary bank borrowing on a uniform basis. Periodically the Regional Hospital Districts Financing Authority (see below) provides
long-term financing by purchasing debentures issued by districts, thus enabling
regional hospital districts to repay their temporary bank borrowings.
Each year the Provincial Government pays through Hospital Programs from
the Hospital Insurance Fund a portion of the principal and interest payments
required on the debentures in accordance with section 22 of the Act. Each district
raises, by taxation, the remainder of the annual principal and interest payments
required to retire the debentures which are held by the B.C. Regional Hospital
Districts Financing Authority.
 MEDICAL AND HOSPITAL PROGRAMS
J 95
Under the sharing arrangements, the Province pays annually to, or on behalf
of, each district 60 per cent of the approved net cost of amortizing the district's
borrowings for hospital construction projects, after deduction of any items which
are the district's responsibility, such as provision of working capital funds for
hospital operation, etc. If a 4-mill tax levy by the district is inadequate to discharge its responsibility in regard to annual charges on old debt for hospital projects, as well as the remaining 40 per cent of the charges on the new debt resulting
from hospital projects, the Province will provide 80 per cent of the funds required
in excess of the 4-mill levy.
The affairs of each regional hospital district are managed by a board comprised of the same representatives of the municipalities and unorganized areas who
comprise the board of the regional district (incorporated under the Municipal Act),
which has the same boundaries as the regional hospital district. The board of
each regional hospital district is responsible for co-ordinating and evaluating the
requests for funds from hospitals within the district, and for adopting borrowing
by-laws, subject to approvals and conditions required under the Act, in respect to
either single projects of an over-all program of hospital projects for the district.
In 1975 the British Columbia Regional Hospital Districts Act was amended to
increase the discretionary amount which a regional hospital district can raise
annually for unforeseen capital expenditures, if specified by the Minister, to
$200,000, or the product of one quarter of a mill, whichever is the greater.
BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS
FINANCING AUTHORITY ACT
This Act established a Provincial Government authority similar to the one
set up to assist school districts in financing their projects. The functions of the
authority are referred to briefly above.
In 1975 the purposes of the authority were expanded to permit assistance to
medical and health facilities and community, human resources, and health centres
and any other community, regional, or Provincial facilities for the social improvement and welfare of the community or the general public good. Also, the authority
was permitted to purchase debentures from incorporated bodies other than
regional hospital districts, provided they are authorized under any Act or their
charter or their memorandum of association to issue debentures for the financing
of projects permitted under the Act.
HOSPITAL INSURANCE ACT
The Hospital Programs branch of the Department of Health operates under
the authority of the provisions of this statute which also authorizes the establishment of the Hospital Insurance Fund, from which grants are made to hospitals
toward operating expenses and capital costs. Grants are also made to regional
hospital districts toward capital expenditures made to hospitals.
• Generally speaking, every permanent resident who has made his home in
British Columbia during the statutory waiting-period is entitled to benefits
under the Act.
• Reimbursement to public general hospitals is based on an approved annual
budget; for accounting purposes per diem rates are used for medically
necessary in-patient care rendered to qualified British Columbia residents
 J 96 DEPARTMENT OF HEALTH REPORT,  1976
who are suffering from an acute illness or injury, and those who require
active convalescent, rehabilitative, and extended hospital care. The payment made to a hospital by Hospital Programs from the Hospital Insurance
Fund amounts to $4 less than the per diem rate, and in the case of extended-
care patients under 19 years of age, $1 less than the per diem rate, approved
for that particular hospital. The patient is responsible for paying the remainder. The Provincial Government pays the above-noted daily $4 or $1, as
applicable, on behalf of Provincial social welfare recipients.
• The wide range of in-patient and out-patient benefits provided under the
Act is described below.
• Qualified persons who are temporarily absent from British Columbia are
entitled to certain benefits for a period of 12 months following their departure from the Province.
• In addition to the payment toward operating costs, paid to hospitals as
described above, hospitals and regional hospital districts receive grants of
up to 60 per cent of approved costs of construction or acquisition of hospital
facilities, one third of the cost of minor movable equipment, 75 per cent
of the cost of major diagnostic equipment, and 100 per cent of the cost of
equipment which results in proven savings in operating costs.
HOSPITAL ACT
One of the important functions of Hospital Programs is the administration of
the Hospital Act. The Deputy Minister of Medical and Hospital Programs is also
the Chief Inspector of Hospitals for British Columbia under the Act.
The Hospital Act controls the organization and operation of hospitals, which
are classified as follows:
• Public hospitals: Nonprofit hospitals caring primarily for acutely ill persons.
• Private hospitals: This category includes small hospitals, most of which are
operated in remote areas by industrial concerns primarily for their employees, and licensed nursing-homes which are not under hospital insurance coverage.
• Rehabilitation and extended-care hospitals: These nonprofit hospitals are
primarily for the treatment of persons who require long-term rehabilitative
and extended hospital care.
HOSPITAL RATE  BOARD AND METHODS OF
PAYMENT TO HOSPITALS
The Hospital Rate Board, appointed by Order in Council, is responsible for
advising the Deputy Minister in regard to hospitals' operating budgets and rates
of payments to hospitals for both in-patient and out-patient benefits.
A system of firm budgets for hospitals, which, with modifications, has been
in use since January 1, 1951, provides for a review of hospitals' estimates by the
Rate Board. Under the firm-budget procedure, hospitals are required to operate
within the total of their approved budgets, with the exception of fluctuation in days'
treatment and other similar items. They are further advised that deficits incurred
through expenditures in excess of the approved budget will not be met by the
 MEDICAL AND HOSPITAL PROGRAMS
J 97
Provincial Government. However, hospitals retain surplus funds earned as a
result of keeping expenditures within the total amount approved.
The value of variable supplies used in patient-care has been established. It is
generally recognized that the addition of a few more patient-days does not add
proportionately to costs because certain overhead expenses (such as heating, etc.)
are not affected. However, some additional supplies will be consumed, and it is
the cost of these variable supplies which has been determined.
When the number of days' treatment provided by the hospital differs from the
estimated occupancy, the budgets are increased or decreased by the number of
days' difference multiplied by the patient-day value of the variable supplies.
Individual studies and additional budget adjustments are made in those instances
where large fluctuations in occupancy involve additions or reductions in stand-by
costs.
Policies to be used in the allocation of the total funds provided are approved
by the Government. The Hospital Rate Board reviews the detailed revenue and
expenditure estimates forwarded by each hospital and applies the policies in establishing approved budgets.
Approximately 96 per cent of all in-patient hospital accounts incurred in
British Columbia are the responsibility of Hospital Programs. Cash advances to
hospitals are made on a semimonthly basis, so that hospitals are not required to
wait for payment until patients' accounts are submitted and processed by Hospital
Programs. Qualified patients are charged $4 per day, and in the case of extended-
care patients under 19 years of age, $1 per day, effective June 1, 1976, which is
deductible when calculating payments to hospitals from the division.
Nonqualifying residents are charged the hospitals' established per diem rate,
which is all-inclusive, that is, the daily rate covers the cost of all the regular
hospital services, such as X-ray, laboratory, operating-room, etc., provided to
patients, in addition to bed, board, and nursing care.
"The Wheeling Eights" perform a square dance—part of the patient rehabilitation
program at Shaughnessy Hospital's spinal cord injury unit.
 J 98 DEPARTMENT OF HEALTH REPORT,  1976
HOSPITAL CONSULTATION AND INSPECTION
DIVISION
This division provides consulting services to public and private hospitals, and
to other divisions of Hospital Programs and the Department of Health, in all
aspects of hospital organization, operation, and management. It is also responsible for an inspectional program to ensure that minimum standards of care,
safety, and licensure are met.
The services of the division are. provided by teams consisting of consultants
in hospital administration, biomedical engineering, dietetics, laboratory, social
services, management engineering, nursing, and X-ray.
Consultation and Inspection
The ongoing work of consultation and inspection, which was carried out
during the year using a "team approach," involved 57 visits to private hospitals,
141 visits to general hospitals, and participation in many other activities such as
federal-provincial meetings and task forces, and educational seminars. Other
activities during the year include visits to 33 hospitals regarding cost-containment
studies which were related to the level of over-expenditure, and further special
assistance was given to hospitals in certain problem areas. In addition, work was
also done on a laboratory work unit study, a review of hospital social service statistical requirements, and eight special hospital management engineering studies. Staff
members prepared a training guide for dietetic departments, and were involved in
the identification and correction of patient care equipment hazards and in "quality
assurance" committee activities.
Private Hospital Visiting
The year 1976 saw a continuation of the consultation and inspection service
to private hospitals. In addition to team visits, most private hospitals in the
Province received special visits from consultants in nursing, administration, and
dietetics. It is intended that this approach to the inspection of private hospitals
will be continued in 1977.
Participation in Educational Program
Three members of the division are participants in "GAMAT," which is a program developed by the British Columbia Health Association to provide education
for hospital society trustees and emphasizes their role and responsibilities. The
GAMAT team has 12 members representing the Government, administration,
medicine, the association, and trustees.
RESEARCH  DIVISION
The division performs a statistical resource function for Hospital Programs
and serves as a focal point for data collection and analysis. Primarily responsible
for examining the need for new hospital beds and services, the division is also
involved in a wide range of activities.
The preparation of recommendations for additional hospital capacity, in the
face of an ever-increasing range of benefits and services covered by Hospital
Programs, necessitates close liaison at the hospital, regional, and Provincial level.
In spite of a greater emphasis being given to alternatives to acute in-patient beds
 MEDICAL AND HOSPITAL PROGRAMS
J 99
in recent years, the population growth of the Province necessitates a continuing
review of general hospital bed requirements. Reports and proposals for additional
hospital capacity are placed before the planning group of Hospital Programs for
review, and if approved are submitted to the Minister for approval. During the
course of the year, 36 studies of hospital requirements for both acute and extended-
care beds were completed.
The division also compiles statistical data relating to all hospitalization in the
Province. The admission/separation records submitted by the hospitals for each
patient form the basis of this information. All diagnosis and operations are coded
according to the Eighth Revision of the International Classification of Diseases
Adapted (ICDA). Through this classification system, the incidence of disease is
analysed by age, sex, geographical location, as well as other variables.
In connection with morbidity analysis, the division publishes a number of
annual reports. The Statistics of Hospital Cases Discharged includes the standard
morbidity tables consistent with other provinces, and which affords an opportunity
to make interprovincial comparisons of hospital data. The Statistics of Hospitalized
Accident Cases, which is also prepared annually, provides a broad analytical
coverage of hospitalized accident cases by circumstance, type of accident, and
nature of injury. A report of the Day Care Surgery in British Columbia Hospitals
is also prepared by the division for purposes of showing the potential and development of this type of service. In addition to these reports, the division supplies
data to many agencies, both inside and outside of the Government. The demand
for hospital morbidity data continues to grow and has become particularly useful
in the planning of specialized hospital services.
The division also maintains a reporting system for therapeutic abortions
performed in hospitals in the Province.
HOSPITAL FINANCE DIVISION
The Hospital Finance Division is responsible for the assembling of relevant
information and the preparation of data for the use of the Hospital Rate Board in
its review of the annual and preconstruction operating estimates of hospitals.
During this process, estimated revenues and expenditures are examined in detail,
and adjustments to estimated amounts are recommended. The gross expenditure
approved by the Hospital Rate Board for public general, rehabilitation, and extended-care hospitals for 1976 amounted to approximately $520 million.
The division also reviews the annual budgets prepared by regional hospital
districts, and works closely with the British Columbia Hospital Financing Authority
and the regional hospital districts in the financing of hospital capital projects and
repayment of debentures. Total regional hospital district debenture sales to the
British Columbia Regional Hospital Districts Financing Authority amount to
$254 million, of which $67 million was added during the current year.
Another function of the Finance Division is the processing of admission-
separation records (accounts), which hospitals submit for each patient, and
approving for payment all acceptable claims and the coding for residential data,
etc.   Also included are out-patient, day care, and out-of-Province accounts.
The division is also responsible for the approval of grants to assist hospitals
in the purchase of equipment. The equipment grant structure is such that Hospital
Programs pays 100 per cent on approved equipment where the equipment purchase
will result in a reduction in approved operating costs and the recovery of the capital
cost in a reasonable time.    Grants of 75 per cent are paid on major diagnostic
 J  100
DEPARTMENT OF HEALTH REPORT,  1976
equipment used in pathology, radiology, nuclear medicine, and ultra-sound, and
33JZs per cent grant on all other movable depreciable equipment. In 1975, after
review of approximately 7,200 applications received from hospitals, grants totalling
$7.5 million were approved on purchases of movable and fixed technical equipment amounting to approximately $12.5 million.
The division assists in administering the Federal/Provincial Agreement under
the Hospital Insurance and Diagnostic Services Act. This involves the preparation
of annual claims and the disbursement of Hospital Programs funds in a manner
that will maximize the Province's reimbursement under the agreement.
In order to ensure that plans for new hospitals or hospital additions are prepared with economical and efficient operation in mind, preconstruction operating
estimates are completed by hospitals at the final sketch plan stage. It is essential
that the estimated operating costs of the new hospital, or new addition, compare
favourably with other hospitals actually in operation. Where the hospital's preconstruction operating estimates do not indicate a reasonable operating cost, it may be
necessary for the hospital board to revise its construction plans to ensure efficient
and economical operation. Once a satisfactory preconstruction operating budget
has been agreed upon by the hospital officials and Hospital Programs, the hospital
board is required to provide written guarantees relative to the projected operating
cost. It is considered that this method of approaching the operating picture for
proposed hospital facilities ensures more satisfactory planning, efficient use of
hospital personnel, and an economical operation.
As a means of assisting hospital staff to maintain and develop health care
skills, Hospital Programs provided over $390,000 in hospital operating budgets
during the year to enable hospital employees to attend or participate in short-term
educational training courses.
The following is a summary of comparative expenditures of Hospital Programs (including capital) for the fiscal years ending March 31, 1972-76, inclusive:
1972
1973
1974
1975
1976
S
1,400,095
206,667,254
$
1,538,905
235,594,194
$
1,800,229
275,801,859
$
2,438,265
370,927,805
$
3,556,066
Payments to hospitals -  	
483,107,890
Totals	
208,067,349
237,133,099
277,602,088
373,366,070
486,663,956
Finance Claims Section
Patient accounts processed during the year were in excess of 2,000 per
working-day, plus over 2,600 emergency-service and minor-surgery accounts.
The staff of Admission Control reviews each application for benefits under
the Hospital Insurance Act. Details of residence are checked with the verifying
documents, and as a result over 5,300 claims had to be returned to the hospitals
during the year because they were incomplete or unacceptable, and over 1,600
letters were written on eligibility, verification, and related matters.
The In-patient Claims Section pre-audits the charges made to Hospital Programs, and ensures that all information shown on each claim is completed so that
it can be coded for statistical purposes, and that it is charged to the correct agency,
such as Hospital Programs, Workers' Compensation Board, the Department of
Veterans Affairs, or other provinces and territories. Preliminary figures for 1976
show that more than 449,000 accounts (excluding out-of-Province) were processed.
 MEDICAL AND HOSPITAL PROGRAMS
J 101
The day-care surgical services, day-care/night-care psychiatric services, outpatient psychiatric services, day-care diabetic services, and dietetic counselling
accounts increased in volume to over 11,000 per month in 1976. During the year
the service continued to provide a quarterly statistical run of day-care surgical services for the hospitals of the Province. Payment for out-patient physiotherapy
patients was provided and preliminary figures indicate that accounts for over
373,000 treatments were processed.
The Out-of-Province Section processes all claims for hospital accounts
incurred by British Columbia residents in hospitals outside the Province. This
requires establishing eligibility and the payment of claims. During 1976 over 750
accounts were processed each month, resulting in an estimated total annual
expenditure of over $8 million.
The claims distribution centre receives, sorts, and distributes all the forms
and correspondence received in the Hospital Claims Section; approximately 12,000
claims, documents, and letters are handled daily.
HOSPITAL CONSTRUCTION AND PLANNING DIVISION
During 1976 this division has continued to provide a consultative service to
hospital boards planning new acute or extended-care hospital facilities, diagnostic
and treatment centres, and additions or alterations to these buildings. With inflation, continued emphasis was placed on using public funds to the best advantage
and deleting any work not considered strictly necessary. All construction programs
and applications for grants toward minor building improvements submitted to the
branch were reviewed with this in mind.
During the year 18 major projects were completed or substantially completed
in the Province, costing over $33 million; 254 new extended-care beds have been
provided. Nearing completion were 300 new extended-care beds on the campus
of The University of British Columbia, and construction of 100 beds was completed at year-end in North Kamloops.
Both these facilities were expected to admit their first patients early in 1977.
The remaining 154 extended-care beds have been provided at the expanded Holy
Family Hospital in Vancouver, which also provided 24 additional activation/rehabilitation beds. The completion of the fourth floor of the G. F. Strong Rehabilitation
Centre has added 50 beds to that facility. Details of the balance of the projects are
included in this report.
The latest national building codes require fire-resistant construction, fire separation around patient rooms, door closers, etc., at tremendous capital cost. For
example, recent code requirements call for a type of patient-room door costing
$1,000 installed. However, this and other requirements tend to hamper the functional needs of a health care facility, therefore we have undertaken a study in conjunction with National Research Council on hospital fires. This preliminary study
confirmed that major disasters from hospital fires have been avoided in this Province
due largely to quick and effective action by hospital staff. Unfortunately there is
insufficient evidence at the present time to demonstrate to the writers of the code that
the hospital staff is the first line of fire control. When the case is sufficiently substantiated, a presentation will be made to the National Standing Committee on
Fire Safety in Buildings by the Director of the division, who was recently appointed
to that committee.
The division records its sincere appreciation to the office of the Provincial Fire
Marshal for all the assistance they have given during the year in arriving at a better
 J  102 DEPARTMENT OF HEALTH REPORT,  1976
mutual understanding of fire and National Building Code requirements as they
relate to hospital construction, particularly projects involving renovations and
upgrading.
To speed up planning for new acute and extended facilities, the division has
been working on additional comprehensive guidelines. Suggestions and criticisms
from existing extended-care units in the Province have been solicited and are currently being evaluated for inclusion in a revised extended-care program and design
guide which will be completed next year. With regard to acute facilities, staff from
the division are refining guidelines for hospital departments which will be considered
in the development of planning criteria on a national basis. The Director of the
division, G. F. Fisher, is a member of the federal subcommittee on Health Planning
and Construction.
The effect of metric conversion on the construction industry in January 1978
is being investigated by the division.
Since E. B. Foxon, Chartered Quantity Surveyor, joined the division, greater
attention is being paid to the correct wording of contract documents and to ensuring
that adequate insurance coverage is provided on construction projects. Mr. Foxon
is a member of the Joint Technical Planning Committee, on which representatives
from Government and industry try to resolve mutual problems in connection with
insurance, bonding, contract arrangements, mediation, and the preparation of
standard documents for use by Government and industry. Besides being a member
of the Insurance Subcommittee, which is trying to achieve uniform insurance for all
Government departments, Mr. Foxon is chairman of the Mediation Council for the
settlement of disputes between owners and contractors.
The engineering section has been involved in the Canadian Standards Association Subcommittee on Essential Electrical Systems in Hospitals and new CSA
standards for medical gas systems. Liaison has been maintained with consultants
engaged in hospital design, particularly regarding methods of energy management.
PROJECTS COMPLETED DURING  1976
Dawson Creek & District Hospital—Stage I of a renovation program which
entailed the relocation of a 24-bed nursing unit, was completed in June 1976.
Fort Nelson General Hospital—Stage I of an expansion and renovation program, the excavation and foundation work, etc., was completed in June 1976.
Fort St. John General Hospital—The completed expansion program was
officially opened by the Honourable R. H. McClelland, Minister of Health, on
September 11, 1976. The program included ambulatory care, radiology, nuclear
medicine, and central sterilizing facilities.
Overlander Extended Care Hospital, Kamloops—The new 100-bed extended-
care facility was opened on December 11, 1976.
Keremeos Diagnostic & Treatment Centre—The new diagnostic and treatment
centre (no holding beds) and ambulance garage were opened in May 1976.
Powell River General Hospital—The completed renovation program was
officially opened on March 12, 1976. The project included the provision of a four-
bed intensive care unit, a hydrotherapy pool, and a ventilation system.
Prince George Regional Hospital—The clinical facilities for the diploma nursing program were completed in September 1976.
Queen Charlotte Islands General Hospital—A program of upgrading the mechanical, electrical, and plumbing systems was completed in October 1976.
 MEDICAL AND HOSPITAL PROGRAMS
J  103
TraiTRegional Hospital—Stage I of an upgrading project, which involved the
dietary department, was completed in June 1976. The project also included the
air-cooling of the existing hospital and the provision of a new nurses' station on
the second floor.
Vancouver
Cancer Control Agency of B.C.—Temporary structures for oncology residents
and cytology records computerization were completed in June 1976.
Children's Hospital—The new ambulatory care facilities were completed in
June 1976.
G. F. Strong Rehabilitation Centre—In October 1976 the fourth floor for 50
rehabilitation beds and a second hydrotherapy pool were completed.
Holy Family Hospital—An addition and renovation program, which provides
80 activation/rehabilitation and 154 extended-care beds, was officially opened on
June 20, 1976, by the Honourable Grace McCarthy, Provincial Secretary.
St. Paul's Hospital—A program of alterations and improvements to the diagnostic and treatment and service areas was completed in December 1976.
Vancouver General Hospital—The first patients were admitted to the new
acupuncture clinic on January 5, 1976.
The E.M.I, brain scanner, Stage I of the neurosciences project, was officially
opened by the Honourable R. H. McClelland on October 1, 1976.
The renovations to the Willow Pavilion, which provided a new intensive care
nursery, were substantially completed early in July 1976.
Mount Saint Mary Hospital, Victoria—A kitchen addition and a renovations
program were completed in December 1976.
PROJECTS UNDER CONSTRUCTION AT YEAR-END
Burnaby General Hospital—A major expansion program is being carried out
under project management, including the provision of 260 additional acute beds.
A second block will house expanded diagnostic, treatment, and service facilities.
Cumberland General Hospital—Construction of an intermediate care unit of
50 beds and a diagnostic and treatment centre with six holding beds.
Dawson Creek & District Hospital—Stage II will include the expansion of the
administration area, day care surgery, emergency, and radiology departments.
Delta Centennial Hospital Society—A new 100-bed extended-care hospital
based on the same design as Overlander, Kamloops.
Elkford Diagnostic & Treatment Centre Society—Construction of a diagnostic
and treatment centre with three holding beds.
Fort Nelson General Hospital—Stage II, including expansion of ambulatory
care and diagnostic facilities.    Also the provision of seven acute beds in "shell."
Wrinch Memorial Hospital, Hazelton—A new hospital providing 27 acute
beds, plus eight in "shell" and four extended-care beds, is being built under construction management to replace the existing 50-bed hospital.
Royal Inland Hospital, Kamloops—The second phase of the first stage of an
expansion program including the enlargement of diagnostic service, X-ray, emergency, laboratory, and dietary departments and provision of 14 acute beds in
"shell," is now under way.   Also, safety measures as required by the Fire Marshal.
 J  104 DEPARTMENT OF HEALTH REPORT,  1976
Kelowna General Hospital—A new extended-care hospital on a-new site providing 100 beds plus 50 in "shell." The plans for the Overlander extended-care
hospital in North Kamloops are also being used for this project.
Queen's Park Hospital Society, New Westminster—A new hospital facility
providing 300 extended-care beds, 100 of which are to be teaching beds, is being
built under construction management adjacent to Woodlands School.
Royal Columbian Hospital, New Westminster—A major expansion consisting
of an addition of 100 acute beds plus a further 45 beds for special services (intensive
care, activation, renal dialysis, and metabolic investigation), is being carried out
under project management.
Pemberton & District Hospital Society—A new diagnostic and treatment
centre with three holding beds.
Mills Memorial Hospital, Terrace—An expansion program consisting of an
addition of 25 acute beds in "shell," 16 psychiatric beds, six day care psychiatric
spaces, and renovations to the service area, is under way under construction
management.
Vancouver
Children's Hospital—Projects to expand the surgical suite and provide a cleft
palate unit are at present under way.
Mount Saint Joseph Hospital—Construction of an addition and conversion of
existing extended-care beds to increase the hospital's capacity to 161 acute beds,
including 20 psychiatric beds and day care psychiatric facilities. Also a new 150-
bed extended-care unit and upgrading and expansion of services. This project is
under construction management.
St. Vincent's Hospital—Phase II of the hospital's expansion program involves
alterations and renovations to the 1939 East Wing, including the alteration of the
old dietary department for ambulatory services, renovation of the radiology and
physiotherapy departments, and upgrading the electrical and elevator services.
UBC Health Sciences Centre—The new 300-bed extended-care unit was completed in October 1976.
Vancouver General Hospital—The provision of a surgical day care unit.
Royal Jubilee Hospital, Victoria—An interim program to upgrade the emergency department is being carried out by hospital staff.
TENDERING STAGE AT YEAR-END
Saanich Peninsula Hospital—Construction of a new 75-bed acute facility.
Tofino General Hospital—Expansion of services.
PROJECTS IN ADVANCED STAGES OF PLANNING
Matsqui-Sumas-Abbotsford General Hospital—Expansion of the emergency
department and psychiatric unit.
Langley Memorial Hospital—Construction of a 75-bed extended-care unit
adjacent to the existing hospital.
Nanaimo Regional General Hospital—Completion of a 12-bed intensive-care
unit presently in "shell" form.   Nine beds only are to be placed in service initially.
 MEDICAL AND HOSPITAL PROGRAMS
J  105
Young visitors to Victoria General Hospital receive colouring books from Nurse
Sherry Fossum, Associate Director of Patient Care, as part of hospital's familiarization
program.   Photo courtesy of The Victorian.
Coronary intensive care unit with full patient monitoring opened at
Victoria's Royal Jubilee Hospital during 1976.
 J 106 DEPARTMENT OF HEALTH REPORT, 1976
Lions Gate Hospital, North Vancouver—Northern (Services) expansion
project.
South Okanagan General Hospital, Oliver—Development of plans for a 75-
bed extended-care unit.
Prince George Regional Hospital—Planning for a 75-bed extended-care unit.
Trail Regional Hospital—Development of Stage II of a master plan including
central sterilizing area, emergency, surgical facilities, etc.
Victoria General Hospital—Radiology renovations and expansion of electro-
diagnostic services.
ADDITIONAL PROJECTS APPROVED AND IN VARIOUS
STAGES OF PLANNING
New facilities—
Acute hospitals—Coquitlam (150); Port McNeill (10); also replacement
of a portion of Victoria General Hospital (250) on a new site.
Diagnostic and treatment centres—Delta.
Additional and (or) replacement acute beds—Abbotsford (129, including 20
psychiatric and 15 activation/rehabilitation), Cranbrook (42), Duncan (12 psychiatric), Kamloops (Royal Inland, 47), Mackenzie (seven plus five in "shell"),
Maple Ridge (97, including some psychiatric), Masset (4), Mission (47), Richmond (150), Salmon Arm (12), Vancouver (Cancer Control Agency of B.C.,
28; New Children's, 200).
New extended-care facilities—Coquitlam (75), Creston (35), Merritt (10),
Mission (50), Princeton (10), Rossland (12).
Additional extended-care beds—Castlegar (15); Comox (15); Salmon Arm
(15); Surrey (78); Vancouver (Metropolitan Council, 80 plus 80 intermediate
care; Sunny Hill, 22), Victoria (Glengarry, 150).
Expansion and (or) updating of services—Chilliwack, Clearwater, Comox,
Cranbrook, Creston, Fort St. John, Ganges, Kamloops (Royal Inland), Maple
Ridge, Masset, Penticton, Prince George, Richmond, Sechelt, Tahsis, Trail, Vancouver (St. Paul's, Shaughnessy, Sunny Hill, Vancouver General), Victoria (Royal
Jubilee, Victoria General).
MEDICAL CONSULTATION  DIVISION
The function of this division is to provide medical consultation within Hospital
Programs, with Community Health Programs, with other departments of the Government, with hospitals at all levels of care and with regional hospital districts. For
example, within Hospital Programs, in addition to general medical consultation, the
division assists in planning and implementation of new services by having representatives on the planning group, Equipment Committee, and the Functional Program Review Committee of Hospital Programs.
The division has maintained liaison with other health agencies, such as the
College of Physicians and Surgeons of British Columbia, the B.C. Medical Association, B.C. Hospitals' Association, and the Faculty of Medicine at UBC. Understandably, in a province with more than 100 hospitals, problems relating to medical
staff activities occur; these organizations have provided valued assistance in resolution of these difficulties.   Participation on the Medical Advisory Committee of the
 MEDICAL AND HOSPITAL PROGRAMS
J  107
B.C. Medical Association with Advisory Subcommittees to the Government on
many subjects continues to be a useful function. In 1976, perinatal programs was
established as a new continuing subcommittee and the Fifth Open Heart Review
was received from the Task Committee which began its work in 1975.
Medical Consultation Division has the responsibility for a general auditing of
the quality of medical care for hospitals. This function is performed by a central
review of discharge diagnoses and related information, patterns of care, hospital
role, and by on-site visits. Regular visits by the Medical Record Librarian Consultant assist hospitals in maintaining a high standard of medical documentation.
The audit process also involves assessment of eligibility for acute care or other types
of care or insured benefit. Registered nurses within the division audited and did
the medical coding of approximately 450,000 admission/separation records and
65,000 day care surgical services records. The information coded by these individuals is utilized by the Research Division to produce the regional and hospital
profiles necessary for planning and audit functions.
The Medical Consultation Division has the responsibility for both the program
and eligibility status of extended-care patients. The Central Registry for long-term
care applications is continuing to develop and now is capable of managing all
hospital waiting lists. An initial on-site assessment of applicants for long-term
care is being started in co-operation with Community Health Programs and local
units. These assessors will mobilize community resources on behalf of patients
waiting for long-term care and ensure that their names are on the correct list.
During 1976 a new extended-care unit of 154 beds was established at Holy
Family Hospital, Vancouver, together with 100 beds built at the Overlander Hospital
in Kamloops, and 300 beds for the UBC Extended Care Unit. This latter unit will
be ready for occupancy in January 1977. In addition, 75 beds in the Arbutus
Private Hospital came under coverage and beds were designated for extended care
in Prince George Regional Hospital (22 beds), Kimberley & District Hospital (18
beds), Trail Regional Hospital (12 beds), together with a number of small extended-
care "holding units" within community hospitals throughout the Province. There
are now 4,320 extended-care beds with very close to a 100-per-cent occupancy, a
further 950 extended-care beds will be available for patients in 1977 and 15 more
units are involved in various stages of approved planning.
These institutions receive a regular quarterly review by a special multidisci-
plinary team. This latter function emphasizes a consultative review of the hospitals
to assist in establishing optimal patient programs. The review also permits an
individual audit to establish the need and eligibility for continuing care. The shortage
of beds in intermediate care tends to hamper the placement of patients upgraded
to this type of care in the extended-care system. The policy of short-term admission
of extended-care patients continues to be useful, supporting and encouraging relatives who wish to take care of extended-care patients in their own homes, but who
require occasional holiday or other relief.
During 1976 the Medical Consultation Division continued to have responsibility
for determining eligibility for the applicants for admission to the five designated
intermediate-care homes in the Province, totalling 663 beds. These homes are
visited quarterly to contribute to the development of an intermediate-care program
in the unit and, secondly, to assess the continued eligibility of the residents.
Good co-operation was provided by the operators of these units in a joint
endeavour for providing care based on a home rather than a hospital model. However, those residents who are incompatible with the usual units because of mental
and emotional handicaps present a challenge to all concerned.   It is hoped that this
 J  108 DEPARTMENT OF HEALTH REPORT,  1976
type of care, particularly in larger communities, can be suitably provided within
special extended-care programs or other facilities, rather than in standard intermediate-care units.
ADMINISTRATIVE SERVICES DIVISION
The division provides a variety of administrative services to the other divisions
of Hospital Programs and to outside agencies. These services include the following:
Administration
The personnel function, including payroll, recruitment, promotion, and labour
relations matters.
The review of requisitions and vouchers for all divisions, including travel
expenses and requisitions for supplies and equipment.
The receipt and deposit of all incoming cheques.
The handling and distribution of all hospital forms and the sorting and distribution of mail.
The co-ordination of the preparation of the annual estimates for Hospital
Programs.
The preparation and publication of the Hospital Programs Bulletin.
The preparation and distribution of information pamphlets for Hospital
Programs.
Legislation
The drafting of legislation, regulations, and Orders in Council related to the
various statutes administered by Hospital Programs. In the performance of these
duties the division works closely with the Attorney-General's Department. Statutes
which relate to the division's activities include
• Hospital Insurance Act;
• Hospital Act;
• Regional Hospital Districts Act;
• British Columbia Regional Hospital Districts Financing Authority Act;
• Medical Centre of British Columbia Act.
Hospital Societies
The provision of assistance to hospital societies in connection with the drafting
of hospital constitutions and by-laws and their interpretation and application.
The review of hospital by-laws or amendments to hospital by-laws prior to their
submission for Government approval as required under the Hospital Act.
The processing, in collaboration with the Hospital Consultation and Inspection
Division, of transfers of private hospital property and transfers of shares in the
capital stock of private hospital corporations.
The co-ordinating of the acquisition and disposal of hospital sites and private
hospitals.
In conjunction with the Land Registry Office, control over the property of
hospitals and private hospitals to ensure that the property records are suitably
endorsed so that land transfers may not be made until they are approved under the
Hospital Act.
 MEDICAL AND HOSPITAL PROGRAMS
J 109
Federal-Provincial Hospital Arrangements
The drafting and processing of the necessary amendments to the Federal-
Provincial Agreement and associated matters.
Regional Hospital Districts
In conjunction with officials of other divisions, other Government departments,
and the various regional hospital districts, the division assists in processing capital
expense proposals and in arranging for the necessary by-laws and Orders in Council
for temporary borrowings and related matters.
Eligibility
The review of applications for benefits made by or on behalf of persons
admitted to hospitals.
The maintenance of uniform standards of eligibility in all hospitals and the
provision of assistance to hospitals in training admitting staff.
The handling of applications to the Health Insurance Supplementary Fund.
Third-party Liability
The review of all hospitalization reports for patients admitted to hospitals
with accidental injuries.
The processing and verification of the reimbursement from public liability
companies for hospital expenses paid on behalf of accident victims. During the
year ending March 31, 1976, a total of over $2 million was recovered through the
process.
APPROVED HOSPITALS
Hospitals as Defined Under the Hospital Insurance Act Designated by Order in
Council 1391/1958 (Revised to November 30,1976)
(Hospitals defined as such under section 2 of the Hospital Act)
PART I
(a)  Public Hospitals
A. Maxwell Evans Clinic, Vancouver.
Armstrong & Spallumcheen Hospital, Armstrong.
Arrow Lakes Hospital, Nakusp.
Ashcroft & District General Hospital, Ashcroft.
Bella Coola General Hospital, Bella Coola.
Boundary Hospital, Grand Forks.
Bulkley Valley District Hospital, Smithers.
Burnaby General Hospital, Burnaby.
Burns Lake & District Hospital, Burns Lake.
Campbell River & District General Hospital,
Campbell River.
Cariboo Memorial Hospital, Williams Lake.
Castlegar & District Hospital, Castlegar.
Chemainus General Hospital, Chemainus.
Chetwynd General Hospital, Chetwynd.
Children's Hospital, Vancouver.
Chilliwack General Hospital, Chilliwack.
Cowichan District Hospital, Duncan.
Cranbrook & District Hospital, Cranbrook.
Creston Valley Hospital, Creston.
Dawson Creek & District Hospital, Dawson
Creek.
Dr. Helmcken Memorial Hospital, Clearwater.
Enderby & District Memorial Hospital,
Enderby.
Fernie District Hospital, Fernie.
Fort Nelson General Hospital, Fort Nelson.
Fort St. John General Hospital, Fort St.
John.
Fraser Canyon Hospital, Hope.
G. R. Baker Memorial Hospital, Quesnel.
Golden & District General Hospital, Golden.
Grace Hospital, Vancouver.
 J  110
DEPARTMENT OF HEALTH REPORT,  1976
(a) Public Hospitals—Continued
Kelowna General Hospital, Kelowna.
Kimberley & District Hospital, Kimberley.
Kitimat General Hospital, Kitimat.
Kootenay Lake District Hospital, Nelson.
Lady Minto Gulf Islands Hospital, Ganges.
Ladysmith & District General Hospital,
Ladysmith.
Langley Memorial Hospital, Langley.
Lillooet District Hospital, Lillooet.
Lions Gate Hospital, North Vancouver.
McBride & District Hospital, McBride.
Mackenzie & District Hospital, Mackenzie.
Maple Ridge Hospital, Maple Ridge.
Mater Misericordis Hospital, Rossland.
Matsqui-Sumas-Abbotsford General Hospital, Abbotsford.
Michel-Natal District Hospital, Sparwood.
Mills Memorial Hospital, Terrace.
Mission Memorial Hospital, Mission City.
Mount Saint Joseph Hospital, Vancouver.
Nanaimo Regional General Hospital, Nanaimo.
Nicola Valley General Hospital, Merritt.
Ocean Falls General Hospital, Ocean Falls.
100 Mile District General Hospital 100 Mile
House.
Peace Arch District Hospital, White Rock.
Penticton Regional Hospital, Penticton.
Port Alice Hospital, Port Alice.
Port Hardy Hospital, Port Hardy.
Pouce Coupe Community Hospital, Pouce
Coupe.
Powell River General Hospital, Powell River.
Prince George Regional Hospital, Prince
George.
Princeton General Hospital, Princeton.
Prince Rupert Regional Hospital, Prince
Rupert.
Queen Charlotte Islands General Hospital,
Queen Charlotte City.
Queen Victoria Hospital, Revelstoke.
Rest Haven General Hospital, Sidney.
Richmond General Hospital, Richmond.
Royal Columbian Hospital, New Westminster.
Royal Inland Hospital, Kamloops.
Royal Jubilee Hospital, Victoria.
R. W. Large Memorial Hospital, Waglisla.
St. Bartholomew's Hospital, Lytton.
St. George's Hospital, Alert Bay.
St. John Hospital, Vanderhoof.
St. Joseph's General Hospital, Comox.
Saint Mary's Hospital, New Westminster.
St. Mary's Hospital, Sechelt.
St. Paul's Hospital, Vancouver.
St. Vincent's Hospital, Vancouver.
Shaughnessy Hospital, Vancouver.
Shuswap Lake General Hospital, Salmon
Arm.
Slocan Community Hospital, New Denver.
South Okanagan General Hospital, Oliver.
Squamish General Hospital, Squamish.
Stewart General Hospital, Stewart.
Stuart Lake Hospital, Fort St. James.
Summerland General Hospital, Summerland.
Surrey Memorial Hospital, North Surrey.
Tahsis Hospital, Tahsis.
Tofino General Hospital, Tofino.
Trail Regional Hospital, Trail.
University Health Service Hospital, University of British Columbia, Vancouver.
University of British Columbia, Health Sciences Centre Hospital, Vancouver.
Vancouver General Hospital, Vancouver.
Vernon Jubilee Hospital, Vernon.
Victoria General Hospital, Victoria.
Victorian Hospital, Kaslo.
West Coast General Hospital, Port Alberni.
Windermere District Hospital, Invermere.
Wrinch Memorial Hospital, Hazelton.
(b) Outpost Hospitals
Red Cross Outpost Nursing Station, Alexis Creek.
Red Cross Outpost Nursing Station, Atlin.
Red Cross Outpost Nursing Station, Bamfield.
Red Cross Outpost Nursing Station, Blue River.
Red Cross Outpost Nursing Station, Edgewood.
Red Cross Outpost Nursing Station, Kyuquot.
(c) Federal Hospitals
Canadian Forces Station Hospital Holberg, San Josef.
Canadian Forces Station Hospital Masset, Masset.
PART II
(Private hospitals which are defined as such under section 7 of the Hospital Act, and with which
the Province has entered into an agreement requiring the hospital to furnish the general
hospital services provided under the Hospital Insurance Act)
Cassiar Asbestos Corporation Private Hospital, Cassiar.
Mica Creek Private Hospital, Mica Creek.
 MEDICAL AND HOSPITAL PROGRAMS
J  111
PART III
Rehabilitation Hospitals
(Hospital Act, Sec. 25)
G. F. Strong Rehabilitation Centre, Vancouver.
Gorge Road Hospital, Victoria.
Holy Family Hospital, Vancouver.
Pearson Hospital (Poliomyelitis Pavilion),
Vancouver.
Queen   Alexandra   Hospital   for   Children,
Victoria.
Shaughnessy Hospital, Vancouver.
Sunny Hill Hospital for Children, Vancou
ver.
PART IV
Extended-care Hospitals
(Hospital Act, Sec. 25)
Fellburn Hospital, Burnaby.
Louis Brier Hospital, Vancouver.
Menno Hospital, Abbotsford.
Mount St. Francis Hospital, Nelson.
Mount St. Joseph Hospital, Vancouver (top
floor).
Mount St. Mary Hospital, Victoria (excluding top floor).
Pearson Hospital, Vancouver (excluding facilities for tuberculosis patients).
Saanich Peninsula Hospital, Saanichton.
Juan de Fuca Hospital, Victoria.
PART V
Diagnostic and Treatment Centres
Arthritis Centre of British Columbia, Van- Houston Hospital, Houston.
couver.
Cumberland General Hospital, Cumberland.
Gold River Health Clinic, Gold River.
Keremeos Diagnostic and Treatment Centre.
Keremeos.
STATISTICAL DATA
The tables below represent statistical data compiled by the Hospital Finance
Division, showing the extent of hospital coverage provided to the people of British
Columbia through Hospital Programs.
In 1976 there were 103 public general hospitals as well as three diagnostic
and treatment centres. In addition, care was also provided by six Red Cross outpost hospitals; two federal hospitals; two contract hospitals, five public rehabilitation hospitals, plus one rehabilitation hospital operated by the Provincial Government. There were also two specialized out-patient facilities which are the Canadian
Arthritic Society at their Vancouver Centre, and the Narcotic Addiction Services,
who provide services in several facilities throughout the Province. Hospital coverage under the Hospital Insurance Act for patients in the extended-care hospitals
and units commenced December 1, 1965, and by the end of 1976 had increased to
54 extended-care units, which includes one facility operated by the Provincial
Government.
Data for the year 1976 have been estimated, based on reports submitted by
hospitals to August 31, 1976, and are subject to revision when the actual figures
for the year are submitted.
Table 16 shows that 395,706 adult and children patients were discharged
(separated) from British Columbia public hospitals in 1976, a decrease of 2,573
or 0.65 per cent less than 1975. This table also shows that 95.7 per cent of the
total adult and children patients discharged (separated) from British Columbia
public hospitals were covered by Hospital Programs. Table 17 indicates that, in
1976, Hospital Programs was responsible in British Columbia for 3,371,036 general
 J  112
DEPARTMENT OF HEALTH REPORT,  1976
hospital days of care for adults and children, a decrease of 42,594 days or 1.25
per cent less than in 1975.
As shown in Table 18, the average length of stay for public hospitals adult
and child patients in British Columbia during 1976 was 8.52 days and the days of
care per 1,000 population was 1,474. These figures, which show a continuation of
the trend of decreased length of stay, are a result of a more effective utilization of
hospital beds and ambulatory services. For comparison purposes, the data for
extended-care hospitals are not included in the above observations, although an
additional 603 days of care per 1,000 population were provided for these patients.
Table 19 is supplemented by Table 20 because the number and volume of
ambulatory services covered by Hospital Programs have been expanded considerably. It should be noted that psychiatric and diabetic day-care services are provided only in a limited number of hospitals. Services listed under "Other" are
related to special out-patient services provided by the Cancer Control Agency of
B.C., G. F. Strong Rehabilitation Centre, and the Narcotic Addiction Services.
The growth of ambulatory services reflects a trend toward the broader provision
of hospital-based services, providing greater patient convenience and reducing the
pressure for construction and maintenance of in-patient beds, which is partially
reflected by the reduction in incidence of patient-days noted above.
Table 16—Patients Separated and Proportion Covered by Hospital Programs,
British Columbia Public General Hospitals1 Only (Excluding Federal, Private,
Extended-care, and Out-of-Province Hospitalization)
Total Hospitalized in
Public Hospitals
Covered by Hospital
Programs
Adults
and
Children
Newborn
Total
Adults
and
Children
Newborn
Total
Patients separated—
1971  	
1972 ...	
1973 	
1974 _	
380,651
391,732
395,120
412,500
415,805
413,397
35,101
34,774
34,544
35,566
36,538
36,392
415,572
426,506
429,664
448,066
452,343
449,789
364,452
375,373
377,719
394,507
398,279
395,706
95.7
95.8
95.6
95.6
95.8
95.7
33,732
33,595
33,599
34,665
35,700
35,630
96.1
96.6
97.3
97.5
97.7
97.9
398,184
408,968
411,318
429,172
19752	
433,979
19763	
Percentage of total patients separated—
1971	
431,336
95.8
1972	
95.9
1973
95.7
1974   	
95.8
1975 2	
95.9
19763	
95.9
|
1 Includes rehabilitation hospitals.
2 Amended as per final report received from hospitals.
3 Estimated, based on hospital reports to August 31, 1976.
 MEDICAL AND HOSPITAL PROGRAMS
J 113
Table 17—Total Patient-days and Proportion Covered by Hospital Programs,
British Columbia Public General Hospitals1 Only (Excluding Federal, Private,
Extended-care, and Out-of-Province Hospitalization)
Total Hospitalized in
Public Hospitals
Covered by Hospital
Programs
Adults
and
Children
Newborn
Total
Adults
and
Children
Newborn
Total
Patient days—
1971    	
3,400,366
3,462,509
3,400,453
3,582,774
3,565,532
3,514,514
227,372
219,158
214,003
213,439
213,846
206,795
3,627,738
3,681,667
3,614,456
3,796,213
3,779,378
3,721,309
3,259,097
3,323,252
3,257,106
3,400,873
3,413,630
3,371,036
95.8
96.0
95.8
94.9
95.7
95.9
216,305
210,764
206,178
206,376
207,471
200,671
95.1
96.2
96.3
96.7
97.0
97.0
3,475,402
1972	
3,534,106
1973	
3,463,284
1974	
3,607,249
19752	
19763	
3,621,101
3,571,707
Percentage of total, patient-days—
1971	
95.8
1972  	
96.0
1973-	
95.8
1974	
95.0
19752	
95.8
19763 _	
96.0
1 Includes rehabilitation hospitals.
2 Amended as per final report received from hospitals.
3 Estimated, based on hospital reports to August 31, 1976.
Table 18—Patients Separated, Total Patient-days and Average Length of Stay,
According to Type and Location of Hospital for Hospital Programs Patients
Only, and Days of Care per 1,000 of Covered Population
Total
(Excluding
Extended Care)
Adults
and
Children
Newborn
B.C. Public
Hospitals
Adults
and
Children
Newborn
Other
B.C. Hospitals,
Including Federal
and Private
Adults
and
Children
Newborn
Institutions
Outside
British Columbia
Adults
and
Children
Newborn
Extended-
care
Hospitals
Patients separated—
1971	
1972	
1973	
1974. _	
1975L	
19762	
Patient-days—
1971	
1972_	
1973 ._
1974 __
19751-
19762..
Average days of stay-
1971	
1972	
1973	
1974......
19751_.
19762....
379,144 34,192|
388,747| 33,878[
392,550| 33,9621
404,271| 34,9791
4O6,O0O| 36,059|
406,0311  36,1801
364,452
375,353
377,719
394,507
33,732
33,595
33,599
34,665
3,486,671
3,543,587
3,474,733
3,565,198
3,486,573|209,631
3,456,383|203,761
218,971
212,549
208,154
208,224
398,279| 35,700
395,706| 35,630
3,259,097|216,305
3,323,2521210,764
3,257,106 206,178
3,40O,873|206,376
3,413,630|207,471
3,371,036|200,671
9.20
9.12
8.85
8.81J
8.59|
8.51|
6.40
6.27
6.14
5.95
5.81
5.63
I
8.94
8.85
8.62
8.62
8.57
8.52
6.41
6.27
6.14
5.95
5.81
5.63
8,654
8,140
8,092
3,572
1,4251
475
167,339
168,950
155,150
103,064
15,517
1,6471
19.34
20.76
19.17
28.85
10.89|
3.471
109
39
34
78
72
80
442
264
172
464
.336|
390[
6,038
5,234
6,739
6,190
6,296
9,850|
60,235
51,385
62,477
61,261
57.426J
83,700|
351
244
329
237
287
470
3,224
1,521
2,164
1,384
1,495
1,822
2,293
2,449
3,022
3,696
4.06
9.98
6.34
6.77
9.82
6.23
5.06
9.27
6.58
5.95
9.90
5.84
4.67
9.12
6.36|
4.88
8.50
5.74]
672,099
817,321
1,044,529
1,227,949
1,82411,357,352
2,700(1,497,312
449.56
448.58
455.53
501.41
449.16
405.12
1 Amended as per final reports from hospitals.
2 Estimated, based on hospital reports to August 30, 1976. Estimated patient-days (including newborn) per
1,000 of population covered by Hospital Programs: 1971, 1,696; 1972, 1,669; 1973, 1,600; 1974, 1,531; 1975,
1,512; 1976, 1,474. (Because the armed forces, Royal Canadian Mounted Police, and some other groups are
not insured under the Provincial plan, the actual incidence of days would be somewhat higher than shown.) In
addition, estimated patient-days per 1,000 population for extended care amounted to 308 in 1971, 372 in 1972,
454 in 1973, 502 in 1974, 555 in 1975, and 603 in 1976.   Population figures according to latest census figures.
 J 114
DEPARTMENT OF HEALTH REPORT,  1976
Table 19—Summary of the Number of Hospital Programs In-patients and
Out-patients, 1971-76
Total Adults,
Children,
and Newborn
In-patients
Estimated
Number of
Emergency,
Minor Surgery,
Day Care, and
Out-patients
Total
Receiving
Benefits
1971                       	
414,831
424,447
428,805
441,699
445,091
445,907
292,850
453,589
792,367
1,045,460
1,191,650
1,285,200
707,681
878,036
1972    .               	
1973                 ._ -
1,221,172
1974	
19751	
19762	
1,487,159
1,636,741
1,731,107
i Amended as per final reports received from hospitals.
2 Estimated, based on hospital reports to August 31, 1976.
Table 20—Summary of Hospital Programs Out-patients Treatments by Category,
1971-76
1971
1972
1973
1974
1975
1976
Psychiatry—
Out-patient	
5,012
7,536
191,113
40,259
	
7,955
8,131
267,203
44,633
167
8,943
9,277
408,925
50,089
885
162,997
12,771
19,737
503,492
55,920
1,493
296,863
17,915
34,219
571,055
62,019
2,354
338,583
5,937
159,568
22,300
40,000
Minor and emergency	
Day-care surgery..	
600,000
65,000
3,300
373,500
9,900
Other*	
48,900
125,500
	
151,251
155,184
171,200
292,850
453,589
792,367
1,045,460
1,191,650
1,285,200
i Commenced October 1972.
2 Commenced April 1973.
3 Commenced January 1975.
4 Other includes (a)  cancer out-patients,  (b)  rehabilitation day care,
(1972-76 only).
(c)   narcotic  addiction  out-patients
Table 21—Patients Separated, Total Days' Stay, and Average Length of Stay in
British Columbia Public Hospitals for Hospital Programs Patients Only,
Grouped According to Bed Capacity, 19761 (Excluding Extended-care
Hospitals)
Bed Capacity
Total
250 and Over
100 to 249
50 to 99
25 to 49
Under 25
Patients separated—
395,706
35,630
3,371,036
200,671
8.52
5.63
215,039
16,991
1,941,212
101,758
9.03
5.99
97,244
9,541
762,229
50,496
7.84
5.29
44,466
5,752
412,831
31,906
9.28
5.55
29,848
2,421
203,133
12,247
6.81
5.06
9,109
925
Patient-days—■
Adults and children	
51,631
4,264
5.67
Average days stay—
4 61
i Estimated, based on hospitals reports to August 31, 1976.
 MEDICAL AND HOSPITAL PROGRAMS
J 115
Table 22—Percentage Distribution of Patients Separated and Patient-days for Hospital Programs Patients Only, in British Columbia Public Hospitals, Grouped
According to Bed Capacity, 19761 (Excluding Extended-care Hospitals)
Bed Capacity
Total
250 and Over
100 to 249
50 to 99
25 to 49
Under 25
Patients separated—
Per Cent
100.0
100.0
100.0
100.0
Per Cent
54.34
47.69
57.59
50.72
1
Per Cent
24.57
26.78
22.61
25.16
Per Cent
11.24
16.14
12.25
15.90
Per Cent
7.54
6.79
6.03
6.10
Per Cent
2.31
Newborn	
Patient-days—
Adults and children	
2.60
1.52
2.12
1 Estimated, based on hospitals reports to August 31, 1976.
CHARTS
The statistical data shown in the following charts prepared by the Research
Division are derived from admission/separation forms submitted to Hospital Programs. Readers interested in more detailed statistics of hospitalization in this
Province may wish to refer to "Statistics of Hospital Cases Discharged During
1975" and "Statistics of Hospitalized Accident Cases, 1975," available from the
Research Division.
 J  116
DEPARTMENT OF HEALTH REPORT,  1976
Chart I—Percentage Distribution of Days of Care* by Major Diagnostic Groups,
Hospital Programs, 1975 (in Descending Order)
■fV  ■Z'-Srr      -tlgg- ■ :;15l"v
Other 2.3%
Skin
Congenital
anomalies 1.5%
Metabolic diseases 2.4%
Infective and o icr
parasitic diseases ■*■■-> /o
Nervous system 3.8%
Bones
5.6%
Genito-urinary   , _„
system 6.5%
Mental
disorders 6.7%
11.5%
Respiratory
system
Neoplasms
■ ■•■■■■IIIIIIIIIIIIIIIIIIIIIIIIMIIIMIIIIIIIIIIIIIIIIIIIIIIIIIimilllllMI
FEMALES
■llllllllll
Other
1.9%
Skin
1.2%
Ill-defined , onf \-
conditions 1.8%    \
Infective and >■»
parasitic diseases 2.0%
Metabolic
diseases
2.6%
Nervous system 3.4%
Respiratory
system 6.0%
Bones
6.5%
Deliveries 13.6%
Accidents 13.4%
Circulatory , -_,
system li.z%
Digestive system 10.2%
Neoplasms 8.9%
Genito-urinary      _ „~
system 7.9%
Mental disorders   7.4%
' Including rehabilitative care.
 MEDICAL AND HOSPITAL PROGRAMS
J  117
a
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<o        O        ■*!        —        ^
 J 118
DEPARTMENT OF HEALTH REPORT,  1976
Chart III—Percentage Distribution of Hospital Cases* by Type of Clinical Service,
Hospital Programs, 1975
MALES
Adult Surgical
44.4%
Adult Medical
29.3%
Pediatric Medical        10.3%
Paediatric Surgical 9.9%
Psychiatric
5.1%
Rehabilitative Care      1.0%
FEMALES
Adult Surgical
Adult Medical
42.1%
21.9%
Maternity
18.4%
Pediatric Medical
6.0%
Paediatric Surgical 5.5%
Psychiatric
5.4%
Rehabilitative Care       0.7%
* Including rehabilitative care.
 MEDICAL AND HOSPITAL PROGRAMS
J  119
Chart IV—Percentage Distribution of Hospital Days* by Type of Clinical Service,
Hospital Programs, 1975
MALES
Adult Surgical
42.4%
Adult Medical
36.5%
Paediatric Medical
6.9%
Psychiatric
6.0%
^
Paediatric Surgical
4.5%
I    \  -\
Rehabilitative Care
3.7%
 --rn
FEMALES
Adult Surgical
39.6%
Adult Medical
30.1%
Maternity
11.9%
Psychiatric
7.5%
Paediatric Medical        4.7%
Rehabilitative Care        3.3%
Paediatric Surgical 2.9%
* Including rehabilitative care.
\
 J  120
DEPARTMENT OF HEALTH REPORT,  1976
Chart V—Average Length of Stay of Cases* in Hospitals in British Columbia, by Major
Diagnostic Groups in Descending Order, 1975 (Excluding Newborns)
Certain causes of perinatal
morbidity and mortality
Diseases of the circulatory
system
Neoplasms
Mental disorders
Endocrine, nutritional, and
metabolic diseases
Diseases of the musculoskeletal
system and connective tissue
Congenital anomalies
Diseases of the skin and
subcutaneous tissue
Diseases of the digestive
system
PROVINCIAL AVERAGE
LENGTH OF STAY
Accidents, poisonings, and
violence
Diseases of the blood and
blood-forming organs
Diseases of the nervous
system and sense organs
Diseases of the genito-urinary
system
Infective and parasitic
diseases
Diseases of the respiratory
system
Complications of pregnancy,
childbirth, and the
puerperium
Symptoms and ill-defined
conditions
■-.
15.6
13.7
13.1
12.8
12.2
12.0
9.6
9.2
9.0
§8.9
8.9
8.6
8.0
7.3
7.2
6.2
5.0
4.8
hHHHhMHHHRI
; Including rehabilitative care.
 Medical Services Commission
On July 1, 1968, the Government established an over-all Medical
Services Plan, which is administered and operated in accordance with
the Medical Services Act and regulations, under the supervision of
the Medical Services Commission. The commission is empowered
to function as the public authority appointed by the Government of
the Province to be responsible to the Minister in respect of the
administration and operation of the plan established under the regulations.
The Medical Services Plan of British Columbia provides a prepaid medical services plan upon uniform terms and conditions for all
residents of the Province and their dependants. Insured services under
the plan are paid for insured persons regardless of age, state of health,
or financial circumstances, provided the premiums fixed by the commission are paid. Payment for the services provided is made, on a fee
for services basis, according to a tariff of fees approved or prescribed
by the commission, or by salaried, sessional, or contract basis at levels
approved by the commission.
o
as
o
u
>
<
u
5
121
 J 122 DEPARTMENT OF HEALTH REPORT,  1976
MEDICAL SERVICES COMMISSION  HIGHLIGHTS
• Geoffrey A. Stewart retired as chairman of the Medical Services Commission in
June 1976 after a number of years of distinguished service in the field of government health. Commencing with service as president of the Government Employees Medical Services, he later became the president of the British Columbia
Medical Plan on its inception in 1965, continuing in that position until the
dissolution of the society in 1974. When the Medical Services Commission was
constituted in 1967 to develop and implement the present Medical Services Plan
of British Columbia, Mr. Stewart became its first chairman, continuing in that
position until his retirement. The successful implementation and operation of
the plan was due in large measure to his efforts and guidance throughout that
period.
• Premium rates had remained unchanged since the introduction of Medicare in
1968 when the premiums initially set for the British Columbia Medical Plan in
1965 were simply continued. The escalating costs of providing medical services
in recent years resulted in expenditures substantially exceeding revenues. Because
of this continuing trend a decision was made to increase premium rates to ensure
that a larger proportion of the costs were paid in this manner. The premium
rates established by the Medical Services Commission were increased 50 per cent,
effective July 1, 1976.
• The planning stage of the new Health Services Building, at present under construction, generated a great deal of interest among the staff of the commission
and the Medical Services Plan. An able team of planners regularly conferred
with senior staff members and supervisors to assist in planning the furniture
lay-out of every employee. The final lay-out sketches for each of the four floors
were prominently displayed.   Occupancy is expected early in 1977.
• The total expenditure for insured benefits under the Medical Services Plan rose
32.34 per cent to $280,509,129 in 1975/76 from $211,966,988 in 1974/75.
• The per capita cost of insured services shared by the Federal Government, including salaried and sessional costs, increased by 26.2 per cent to $104.53 in
1975/76 from $82.80 in 1974/75.
• The per capita cost of insured benefits not shared by the Federal Government
rose 31.3 per cent to $6 in 1975/76 from $4.57 in 1974/75.
• Contributions to British Columbia Medical Services Commission under the
Medical Care Act (Canada) and Hospital Insurance Diagnostic Services Act was
$107,755,002, or 40.5 per cent of the shareable cost.
• Administration costs were 4.3 per cent of the total costs in 1975/76.
• The increased costs to the Medical Services Plan are a result of upward revisions
to the fee schedule, increased utilization of benefits, changes in the practitioner/
population ratio, increased population, and significant improvements in the claims
processing time.
BENEFITS UNDER THE PLAN
BASIC MEDICAL SERVICES
The Medical Services Plan provides insurance coverage for all medically required services rendered by medical practitioners, including osteopathic physicians,
in British Columbia, and certain surgical procedures of dental surgeons where
 DEPARTMENT OF HEALTH EXPENDITURES, 1975/76
J 123
Medical Services Commission operates 120 keyboards as part of its
computerized handling of claims for payment.
necessarily performed in a hospital as provided under the Medical Care Act
(Canada). A contribution from the Federal Government is payable to the Province
toward the cost of these insured services on the basis of 50 per cent of the national
per capita cost of these services multiplied by the average number of insured persons
in the Province during the 12-month period ending on March 31. Restrictions
were placed by the Federal Government on the increase in the amount to be shared
commencing in 1976/77.
ADDITIONAL BENEFITS
In addition to payment for the above services, additional benefits, when
rendered in the Province, are provided without extra premium by the Government
of British Columbia. The Federal Government does not share in these costs.
All payments are paid only at a tariff of fees approved by the commission. "Year"
means calendar year. A brief description of these additional benefits follows.
For exact details, see the Medical Services Act Regulations.
Chiropractic—Payment for the services of a registered chiropractor is limited
in any one year to a total of $75 per patient under the age of 65 years and $100
per patient 65 years of age or over. There is no payment for X-rays taken by a
chiropractor.
Naturopathic—Payment for services of a naturopathic physician is limited in
any one year to a total of $75 per patient under the age of 65 years and $100 per
patient 65 years of age or over. There is no payment for X-rays taken by a
naturopathic physician.
Orthoptic treatment—Payment for orthoptic treatment is limited to $50 per
patient in any one year and a maximum of $100 per family in any one year when
rendered to an insured person on the instructions of, or referral by, a medical
practitioner.
 J 124 DEPARTMENT OF HEALTH REPORT, 1976
Physiotherapy—Payment for the services of a registered physiotherapist on
the instructions of, or referral by, a medical practitioner where performed other
than in general or rehabilitative hospitals, is limited in any one year to a total of
$75 per patient under the age of 65 years and $100 per patient 65 years of age
or over. Out-patient physiotherapy services in general hospitals or ih rehabilitative
hospitals on referral by a medical practitioner are benefits provided by the British
Columbia Hospital Programs.
Podiatry—Payment for services of a registered podiatrist is limited to $50 per
patient in any one year and a maximum of $100 per family in any one year when
rendered other than on the instructions of, or referral by, a medical practitioner
within the year.   There is no payment for X-rays taken by a podiatrist.
Optometry—Services of registered optometrists are approved for required
diagnostic optometric services to determine the presence of any observed abnormality in the visual system.   The plan does not pay for the fitting or cost of lenses.
Orthodontic—Service provided by a dental surgeon for an insured person
20 years of age or younger and which is consequentially necessary in the care of a
cleft lip and (or) cleft palate is paid only where that service arises as part of or
following plastic surgery repair performed by a medical practitioner. There is no
payment for dentures, appliances, prostheses, or for general dental services other
than those referred to under basic medical services involving certain medical procedures of dental surgeons, where necessarily performed in a hospital.
Special nursing—Special nursing services of a registered nurse shall be paid,
including the cost of board, to a maximum of $40 per patient in any one year, but
only where such services are deemed advisable by a medical practitioner.
Under existing arrangements, the services of a member of the Victorian Order
of Nurses, acting under or with an attending medical practitioner, shall be paid under
the plan at a rate of $2 net per visit to a maximum of $40 per patient per year, but
this limit will not apply to the administering of injections on the instructions of a
physician.
No payment is made for any of the additional benefits performed outside the
Province of British Columbia.
SERVICES  EXCLUDED  UNDER THE PLAN
Services which are provided under other federal or Provincial Acts such as
the National Defence Act (Canada), the Hospital Insurance Act, and the Workers'
Compensation Act of the Province.
Pathology, radiology, and (or) electrodiagnostic services performed within
the Province at a laboratory that, at the time the service is rendered, is not an
approved laboratory for the performance of the service.
Services which are not considered to be medically required by the patient,
e.g., cosmetic services, examinations at the request of a third party, medico-legal
services, advice by telephone, travel charges of a practitioner.
While unexpected medical services arising when an insured person is temporarily absent from British Columbia are covered at British Columbia rates, prior
authorization in writing from a medical director of the plan is required where the
insured person elects to seek medical attention outside the Province, otherwise payment may not be made under the plan.
 MEDICAL AND HOSPITAL PROGRAMS
J  125
PREMIUM RATES AND ASSISTANCE
For those persons having maintained a permanent residence in British Columbia for the 12 consecutive months immediately prior to making application, and
who otherwise qualify as eligible under the Medical Services Act Regulations,
premium assistance is available as follows:
(a) Applicants who were not liable to pay income tax in the 12 months
ending December 31 of the previous year qualify for a subsidy of
90 per cent of the full premium rate:
(b) Applicants whose taxable income in the 12 months ending December 31 of the previous year did not exceed $1,000 qualify for a
subsidy of 50 per cent of the full premium rate.
Monthly premiums payable by subscribers, effective July 1, 1976,
are as follows:
If Qualified for—■
Full 50 Per Cent 90 Per Cent
Premium Subsidy Subsidy
$ $ $
One person     7.50 3.75 .75
Family of two  15.00 7.50 1.50
Family of three or more  18.75 9.37 1.87
(c) Temporary premium assistance is available for a three-month period
under unusual circumstances which, by reason of illness, disability,
unemployment, or financial hardship render an eligible person unable to pay his currently required premiums for coverage under the
plan. Temporary premium assistance is at 90 per cent of the full
premium rate.
LABORATORY APPROVAL
A six-member Advisory Board on Laboratories, appointed by the commission,
continues to provide advice and recommendations to the commission pertinent to
its determination of approval of laboratories for the performance of insured services under the regulations set down by the Lieutenant-Governor in Council in
September 1971. The commission is responsible for ensuring the reasonable availability of quality laboratory services for insured persons throughout the Province,
of controlling the expansion of facilities or provision of new facilities until there is
reasonable utilization of existing facilities, and of requiring that, where approved
public facilities provide service of equal quality and availability, priority consideration be given to the services provided by such approved public facilities.
PROFESSIONAL REVIEW COMMITTEES
As in the past, the commission has continued to work closely with the peer
review committees of physicians and other practitioners providing services under
the plan.
The commission provides data to the professional licensing authorities or
other relevant practitioner bodies with respect to the volume and type of services
rendered under the plan and various other statistical information on an annual
basis, whenever feasible. The Commission also provides various statistical information to them on a request basis.
 J 126 DEPARTMENT OF HEALTH REPORT, 1976
SALARIED AND SESSIONAL
While most medical services in British Columbia are paid for on a fee-for-
service basis, there is, nevertheless, a substantial volume of services paid on a
salary or sessional fee basis.
Apart from the Provincial Government, which employs physicians in this way,
there are many other organizations within the Province which make arrangements
with physicians to provide insured services on this basis and arrange with the Medical Services Commission for reimbursements of their costs.
When the Medical Services Commission reimburses an organization which
employs a doctor performing insured services on a salaried basis, a payment is
made to the organization for the shareable portion of the doctor's salary, that is, the
proportion of the salary which represents the time he spent on providing insured
services to individuals. An additional amount is paid to cover the relevant overhead costs of the organization employing the doctor.
A sessional fee is a payment of a set amount of money for the part-time services of a physician for half a day (three and one-half hours) and the sessional fee
includes, where pertinent, a payment for overhead, which goes to the physician
because of his continuing overhead costs in his additional private practice.
In the year 1975/76 the total expenditure on medical services by the Medical
Services Commission was $280,509,129, which was made up of $265,071,609 in
the form of fee-for-service payments and $15,437,520 for salary and sessional
payments.
STATISTICAL TABLES
STATISTICAL HIGHLIGHTS
The total expenditure for insured benefits under the Medical Services Plan rose
32.34 per cent to $280,509,129 in 1975/76 from $211,966,988 in 1974/75 (see
Table 31).
The per capita cost for insured benefits rose 29.64 per cent (population
October 1, 1974=2,408,000; October 1, 1975=2,458,000).
The per capita cost of insured benefits shared by the Federal Government rose
26.2 per cent to $104.53 in 1975/76 from $82.80 in 1974/75 (see Table 31
"Medical Fee-for-service" and "Salaried and Sessional").
The per capita cost of insured benefits not shared by the Federal Government
rose 31.3 per cent to $6 in 1975/76 from $4.57 in 1974/75 (see Table 31 "Additional Benefits").
Contributions to the Medical Services Commission under the Medical Care Act
(Canada) and Hospital Insurance Diagnostic Services Act was $107,755,002 or
40.5 per cent of the shareable cost (see Table 31).
Administration costs were 4.3 per cent of the total costs in 1975/76 (see
Table 31).
The increased costs to the Medical Services Plan are a result of upward revisions to the fee schedule, increased utilization of benefits, changes in the practitioner/population ratio, and increased population. During the year a significant
improvement was made in the speed with which fee-for-service accounts were paid
and this also contributed to the actual total payments made during 1975/76.
 MEDICAL AND HOSPITAL PROGRAMS
SUBSCRIBER STATISTICS
Table 23—Registrations and Persons Covered1 by Premium Subsidy
Level at March 31,1976
Subsidy
(Per Cent) Subscribers Persons
90       231,183 373,758
50         29,140 54,637
Nil       815,828 2,060,331
Totals   1,076,151 2,488,726
J 127
Table 24—Persons Covered by Age-group at March 31,1976
Age-groups Persons
Under 1   31,349
1-4   144,689
5-14   435,661
15-24   477,983
25-44   661,194
45-64  -  479,855
65-69   81,975
70-79   101,921
80-89   44,537
90 and over  7,731
Unknown   21,831
Total  2,488,726
1 Coverage data do not include members of the Canadian Armed Forces, RCMP, and inmates of federal
penitentiaries.
FIGURE 1—COVERAGE BY AGE-GROUP AT MARCH 31, 1976
6
661,194
5
435,661
■^
?
236,164
1
144,689
0
31,349
21,831
Under 1
5-14
15-24 25-44
Age Group
45-64
65 and Over      Unknown
 J  128
DEPARTMENT OF HEALTH REPORT,  1976
Table 25—Coverage by Family Size at March 31, 1976
Family Size
(Persons)
1   	
2 	
3 _____
4 	
5 	
6 	
7 _____
9 or more
Number of
Families
467,009
242,575
115,220
136,248
70,321
28,744
10,162
3,631
2,241
Total  1,076,151
FIGURE 2—COVERAGE BY FAMILY SIZE AT MARCH 31,  1976
2   4
S    3
E
9
z
467,009
242,575
115,220
136,248
28,744
10,162
	
3,631
2,241
4 5 6
Family Size (Persons)
 MEDICAL AND HOSPITAL PROGRAMS J  129
FEE-FOR-SERVICE PAYMENTS
Medical Practitioners and Dental Surgery in Hospital
(Shareable under Medical Care Act (Canada) and Hospital Insurance Diagnostic Services Act)
Table 26—Distribution of Fee-for-service Payments for Medical Services
(Shareable)
Specialty
Amount Paid1
Percentage of Total
Cost per
Person2
1974/75
1975/76
1974/75
1975/76
1974/75
1975/76
$
82,177,788
1,967,399
1,330,210
5,707,746
196,666
7,040,645
7,318,932
79,167
3,369,209
13,327,682
1,113,838
4,386,095
1,329,294
1,200,697
3,216,603
4,055,096
11,272,817
14,428,831
12,957,618
7,371,601
308,232
72,989
403,906
206,284
4,323,452
$
105,060,418
2,863,102
1,879,674
7,241,146
255,350
9,423,996
9,499,490
4,378,720
67,808
16,236,333
1,487,416
6,100,443
1,924,550
1,534,638
4,234,210
5,207,397
14,729,605
18,791,569
18,512,358
9,562,753
349,134
37,125
797,895
267,524
4,839,927
43.44
1.04
0.70
3.02
0.10
3.72
3.87
0.04
1.78
7.05
0.59
2.32
0.70
0.64
1.70
2.14
5.96
7.63
6.85
3.90
0,16
0.04
0.21
0.11
2.29
42.83
1.17
0.77
2.95
0.10
3.84
3.87
1.79
0.03
6.62
0.61
2.49
0.78
0.63
1.72
2.12
6.00
7.66
7.55
3.90
0.14
0.02
0.33
0.11
1.97
34.1270
0.8170
0.5524
2.3703
0.0817
2.9239
3.0394
0.0328
1.3992
5.5348
0.4626
1.8215
0.5520
0.4986
1.3358
1.6840
4.6814
5.9920
5.3811
3.0613
0.1280
0.0303
0.1677
0.0857
1.7955
42.7422
Dermatology	
Neurology	
1.1648
0.7647
2.9460
Neuropsychiatry.	
Obstetrics, gynaecology	
Ophthalmology-	
Otolaryngology	
0.1039
3.8340
3.8647
1.7814
0.0276
General surgery.	
Neurosurgery 	
Orthopaedic surgery	
Plastic surgery	
6.6055
0.6051
2.4819
0.7830
0.6243
1.7226
Paediatrics	
2.1186
5.9925
Radiology	
Pathology	
7.6451
7.5315
3.8905
0.1420
Public health	
0.0151
Dental surgery in hospital	
Osteopathy.__	
Unclassified -	
0.3246
0.1088
1.9691
Totals	
189,162,797
245,282,581
100.00
100.00
78.5560
99.7895
1 Includes only those services which have been paid during the respective fiscal periods.
2 Based on population as at October  1,  as provided by Statistics Canada   (October  1,  1974=2,408,000;
October 1, 1975 -=-2,458,000.
 J  130
DEPARTMENT OF HEALTH REPORT, 1976
Table 27—Distribution of Medical Fee-for-service Payments
and Type of Service
Number of Services1
Amount Paid1
1974/75
1975/76
1974/75
1975/76
General Practitioners
Complete examination -	
694,421
4,245,887
2,011,831
450,746
117,812
■55,845
1,594,119
840,991
4,750,866
2,015,474
504,508
117,426
52,857
1,588,357
$
10,343,599
32,489,645
9,684,592
8,519,867
1,704,113
640,493
6,376,835    |
$
14,755,705
41,781,369
11,165,550
Night, Sunday, holiday, or emergency visit	
11,130,950
1,949,202
Subsequent house visit 	
Hospital visit	
696,007
7,285,156
Subtotals	
9,170,661
9,870,479
69,759,144
88,763,939
Specialists
693,882
5,516
357,088
425,857
818,317
7,101
410,533
511,561
19,715,426
149,076
2,224,673
2,962,854
27,138,260
219,769
3,032,591
4,052,763
Subtotals 	
1,482,343
1,747,512
25,052,029
34,443,383
Other Medical
1,741,178
47,683
411,828
600,370
1,072,759
4,961,588
1,196,042
201,022
14,294
11,802
1,972,565
52,326
455,903
678,922
1,196,817
5,888,239
1,279,209
208,876
16,173
12,602
9,601,240
6,109,361
26,542,660
7,721,035
14,333,678
16,966,158
5,352,581
4,474,470
381,530
2,868,910
12,428,983
Obstetrics —	
Surgery  	
7,533,653
34,101,129
10,080,800
X-ray
18,418,583
24,042,481
6,661.863
Psychotherapy  - —
Electrodiagnosis  	
Miscellaneous	
5,597.453
2,682,477
527,837
Subtotals  -	
10,258,566
11,761,632
94,351,623
122,075,259
Totals                           	
20,911,570
23,379,623
189,162,796
245,282,581
1 Includes only those services which have been paid during the respective fiscal periods.
 MEDICAL AND HOSPITAL PROGRAMS J 131
Table 28—Average Fee-for-service Payments by Type of Practice1
Type of
Number of Active
Practitioners
Average Payment2
Median Payment2
1974/75
1975/76
1974/75
1975/76
1974/75
1975/76
1,395
30
21
94
2
100
107
48
144
18
70
21
13
47
48
128
157
4
3
18
20
18
1,461
33
23
104
2
102
115
51
161
19
76
24
13
46
53
143
170
5
4
43
22
18
$
53,620
59,920
64,124
51,293
93,901
67,420
67,476
72,319
66,650
60,773
61,700
60,954
103,025
67,036
55,210
66,357
46,826
52,417
58,759
48,507
54,483
41,060
$
63,680
80,513
82,550
60,483
127,108
87,414
82,783
88,011
81,268
77,072
79,121
79,901
126,949
91,589
66,544
79,408
57,721
58,352
62,781
59,124
63,241
52,311
$
52,872
57,808
63,689
50,989
93,901
67,167
65,310
69,659
65,321
57,404
58,712
60,991
112,629
64,896
54,001
60,483
46,986
49,283
46,126
49,848
46,815
36,718
$
63,991
Dermatology 	
76,170
82,485
Psychiatry	
61,883
127,108
85,142
81,112
86,383
77,791
Neurosurgery	
71,803
75,735
75,861
Thoracic and cardiovascular surgery
Urology	
Pediatrics	
137,141
86,612
61,754
77,143
Anaesthesia -	
56,978
60,640
Osteopathy	
47,240
60,737
Paediatrics, general practice3	
Internal medicine, general practice3.
57,400
48,158
i Type of practice is based on practice being carried out, rather than on certification.
2 Includes only those physicians whose services on a fee-for-service basis grossed $20,000 or more.
3 These are special classifications created for statistical purposes.   Physicians in these categories are certified
specialists, but derive 50 per cent or more of their income from general practice services.
ADDITIONAL BENEFITS
Fee-for-service Payments, Nonshareable by Federal Government
Table 29—Distribution of Fee-for-service Payments for Insured Services,
Nonshareable Additional Benefits
Type of Service
Amount Paid1 2
Percentage of Total
Cost per
Person3
1974/75
1975/76
1974/75
1975/76
1974/75
1975/76
$
4,721
75,565
12,798
5,747,051
191,174
1,290,244
829
3,928
1,014,628
2,671,380
6,984
—4,472
$
2,869
24
14,180
6,948,718
282,599
2,458,833
81
4,448
1,279,644
3,632,256
73,830
52,048
0.04
0.69
0.12
52.17
1.74
11.71
0.01
0.04
9.21
24.25
0.06
—0.04
0.02
0.00
0.10
47.11
1.92
16.67
0.00
0.03
8.67
24.63
0.50
0.35
$
0.0020
0.0314
0.0053
2.3866
0.0794
0.5358
0.0004
0.0016
0.4214
1.1094
0.0029
—0.0019
$
0.0012
0.0000
0.0058
2.8270
0.1150
1.0003
0.0000
0.0018
0.5206
1.4777
0.0300
0.0212
Totals	
11,014,830
14,749,530
100.00
100.00
4.5743
6.0006
1 These amounts are fee-for-service payments made under the plan only and in no way reflect the total for
the services of these practitioners.
2 Includes only those services which have been paid during the respective fiscal periods.
3 Based on insured population at October 1, as provided by Statistics Canada (October 1, 1974=2,408,000;
October 1, 1975=2,458,000).
 J  132
DEPARTMENT OF HEALTH REPORT,  1976
Table 30—A verage Fee-for-service Payments by Type of Practice,
Nonshareable Additional Benefits
Type of Practice
Number of Active
Practitioners1
Average Payment1
Median Payment
1974/75       1975/76
1974/75
1975/76
1974/75
1975/76
158    |         174
7                 8
38    |           62
24    |           27
122    |         132
$
34,702
23,989
27,626
38,543
20,691
$
38,476
32,514
33,276
42,384
26,354
$
33,158
23,216
27,127
40,064
18,658
$
36,267
32,254
27,519
Podiatry  	
Optometry   	
45,592
25,401
i Includes only those practitioners whose payments from the British Columbia Medical Services Commission
grossed $10,000 or more. It must be emphasized that these payments in no way represent the practitioners'
total income or net income.
Table 31—Summary of Expenditures, 1969/70 to 1975/76
Medical
Fee-for-Service
Salaried and
Sessional
Additional
Benefits
Administration
Total
1969/70	
1970/71	
1971/72 -
1972/73	
$
105,700,011
122,818,267
127,000,505
139,532,341
159,614,356
190,452,494
250,026,0931
$
3,677,387
4,375,798
4,788,365
6,022,920
7,991,062
10,424,602
15,437,5201
$
6,929,779
6,611,815
5,534,520
7,897,244
8,963,080
11,089,892
15,045,516
$
5,687,035
6,030,059
6,567,847
7,320,137
8,581,794
12,501,015
12,659,521
$
121,944,212
139,835,939
143,891,237
160,772,642
1973/74	
1974/75-	
185,150,292
224,468,003
1975/76	
293,168,650
1 The federal contribution applicable to 1975/76 is projected to be $107,775,002 or 40.5 per cent of total
payments for shareable costs.
 z
o
z
Government Health Institutions
Although the emphasis in mental health care is on community-
based services, there will continue to be a need for specialized facilities
to accommodate those whose treatment cannot be adequately taken
care of at the community level. Facilities for specific types of care have
been developed under Government agencies. These include facilities
and services for those of the mentally ill, the emotionally disturbed,
and the senile aged, as well as the tubercular and the profoundly
physically disabled whose condition requires admission to a specialized
treatment unit.
Effective December 1, 1975, J. Bainbridge was appointed as
Director of Government Health Institutions. These institutions comprise Riverview Hospital and Valleyview Hospital (Essondale), Dellview Hospital (Vernon), Pearson Hospital, and the Willow Chest
Clinic (Vancouver).   A brief report of these facilities follows:
<
III
X
I-
z
III
3
>
o
133
 J  134 DEPARTMENT OF HEALTH REPORT, 1976
ADMINISTRATION
The administration of Government hospitals was taken over by Medical and
Hospital Programs at the end of 1975. The organizational structure remained
much the same as it had been under the previous administration, namely, central
administrative offices are located in Victoria, with a Central Accounting Division,
Central Stores, and Central Pharmacy in Vancouver.
The Central Stores supplies a wide variety of dietary items to the hospital
complex, as well as clothing and other supplies. The items are bought through the
Government's Purchasing Commission and held in inventory for distribution to the
various Government institutions.
Similarly, the Central Pharmacy stores and distributes pharmaceuticals and
medical and surgical supplies for Government hospitals, as well as the institutions
for the mentally retarded operated by the Department of Human Resources and
the mental health clinics throughout the Province. The Central Accounting Division takes care of the accounting functions connected with these centrally administered operations, as well as providing central accounting functions for financial
control throughout the Government-operated hospitals.
RIVERVIEW HOSPITAL
In 1976 the patient population at Riverview declined at a slower rate than
was experienced in the past few years. In January 1976 there were 1,298 patients
which decreased to approximately 1,240 toward the end of the year. While the
number of patients admitted declined, an increasing proportion were more seriously
ill, including an increase in male patients being admitted with schizophrenia, on
an involuntary basis.
Plans to accommodate these changes in the patient population progressed
during the year, and in May a conference on the role of Riverview Hospital was
held. Mental health workers and other interested professionals from all parts of
the Province contributed their ideas, following an encouraging address from the
Minister on the important role which Riverview has to play in delivery of health
care in the future. The Minister also endorsed the aim of full accreditation by the
Canadian Council on Hospital Accreditation by 1977.
The Crease Unit was designated to be the acute admitting unit, and Centre
Lawn the unit offering special programs such as Organic Brain Syndrome, Behaviour Modification, and Young Adults. Organizational changes to effect these
programs were under way during the latter half of the year, including arrangements
with other hospitals to provide surgical services which can no longer be provided
safely and economically at Riverview because of the reduced surgical volume.
Delivery of service at the beginning of the year was severely hampered by a
shortage of psychiatrists on hospital staff. With the formulation of a more clear-
cut future role for Riverview Hospital, and agreement being reached between the
British Columbia Medical Association and the Government with regard to remuneration for physicians, advertisements were placed in the professional journals
toward the latter part of the year, and medical staffing improved, although shortages
continued to exist. During the year the hospital experienced a shortage of beds
for male patients.
Closer co-operation with the Greater Vancouver Mental Health Service was
achieved through informal meetings among the respective medical and administrative staffs, and with staffs of general hospital psychiatric units.
 DEPARTMENT OF HEALTH EXPENDITURES,  1975/76
J  135
The Department of Nursing revised the nursing care standards and at the
year-end was reviewing the nursing policies and nursing care plans, as well as
conducting an audit of nursing activities and reviewing the organizational structure.
New appointments in the year included George Schwartzenhauer, Director of
Personnel, succeeding Mrs. Anne Allen, who moved to the Liquor Control Board,
and Ian Manning, Executive Director, succeeding Dr. J. C. Johnston, who became
a special study director with the Ministry of Health.
Communication between the administration and the employees was maintained through various joint committees which were enhanced by multidisciplinary
meetings in each unit, and by an employees' liaison group meeting regularly with
administration. Also, discussions were held with the Canadian Mental Health
Association and other interested persons on the protection of patients' rights and
related matters.
Volunteers from the Canadian Mental Health Association continued in their
dedicated work of extending a friendly hand to the patient.
VALLEYVIEW HOSPITAL
The year 1976 was very active at Valleyview Hospital with referrals up to
SV2 per cent and a similar increase in numbers accepted for admissions.
As part of a general program of improvement, 36-inch beds have been
introduced, bringing the number of patient beds available to 618. This in turn
reduced beds available for admissions from the community and, along with a
mid-year increase in applications, temporarily lengthened the waiting list.
The hospital added a 35-bed ward, increasing to 70 the beds devoted to
active psychiatric care. This improved the hospital's capacity to prepare patients
to return to suitable community accommodation (whether it be home or a health
care facility). The problems of finding this type of accommodation for the more
ambulatory patients became more of a problem during 1976, because of the
change in use of some of the community beds previously available, and the closing
of some of the private hospitals.
A valuable meeting was held in June when the medical consultation staff of
Hospital Programs spent a day at Valleyview. There appeared to be a prospect
that patients in this hospital needing extended care, without psychiatric management, might be accepted in large numbers when the UBC and Queen's Park units,
each of 300 beds, open during the next 12 months.
The Nursing Department had more involvement with surgical cases since
mid-year, when patients commenced leave to general hospitals in the community.
Nursing escorts must accompany them for each shift in the majority of cases.
The changes in the administrative set-up at Valleyview had a fairly far-reaching effect on the hospital's operation. Dr. W. W. Black, who served as Director,
had, for the past several years, recommended the appointment of a non-medical
Executive Director to free the senior Medical Officer to pursue the important
clinical aspect of the hospital operation. In July, T. Acton Kilby was appointed
Executive Director of Valleyview with Dr. Black becoming Clinical Director. A
program was started to prepare the hospital for an initial informal accreditation
survey in the spring of 1977, and a formal survey one year later. Various administrative and professional committees were struck to help restructure the hospital to
improve its operations and lead up to accreditation.
 J  136 DEPARTMENT OF HEALTH REPORT,  1976
DELLVIEW HOSPITAL
Dellview Hospital is a special care facility located in the City of Vernon, and
was decertified as a mental health facility under the Mental Health Act on April 1,
1975. Its function is to provide for the needs of geriatric patients who also suffer
from mental disability.
Admissions for the year totalled 98, with a minimal waiting list at any time.
The question of the age-limit for admission is currently under study.
During the year the Eligibility Committee, which reviews all patient admissions, met on a regular weekly basis with the Patient Program Co-ordinating Committee. The purpose of the over-all program was to better meet the patients' needs
by providing input from all disciplines.
The Volunteer programs were most successful this year, and involved a total
of 150 Vernon residents ranging from junior high school students to senior
citizens.
Under the direction of an activity work, the recreational and occupational
therapy programs increased tremendously, and a total of approximately 1,100
patients were involved in the following programs: Remedial exercises, occupational therapy, bowling (indoor); activation and dance class, bingo, musical sing-a-
longs, pub therapy, birthday parties, outdoor barbecues, shopping trips, and
outings to local areas of interest.
Medical services were provided through the part-time services of a physician,
with dental services available through a local dentist using the hospital's dental
suite. Psychiatric services were available through the Vernon Mental Health
Centre, while physiotherapy, pharmaceutical, radiological, and regional laundry
services were available through the Vernon Jubilee Hospital.
During the year the Okanagan College assessed Dellview's nursing program
with the possibility of providing geriatric nursing experience for registered and
licensed practical nursing students to commence in early 1977. The Nursing
Department was eagerly anticipating this new program as it would provide new
incentives to nursing staff to raise and maintain high standards of patient care.
Dellview's in-service education was active with a total of 127 programs,
involving the presenting of 525 sessions. Films, filmstrips, cassette, and lectures
were well utilized to present a complete range of subjects, including safety, fire,
dietary, housekeeping, nursing diagnostic procedures, supervision, and administration.
During the year the female annex ward underwent necessary repairs by the
Department of Public Works, which contracted out the installation of a new air-
circulating system and emergency-lighting system. The wiring of the hospital's
fire alarm system into the city system and the installation of a new telephone and
paging system were also completed.
PEARSON HOSPITAL AND WILLOW CHEST CLINIC
Pearson Hospital is presently providing in-hospital care for tuberculosis
patients, persons with severe respiratory disabilities from poliomyelitis, and extended-care patients, with emphasis on the younger age-group.
The early part of 1976 saw a major reorganization within Public Health Programs, and Pearson Hospital was transferred from the Bureau of Special Health
Services to a new organization, under Hospital Programs, known as Government
Health Institutions.
At year-end there were no patients in residence at the Willow Chest Centre,
pending completion of renovations to the entire physical plant.
 MEDICAL AND HOSPITAL PROGRAMS
J 137
One of the major improvements in the delivery of patient care during the
year was the development of a team approach not only within senior management
but in particular at the ward level in the actual planning of patient care. Interprofessional teams were working on all extended-care wards as well as on the
polio unit.   Both staff morale and patient care appeared to have improved.
During the year the Nursing Department completed their procedure manuals,
policy manuals, and a forms manual. The removal, to a large extent, of the
dichotomy in the assignment of duties between male and female nurses, and the
careful commencement of this in the assignment of auxiliary nursing staff, was
accomplished. Of major significance was a decision to review the organizational
structure within the Nursing Department.
Within the activity services the occupational therapists, physiotherapists,
recreation and teaching staff were most enthusiastic about their team activities on the
wards, and relationships with the Nursing Department have improved considerably.
A small out-patient program was commenced and it was expected that it would be
expanded, in an endeavour to teach skills to disabled people that will delay their
need for direct hospital in-patient care.
During 1976 a number of changes took place in the Dietetics and Food
Service Department. A new system of portion control was implemented and a
major revision was made of staff work schedules and assignments in order to offset
increased food costs as well as a reduced work week. In January, staff meals
were provided for the first time. Hospital-prepared food was being dispensed on
a 24-hour basis through vending machines and microwave oven.
Nurses monitor newborn in Vancouver General Hospital's cardiothoracic unit in the
Willow Chest Centre.
 J  138 DEPARTMENT OF HEALTH REPORT,  1976
During the year decisions were made in conjunction with the Consultation
Division of Hospital Programs, on the need for, and general location of, a new
centralized main kitchen.
The Director of the Social Service Department was given more responsibility
for co-ordinating extended-care programs, with the individual workers becoming
more involved through team activity on the wards.
A Pharmacy Manual was completed and a Pharmacy and Therapeutics
Committee was established. Emergency drug boxes were set up in co-operation
with the nursing and medical staff, and were placed on each ward. Individual
patient drug profiles were started during the year.
The laboratory participated in the B.C. laboratory accreditation program.
This was accompanied by the introduction of a quality control program involving
consultative input from the Clinical Laboratory at Shaughnessy Hospital, and use
of the American Pathology Association's quality control kits with computerized
performance reports.
The hospital's in-service training program was expanded to include instruction
to staff from other health care facilities. At year-end two community facilities
were attending lectures and demonstrations in such subjects as body mechanics,
fire safety and aseptic techniques, as well as alcohol counselling sessions related
to management of problem patients.
The Public Works Department continued to provide building repair services
during the year, including considerable reroofing as well as replacement of water
pipes throughout the hospital.
To improve communications, monitor standards, and move closer to accreditation requirements, a number of committees were established, including a Management Committee, a Bed Utilization Committee, an Infection Control Committee,
and a form of Medical Advisory Committee. The hospital was without a Medical
Co-ordinator for most of the year, but recruitment to the position was under way
at year-end.
  J  140 DEPARTMENT OF HEALTH REPORT,  1976
EMERGENCY HEALTH SERVICES COMMISSION
The commission was established pursuant to an Act of the Legislature effective
July 1, 1974, with the following powers and authorities:
• to provide emergency health services in the Province;
• to establish, equip, and operate emergency health centres and stations in
such areas of the Province that the commission considers advisable;
• to assist hospitals, other health institutions and agencies, municipalities,
and other organizations and persons to provide such services, and to enter
into agreements or arrangements for that purpose;
• to establish or improve communication systems for emergency health services in the Province;
• to make available the services of medically trained persons on a continuous, continual, or temporary basis to those residents of the Province who
are not, in the opinion of the commission, adequately served with existing
health services;
• to recruit, examine, train, register, and license emergency medical assistants;
• to provide ambulance services in the Province; and
• to perform any other function related to emergency health services as the
Lieutenant-Governor in Council may order.
To these functions has been added the responsibility for the medical aspects
of the Provincial Emergency Programme such as medical involvement in disaster
planning, responsibility for federal stores stockpiled around the Province, and
involvement when actual disasters occur.
Further development of the Provincial ambulance service has involved the
establishment of new services in the communities of Port Renfrew, Madeira Park,
Lumby, and Clinton.
Although basic training programs were temporarily suspended during the
year, the advanced "paramedic" program provided at the Royal Columbian
Hospital was continued and a further nine crew members were expected to
graduate by year-end as Emergency Medical Assistants Grade III. In addition,
in co-operation with the Continuing Medical Education Department, University
of British Columbia, two emergency physicians and one emergency department
nurse were sent to the communities of Smithers, Terrace, and Kitimat to provide
instruction to emergency department personnel, and local physicians and dentists,
in basic cardiopulmonary resuscitation, and in the care of patients who have
suffered multiple trauma. These programs proved very popular and were oversubscribed 100 per cent in the areas in which they were offered.
Two meetings were held in 1976 with representatives of the Province of
Alberta, Saskatchewan, and Manitoba responsible for ambulance services. The
Executive Director of the commission also participated in the following meetings:
Highway safety, organized by the Insurance Corporation of British Columbia; a
large international meeting held in Baltimore, Maryland, attended by representatives from 14 foreign countries to consider emergency medical services; and the
annual meeting of the American Association for Automotive Medicine, where
much interest was shown in the functions of the commission in British Columbia.
The Executive Director also acted as chairman of a committee set up by the
Emergency Measures Organization of the Federal Government to design a first aid
kit suitable for use at all federally operated airports across Canada. The assistance
 DEPARTMENT OF HEALTH EXPENDITURES,  1975/76
J  141
of emergency physicians and general surgeons was sought within British Columbia,
and the final makeup of the kit was presently under consideration at year-end by
representatives of the Federal Government.
Arrangements were made for the St. John Ambulance Society to administer
a plan to teach basic cardiopulmonary resuscitation (life support) to selected
groups of individuals in this Province, with the support of the commission.
The commission continued to produce its own ambulances at a reduced rate
during the year, but still at a considerable saving over commercially available
vehicles.
As in 1975, a physician was employed by the commission to provide medical
attention for the fishing fleet for one month at Rivers Inlet, and a subsequent month
at Port Renfrew.
During the past year the Executive Director travelled over 5,000 miles around
the Province visiting commission personnel and, on occasion when time allowed,
visiting administrators of local hospitals and some local physicians.
The number of employees within the commission remained approximately the
same as last year. It was anticipated that the volume of calls experienced by
December 31, 1976, would be approximately 142,000, compared with. 124,822
for 1975, an increase of 14 per cent.
Emergency Health Services Commission continued to build its own ambulances
during 1976, at a considerable saving over commercially manufactured units.
 J  142 DEPARTMENT OF HEALTH REPORT,  1976
AUDITOR'S REPORT
To the Members of the
Emergency Health Services Commission,
Province of British Columbia
I have examined the statement of financial position of the Emergency Health Services
Commission as at March 31, 1976, and the statement of operations and surplus (deficit) for
the year then ended. My examination included a general review of the accounting procedures
and such tests of accounting records and other supporting evidence as I considered necessary
in the circumstances.
In my opinion these financial statements present fairly the financial position of the
Emergency Health Services Commission as at March 31, 1976, and the results of its operations
for the year then ended, in accordance with generally accepted accounting principles applied
on a basis consistent with that of the preceding period.
K. M. LIGHTBODY
Acting Comptroller-General
Victoria, B.C., November 17, 1976
Table 32—Statement of Operations and Surplus  (Deficit), Emergency Health
Services Commission
Ten-month
Year Ended Period Ended
March 31, March 31,
1976 1975
Income: $ $
Emergency service fees      1,068,742 716,256
Province of British Columbia  16,486,599        6,097,477
17,555,341        6,813,733
Expenditure:
Operations—
Salaries, wages, and benefits  10,205,950 4,218,920
General expenses   1,083,526 1,201,262
Vehicle expenses   927,995 164,697
Training   621,934 258,467
Supplies   551,316 171,875
Land and buildings purchased  53,640 —
Vehicles and equipment purchased  1,702,549 653,885
15,146,910 6,669,106
Administration—
Salaries and benefits  623,444 373,880
General office expenses   110,774 129,944
Public education program  1,701 73,578
Office furniture and equipment purchased  2,579 52,079
738,498 629,481
15,885,408        7,298,587
Excess of income over expenditure (expenditure over
income) for the year  1,669,933 (484,854)
Deficit, beginning of the year  484,854             —
Surplus (deficit), end of the year  1,185,079 (484,854)
 MEDICAL AND HOSPITAL PROGRAMS J 143
Note to the Financial Statements for the Year Ended March 31, 1976
Significant accounting policies—Land and buildings, operator vehicles and equipment, and
office furniture and equipment are charged to operations at the time of acquisition, and concurrently are recorded in the Capital Fund. The original cost of the assets is removed from
the Capital Fund upon disposal.
Table 33—Statement of Financial Position, Emergency Health Services Commission
ASSETS
March 31
1976
Operating Fund: $
Cash          92,348
Accounts receivable—
Province of British Columbia  1,575,000
Service fees and other	
Operator advances 	
Prepaid expenses 	
Capital Fund:
Fixed assets at cost (note)—
Land and buildings
Vehicles and equipment 	
Office furniture and equipment
March 31
1975
512
303,102
308,903
82,486
616,596
230,067
2,361,839
847,175
53,640
2,356,434
54,658
653,885
52,079
2,464,732
705,964
LIABILITIES AND SURPLUS (DEFICIT)
Operating Fund:
Accounts payable and accrued liabilities  1,163,660 1,126,929
Accountable  advance—Province  of British Columbia         13,100 205,100
Surplus  (deficit)    1,185,079 (484,854)
2,361,839; 847,175
 L 	
Capital Fund: Net investment in fixed assets  2,464,732 705,964
Approved on behalf of the Commission:
D. H. Weir
Chairman, Emergency Health Services Commission
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 J  146 DEPARTMENT OF HEALTH REPORT,  1976
FORENSIC PSYCHIATRIC SERVICES COMMISSION
During the year the commission continued to expand and improve the quality
of forensic psychiatric services in the Province. In May a forensic clinic was
opened in Victoria with an establishment of four professional staff. This unit,
which is housed in the Victoria Mental Health Centre, will initially serve the
southern end of Vancouver Island. In August a forensic clinic was opened in
Vancouver to serve the Lower Mainland. This unit, which incorporates the former
forensic clinic situated at Vancouver General Hospital, will provide in common
with the Victoria unit, assessment, treatment, consultation and follow-up for
mentally ill offenders who can be cared for in an out-patient setting. The Vancouver Clinic, situated at 805 West Broadway, also provides office accommodation
for the commission and the administrative staff.
In July, 21 new positions were approved by the Treasury Board, bringing the
Forensic Psychiatric Service's establishment to 161 positions. The additional staff
were required in order to set up a small administrative staff, inaugurate the two
forensic clinics, and meet the increased demands upon the Forensic Psychiatric
Institute.
The development of an in-service education program in the highly specialized
field of forensic psychiatric medicine was a necessity which continued to be the
object of intensive study and development.
The work load of the Forensic Institute greatly increased during the year as
a result of more admissions. It appeared that there would be at least a 20-per-cent
increase in admissions.
The development of new programs included supervised holidays for patients
at selected camps operated by the Corrections Branch, and increasing involvement
in pre-release planning for patients. In-patient units at the Shaughnessy Hospital
and Eric Martin Institute, Victoria, had not come into operation by year-end and
it was possible that recent amendments to the Criminal Code permitting the greater
use of community facilities would obviate the need of these developments.
The commission was studying the forensic psychiatric needs of centres outside
the Lower Mainland, and discussions had taken place with regard to the level of
service to be provided by the commission in the fields of mental retardation and
juvenile delinquency. The lack of services in this latter field are of particular
concern. Provincial/federal co-operation in the forensic psychiatric field remained
at a very high level and planning continued for projected joint programs.
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 J  148
DEPARTMENT OF HEALTH REPORT,  1976
ALCOHOL AND DRUG COMMISSION
The philosophy of the Alcohol and Drug Commission (ADC) is to become
actively involved with regional and community agencies in determining regional
and community needs, and with the Department of Health in providing a direct
service to the public, where it is more economical and effective to do so.
On July 1, 1976, the Narcotic Addiction Services, the Alcohol and Drug
Counselling Services, and the Youth and Family Counselling Services were transferred from the Vancouver Resources Board to the ADC. In addition to its own
service, the commission provides financial support to 42 service agencies throughout
the Province.
The commission has developed its system of care for the problem drinker and
alcoholic, and is undertaking to bring this total system of care to an acceptable
level in the four operational regions of the Province. Still to be developed is the
system of care for the heroin abuser, and at year-end this was being studied by the
commission and its Advisory Council.
In the field of education, because post-educational programs have been less
than effective and no adequate monitoring and evaluation techniques have been
developed, the commission, in conjunction with the Department of Education and
other appropriate organizations, was discussing the development of an effective
school program with a built-in monitoring and evaluation component.
REGIONALIZATION
The commission decided that, in order to have an effective and equitable
distribution of services in the Province, it was necessary to plan on a regional rather
than Province-wide basis. Residential treatment centres, for instance, are best
conceived of as serving a geographical area and working in close co-operation with
other services in the area.
During the year, approval was obtained to divide the Province initially into
four regions—Northern B.C., Central and Southeastern B.C., Vancouver Island
and West Coast, and Lower Fraser Valley.
It is proposed that the regions will become planning and administrative units.
Eventually each region will have a regional director who will be an employee of
the commission and who will be responsible for program and program co-ordination in the region. Each region will also have an advisory committee appointed
from well-informed and interested professionals and citizens in the region. The
committee will advise the commission on what services are required, and the
appropriateness of the services that are provided.
While full implementation of this plan will take some time, at year-end the
commission was planning to hold regional workshops to orient program workers
to the system of care in Prince George, Kamloops, Nanaimo, and Vancouver.
SYSTEM OF CARE
The system of care developed by the ADC for problem drinkers refers to the
continuation of services which, it is felt, should be available to the chemically
dependent person seeking help within each region of the Province.
The elements of the system are as follows:
• Detoxification facilities.
• Out-patient counselling assessment and referral clinics.
• Residential treatment centres.
• Residential support facilities, i.e., recovery homes/halfway houses, etc.
 DEPARTMENT OF HEALTH EXPENDITURES,  1975/76
J  149
It is vital to the system that close co-operation exist between the individual
services, and that appropriate referrals from one to the other are easily arranged.
It is anticipated that each of the four regions of the Province will have one
major residential treatment centre, one or more residential support facilities, one
or more detox units, a number of out-patient clinics strategically located in population centres to provide entry into the system, ongoing nonresidential treatment
where appropriate, and follow-up care for clients leaving a residential setting.
At year-end all or some of these facilities were available in each region, and
priority was being given where possible to filling the gaps, on a regional basis.
DIRECT SERVICES
One of the commission's policies is that, where appropriate, services may be
provided directly by the commission, with the staff being employees of the Provincial Government. It is felt that this will give the commission more direct
control over the type and quality of services provided.
Until June 1976 the only direct service of the commission was the downtown
detoxification centre in Vancouver. On July 1, 1976, however, the drug services
formerly administered by the Vancouver Resources Board were transferred to the
commission. The employees became Provincial public servants, and the commission assumed responsibility for all aspects of the operation of the program.
This added three programs to the direct services of the commission. The
Narcotic Addiction Services operates five clinics, offering treatment to heroin
addicts where methadone maintenance is a major component of the program.
There are also pharmacy and laboratory services needed to support a methadone
program.
The Alcohol and Drug Counselling Service provides out-patient counselling
and assessment for individuals with alcohol-related problems. This service has a
large case load and a sizeable proportion of it represents referrals from business
and industry.
The youth services program provides a range of services aimed at young
people and families, where the primary problem is some type of drug involvement.
This service ranges from crisis intervention to long-term intensive individual or
family counselling, aimed at reorienting the individual to more acceptable behaviour
or helping the family to take a more constructive approach to the problems of its
members.
ALCOHOL SERVICES
Several types of services are required to deal adequately with this problem.
The commission provides some of these services either directly or through
funded agencies. The commission operates one detox and one alcohol out-patient
counselling service. Residential treatment is offered in four locations by funded
agencies, and there are five supportive after-care residences. In addition to
Vancouver, out-patient counselling is offered in 11 communities throughout the
Province, and there are four other detoxification centres. There are also counsellors
in 11 communities who are more oriented to problems of alcoholism in the native
Indian community.
The commission is assessing the effectiveness of these services, and their
responsiveness to the needs of the communities in which they are located. It hopes
to develop the quality of these services and to expand them into other communities
and regions of the Province which require services.
 J  150 DEPARTMENT OF HEALTH REPORT,  1976
These services emphasize a professional approach to the client, based on the
belief that through professional counselling people can accept responsibility for
their behaviour, and learn more acceptable ways of dealing with life situations
rather than resorting to alcohol. The commission recognizes the valuable past and
ongoing role of Alcoholics Anonymous. Clients in the programs are made aware
of the Alcoholics Anonymous Fellowship and are encouraged to attend meetings
if they feel it will be helpful to them.
NARCOTIC SERVICES
The principal treatment approach to narcotic dependency over the past decade
has been voluntary methadone maintenance. The commission operates five methadone clinics in Vancouver directly, and funds a further seven in various locations
in the Province. While methadone maintenance is a controversial form of treatment, where it has been well managed within the commission protocols it has been
successful in greatly reducing the illicit drug use of a significant number of heroin
addicts.
The commission funds one small drug-free program for heroin addicts in
Kamloops, modelled on the therapeutic community.
At year-end the commission was actively investigating a number of the
approaches to narcotic dependency, and hoped to have a much broader range of
treatment programs available in the future.
The commission was also studying over-all approaches to the problem of
narcotic dependency, with a view to recommending a comprehensive program for
consideration by March 31, 1977.
NEW PROGRAMS
In the last quarter of the year the commission was planning and implementing
a number of new programs:
Residential Treatment Centre
A model residential treatment centre was planned for the Lower Fraser Valley
Region. The centre would be a treatment resource for the Lower Mainland, a
model for developing programs throughout the Province, and a training centre for
professionals working in this field.
The facility will have a capacity of about 30 beds and will have an intensive
therapy program of about four weeks' duration.
Maple Cottage Detox
At year-end detailed planning was under way for a detoxication centre at
New Westminster, which will service the South Burnaby, New Westminster, Surrey,
Richmond, Delta, and Coquitlam area. Its initial capacity will be 20 beds with
possible further expansion to an additional 15-20 beds when required.
RESEARCH
One of the priority items of the ADC was the build-up of its Research
Department. The department had three sections—monitoring, planning, and
evaluation.  The evaluation section was not yet operational.
All direct service (commission) and indirect service (funded) agencies
participate in the client monitoring system, as do two nonfunded agencies.   The
 MEDICAL AND HOSPITAL PROGRAMS
J 151
system will provide information on client drug use, referral pattern within the
system of care, and client profiles for each program. The first data from the
monitoring system covering the period from April 1, 1975, to September 30, 1975,
had been processed and all participants had received individual reports. The
program will be up to date by March 31, 1977, and will be the first such extensive
overview of Government-funded agencies in any Canadian province.
The monitoring system will provide some of the basic data for the planning
and evaluation sections. The planning component will study the needs and services
of an area as it relates to the system of care for the chemically dependent. All
available data will be considered in analysing the needs and resources of a community or region. Such data will provide a basis for future development of
services and funding decisions on existing programs. The evaluation section was
not yet in operation by year-end.
   J 154
DEPARTMENT OF HEALTH REPORT, 1976
Table 34—Expenditure by Principal Categories in the Department of Health
for the Fiscal Year 1975/761
Total Expenditure in
Fiscal Year Ended
March 31, 1976
$
Public Health Services     40,664,344
Mental Health Services     55,356,322
Hospital Insurance Services  486,663,956
The Medical Services Plan of British Columbia ... 293,168,6502
Emergency Health Services     16,486,599
Total Health Services  892,339,871
Chart VI—Expenditure by Principal Categories in the Department of Health
for the Fiscal Year 1975/761
Emergency Health Services
$16,486,599	
Medical Services Plan
$293,168,6502
Public Health Services
$40,664,344
Mental Health Services
$55,356,322
Hospital Insurance Services
$486,663,956
Total Health Services
in 1975/76
$892,339,871
i Data are shown in accordance with the 1975/76 Public Accounts of British Columbia.
2 The expenditure of $293,168,650 shown for the Medical Services Plan is the gross operating cost as shown
in the detailed statements in Section F of the Public Accounts. The actual charge to Vote 82 was $145,800,000
and covered the return of the Federal sharing under the Medical Care Act (Canada) and Hospital Insurance
and Diagnostic Services Act, subsidy by the Province for low-income residents, and the estimated deficits not
covered by premiums and other revenues. Similarly the total for the Department of Health is shown as
$892,339,871, whereas the net total is $744,971,221. This latter figure agrees with the total shown in Section D
of the Public Accounts.
 DEPARTMENT OF HEALTH EXPENDITURES, 1975/76
J  155
Table 35—Detailed Expenditure by Principal Categories in the
Department of Health for the Fiscal Year 1975/761
Public Health Services:
Minister's office	
Office of Consultant to the Minister
Health Advisory Council	
Accounting Division	
General services 	
Home dialysis service	
Total Expenditure in
Fiscal Year Ended
March 31, 1976
$
83,964
57,930
Nil
796,584
2,166,010
470,604
431,338
Division of Occupational Health	
Division for Aid to Handicapped       1,103,361
Development of alternative care facilities
Hearing-aid Regulation Act	
Grants for health agencies	
Community health services development
Local health services	
Division of Laboratories	
Division of Vital Statistics	
Division of Venereal Disease Control
Division of Tuberculosis Control	
Division of In-patient Care	
Action B.C.	
Training in the expanded role of nurses
Salary contingencies	
Subtotal, Public Health Services
350,263
11,963
2,571,519
264,704
20,009,684
1,798,217
1,195,601
396,339
1,218,576
4,526,333
275,000
73,530
2,862,824
40,664,344
Mental Health Services:
General administration	
Division of Nursing Education
Community services	
In-patient care	
Salary contingencies	
Subtotal, Mental Health Services
6,290,677
290,364
3,493,454
41,781,184
3,500,643
55,356,322
Hospital Insurance Services:
Administration 	
Payments to hospitals-
Claims 	
Grants in aid of equipment
3,556,066
469,946,696
2,374,458
Capital and debt services     10,786,736
Subtotal, Hospital Insurance Services  486,663,956
1 Data are shown in accordance with the 1975/76 Public Accounts of British Columbia.
 J  156 DEPARTMENT OF HEALTH REPORT,  1976
Table 35—Detailed Expenditure by Principal Categories in the Department
of Health for the Fiscal Year 1975/761—Continued
The Medical Services Plan of British Columbia expenditure:
Benefits— $
Medical care  256,933,126
Additional benefits     14,759,859
271,692,985
Adjustment of provision for unpresented
and unprocessed benefit costs       8,816,144
  280,509,129
Administration—
Salaries and employee benefits     8,880,645
General office expenses       3,778,876
     12,659,521
Subtotal, The Medical Services Plan of British
Columbia*    293,168,650
Emergency Health Services     16,486,599
Total Health Services  892,339,871
1 Data are shown in accordance with the 1975/76 Public Accounts of British Columbia.
2 The complete 1975/76 Financial Statements and notes for the Medical Services Plan are on pages 157 to
159.
MEDICAL SERVICES PLAN
Financial   Statement
AUDITOR'S REPORT
I have examined the statement of working capital and financial position of the Medical
Services Plan of British Columbia operating under the direction and control of the Medical Services Commission of British Columbia as at March 31, 1976, and the related statements of operations and changes in cash position for the year then ended. My examination included a general
review of the accounting procedures and such tests of accounting records and other supporting
evidence as I considered necessary in the circumstances.
In my opinion these financial statements present fairly the financial position of the Medical
Services Plan of British Columbia as at March 31, 1976, and the results of its operations for
the year then ended, in accordance with generally accepted accounting principles applied on a
basis consistent with that of the preceding year.
K. M. Lightbody
Deputy Comptroller-General
July 19, 1976
Victoria, B.C.
 DEPARTMENT OF HEALTH EXPENDITURES,  1975/76 J  157
Table 36—Statement of Working Capital and Financial Position as at
March 31, 1976, of the Medical Services Plan of British Columbia
1976 1975
$ $
Working capital (deficiency)—beginning of year     (1,544,256) 17,809,137
Excess of expenditure over revenue (Table 37) ______ (70,779,366) (19,353,393)
(72,323,622) (1,544,256)
Payments from the Consolidated Revenue Fund,
Province of British Columbia (Note 2)      17,628,556 —
Working capital deficiency—end of year (Note 2) __ (54,695,066) (1,544,256)
Represented by (financial position):
Liabilities—
Estimated liabilities for unpresented and
unprocessed benefit costs—
Medical care     44,653,300 36,263,808
Additional benefits        2,446,700 2,020,048
47,100,000 38,283,856
Premiums paid in advance     11,373,175 9,048,304
58,473,175 47,332,160
Less assets—
Cash        3,778,109 4,787,904
Bank deposit receipts           — 41,000,000
3,778,109 45,787,904
Working capital deficiency     54,695,066 1,544,256
Approved on behalf of the Commission:
D. H. Weir
Chairman pro tern., Medical Services Commission
of British Columbia
See accompanying notes to financial statements.
 J  158
DEPARTMENT OF HEALTH REPORT,  1976
Table 37—Statement of Operations for the Year Ended March 31, 1976,
of the Medical Services Plan of British Columbia
Revenue:
Premiums—
Subscribers' premiums
1976
95,316,199
Adjustment of provision for prepaid premiums      (2,324,871)
92,991,328
Government of British Columbia—premium assistance     19,851,008
Interest income
Government of Canada contributions—
Medical Care Act     86,368,370
Hospital Insurance and Diagnostic Services Act     21,386,632
Expenditure:
Benefits—
Medical care  256,933,126
Additional benefits      14,759,859
271,692,985
Adjustment of provision for unpresented
and unprocessed benefit costs       8,816,144
Administration (Note 3)—
Salaries and employee benefits       8,880,645
General office expenses       3,778,876
12,659,521
Amalgamation administration expenses
Excess of expenditure over revenue     70,779,366
1975
$
88,930,257
279,738
89,209,995
19,175,882
112,842,336 108,385,877
1,791,946 5,323,636
81,541,066
9,864,031
107,755,002 91,405,097
222,389,284   205,114,610
199,371,953
11,014,830
210,386,783
1,580,205
280,509,129   211,966,988
6,868,010
3,524,534
10,392,544
2,108,471
293,168,650   224,468,003
19,353,393
See accompanying notes to financial statements.
 DEPARTMENT OF HEALTH EXPENDITURES,  1975/76 I  159
Table 38—Statement of Changes in Cash Position for the Year Ended
March 31,1976, of the Medical Services Plan of British Columbia
1976 1975
Cash provided: $                          $
Subscribers' premiums  95,316,199 88,930,257
Government of British Columbia—
Premium assistance  19,851,008 19,175,882
Operating cash requirements  17,628,556                —
37,479,564 19,175,882
Government of Canada  107,755,002 91,405,097
Interest income       1,791,946 5,323,636
242,342,711        204,834,872
Cash applied:
Medical Plan benefits  271,692,985        210,386,783
Administration      12,659,521 12,501,015
284,352,506        222,887,798
Decrease in cash     42,009,795 18,052,926
Cash assets:
Beginning of year     45,787,904 63,840,830
End of year       3,778,109 45,787,904
See accompanying notes to financial statements.
Notes to Financial Statements for the Year Ended March 31, 1976
1. Accounting Policies
Income determination—The Commission recognizes premium income as it is received.
Premiums paid in advance are shown as a liability until the month in which they are earned.
Interest and Government contributions are recognized as income when received.
Benefit costs—The Commission provides for unpresented and unprocessed benefit costs.
These costs are charged to income for the year on the basis of claims experience during the
current year.
2. Working Capital Deficiency
Section 11 of the Medical Services Act, chapter 24, 1967, provides for the funding of any
working capital deficiency from the Consolidated Revenue Fund, as required. During the year
ended March 31, 1976, $17,628,556 was transferred from the Consolidated Revenue Fund to
meet cash requirements.
The estimated cash operating requirements for the year ending March 31, 1977, have been
provided for in the 1976/77 Estimates of Expenditure.
3. Administration
The public sector activities of the former licensed carriers, Medical Services Association
and CU. & C. Health Services Society, have now been amalgamated with the operations of the
Medical Services Plan of British Columbia. The comparative figures for the year ended March
31, 1975, have been restated accordingly.
4. Financial Statement Presentation
For the purpose of a more informative presentation, the former Statement of Financial
Position has been replaced by a Statement of Working Capital and Financial Position, and in
addition a Statement of Changes in Cash Position is now included. Prior year figures have
been restated accordingly.
 J  160
DEPARTMENT OF HEALTH REPORT, 1976
ANNUAL REPORT ADVISORY COMMITTEE
Chairman: M. L. Chazottes.
Editor: R. H. Thompson.
Co-ordinators: J. Doughty, K. Williams, J. Berry.
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1977
2,030-1276-3236

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