BC Sessional Papers

Department of Health Annual Report 1975 British Columbia. Legislative Assembly 1976

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 PROVINCE OF BRITISH COLUMBIA
Department of Health
ANNUAL REPORT
1975
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1976
  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 1975.
r. h. McClelland
Minister of Health
Office of the Minister of Health,
Victoria, B.C., July 2, 1976.
L
 Department of Health,
Victoria, B.C., July 2, 1976.
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 1975.
J. MAINGUY
Deputy Minister of Health
 DEPARTMENT OF HEALTH
The Honourable R. H. McClelland, Minister of Health
J. W. Mainguy W. F. Locker
Deputy Minister of Health Director of Personnel
N. S. Wallace F. G. Tucker
Senior Financial Adviser Consultant in Mental Health
W. Dietiker J. S. Bland
Director of Data Processing Consultant ill Geriatrics
COMMUNITY HEALTH PROGRAMS
G. R. F. Elliot W. D. Burrowes
Deputy Minister, Community Health Pro- Acting Director, Division of Vital Statistics
grams
N. McDonald
J. H. Doughty Director, Division of Public Health Edu-
Acting Director of Administration cation
Public Health Programs
K. I. G. Benson F. McCombie
Associate Deputy Minister and Provincial Director, Division of Dental Health Ser-
Health Officer vices
W. Bailey R. G. Scott
Director, Division of Environmental Engi- Director, Division of Public Health Inspec-
neering tioiP
L. M. Crane P. Wolczuk
Director, Division of Public Health Nursing Director, Division of Community Nutrition
A. A. Larsen G. D. Zink
Director, Division of Epidemiology Director, Division of Speech and Hearing
Special Health Services
J. H. Smith H. K. Kennedy
Director, Bureau of Special Health Services Director, Division of Veneral Disease Con
trol
W. I. Bowmer w   „   „
„.,„...        , ,  ,   .  .    . L. D. Kornder
Director, Division of Laboratories „. „.  . . , ^. , r.    ...
Director, Division of Occupational Health
C. E. Bradbury F. D. Mackenzie
Director, Division for Aid to Handicapped Director, Division of Tuberculosis Control
Mental Health Programs
A. Porteous R. S. McInnes
Associate Deputy Minister Co-ordinator of Mental Health Centres
H. W. Bridge
Co-ordinator of Adult Psychiatric Services "■■ "• Devries
F. A. Matheson Consultant in Psychology
Comptroller }  B  FARRy2
R. H. GoodacreI Consultant in Social Work
Consultant in Sociology
M. M. Lonergan Mrs. F. Ireland
Consultant in Nursing Co-ordinator of Boarding-homes
1 Resigned September 30, 1975, to become Director of Research in Hospital Programs.
2 Appointed June 1, 1975.
 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
W. J. Pettit
Director, Hospital Finance Division
(K. G. Wiper 3
(J. D. Herbert4
Director, Administrative Services
(Vacant)
Director,   Hospital
spection Division
Consultation  and  In-
jD. S. Thomson »
[R. H. Goodacre6
Director, Research Division
G. F. Fisher
Director, Hospital Construction and Planning Division
Medical Services
G. A. Stewart
Chairman
D. H. Weir
Assistant to the Chairman
D. M. Bolton
Senior Medical Consultant
A. W. Brown
Executive Manager, Plan Administration
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
3 Retired July 15, 1975.
* Appointed Director, Administrative Services, effective July 15, 1975.
5 Resigned July 31, 1975, to become Associate Director, Cancer Control Agency of B.C.
6 Appointed Director, Research Division, effective October 1, 1975.
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  TABLE OF CONTENTS
Page
Year in Review  15
Demographic Features  17
Department Highlights, 1975  17
COMMUNITY HEALTH PROGRAMS
Public Health Programs
Introduction  25
Communicable and Reportable Disease  27
Health and Our Environment  32
Specialized Community Health Programs  38
Community Public Health Nursing Services  43
Home Care Programs  47
Dental Health Services  48
Nutrition Services  50
Public Health Education  51
Vital Statistics  5 3
Aid to Handicapped  5 6
Laboratory Services  57
Community Human Resources and Health Centres  60
Action B.C  61
Council of Practical Nurses  61
Voluntary Health Agencies  62
Tables—
1—Reported Communicable Diseases, British Columbia, 1971-75—  63
2—Reported Infectious Syphilis  and Gonorrhoea,  British  Columbia,
1946, 1951, 1956, 1961, and 1966-75  63
3—Selected Activities of Provincial Public Health Nurses, September
1974 to August 1975, Inclusive  64
4—Selected Activities of Public Health Inspectors, 1972-75, Inclusive 65
5—Number and per Cent of Children Immunized Prior to Entry Into
Kindergarten (as at September 1974)  66
6—Number and per Cent of Grade V Pupils Immunized as at June
1975  66
7—Number and per Cent of Grade V Girls Immunized for Rubella as at
June 1975  66
8—Pupils Referred for Health Services  67
9—Registrations, Certificates, and Other Documents Processed by Division of Vital Statistics, 1974 and 1975  67
10—Case Load of Division for Aid to Handicapped, 1975  68
11—Tests Performed by Division of Public Health Laboratories, 1974
and 1975  69
12—Licensing of Practical Nurses  70
 Page
13—Number of Cases Referred for Hearing Assessment, by Source,
Division of Speech and Hearing, 1975     70
14—Number of Cases Referred for Hearing Assessment, by Type of
Evaluation, Division of Speech and Hearing, 1975     70
15—Hearing-impaired Cases, by Degree and Type of Impairment, Division of Speech and Hearing, 1975     70
Mental Health Programs
Introduction  73
Community Mental Health Centres  75
The Greater Vancouver Mental Health Service  81
The Burnaby Mental Health Plan  82
The British Columbia Youth Development Centre  83
The Boarding Home Program  86
Consultants  88
Tables—
16—Patient Movement Trends, Mental Health Facilities, 1972-75     94
17—Patient Movement Data, Mental Health Facilities, 1975     95
MEDICAL AND HOSPITAL PROGRAMS
Hospital Programs
Introduction  101
British Columbia Regional Hospital Districts Act  103
British Columbia Regional Hospital Districts Financing Authority Act.. 103
The Hospital Insurance Act  104
The Hospital Act  104
The Hospital Rate Board and Methods of Payment to Hospitals  105
Hospital Consultation and Inspection Division  107
Research Division  107
Hospital Finance Division ,  108
Hospital Construction and Planning Division  110
Medical Consultation Division  117
Administrative Services Division  119
Approved Hospitals  120
Statistical Data  122
Tables—
18—Patients Separated and Proportion Covered by Hospital Programs,
British Columbia Public General Hospitals Only (Excluding Federal,
Private, Extended-care, and Out-of-Province Hospitalization)  123
19—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)  124
20—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 Thousand Covered Population 124
10
 Page
21—Summary of the Number of Hospital Programs In-patients and
Out-patients  125
22—Summary of Hospital Programs Out-patient Treatments by Category,
1971-75, Inclusive  125
23—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, 1975 (Excluding
Extended-care Hospitals)  125
24—Percentage Distribution of Patients Separated and Patient-days
for Hospital Programs Patients Only, in British Columbia Public
Hospitals, Grouped According to Bed Capacity, 1975 (Excluding
Extended-care Hospitals)  126
Charts—
I—Percentage  Distribution of Days of Care by Major Diagnostic
Groups, Hospital Programs, 1974  127
II—Percentage Age Distribution of Male and Female Hospital Cases
and Days of Care, Hospital Programs, 1974  128
III—Percentage Distribution of Hospital Cases by Type of Clinical Service, Hospital Programs, 1974  129
IV—Percentage Distribution of Hospital Days by Type of Clinical Service, Hospital Programs, 1974  130
V—Average Length of Stay of Cases in Hospitals in British Columbia
by Major Diagnostic Groups, Hospital Programs, 1974 (Excluding
Newborns)  131
Medical Services Commission
Introduction  135
Benefits Under the Plan  137
Services Excluded Under the Plan  139
Premium Rates and Assistance  139
Laboratory Approval  140
Professional Review Committees  140
Salaried and Sessional  140
Tables—
25—Registration and Persons Covered by Premiums and Subsidy Level,
Medical Services Plan, at March 31, 1975  141
26—Persons Covered by Age-group, Medical Services Plan, at March
31,1975  141
27—Distribution of Fee for Service Payments for Medical Services
(Shareable), Medical Services Plan, 1973/74 and 1974/75  142
28—Distribution of Fee for Service Payments for Insured Services, Non-
shareable Additional Benefits  142
Government Health Institutions  145
Emergency Health Services Commission  153
Forensic Psychiatric Services Commission  159
11
 DEPARTMENT OF HEALTH EXPENDITURES,  1974/75
Financial Tables and Chart
Tables— PA0E
29—Expenditure by Principal Categories in the Department of Health
for the Fiscal Year 1974/75  163
30—Detailed Expenditure by Principal Categories in the Department of
Health for the Fiscal Year 1974/75  164
Chart—
VI—Expenditure by Principal Categories in the Department of Health
for the Fiscal Year 1974/75  163
12
   1975 Annual Report of
Department of Health
YEAR IN  REVIEW
The year 1975 was characterized by diverse changes in the provision of
services, in Federal-Provincial relations, and in Departmental organization. The
following is a summary of the changes which took place in these major areas
of concern:
The B.C. Hearing-aid Program was launched in September in five regional
centres, with gratifying public response. The program provided hearing-aids at
cost to the public and all referrals are by physician.
A combined poison control and drug information referral centre was established at St. Paul's Hospital, Vancouver, and made available to physicians and other
health professionals throughout the Province. Poison control information to the
public was provided through poison control centres at 59 hospitals.
Twenty major hospital construction projects were completed, costing an estimated $20 million.
An exemplary spinal cord injury unit was opened at Shaughnessy Hospital to
act as the referral centre for the Province. It is believed to be one of the finest of
its kind in North America.
A major nuclear medicine laboratory was opened at the Vancouver General
Hospital.
Speech and language services were introduced at hospitals located in five
health units.   Nutrition services were expanded.
These and other highlights of the year are outlined in "Department Highlights,
1975" (page 17).
The year was one of both optimism and controversy in Federal-Provincial
relations related to health. In September 1974 the provinces had unanimously
rejected a new cost-sharing formula for medical and hospital care which had been
proposed some time previously by the Federal Government. This formula would
have related the increase in the Federal contributions to the rise in the gross national
product. In January 1975, at the meeting of Federal and Provincial Ministers
of Health, the Federal Minister proposed a review of interim measures, designed
to bring under Federal sharing certain programs which were lower cost alternatives to high cost services. Provincial Ministers agreed and a Federal-Provincial
Technical Committee was struck to work out the details.
These discussions were set back when the Federal Minister of Finance announced in June that the Medical Care Act of Canada was to be amended to
introduce ceilings on the rate of increase in Federal sharing of the cost of physician
services. These ceilings were to be 13.0 per cent in the fiscal year 1976/77, 10.5
per cent in 1977/78, and 8.5 per cent in 1978/79 and thereafter. At the meeting
of Provincial Ministers of Health held in Victoria in August, the provinces unanimously protested the move, which had been made without consultation with the
15
 EE 16 DEPARTMENT OF HEALTH REPORT,  1975
provinces. It was agreed that the discussions on interim arrangements would cease
until a further meeting of Federal and Provincial Ministers had been arranged.
The Minister of Health of British Columbia announced at the meeting that the
Federal action would cost this Province about $170 million over the next five years.
The Federal Anti-inflation Guidelines were announced in October and these
could act to reduce the loss to the provinces. Talks on the proposed interim sharing
arrangements had not been resumed by the year-end.
Changes in Departmental organization were made along the lines announced
by the Minister in October 1974. In January, appointments were made to positions of Deputy Minister of Health, Deputy Minister of Medical and Hospital
Programs, and Deputy Minister of Community Health Programs. The new organization brought to an end the previous arrangement under which the Minister had
personally to co-ordinate all branches and agencies of the Department. Other
senior appointments were confirmed shortly thereafter.
On December 1, the responsibility for administering Riverview, Valleyview,
Dellview, and Pearson Hospitals was transferred to the Medical and Hospital
Programs branch of the Department and placed under the newly appointed Director of Government Health Institutions. This was to allow Government units to
be operated under conditions more closely resembling those of general hospitals
and other community-operated institutions.
At the year-end, reporting arrangements for the Development Group for
Community Human Resources and Health Centres were being changed so that
the group would report on the health aspects of its program to the Deputy Minister
of Community Health Programs, rather than direct to the Minister.
A nucleus of Departmental support services was created by transfer of positions within the Department. This involved the Senior Finance Adviser, the Director of Personnel, the Director of Data Processing, the Consultant in Mental Health,
and the Consultant in Geriatrics.
The Medical Services Commission completed the immense task of amalgamating with the Government-operated B.C. Medical Plan, the operations of the
Medical Services Association, and CU & C insurance plans. This resulted in a
single carrier handling the medical insurance program under the Medical Services
Act of the Province. One result was the reduction in the number of persons required to administer the program.
Control of facilities under the Community Care Facilities Licensing Act was
improved by the establishment of two boards—one for adults and one for child
care. To each board were added three additional members from the community
at large.
By Order in Council 3845, of December 23, 1975, the Alcohol and Drug
Commission was transferred from the Department of Human Resources to the
Department of Health.
With respect to communicable diseases, it can be reported that there were no
major outbreaks during the year, although the incidence of rubeola (red measles),
rubella (German measles), and salmonella was higher than in 1974. Cases of
diphtheria and infectious hepatitis declined considerably.
Venereal disease continued to be a major concern, with a 5-per-cent increase
in notifications of gonorrhoea, and a 20-per-cent increase in notifications of infectious syphilis. Case finding and control measures were intensified and a public
awareness program carried out.
 YEAR IN REVIEW EE 17
DEMOGRAPHIC  FEATURES
The population of the Province at mid-year approached two and a half million,
the official estimate being 2,457,000, an increase of 62,000 over the 1974 figure.
While this was a slightly lower growth rate than has been experienced in recent
years, the numerical increase was second only to Ontario among the Canadian
provinces.    British Columbia's population has doubled since 1952.
The following information is based on the preliminary vital statistics of the
Province for 1975:
During the year the number of births remained substantially unchanged, yielding a birth rate of 14.4 per 1,000 population, slightly below that for 1974. The
proportion of these births recorded as having occurred out of wedlock was somewhat higher this year, being 12.4 per cent compared to 12.1 per cent the previous
year.
The number of marriages declined slightly from 1974 to 1975, and because
of the accompanying increase in population, the marriage rate per 1,000 population declined to 8.8 from 9.1 the previous year.
Deaths in British Columbia declined somewhat during 1975. The death rate
per 1,000 population was 7.7, down from the figure of 8.0 for 1974 and a new
record low. As in 1974, the lower death rate was reflected in each of the major
causes of death.
The rate of deaths from heart disease in 1975 was only 258.6 per 100,000
population, a reduction from the 1974 figure of 263.8.
Total cancer mortality declined only slightly to 154.1 deaths per 100,000
population, compared to 155.9 in 1974. However, deaths from cancer of the lung
showed a 7-per-cent increase.
Deaths from cerebrovascular disease caused about the same number of deaths
in the two years being compared, the 1975 rate being 81.3 compared to the 1974
figure of 82.7.
It is gratifying to be able to report a substantial reduction in the death rate
from accidents for this year. In 1974 an excessively high number of 83.3 persons
per 100,000 population died from accidental causes, and while this year's figure
of 74.8 is still at an undesirably high level it marks a considerable improvement.
A 17-per-cent reduction in motor-vehicle fatalities contributed to the decline as
did substantial declines in the number of deaths from falls and from poisonings.
The suicide rate was also somewhat lower in 1975, 16.8 suicides per 100,000
population having been recorded, compared to 17.0 in'1974.
There were fewer infant deaths this year than in 1974 and the rate was down
to 14.8 per 1,000 live births from the 1974 figure of 16.1.
DEPARTMENT  HIGHLIGHTS,  1975
COMMUNITY HEALTH PROGRAMS
The British Columbia Hearing-aid Program was launched in September in five
regional centres with gratifying public response. The program provides hearing-aids
at cost to the public and all referrals are by physician.
Speech/Language Services were introduced at hospitals in the Selkirk, West
Kootenay, North Okanagan, Simon Fraser, and Northern Interior Health Units.
 EE 18 DEPARTMENT OF HEALTH REPORT,  1975
The control of facilities coming within the purview of the Community Care
Facilities Licensing Act was improved by the establishment of two separate Boards,
one devoting its attention to adult care facilities and the other to child care facilities.
Provision was also made for each Board to have three additional members appointed
from the community at large.
•
A combined poison control and drug information referral centre was established
at St. Paul's Hospital, Vancouver, and made available to physicians and other
health professionals throughout the Province. Poison control information to the
public was provided through poison control centres at 59 hospitals.
Improved techniques were introduced into the dialysis program for patients
with kidney failure. Treatment is becoming more economical and less demanding
on the patient. The use of disposable artificial kidneys was introduced during the
year.
•
Engineering guidelines were prepared for the design, submission, and construction of domestic waterworks systems, including private systems, and those
under the jurisdiction of utilities, improvement districts, and municipalities.
•
Home care programs were expanded to cover 90 per cent of the population of
British Columbia with approximately 80 per cent of the population having access
to the comprehensive "hospital replacement" type of home care program.
Over 9,000 new mothers and 5,600 new fathers attended educational classes
for expectant parents. Public health nurses made at least one home visit to almost
99 per cent of all newborn babies, in order to carry out general health assessment
and appraisal, and to provide advice and counselling on child care.
Home visits of all types by public health nurses totalled over 333,000, a 38-percent increase over the previous year.
Almost half a million individual immunizations were performed by public
health nurses and over 29,000 tests for diphtheria, tuberculosis, and other conditions
were given.
•
The mobile dental units visited 24 communities which lack a resident dentist
in the northern part of the Province and in the Kootenays.
Analysis of Province-wide dental surveys carried out since 1958 revealed
significant improvements in the dental health status of children in the Province.
•
Nutrition services were expanded by the addition of five field nutritionists and
one nutrition consultant. An Infant Nutrition Guide was developed and distributed
to all health professionals involved in infant care and to all hospitals. Public heath
education activities were strengthened by staff appointments both at headquarters
and in the field, and by the provision of well-equipped central facilities for the
division.
 YEAR IN REVIEW
EE 19
An estimated 12,500 patients were treated in the Province's 30 mental health
centres during the year, and, in addition, professional staff provided consultative
services to a variety of community agencies.
The Boarding Home Program, a community residential placement program
for psychiatric care, was also operated in most areas of the Province, which supervised a continuing case load of approximately 1,900 mentally ill and retarded
persons.
By the end of 1975 the Greater Vancouver Mental Health Service had six
Community Care Teams operating in West End, Strathcona, Mount Pleasant-Fair-
view, Richmond, Kitsilano, and West Side, additionally, two teams were operating
in Burnaby out of the Burnaby Mental Health Centre.
Venture and Vista (halfway houses for former patients of Riverview Hospital)
were transferred to the Greater Vancouver Mental Health Service in April, providing
16 beds for short-term crisis patients. Riverview's Out-patient Department also
came under the administration of the Service during the year, and was renamed the
Broadway Clinic.
•
In October 1975 the patient load of the Greater Vancouver Mental Health
Service was 2,116, compared with 949 one year previously.
The Burnaby Mental Health Plan continued to provide the Province's only
regionalized program of decentralized comprehensive psychiatric services for
adults and children. The plan included a fully utilized 25-bed acute psychiatric
in-patient unit, an adult day program, adult and children's out-patient service, and
consultation and educational services.
•
Twenty psychiatric nurses completed a special in-service training program in
March, and commenced service in various communities. This group will provide
home care for adult patients who might normally require admission to hospital.
MEDICAL AND HOSPITAL PROGRAMS
Gross expenditure for public general, rehabilitation, and extended-care hospitals for the year of 1975 amounted to $460 million.
A total of 405,598 adult and child B.C. Hospital Program patients was
discharged in 1975, an increase of 11,091 or 2.8 per cent more in 1974; 95.7 per
cent of all patients discharged were covered by Hospital Programs.
Hospital Programs paid public hospitals in British Columbia for 3,472,971
days of care for adults and children, an increase of 72,098 days or 2.1 per cent
over 1974.   The average length of stay was 8.56 days.
 EE 20 DEPARTMENT OF HEALTH REPORT,  1975
In 1975, 20 major hospital projects were completed, involving an estimated
$20 million. Two special unit projects were the Spinal Cord Injury Unit at Shaugh-
nessy Hospital and the Nuclear Medicine Laboratory at the Vancouver General
Hospital.
•
Approval was given during the year for multi-million-dollar hospital projects,
including renovations and construction at Burnaby and New Westminster, to be
carried out under project management.
•
At the year-end there were 4,001 extended-care beds in the Province, and
approximately 2,015 additional extended-care beds under construction or in planning stages.   Five designated intermediate care homes provided a total of 663 beds.
•
During 1975 the regional hospital districts debenture sales to the B.C. Regional
Hospital Districts Financing Authority amounted to $27.5 million.
Grants totalling $6 million were approved toward purchases of moveable
and fixed technical equipment amounting to approximately $10 million. Over
6,800 applications for such grants were received from hospitals.
•
In excess of 2,000 patient accounts and over 2,550 emergency-service and
minor-surgery accounts were processed daily by Hospital Programs.
Over 575 out-of-Province hospital accounts were processed each month,
resulting in an estimated total expenditure of over $4.6 million.
•
The total expenditure for insured benefits under the Medical Services Plan
increased by 20.1 per cent to $211,966,988 in 1974/75, from $176,568,498 in
1973/74. These figures included services rendered by physicians on a salaried,
sessional, or contract basis, which amounted to $8,037,662 in 1973/74 and
$10,209,157 in 1974/75. Total expenditures, including administrative costs, were
$224,468,003 in 1974/75, compared to $185,150,292 in 1973/74.
The per capita cost of insured medical services (shared by the Federal Government) increased to $78.56 in 191 A/15 from $66.52 in the previous year, based on
population statistics provided by Statistics Canada. The most significant increases
were in general practice, laboratory and radiology, and internal medicine.
The per capita cost of additional medical service benefits (not shared by the
Federal Government) increased to $4.57 from $3.66 the previous year. The
increases were principally related to optometric and chiropractic costs.
Increased costs under the Medical Services Plan were brought about through
upward revisions to the agreed schedule of costs for medical practitioners; changes
in the additional insured benefits, resulting in increased servicing; increased utilization of insured benefits; changes in the practitioner/population ratio; increased
population, and increased administrative costs.
 COMMUNITY HEALTH
PROGRAMS
    Public Health Programs
In British Columbia, the first legislation to authorize a Provincial Board of Health
was passed in the late 1860's, but such a Board did not actually function until almost
30 years later. Beginning in the 1890's, however, the Board exercised its authority in
administering the Province's public health services and continued to do so for some 50
years. Then, in 1946, the services were given full departmental rank when the Department of Health and Welfare was created.
The branch of the present Department of Health known as Public Health
Programs 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 additional 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:
25
  COMMUNICABLE AND  REPORTABLE  DISEASE
DIPHTHERIA
It was gratifying that the upsurge in diphtheria noted in 1973 and 1974 did
not continue into 1975. Only 22 cases were reported, compared to 69 the year
before. There were two deaths from this disease during the year. These minor
outbreaks over the past four years led to a considerable increase in childhood
immunization, which, although it may not altogether prevent the spread of diphtheria, has assured that protected children will not die from this disease.
SALMONELLA
Salmonella food infection continued to be a problem, with 456 cases being
reported. There is good reason to feel that the cases reported are only "the tip of
the iceberg." The prevention of Salmonella infections requires the closure of many
avenues of transmission. One such avenue was closed this year by new regulations
which required frozen pet food, which can easily be infected with Salmonella
organisms, to be treated so that it is free of organisms that cause disease in man.
INFECTIOUS HEPATITIS
Although infectious hepatitis is always present in British Columbia, it is a
cyclical disease, and less than 1,000 cases were reported this year. In contrast
there were nearly 1,400 in 1974 and almost 2,000 in 1971. Immune serum
globulin, a by-product of human blood, prevents the development of severe illness
when given to contacts of this disease. It does not prevent infection, however,
and its use probably results in more cases of hepatitis than would otherwise occur,
because infected persons remain well enough to move about the community. The
only real means of controlling this condition is through immunization, and effective
vaccine has not yet been developed. In the meantime, simple precautions, such as
careful handwashing, remain the most useful control measures.
MEASLES
More than 1,100 cases of measles were reported in 1975. This was a marked
increase over 1973 and 1974, when 158 and 573 cases respectively were reported.
Measles is a cyclical disease and yearly fluctuation can always be expected.
Measles vaccine has been available at no cost to parents for a number of years,
and if every infant were protected at one year of age, there would be a great reduction in the number of cases of this disease.
Some concern has been expressed about the effectiveness of the currently
available measles vaccine and studies are planned to determine whether reinforcing
injections should be given during school life. Current experience in the United
States indicates that measles can be almost fully eradicated if every child is immunized during infancy.
Almost 500 cases of rubella were reported, an increase of 134 from the
previous year and 399 more cases than in 1973. These included 25 women who
contracted rubella during the early weeks of pregnancy. The Health Department
continued to provide immunization to all children, starting at one year of age,
as a short-term solution to this problem, in order to reduce the risk of susceptible
27
 EE 28 DEPARTMENT OF HEALTH REPORT,  1975
mothers contracting rubella from exposure to their own children. At the same
time, public health staff have intensified their efforts to assure that every girl is
protected from rubella before puberty.
TYPHOID FEVER
A few cases of typhoid fever are reported every year, and in 1975 eight cases
were diagnosed, none of which spread to the contacts. Milk and water are no
longer significant sources of typhoid fever in this Province. Instead, older chronic
carriers, and visitors or immigrants from countries where typhoid is more prevalent,
are usually found to be responsible for this disease.
RHEUMATIC FEVER PROPHYLAXIS
This year there were about 800 young people receiving prophylactic antibiotics from the Health Department to prevent a recurrence of their rheumatic
fever. An injectable antibiotic, Bicillin, was offered during the year, in addition
to the oral antibiotics that have been in use since this program was started some
15 years ago. This permits those on the program the choice of taking a tablet twice
a day or having an injection once a month.
TUBERCULOSIS CONTROL
During the last decade significant changes have been made toward the control of tuberculosis in British Columbia. These include a lower incidence of
active tuberculosis; shorter hospital stay corresponding to a greater use of outpatient and anti-tuberculosis drug therapy, expanded clinic facilities, closer supervision of at-risk inactive cases, and a preventive treatment program among those
at-risk, including contacts to active cases and persons with a positive tuberculin
reaction.
The number of new active cases has ranged in the last 10 years from a high
of 600 cases in 1967 to lows of approximately 440 cases in 1969 and 1975. The
rates of active disease among those of Chinese and East Indian origin are estimated
to be 10 times higher than those of other racial groups, mainly Caucasian. During
1975, daily bed occupancy averaged 70, while close to 700 cases were on anti-
tuberculin drugs as out-patients.
On August 20, 1975, all Willow Chest Centre in-patients were transferred to
Pearson Hospital, to prepare the centre for the second phase of renovations.
In co-operation with the Metropolitan Health Department of Vancouver, a
tuberculin survey of all new Canadians registered in the schools for the first time
was carried out. As a result, a number of children considered at high risk have
been started on chemoprophylaxis.
VENEREAL DISEASE CONTROL
A variety of infections produce a discharge or skin lesion in the male or
female, but only those which are transmitted by sexual intercourse are considered
to be venereal diseases. Two of these, gonorrhoea and syphilis, are present in
the Province in sufficient numbers to necessitate close attention by the Division
of Venereal Disease Control.
 *»S3»rS«<
 EE 30 DEPARTMENT OF HEALTH REPORT,  1975
Gonorrhoea
Gonorrhoea is a specific bacterial infection with an incubation period of four
to five days. It produces severe symptoms of pain and discharge in the male, but
few noticeable symptoms in the female. At least 80 per cent of infected women
do not know they are infected and 5 per cent of infected males do not have any
signs or symptoms of disease. This infection occurs mostly in young, single adults
with a peak incidence at age 20 to 22. The high incidence groups in the community
are alcoholic women, male homosexuals, and alienated youth.
Gonorrhoea has been increasing each year since 1969, 9,793 cases having been
reported this year compared to 9,284 in 1974. As no single control measure has
proven to be satisfactory, it is necessary to employ several methods. The procedures presently being used are as follows:
• The operation of a control centre from which information regarding contacts to this infection is rapidly transmitted to the local health department,
so that these persons can be brought to treatment. The control centre
physicians provide a consultative service regarding this infection to physicians and health departments throughout the Province.
• The carrying-out of a contact tracing program by the Division of Venereal
Disease Control in Greater Vancouver and by public health nurses in
health units throughout the Province provides complete coverage of the
Province by contact investigators.
• The compulsory reporting of positive cases by physicians and laboratories
operates throughout the Province. Physicians do not report all cases, so
that this program has only a partial success. Theoretically, if every known
case was interviewed for contacts and these contacts were brought to
treatment, infection could be brought under control. In practice, there
are psychological barriers to revealing information about casual sexual
contacts, and this part of the control program has marked limitations.
• The Health Department operates many clinics throughout the Province
to assist those patients with social disease who are reluctant to consult a
family physician. The main Venereal Disease Clinic and the Pine Clinic
are located in Vancouver. In order to provide a service to people who
work and to reduce the load imposed on the Pine Clinic, the main Venereal
Disease Clinic extended its hours and now remains open until 7.30 p.m.,
Monday and Friday evenings, and is open from 10 a.m. to 1 p.m., Saturdays. Other clinics are operated in Victoria, New Westminster, Kamloops,
Prince George, Dawson Creek, Prince Rupert, and Kelowna.
• The development of a screening program for young women has been found
effective in other areas. This screening applies primarily to single women
between the ages of 15 and 25 located in high-incidence areas. It consists of taking a cervical culture for gonorrhoea whenever a pelvic examination is being done. However, at least 80 per cent of women infected with
gonorrhoea have no symptoms of this disease and do not know they are
infected. They pass infection to the male and, while the symptoms which
develop generally prompt him to seek treatment, if he does not inform
the female she may never know she is infected. She also runs the risk of
developing complications which can affect her health or produce sterility.
These young women constitute a reservoir of infection which continues to
maintain the epidemic. The identification and treatment of this reservoir
could markedly reduce the incidence of the disease. The reasons that it is
so seldom done are twofold:
 COMMUNITY HEALTH PROGRAMS EE 31
• There is a difficulty in using transport or diagnostic culture media
which can be rapidly sent to a laboratory. (The latter must receive
the specimen within 24 hours.)
• There is a reluctance to submit to the test because of psychological
resistance to admitting that a venereal infection may be present.
• There has been direct classroom teaching, workshops to assist teachers and
counsellors, production of a 16-mm film It Takes Two, and revision of
the pamphlet Rhythm and the Blues in the carrying-out of an effective
educational campaign in order to reduce these psychological barriers
against venereal disease. A physician's kit was prepared in co-operation
with the British Columbia Medical Association and details of this kit were
forwarded to physicians throughout the Province. A public awareness program was carried out in the spring using advertising in newspapers and
spot announcements on radio stations. For personal information, a venereal disease information Zenith line was installed.
Infectious Syphilis
While infectious syphilis remains under good control, introduction of the
disease from outside the Province necessitates vigilant attention to each small epidemic which subsequently develops. The common problem is the spread of the
disease by the male homosexual, a single, unattached individual who has usually
acquired the infection in the west coast cities of the United States. Single men
travelling to and from Mexico, and seamen, constitute somewhat less of a problem.
Some of these individuals are bisexual and spread the infection into the heterosexual population. As a result of the interviewing and contact tracing, 400 people
were identified as having syphilis in the Province during 1975, and of these, 179
were found to have the disease in its infectious form.
Latent syphilis—The Provincial Laboratory conducts over 700 tests a day on
specimens from pregnant women, persons having routine physical examinations,
and persons suspected of having a venereal infection. Syphilis may produce few
symptoms and the presence of the disease may only be discovered by blood tests
during its latent phase. It is necessary to continue a screening program to find
these hidden cases of infection so that they may be adequately treated and prevented from developing complications.
THE PUBLIC HEALTH NURSE AND DISEASE CONTROL
The public health nurse played an active role in disease control programs and
provided the following services (see Table 3 for details):  -
• 499,946 individual immunizations and 29,155 tests for diphtheria, tuberculosis, and other conditions were given at neighbourhood clinics, child
health conferences, and kindergartens. This total of 529,101 individual
services represents a saving to the Provincial Medical Services Plan of well
over a million dollars based on the minimum rate which might be paid a
physician for the same service.
• 7,931 visits were made to patients and contacts concerned with venereal
disease.
• 9,062 visits were made concerning tuberculosis control.
• 8,726 visits were made for epidemiological follow-up of other communicable diseases, including infectious hepatitis.
 EE 32 DEPARTMENT OF HEALTH REPORT,  1975
HEALTH AND OUR ENVIRONMENT
ENVIRONMENTAL ENGINEERING
During the year the staff of the Environmental Engineering Division continued
to carry out the functions assigned under the Health Act. These include technical
and consultative support to Medical Health Officers, Government agencies, municipalities, and individuals throughout the entire Province on matters relating to water
supplies, swimming-pools, sewage disposal, solid waste management, sanitation,
and training of water and wastewater personnel.
Field Operations
The concept, introduced in 1974, of offering greater and more direct technical
support to the Medical Health Officers and their staff, by locating Environmental
Engineers in the field, has been successful. District Engineers strategically located
at Cranbrook, Nanaimo, Prince George, Surrey, and Vernon offer direct, rapid
service to the health units, which are grouped into five regions, each containing
three or four health units. District Engineers visit and assist operators of waterworks, sewage works, and swimming-pools, carry out site inspections on the installations, and consult with municipal officials.
With the addition of the five District Engineers, the need for Regional Engineers
in Victoria to travel was reduced. However, engineers from Victoria visit each
health unit on the average of two to three times per year. There were 82 field visits
made by Victoria-based Regional Engineers in 1975.
Description of Functions
A brief description of the basic functions of the Division are as follows:
• Waterworks—All plans and specifications for domestic water systems, including private systems, utilities, improvement districts, and municipalities,
were reviewed. (Certificates of approval from the Health Department are
required before construction proceeds.) The Division has 760 recorded
waterworks systems in the Province, this being 100 more than in 1974.
Certificates of approval were issued to 639 applicants in 1975, 49 fewer
than in 1974.
• Sewage works—Plans for sewage works reviewed by the Division are limited
to public systems with flows under 5,000 gallons per day and not discharging
into a water course.   Two certificates of approval were issued in 1975.
• Swimming-pools—This Division reviews the plans and specifications for all
swimming-pools and auxiliary facilities for compliance with the regulations.
In general, compliance with the regulations ensures that physical safety and
sanitation standards are met. All pools, with the exception of private pools,
require a certificate of approval from the Department of Health before
construction proceeds. Engineers follow up the progress of construction
until the pool is complete, whereupon the jurisdiction is turned over to the
local Medical Health Officer for the issuance of an annual operating permit.
Eight-one certificates were issued in 1975 for the construction of new pools.
This was 34 fewer than in 1974.
• Sanitation—The Division offered increased technical support to the Division
of Public Health Inspection, primarily as a result of the appointment of
District Engineers. Assistance was given on technical aspects of septic
tank construction, tile for disposal fields, package sewage treatment plants,
and preparation of sewage disposal regulation amendments.
  EE 34 DEPARTMENT OF HEALTH REPORT,  1975
• Pollution control permits to discharge—An inherent feature of the Pollution
Control Act, 1967 is the requirement that four other Government agencies
review applications for discharges prior to the issuance of the permit. The
Division, on behalf of the Deputy 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 Environmental Engineering Division.
• Operator training—The Division is active in the preparation and implementation of operator training programs in British Columbia. The delivery
system for training is accomplished through three avenues:
• Preparatory Training of eight months duration is offered at Malaspina
College in Nanaimo. A staff member of the Division is a member of
the Advisory Committee at Malaspina College.
• Workshops, seminars, and schools are offered through the B.C. Section,
American Water Works Association, of which the education chairman
is a staff member of the Division. A five-day water and waste school
for operators was attended by 140 operators. Other workshops and
training sessions carried out in 1975 where the Division was responsible
for the planning or was directly involved in the planning included
Chlorination Workshop, two-day sessions in Richmond; Cross Connection Control Seminar, two one-day sessions in Kamloops and Burnaby;
and B.C. Water & Waste School, a five-day session in co-operation
with the Universtiy of British Columbia, Vancouver.
• Correspondence courses which are suitable for use in British Columbia
have been made available from other areas and the Division is contemplating the implementation of a correspondence course for waterworks
personnel.
Training of swimming-pool operators is the responsibility of the Division.
In previous years a series of workshops was offered throughout the Province, but
this year a new concept was tried. The Division retained the services of two qualified instructors to offer a series of one-day training sessions in swimming-pool
operation. Booklets on swimming-pool operations prepared by the Division were
given to course participants. Eleven one-day sessions were offered at Richmond,
North Vancouver, New Westminster, Chilliwack, Coquitlam, Courtenay, Prince
George, Vancouver, Kelowna, Cranbrook, and Victoria.
The Division offers direct assistance and technical support to other Government
agencies and participates in many specialized committees and groups.
Special Projects
Several new projects were initiated during the year.   These include
• preparation of Engineering Guidelines for Design, Submission, and Construction of Waterworks Systems;
• preparation of amendments to Sewage Disposal Regulations, including a
lecture series for Health Inspectors throughout the Province to disseminate
the information;
• participation in the Environment and Land Use Committee's Task Force
to Resolve Problems Relating to Sewage Effluent Disposal;
 COMMUNITY HEALTH PROGRAMS EE 35
• development of a computerized system for the storage and retrieval of
waterworks information;
• development of a training film for swimming-pool operators.
PUBLIC HEALTH INSPECTION
The major activities of the Division of Public Health Inspection are designed
to provide a comprehensive environmental health program for the people of the
Province. In this regard, new Sewage Disposal Regulations were approved by
Order in Council in August and these contain several significant changes to safeguard the environment. The most notable are:
• Allowances are made for Ministerial Standards of Design for package treatment plants, prefabricated septic tanks, alternate sewage disposal systems,
and for disposal tiles.
• Persons manufacturing or distributing a package treatment plant are
required to obtain the approval of the Director of the Division of Environmental Engineering.
• The owner of a treatment plant system is required to obtain an operating
permit from the Medical Health Officer. In order to obtain this permit,
the owner must maintain a service contract with a package treatment plant
service agent.
• The Local Board of Health is given authority to prohibit sewage discharge
into tidal waters. This only applies to single-family dwellings and duplexes,
as larger sewage volumes are under the jurisdiction of the Pollution Control
Branch.
• Persons who are aggrieved by an order, decision, or action of the Medical
Health Officer may appeal in writing to the Local Board of Health.
• The regulations provide more detailed information on how to conduct
percolation tests, and include more realistic information on permissable
daily sewage flows from various premises.
Sanitary Regulations
Updating of these regulations continued with recent amendments removing
all reference to sewage disposal which is now covered by the sewage regulations.
The amendments removed the obsolete section whereby a city municipality had to
request that an Order in Council be passed to bring into effect certain pertinent
clauses of the regulations.
Food Handler Training Programs
The National Sanitation Training Program for the food service industry was
implemented on the Lower Mainland as a pilot project. It involved the Simon
Fraser, Boundary, and Central Fraser Valley Health Units. The courses were
jointly sponsored by the Canadian Restaurant Association and the local health unit
and were available to all food handlers. The first of these courses was given to
managers, although others attended. British Columbia Ferries are now providing
this training course for their senior food service catering staff at the British Columbia Institute of Technology.   Assistance is provided by public health inspectors.
 ee 36 department of health report, 1975
Activities With Other Departments
The Division worked closely with other Government agencies involved with
the protection of the environment.
These agencies included the Environment and Land Use Committee; the
Pollution Control Branch; the Lands Branch; the Departments of Municipal
Affairs, Housing, Highways and Public Works, and Recreation and Conservation;
Health and Welfare Canada; and the Federal Department of the Environment.
Educational Activities
The Director of the Division is a corresponding member of the Board of
Certification of the Canadian Public Health Association, which is responsible for
conducting the examinations leading to the certification of Public Health Inspectors; and is also a member of the Environmental Technology Advisory Committee
for the British Columbia Institute of Technology. Community Health Programs
provided three months field training for 17 Public Health Inspector students. The
field training requirements were increased to six months to provide a more comprehensive training.
Twenty-three Public Health Inspectors attended the second module of an
ongoing course in communications.
OCCUPATIONAL HEALTH
The Division of Occupational Health offers a fully integrated employee health
program to Provincial Government employees and provides environmental monitoring and consultative services to Governmental and non-Governmental agencies
and institutions.
The Division of Occupational Health in 1975 expanded and extended the
range of Occupational Health services offered to Government employees. The
Division has offices in Kamloops, Prince George, Woodlands, Riverview, Victoria,
and Vancouver.
Service requests are handled on a "team approach" and components of the
team each deal with one of five programs:
• Physicians' Consultative Service.
• Occupational Health Nursing Service.
• Radiation Protection Service.
• Employees' Development Services.
• Employees' Fitness Program.
The physician complement increased to four with the recruitment of an additional doctor for the Victoria office. The physicians provide consultative services
for community occupational health problems, service departmental requests, and
provide on-the-job health service to employees.
This year, representation on interdepartmental committees was extensive.
This involved close liaison with the Departments of Transport and Communication,
Highways, Labour, and the Attorney-General, as well as the Pollution Control
Branch, the Water Investigations Branch, B.C. Hospital Programs, and the Public
Service Commission. Although pre-employment health examination of Public Service candidates has yet to be implemented, a hearing conservation program has
been instituted using interval audiometry for noise-exposed employees. A flight
surgeon's program has been undertaken on behalf of the Government airline pilots.
Also, the structure of a Joint Union Management Committee to deal with disabled
employees has been formalized and expanded.
 COMMUNITY HEALTH PROGRAMS
EE 37
The Occupational Health Nursing Service was further expanded and coordinated with nurses serving 11,858 employees during the year. This included
immunization, counselling, referral to physicians, first aid, screening procedures,
and education of employees.
Three nurses successfully completed an Audiometric Technicians Course
sponsored by the Workers' Compensation Board. This will enable them to screen
employees for hearing loss.
Employee group education remained a conscious concern of the nursing staff.
Classes were held for employees in nutrition, physical fitness, body mechanics,
safety, and infectious disease control.
Radiation Protection Service
The Radiation Protection Service experienced a marked increase in service
demand during 1975. Much of this demand originated from the increase in the
number of dental X-ray installations and the granting of more licences for radioisotope use. There are now over 500 radioisotope licences, covering several different
radioactive sources.
In 1975 the Radiation Protection Service conducted
• 625 radiation surveys;
• 188 consultations and visits
• 25 talks and lectures;
• 505 radiation leak tests;
• 14 monitorings of nuclear submarine visits;
• 158 checks of water samples for radioactivity;
• 360 checks of air samples for radioactivity;
• 155 checks of microwave ovens for leakage (mostly through Public Health
Inspectors).
The Radiation Protection Service completed a working draft of proposed
radiation control regulations calling for registration and inspection, and establishing
some basic parameters for X-ray equipment, operating procedures, and protection.
The proposed regulations are being circulated among the professions and other
interested parties for comment.
A research project was completed in collaboration with the Director of the
X-ray Department of St. Paul's Hospital, Vancouver, on a system of personal and
environmental radiation monitoring known as Thermal Luminescent Dosimetry
(TLD). This dosimetry system, using small Va by Vs-inch LiF crystals is more
stable and accurate over a wider range of exposures than the familar film badge
monitors.   The project was very successful and a report is under preparation.
The awareness that the use of certain ultrasonic devices could be a potential
health hazard resulted in the development of a questionnaire that was sent to all
public hospitals in the Province. These data provided an understanding of the
use of the various ultrasonic units in Provincial hospitals.
Since 1958 a member of the staff of the Radiation Protection Service acted as
Secretary to the Radiological Advisory Council and its several Committees. The
organizational activities of the Radiological Advisory Council have expanded to
become a full-time position, with most of the work done on behalf of the B.C.
Hospital Programs.
In December a training program in microwave oven surveying was developed
for Public Health Inspectors. This will permit the Province-wide surveying of
commercial microwave installations on an alternative yearly schedule.
 EE 38 DEPARTMENT OF HEALTH REPORT,  1975
Employee Development Service
The Employee Development Service conducted an education and counselling
program tailored to the needs of the problem employee. The accent was on
alcoholism.
In liaison with a number of other departments, one-day educational sessions
pertaining to the problem employee were presented at various locations throughout
the Province. These sessions reached top, middle, and operative management
levels and over 1,000 employees participated. A comprehensive training manual
on the policy and program for problem-drinking employees was written and distributed to supervisors throughout the Public Service. Although it is still in a
development phase, the results of the problem-drinking program have been very
encouraging.
Representatives of the Employee Development Service were also active in
addressing community groups such as the Occupational Industrial Program Counsellors, Lions Club, Workers' Compensation Board, and concerned professionals
in the Richmond community.
The Employee Fitness Program was incorporated into the Occupational
Health Division in April. The staff for this program is comprised of a kinesiolo-
gist, a public health nurse, and a nutritionist.
The first exercise sessions began May 5, 1975, and by the autumn approximately 300 employees had participated. The program offers a multiplicity of
services to assist employees in maintaining proper physical fitness. Individually
tailored fitness programs are developed on request. The service facilities at the
Physical Activity Centre at 539 Superior Street, Victoria, have been modernized
with the installation of carpeting, exercise mats, showers, and life-cycle bicycles.
Classes are also conducted at two other locations adjacent to the Legislative
Buildings precinct. Office exercise breaks have been established and approximately 140 people participated.
The program also conducts an educational service. A bimonthly fitness and
health newsletter The Square Wheel commenced its first mailing in August. A
13-page booklet Guidelines for Exercise Leaders, an Activity Plan—The "Half-
as-Much" Approach, and Physical Activity Programs in Business and Industry—
What Road to Follow? were compiled, as well as a variety of material for counselling and class handouts.
The expansion of Community Fitness Programs was encouraged by developing a liaison among existing community fitness groups and responding to outside
requests.
In summary, considerable progress was made toward the implementation of
a comprehensive Occupational Health Service for the Public Service employees.
Representatives of the Division have responded to increased community demands,
particularly in the areas of health education, health maintenance, and environmental monitoring.
SPECIALIZED COMMUNITY HEALTH  PROGRAMS
KIDNEY FAILURE CORRECTION PROGRAM
Six hospitals in the Province have a renal unit for the treatment of kidney
failure. Each year more patients with this disease are kept alive and, in order to
provide adequate treatment and the freedom of living at home, a home dialysis
program has been developed.   This program is conducted by the Medical Supply
 COMMUNITY HEALTH PROGRAMS EE 39
Service of the Department, which operates a warehouse, a machinery servicing
unit, and a delivery service. Patients receive their training for home dialysis at
the Vancouver General Hospital, St. Paul's Hospital, or Royal Jubilee Hospital,
Victoria.
Seventy-two patients in the program were on hemodialysis and 18 on peritoneal dialysis at the end of the year. Several improvements were made in the
dialysis techniques during the year, the main improvement being the development
of an automatic peritoneal dialysis machine. This machine uses a concentrate
which can be diluted with treated water which, in turn, will remove impurities
through the abdomen of the patient. The use of the automatic peritoneal dialysis
machine enables the patient to receive more thorough dialysis in less time and with
less effort.   This method of treatment is also more economical.
A program of completely rebuilding all hemodialysis machines every two
years was instituted.
The use of disposable artificial kidneys was introduced into the program
during the year and this enabled patients to reduce dialysis time of eight to ten
hours down to five or six hours, three times a week.
It takes time to finance such a change and to retrain the patients on the new
technique but, by the year-end, half of the home haemodialysis patients were on
this program.
Many patients in the hospital centres cannot go on home dialysis because
they do not have adequate accommodation or someone to assist them with dialysis
procedures. In order to improve this situation, a program of self-care units is
being instituted. The first will be located at the Division of Tuberculosis Control
on the grounds of the Vancouver General Hospital, with a maximum capacity of
30 patients.
POISON CONTROL PROGRAM
A combined poison control and drug information referral centre was established at St. Paul's Hospital early in the year in excellent quarters provided by the
hospital. This new centre makes available, for distribution to hospitals, information about new products that could be poisonous, and provides a specialized consultative service to physicians who are caring for cases of poisoning. There are
now 59 hospitals providing poison control information to the public and it is
planned to add at least two more during 1976. There were about 5,700 poisoning
incidents reported this year, of which 44 per cent were accidental in nature, 8 per
cent were judged to be due to the misuse of illegally obtained drugs, and the remaining 48 per cent were categorized as attempted suicide.
At the year-end discussions were taking place with the Department of National
Health and Welfare which, it was hoped, would lead to the use of British Columbia-
produced poison control information cards throughout English-speaking Canada.
At the same time, consideration was being given to the use of microfilm in order
to speed up production and distribution of new product information.
HYPOGAMMAGLOBULINEMIA PROGRAM
This year two patients with congenital hypogammaglobulinemia were added
to the program, and 19 children and adults are now being provided with immune
serum globulin on a regular basis. Because a few people have had rather severe
reactions following their injection, the manufacturer now provides a specially processed immune globulin which may permit these life-saving injections to be continued indefinitely.
 EE 40 DEPARTMENT OF HEALTH REPORT,  1975
This program is operated jointly by the Department of Health, the Faculty
of Medicine at the University of British Columbia, and the Canadian Red Cross
Blood Transfusion Service. Funding and administration is provided by the Health
Department, while laboratory facilities and professional consultative advice are
provided by the Red Cross and Faculty of Medicine.
MERCY FLIGHTS
"Mercy flights" were again provided to transport seriously ill or injured persons
by air to a hospital or other treatment centre. For this purpose, aircraft were used
by the Provincial Government, the Canadian Armed Forces, the Canadian Coast
Guard, and in some cases the United States Coast Guard and British Columbia
Forest Products. In each case a medical assessment of the need was made by a
senior medical officer of Public Health Programs, who played a prominent co-ordinating role through telephone conferences with the patient's physician, the providers
of the aircraft, and the receiving hospital.
In 1975, mercy flights totalling 357 were carried out, an increase of 46 per cent
over the 244 such flights in 1974. Six physicians in the Bureau are on an "on call"
system to monitor requests for air evacuation of seriously ill or injured patients.
COMMUNITY CARE FACILITIES LICENSING BOARD
Administration of the Community Care Facilities Licensing Act is the responsibility of the Department of Health. During the year, several major changes were
made in the arrangements for maintaining the quality of care in licensed community
care facilities.
The ever-growing number of licensed facilities and the increasing public interest
in this field made it necessary to divide the interdepartmental licensing board into
separate adult care and child care boards. Each board has three additional members
appointed from the community at large by the Ministers of Health, Human
Resources, and Education.
The terms of reference of both boards have been enlarged and include not only
the administration of the Community Care Facilities Licensing Act but also the
planning and development of new and needed interdepartmental programs in the
field of child and adult care.
Further amendments to the Community Care Facilities Licensing Act were
made to facilitate the use of private homes for family day care without expensive
renovations, and to return the enforcement of municipal by-laws to municipal
officials.
The Board consultative staff is being increased by the seconding of additional
staff from the Departments of Human Resources and Education. Three specialists
in child care and three in adult care are required to provide guidance to operators
and field staff in conducting ongoing training programs and also in answering
queries from the public.
SPEECH AND HEARING SERVICES
During the year the Division continued the program, first reported on in 1973,
designed to meet the needs of those in the Province who suffer from a variety of
speech and hearing disorders.    In addition, several significant accomplishments
provided more effective services to those suffering from communication disorders:
• A Province-wide audiometer calibration service was introduced.   Significant
savings were realized through the program, and in addition, there is assurance
that the audiometers are kept at a satisfactory operating level.
 COMMUNITY HEALTH PROGRAMS EE 41
• The British Columbia Hearing-aid Program was launched in September in
five regional centres serving Skeena, Northern Interior, South Central, South
Okanagan, and West Kootenay Health Units, and public response was
gratifying.   Inquiries regarding this program were numerous.
The Provincial Hearing-aid Program was designed to provide quality services
and quality hearing-aids at a fair price. The program, based on sound audiologic
principles, provides hearing-aids at cost to the public. Audiologic clinics are
located regionally throughout the Province and all referrals to the program are by
physicians. Negotiation with hearing-aid manufacturers culminated in requisition
of high-quality hearing-aids at the lowest possible price.
The first and the most important step in the rehabilitation of the hearing impaired is the evalution, selection, and fitting of optimal amplification. This step is
completed by field audiologists.
Additional features of the program are as follows:
• Hearing-aids are supplied to the field through a central distribution centre.
Each aid, whether new or repaired, is evaluated according to the most rigid
performance standards in North America (as specified by the Government of
British Columbia) before the instrument is fitted or reissued after repair.
• Assistance is given to field audiologists in a practical way. To ensure that
clinical effectiveness and efficiency will result, the Division designs hearing-
aid specifications which supply data pertinent to clinical application and
accuracy.
• Included in an evaluation program are data such as manufacturers' co-operation, instrument delivery time, reply and response to special requests. Part
of the evaluation consists of a circuit analysis of all instruments, and special
instruments and jigs are designed and produced to perform tests more
efficiently and accurately.
• A continuing record is kept on the condition of all measuring equipment used
for evaluation of hearing-aids. This is to ensure measuring instrument
stability and validity at all times.
• Repairs on the measuring equipment and on the hearing-aids are performed
by Health Department personnel. Repairs to hearing-aids are completed
within 24 hours, otherwise loan instruments are available. (Studies have
indicated, at any given time, approximately 45 per cent of hearing-aids
being used are not functioning satisfactorily.)
• All hearing-aids supplied to recipients by the Government are periodically
examined electroacoustically to ensure optimal performance.
• The Government also supplies acoustic couplers, batteries, and repairs
at cost.
• Other rehabilitative audiology services are available, such as hearing-aid
orientation, speech reading, auditory training, speech conservation, speech
pathology, language services, and counselling.
Speech-language Services
The following were included among programs conducted during the year:
Speech-language positions were introduced at the following health units:
South Okanagan (Penticton), South Central and Northern Interior.
Speech-language positions temporarily vacated were filled at the following
health units: West Kootenay, North Okanagan, Upper Fraser Valley, Cariboo, and Northern Interior.
•
•
 s   '
>
I
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 COMMUNITY HEALTH PROGRAMS EE 43
• Speech-language services were introduced in hospitals at Selkirk, West
Kootenay, North Okanagan, Simon Fraser, and Northern Interior. These
programs were conducted by Community Health Programs speech pathologists.
• As of January 1, a new data collection system was introduced for speech-
language assessment and treatment. It will give an indication of the effectiveness of speech-language services and will assist in cost-benefit analysis.
• The Division continued to present workshops for public health nurses, school
teachers, and parent groups. The aim has been to prevent speech and
language problems in the pre-school population and to assist nurses,
teachers, and parents in the identification of speech-language problems and
also to assist teachers in remedying minor speech-language problems. A
major goal has been to extend speech-language services to remote communities throughout the Province.
• Two Division speech and hearing mini institutes were held—one in Kamloops, which dealt with administrative matters in the Division; and one in
Prince George, which dealt with professional development.
VISION SERVICES
Consultative services regarding vision services were provided by the Provincial
orthoptist to over 200 public health nurses, aides, and summer students. Visits
were made to 11 health units and 14 branch offices.
Particular attention was paid to the detection and management of visual
defects in the young child. However, the need for vision services by the remainder
of the community is being reviewed.
With continued visits and demonstrations of screening methods and equipment, all health units are now using the Titmus Stereopsis Test as part of routine
vision screening for kindergarten and pre-school-aged children.
Pilot studies were set up in order to determine the earliest age at which visual
acuity and stereopsis could be carried out and recorded. Statistics on over 5,000
pre-school and kindergarten children were gathered and evaluated. The results
proved most useful in establishing recommendations for the most effective testing
equipment for general use, as well as referral levels for various age-groups.
It is anticipated that, in the near future, each health unit will be provided with
a 'Learning Module' for Vision Screening. The purpose of the module is to provide
public health nurses with information required to carry out parts of the vision
screening program relevant to their district case loads. Early detection of eye
defects is essential to prevent permanent visual damage.
COMMUNITY PUBLIC  HEALTH  NURSING SERVICES
Public health nursing services are available to all persons in the Province.
The public health nurse is a primary health worker and is concerned with total
family and community health. She brings her special skills in preventive and
curative nursing to the community so that she can assist in providing the best
possible health care for the people in her area, according to their special needs.
She is concerned with physical and emotional health, and uses epidemiological
methods to uncover potential health problems so that prevention, or care, can be
arranged before treatment becomes unnecessarily costly to the taxpayer. She is
also concerned with health promotion and the maintenance of maximum health of
the individual and the family.
 EE 44 DEPARTMENT OF HEALTH REPORT,  1975
MATERNAL AND CHILD HEALTH
Prenatal
Educational programs for expectant parents continue to be an important
method used by public health nurses to bring about positive behavioural changes
when parents are most receptive to learning. Through group classes and by individual counselling the public health nurse has a unique opportunity to help expectant parents build a good foundation for the enlarging family, and
• there were 550 classes for expectant parents held at health centres during
the year;
• 9,093 new mothers and 5,631 new fathers attended 48,979 sessions, representing an over-all increased attendance of about 30 per cent;
• 62 per cent of the group sessions had both parents enrolled, representing a
12-per-cent increase over last year;
• 38 per cent of all expectant mothers participated and it is estimated that
over 60 per cent were mothers having their first baby;
• 6,208 home visits were made by public health nurses to supplement group
sessions.
Infant and Pre-school
Public health nurses give special attention to the health supervision of young
children, as good health patterns may be established at this time and many potential health problems prevented if detected early. Home visits, health appraisals,
screening procedures, as well as health protection measures, are emphasized. In
summary,
• 22,585 infants or about 99 percent of all newborn babies received at least
one home visit for general health assessment and appraisal, advice, and
counselling on child care;
• 36,969 home and office visits were made to infants for further follow up
(the number represents a 50-per-cent increase over last year), and these
visits were generally to children with suspected abnormalities or "at risk"
due to unfavourable home conditions, failure to thrive, etc.;
• 26,901 similar visits were made to pre-school children;
• 17,822 infants attended child health conferences at health centres where
58,977 individual services such as counselling on general health, nutrition,
health appraisals, and immunizations were given;
• 84,229 individual services of a similar nature were provided to pre-school
children at child health conferences;
• 18,965 special services such as physical examinations, vision and hearing
tests, and the Denver Development Screening Test were given by public
health nurses at special clinics. Children showing deviation from the
normal pattern were given special help by the public health nurse or referred
to specialists.
FAMILY, ADULT, AND GERIATRIC SERVICES
Public health nurses provide a family health service and, through counselling
and health advice, they are in a position to encourage changes in life-style which
can lead to better general health for the entire family and reduce health care cost.
Examples of this include discussion of obesity, exercise, nutrition, use of seat belts,
cigarette smoking, and a better understanding of disease and of human relations.
Regarding this,
 COMMUNITY HEALTH PROGRAMS EE 45
• 333,306 visits of all types were made to homes, which is a 38-per-cent
increase over last year;
• 5,095 visits were made for home assessment and appraisal of conditions
related to health care;
• 15,086 visits were made for specific referral  and follow-up of special
conditions;
• 461 special geriatric clinics were held for elderly persons to assess health
problems and provide appropriate follow-up;
• 121,694 or 50 per cent of all home visits were to persons over 65 years of
age;
• 284,219 health services were rendered by telephone conversations by public
health nurses with persons concerned about health problems;
• 1,108 family planning clinics were held.
PUBLIC HEALTH NURSING AND HEALTH PROMOTION
Group methods have proved especially effective in providing opportunities for
discussion of health problems for persons with similar concerns. Group discussions
are an excellent health education method for providing scientific and technical
information to persons with common interests, and
• 1,475 sessions were held with parents of 1,062 pre-school children to discuss growth and development and parental problems;
• 28,889 school and adolescents' sessions were held with 19,564 persons in
this category;
• 5,937 sessions were held with 3,358 adults, which were devoted to many
general health and social problems;
• 4,757 meetings were held for health education on specific topics;
• 3,003 meetings were attended by public health nurses as official representatives of the health unit;
• 30,337 visits were made to homes or were held in the office, with health
promotion objectives.
CONTINUITY OF CARE AND COMMUNITY CARE FACILITIES
Public health nurses attempt to provide continuity of care to individuals with
health problems as they move within the health care system, i.e., home, physician,
hospital, or other treatment and care facilities. This is accomplished by liaison and
consultative visits to appropriate persons, agencies, and facilities in the community.
In summary,
• 7,464 routine liaison visits were made to physicians' offices;
• 8,507 liaison visits were made to other agencies on behalf of persons being
cared for by public health nurses;
• 6,623 liaison visits were made to general hospitals;
• 4,133 case conferences were held with members of the health unit staff or
other disciplines;
• 390 visits were made to licensed child care facilities;
• 2,791 visits were made to licensed facilities for adults.
SCHOOL HEALTH SERVICES
Health promotion among school-age children is an inseparable part of the
over-all health service to families. Through maternal, infant, and pre-school services, the public health nurse tries to ensure that all children will enter school in a
 EE 46 DEPARTMENT OF HEALTH REPORT,  1975
state of physical and emotional health which will enable them to grow and learn
to their maximum potential. School and health personnel work together to discover "at risk" and "special needs" children as early as possible, and plan for their
needs to be met. This joint approach toward ensuring each child a good start in
school is enhanced by a continued increase in kindergarten enrolment and day care
services.
Following are some of the services provided by 17 Provincial health units:
• Developmental screening between the ages of birth and 5 years provides an
excellent opportunity to counsel parents whose children demonstrate any
special need. Some 7,800 pre-school-aged children were assessed using the
Denver Developmental Screening Test.
• Screening services carried out after entry to school include vision and hearing on a regular basis and screening for communicable disease or other
health problems as indicated.
• 206,545 screening procedures were carried out by public health nurses and
95,760 by auxiliary workers.
• From the pupils screened the nurses selected 28,974 who required further
investigation, counselling, or referral.
• 68,688 students were referred to the public health nurses for investigation
of a health problem and of these 27,932 were referred by the nurse to
another health resource. A breakdown of the reasons for referral is shown
in Table 8.
• A major contribution of the public health nurse in the school health program is providing a liaison between school and home; 36,724 home or
office visits involving school pupils or their parents were carried out by
public health nurses.
MENTAL HEALTH SERVICES
The nursing consultants in mental health and public health programs are working toward co-ordination of all community nursing services. The long-range objective is to ensure an adequate input of mental health nursing consultation, at the
local and Provincial level, to all generalized public health nursing and home care
programs. As well as services provided for the mentally ill, the emotional needs of
persons with acute or chronic physical illness, or disability, or those in crisis situations, should be recognized and care provided.
Public health nurses share with other professionals the development of a
variety of special community services designed to enhance the mental health of the
community, particularly that of young families. These include discussion groups
for parents, crisis intervention services, programs for children with special problems
and community education.    In summary,
• 6,429 counselling sessions were provided by public health nurses to support
families during illness, family crisis, or a period of loss;
• 9,182 visits were made concerning problems in family relationships and
communication;
• 2,324 visits were made to administer medication for treatment of mental
illness or supervise patients receiving medication;
• 4,288 counselling sessions were held with persons receiving follow-up care
in relation to a mental illness;
• 1,975 visits were made to mentally retarded persons or their families.
 COMMUNITY HEALTH PROGRAMS
HOME CARE PROGRAMS
EE 47
The home care programs throughout the Province continued to provide services in the homes to persons who might otherwise be in acute hospitals, institutions, or who, without services, would be inadequately cared for. The program is
available to persons of all ages except some in isolated areas of the Province.
Through the home care programs, public health nurses work with the physician in co-ordinating and providing services required by a patient. Staff of public
health units provided nursing and physiotherapy services and arranged for other
services such as homemakers, social workers, dietitians, medication, and equipment. Through the program, patients were admitted to a home care program on
referral from their physicians. Home care programs were available to over 90
per cent of the population of British Columbia.
Highlights of the program are summarized as follows:
• Professional nursing care in the home is provided by community public
health services at no cost to the patient or his family.
• Physiotherapy services are available from many public health offices at no
cost, and these services are being extended.
• The Public Health Nurse Co-ordinator working with the patient's physician
arranges for all ancillary services required for the patient and assumes
responsibility for co-ordination of services to the patient and his family.
• Public health staff nurses made 287,428 nursing visits to home care patients
during the year.  This was a 44-per-cent increase from the previous year.
• "Hospital replacement" home care programs were extended to 22 areas and
provided services to approximately 80 per cent of the Province's population.
• When patients are on "hospital replacement," i.e., home care in lieu of
acute hospitalization, all services including medication, equipment and
supplies, homemaker, orderly, laboratory services, and dietitian are paid by
the Provincial Department of Health.
• Over 7,977 patients were admitted to home care programs in lieu of hospitalization. These same patients received 79,859 nursing visits, 6,904
physiotherapy visits, 25,989 hours of homemaker services and 2,428 meals-
on-wheels. Medication was supplied to 4,265 patients and medical supplies and equipment to 4,423 patients.
• The average length of stay for patients on "hospital replacement" was 10.3
days and the average total cost per patient was $135.34.
• The Department of Health continues to assume full financial responsibility
for the services of the Victorian Order of Nurses in Greater Vancouver and,
in November, the Victorian Order of Nurses Branch in Surrey was phased
into the Boundary Health Unit.
PHYSIOTHERAPY SERVICES
During the year, three full-time and twelve part-time physiotherapists provided
consultive and preventive services to patients, patients' families, physicians, public
health staff, hospitals, private agencies, Government departments, and the general
public in nine health units (13 offices).
Services are being provided or are being developed in
• Preventive care—Prevention is an integral part of all physiotherapy and
involves education and training in self-care procedures in order to prevent
secondary complications, deterioration of existing problems, or recurrence
of a treated problem.   Additionally, the therapist is involved in other health
 EE 48 DEPARTMENT OF HEALTH REPORT,  1975
services whose primary function is prevention, such as school health, "well
child," sports injuries prevention and treatment, industrial/occupational
accident prevention, physical fitness, mental retardation screening and assessment, prenatal and postnatal programs, and recreation/activation programs
for senior citizens and disabled groups. The services are provided through
the community clinics, health care agencies, and organized community
programs.
• Treatment—Services provided can be classed in terms of location and type
of care:
• Acute care—This is provided through the home care program.
• Active rehabilitation.
• Convalescent and chronic care.
• Nursing-home care.
Emphasis in treatment service is placed upon the acute care group where
physiotherapy is provided for patients requiring continuous care and specialized
treatments. Thus the community rehabilitation therapists are involved in the treatment of a high percentage of both acute medical and surgical patients. Therapists
have been involved in a wide variety of medical areas.
Home care is also provided for the non-acute patient either on a periodic basis
to deal with fluctuations in his health status or following discharge after rehabilitation to ensure optimum functioning in the home setting.
• Maintenance and follow-up services—These services provide continuous
care for patients suffering from chronic disease processes who may benefit
from intermittent therapy programs. These programs usually involve
periodic treatment or supervision by the physiotherapist over many years
and may include continuous assessment, special training programs, specialized procedures, and the provision and constant re-evaluation of aids and
devices necessary for independence. This program is expected to reduce
hospital readmissions and help patients live a reasonably normal life in the
community.
• The final role of the physiotherapist in the community is that of adviser to
members of the health care team, particularly where the multidisciplinary
approach has been taken. Physiotherapists act as consultants and advisers
to local universities, colleges, and schools, community and health care agencies, industry, health care institutions, Government departments, other health
personnel, and particularly members of the physiotherapy profession. An
important aspect of the advisory service is the therapists' function in advising on features needed in public buildings and facilities to avoid architectural barriers to the disabled.
DENTAL HEALTH SERVICES
In the spring of 1975 the Government of British Columbia announced that it
was planning the introduction of a comprehensive preventive and curative dental
program for children. Furthermore, it stated that the responsibility for the organization and administration of the program would be that of the staff of the Division of
Preventive Dentistry. The name of the Division was thereupon changed to "Division
of Dental Health Services" as this title appeared to be more appropriate.
Later in the year the report of the Children's Dental Health Research Project
was jointly released by the Minister of Health and the President of the College of
 COMMUNITY HEALTH PROGRAMS EE 49
Dental Surgeons of British Columbia, as co-sponsors of the project. During the
balance of the year discussions were held between the two parties in an endeavour
to reach an agreement on the most efficient delivery system for the treatment services.
However, it was mutually agreed that whatever delivery system was adopted would
require a considerable number of additional auxiliary dental personnel. Therefore,
an appointment was authorized for an additional consultant to the Division to be
responsible for the organization of the training of auxiliaries and for planning the
future needs for in-service and extra-mural education of all personnel of the Division.
At the close of the year, finalization was incomplete.
During the year, progress was made in the improvement of conditions in
dentally under-serviced areas.   The following summary explains:
• In Masset and in Queen Charlotte City, dental clinics were provided by the
communities with financial assistance from the Government of British
Columbia. Dentists were recruited by the College of Dental Surgeons of
British Columbia. At the close of the year a similar facility was being constructed in Mackenzie.
• Secondly, in the summer of 1974, there was an acute shortage of dentists in
Prince Rupert and no suitable rental accommodation was available. Therefore, it was arranged that the City would provide, service, and prepare a site
for a large mobile home, to be constructed and equipped to specifications
by the Department and purchased by the Government of British Columbia
to provide living accommodation and a two-operatory dental clinic. This
was leased during 1975 on a 12-month basis to a dentist and his wife, a
dental hygienist.
• During 1974, to improve the quality of treatment services provided on a
fee-for-service basis by dental externs visiting communities without a resident dentist, two large, specially designed motor home-type vehicles had
been purchased and equipped as two-chair dental offices. As a result,
commencing in the early summer of 1975, five mobile dental units visited
12 northern communities. In the fall, these units visited 12 similar communities in the Kootenays and at the close of the year the mobile clinics
moved to northern Vancouver Island to provide similar services.
With the assistance of grants-in-aid from the Department of Health, preventive
dental services of high calibre continued within the Capital Regional District and
Metropolitan Vancouver, which areas are not covered by Provincial health units.
Five regional dental consultants initiated and supervised all dental health programs in 17 health units. The programs were considerably improved and strengthened by the appointment to the headquarters of the Division of a consultant dental
hygienist. A one-week in-service training program was organized and attended by
40 employees of the Division. Subjects presented and discussed included objectives,
evaluation and cost effectiveness of programs, personnel management, and techniques appropriate to the various programs.
In the health unit areas, the dental consultants, dental hygienists, and dental
assistants concentrated most of their time and efforts on the 3-year-old birthday
card programs and dental health programs in the schools.
The birthday card program was modified during the year in negotiation with
the College of Dental Surgeons of British Columbia. Formerly, at no charge to the
parents, 3-year-olds were provided with an examination, appropriate advice on
dietary habits and oral hygiene practices, X-rays, if necessary, and the topical
application of a dental caries-preventing solution. The fees paid to dentists for
these services had remained unchanged for 10 years, and rather than expend the
additional funds required to meet the current fee schedule, it was decided to forego
 EE 50 DEPARTMENT OF HEALTH REPORT,  1975
the X-ray and topical application features in favour of strengthening other dental
health programs. During the year, some 10,000 3-year-olds of this Province
benefited.
School dental health programs were carried out in those areas where dental
auxiliary personnel were available. These were very considerably strengthened
during the last month of the year when the total number of dental hygienists increased
from five to nine. These personnel were supported by 18 dental assistants, 12 of
whom were certified and registered.
To evaluate the effectiveness of all dental health programs in British Columbia,
three Province-wide dental surveys have been carried out in the periods 1958-60,
1961-67, and 1968-74. The combined results of the third series were tabulated
and analysed during 1975. It is encouraging to report significant improvements
in the dental health status of the children of the Province during the period. For
example, the average number of permanent teeth attacked by dental caries has
decreased in each age-group between 7 and 15 years. Specifically, the average
15-year-old in the first series of surveys had 12.4 such teeth but only 10.0 as
recorded in the third series. Furthermore, of these teeth, at the time of the examination, 4.8 had untreated carious lesions and at the latter series only 2.8 were untreated. That treatment coverage had significantly improved was also demonstrated
by the fact that whereas 16.8 per cent of the children aged 7 to 15 years were shown
in the first surveys as having no untreated carious teeth, this percentage had increased
to 32.0 in the third series. The percentage of children receiving orthodontic treatment doubled during this period. However, it is still disturbing to note the high
percentage of children with poor oral hygiene and consequently a relatively high
ratio (26.3 per cent) with evidence of inflamed gingiva; (gums). Also noted is a
similar ratio (27.7 per cent) with "severe" malocclusion for whom orthodontic
treatment would most likely be highly desirable.
In addition to the 1,332 dentists registered and licensed to practise in British
Columbia at the close of 1975, there were also 295 dental hygienists and 656 certified dental assistants, having increased since 1974 from 256 and 552 respectively.
In 1975, close to one third of the total population were beneficiaries of dental care
plans. In communities where the ratio of such beneficiaries was high and the ratio
of population to dentists was also high, serious difficulties arose, since the demand
for dental services considerably surpassed the total services the resident dentists
could provide. It is evident therefore, that the needs for dental services must be
decreased by active and effective dental health programs throughout the Province
and the availability of dental services must be increased, especially by the education
and efficient utilization of more well-trained para-dental personnel.
NUTRITION SERVICES
With an increase in staff, the availability of nutrition services was expanded.
Five field nutritionists and one nutrition consultant were added for a total of nine
staff members in the Division.
Nutrition programs were implemented Province-wide and in individual health
units to meet three main priorities—promotion of sound nutrition knowledge,
implementation of nutrition education programs, and increased emphasis on the
role of nutrition in preventive health. On a Province-wide basis, programs included
• Nutrition Buy line, a nutrition column carried by 53 newspapers;
• infant nutrition education workshop for public health nurses representing
each health unit;
 COMMUNITY HEALTH PROGRAMS
EE 51
• conferences with physicians in 10 different centres in the Province to discuss current nutrition topics, in particular, Health Department policy regarding instruction about infant feeding;
• regional nutrition workshops to meet the needs of individual health units;
• nutrition education and food service workshops for staff of residential
community care facilities and day care centres;
• production of a 15-minute film entitled Why Nutrition to stress the importance of nutrition education in day care centres;
• production and revision of a number of nutrition pamphlets.
In health units with nutritionists (Cariboo, South Central, South Okanagan,
Central Fraser Valley, Simon Fraser, and Boundary), examples of the programs
in which the field nutritionists were involved are
• nutrition in the schools, including nutrition education, student food habit
surveys, assistance to school lunch programs, and projects to remove non-
nutritious food from school vending-machines;
• programs to special groups, e.g., nutrition counselling on an individual
basis, and nutrition presentations, to the elderly;
• participation in ongoing health unit programs, e.g., prenatal nutrition classes
and counselling "at risk" pregnant women;
• provision of nutrition displays for food fairs and exhibitions;
• assistance to self-help weight-reduction groups;
• in-service nutrition education program for health unit staff;
• television and radio appearances to promote sound nutrition information.
As in previous years, an extensive summer student employment program
was conducted by the Division. The projects included a survey of the eating
habits of East Indians living in the Boundary Health Unit; development of nutrition teaching aids for public health nurses; a weight-reduction program for adolescent girls; nutrition pamphlets for parents of pre-school children; a repeat
assessment of the nutrition knowledge, attitudes, and practices of public health
nurses in British Columbia.
A notable project was the development of an Infant Nutrition Guide. This
book is to be distributed to all general practitioners, paediatricians, nutritionists,
public health nurses, schools of medicine, nursing, and nutrition, and hospitals in
the Province. The objective of this publication is to"promote one policy regarding
instruction about infant feeding practices. Workshops and conferences for professionals, and pamphlets for parents, will accompany the release of the guide.
PUBLIC  HEALTH  EDUCATION
For the Division of Health Education, 1975 was a year of significant development and growth. Highlights of the Division's development include the appointment of a Director, staff appointments in Health Units and the Division, and a
move to new, well-equipped, office accommodation.
In keeping with the Department's over-all goal of developing a modern health
care system responsive to the needs of the people, the Division re-examined its
role and established new objectives. These objectives focus on the increased
emphasis that all health agencies are giving to health promotion strategies aimed at
alteration of life-styles.
 EE 52 DEPARTMENT OF HEALTH REPORT,  1975
Briefly, the Division's goals are to administer the health education delivery
system for the Department of Health by providing technical advice, services, and
educational materials for health department programs, branch, division, and health
unit staff, and the general public
• by organizing and developing a health education resources centre for the
production and distribution of audio-visual materials on health and health-
related subjects, and evaluating the usefulness and effectiveness of
materials—
• library services, including a film library (35 mm, 16 mm, Super 8);
a videotape library; and a resource library (books, journals);
• audiovisual production and services including film (35 mm, 16 mm,
Super 8); television and videotape recording; radio spots, editing,
mixing; visual materials (artwork, photography, transparencies, and
displays); sound (slide/filmstrips); printed matter (pamphlets, posters, flipcharts); and the purchase and supply of audiovisual equipment to health units;
• by forecasting and developing health education manpower requirements at
professional and paraprofessional levels and by providing for educational
supervision and professional development;
• by providing effective liaison with other Government departments (Provincial and Federal) and with voluntary health, welfare, and education
agencies in order to co-ordinate interorganizational planning and programming;
• by developing health education projects and activities in co-operation with
the traditional providers of health education, i.e., schools, media organizations, Government and voluntary agencies, health institutions (hospitals
and clinics), and occupational health programs;
• by providing funding for the health education component of the programs
of other divisions.
FIELD OPERATIONS
Five health educators were employed with health units and one health educator was assigned to the Division of Venereal Disease Control to develop and coordinate health education activities.   Highlights of their year's work include
• the Family Health and Fitness Festival at the Coquitlam Sports Arena,
attended by 4,000 people, was a co-operative project sponsored by Simon
Fraser Health Unit, the Parks and Social Recreation Department, and the
Local School Board;
• community organization activities include membership on advisory boards
to school districts at Vernon and Armstrong, organization of a regional
chemical dependency committee in the Comox Valley, and establishment
of an Upper Island Health Education Council;
• VD Awareness Campaign utilizing newspaper advertisements, radio spot,
and posters, and preparation and distribution of a VD Awareness Kit for
physicians;
• school health education involvement was through participation in Family
Life Education programs, smoking education, and input into the health
curriculum;
• media organizations were generous in their allocation of public service time
on radio, TV, and in the press for dissemination of health information.
 COMMUNITY HEALTH PROGRAMS EE 53
VITAL STATISTICS
The Division of Vital Statistics undertakes a wide variety of duties involved
in administering the Vital Statistics Act, the Marriage Act, the Change of Name
Act, and Part II of the Wills Act. These duties are carried out through the central
vital statistics offices in Victoria, a branch office in Vancouver, and 103 district
offices and suboffices throughout the Province.
In addition, the Division provides a centralized statistical service to Community Health Programs, and to certain other Government departments and voluntary health agencies, through a Research Section in Victoria and a Research Office
in Vancouver.
REGISTRATION SERVICES
Table 9 indicates the numbers of the main types of documents processed
under the above-mentioned Acts in 1974 and 1975, and reflects several significant
trends:
• There was an increase in the number of birth registrations over 1974. This
continued last year's upward trend following several years of declining
births.
• The number of wills notices registered under the Wills Act again increased,
although at a lesser rate than in recent years.
• The recent upward trend in numbers of name changes under the Change of
Name Act, following the broadening of the Act in 1972, was unabated in
1975.
• The number of divorce decrees, which has risen steadily since the liberalization of the Federal Divorce Act in 1968, turned more steeply upward
in 1975.
• The demand for certificates and other types of documentation continued
to increase substantially, and would have been greater but for the 40-day
national mail strike in the fall.
BIOSTATISTICAL SERVICES
Various recent developments within the Department have stimulated the
initiation of new research projects, with a resulting increased demand on the Division's Research staff in Victoria and Vancouver.
The Health Surveillance Registry (previously the Registry for Handicapped
Children and Adults) accepted about 3,000 new cases during 1975. The Department of Human Resources co-operated with the Registry in instituting a program
for registering handicapped adults in receipt of the Handicapped Persons Income
Allowance. From this source approximately 2,800 adult registerable cases were
ascertained and are being processed. A continuing procedure for the reporting
of similar cases is being worked out with the Department of Human Resources.
Over 2,000 cases, ascertained from birth, stillbirth, and death registrations,
hospital separation forms, and other sources were added to the file of congenital
anomalies.
The Registry makes extensive use of consultants who are experts in the fields
of genetics, pediatrics, and cancer. In addition to direct assistance in the day-today operation of the Registry these consultants were active in international conferences and workshops related to the work of the Registry.
 DEPARTMENT OF HEALTH REPORT,  1975
The Cancer Register is a specialized entity within the framework of the
Health Surveillance Registry. Further success was achieved during the year in
securing the co-operation of pathologists throughout the Province in submitting
pathological reports to the Cancer Register.
The Division assisted the Central Cytology Laboratory of the Cancer Control
Agency in the analysis of data derived from about 440,000 cervical smears taken
from women screened for cervical cancer. As from January 1975 the responsibility
for mechanical processing of these records was assumed by the Computing and
Consulting Services Branch of the Department of Transport and Communications,
thereby terminating the service rendered by this Division since 1956. The Division,
however, continues to undertake the analysis and interpretation of the annual
data, and general statistical consultation.
Registry staff continued to work closely with the Cancer Control Agency of
British Columbia (previously the B.C. Cancer Institute) and to process the records
of the agency relating to malignancies at the treatment facility in Vancouver.
Statistical consultative advice and data processing services were provided to
the Division of Dental Health Services. Assistance was also given in the development of a new recording form and revised methodology for the continuing series
of dental field surveys. The new form is designed to provide more comprehensive information on the levels of caries experience and restorative or corrective
treatment.
The Division participated actively in the work of the Perinatal Program
Committee of the B.C. Medical Association, which was formed in 1974. One
Research Officer has served as a member of the committee since its inception, and
another was appointed as a statistical consultant during 1975.   A number of special
 COMMUNITY HEALTH PROGRAMS
EE 55
tabulations relating to maternal and child health in this Province were prepared for
the use of the Program Committee.
The Division continued to co-operate with the Child and Maternal Health
Division of the Department of National Health and Welfare in the maintenance
of a national congenital anomalies surveillance program. Lists of anomalies
ascertained from physicians' notices of births were submitted to Ottawa throughout the year, and assistance was given in the critical examination of the resulting
data.
A Research Officer of the Division continued to represent Community Health
Programs on the interdepartmental Metric Committee. He assisted in the work
of subcommittees on training and cost analysis, and in developing a program of
basic education for all Health Department employees in the essentials of the metric
system.
The services rendered to the Division of Tuberculosis Control for many
years entered a new phase in 1975 with the computerization of the Division's punch
card records. Assistance was given to a physician attached to that Division, in
the statistical evalution of all newly diagnosed cases of tuberculosis from 1950 to
date.
The Research Section co-operated with the statistician attached to Mental
Health Programs in the processing of statistics relating to patients of residential
institutions and those treated at day care centres. Arrangements were made for
transferring to the Department of Human Resources the main responsibility for
processing statistics relating to three institutions for the retarded, which were
transferred during the year to that department's jurisdiction from the Health Department.
Services were given to the Community Care Facilities Licensing Board in
maintaining statistics of the operation of personal care homes and day care centres
for children. The transfer of the punch card files of these records to computer
tape has facilitated prompt response to the requirements of the Board for up-to-
date information.
The patient records relating to the expanding Special Home Care Projects were
processed, and summary data supplied to the Division of Public Health Nursing.
Assistance was given to a Public Health Nursing Consultant in preparing a report,
based on a study completed in 1974, on the effectiveness of the physician/public
health nursing liaison program.
In collaboration with the Medical Genetics Department of the University
of British Columbia, the Division initiated a computerized record linkage program
based upon the pioneer work of Dr. H. B. Newcombe at the Chalk River Nuclear
Laboratories of Atomic Energy of Canada Limited. The project involves the
linking of British Columbia vital and health records into individual and family
histories. By this means a wide variety of health-related studies, otherwise impracticable, can be made possible, while the confidentiality of individual records
is rigidly maintained. The project is under the immediate direction of a geneticist
who previously worked with Dr. Newcombe on the Chalk River project.
A new aspect of the Division's work assumed importance in 1975, namely,
the provision of consulting services in relation to behavioural studies. Notable
examples were a design of questionnaires to measure behavioural changes in children resulting from a program of Parent Study Groups in the Courtenay area; and
a study undertaken by the REACH agency, which involved the assessment of a tape
presentation designed to allay concern among the elderly about hospital admission.
 EE 56 DEPARTMENT OF HEALTH REPORT,  1975
The Division's Research Section maintained statistical services to the Divisions
of Epidemiology, Venereal Disease Control, Environmental Engineering, Public
Health Inspection, Speech and Hearing, and to the consultant in Public Health
Nutrition, in the editing and processing of records, and in statistical consultation.
The Mechanical Tabulation Section continued to undertake much of the
Division's requirements for processing of data, including the requirements of the
Research Section, as well as the extensive demands for preparation of indexes and
statistical data arising from the Division's legal registration functions.
Substantial progress was made in 1975 in the computerization of the Division's
data processing system, with a view to replacing the existing outdated unit record
equipment by a computer terminal connected to the central installation of the
Computing and Consulting Services Branch, Department of Transport and Communications. Because of the number and variety of the statistical series to be converted, the process is likely to take another year or two to complete, depending
on the availability of technical staff.
During the year, initial discussions were held with representatives of other
branches of the Department regarding the development of a computerized data system for the entire Health Department.
AID TO HANDICAPPED
The year was one of consolidation rather than expansion. Many new programs aimed at providing more and better services for the handicapped and those
who have been described as "disadvantaged" have been developed under various
Federal and Provincial Government auspices. A major part of the responsibilities
of Aid to Handicapped Consultants in the Province has been the promotion and
development of means by which services within a community can be co-ordinated
to the advantage of disabled people who are served by the Aid to Handicapped
Programs.
The advent of the new programs has resulted in a considerable increase in the
amount of time required for discussions and meetings to ensure that adequate
liaison is maintained with no loss of co-ordination.
In Greater Victoria Region, for instance, a "Co-ordination of Services for a
Deaf and Hard of Hearing" committee was set up. The Committee was chaired by
a representative of Integrated Services for Child and Family Development and was
made up of representatives of many professional services which deal with the deaf
and hard of hearing. The Aid to Handicapped Consultant in the region acted as
liaison with school counsellors and others. This creates a better awareness of the
services available to the deaf and hard of hearing in the community.
The Consultant in Greater Victoria was also involved in the program that
resulted in the publication of a book listing public buildings and recreational
facilities accessible to handicapped individuals.
In the Upper Vancouver Island Region, which includes Powell River and part
of the Sunshine Coast, a Consultant was involved with the Department of Labour
and the Department of Manpower in a joint Federal/Provincial program known as
the Community Employment Strategy Program. This is aimed at finding ways to
reduce barriers and open up job opportunities for chronically unemployed and
handicapped people. A number of active projects were developed under the
auspices of this program in the Nanaimo-Parksville area. The Consultant was also
responsible for the development of a group which dealt with the needs of a number
 COMMUNITY HEALTH PROGRAMS
EE 57
of students who, because of educational, mental, and physical handicap, would
experience more than average difficulty in making the transition from school into
employment.
The Committee included the Director of Special Education Services, the Director of Malaspina College Study School Centre, and representatives from the Canada
Manpower Centre.
In the South Fraser Region, which extends from Delta eastward to Hope, the
Aid to Handicapped Consultant was involved in the development of several community projects, some of which envisage the setting-up of workshops for the disabled. It is hoped that, if regular gainful employment cannot be predicted for
certain of the disabled, at least a useful and satisfying activity may be planned.
The Northwest Region, in which major centres are Prince Rupert, Terrace,
Kitimat, and Smithers, was staffed with a Consultant. Much developmental work
to ensure the co-ordination of community facilities and programs was required.
Other highlights of the Division's work were that
• working relationships were established with various agencies in the Skeena
Health Unit Area, including the B.C. Vocational School at Terrace where
many clients were referred over the past year for practical assessment programs and training, and Northern Training Centre at Smithers; programs
included assessment, practical training in farm work, social orientation and
experience, and workshop activities;
• Aid to Handicapped Committees were involved with new agencies and programs that have started up in the Health Unit Area over the past year,
including Osborne Guest Home, Terrace (a boarding-home primarily set
up for persons with some degree of mental impairment); Audiological Services, Terrace (an Audiologist was appointed to the Skeena Health Unit
during the past year and many clients were referred for assessment and
follow-up);
• the B.C. Vocational School in Terrace was transformed into a combination
of Vocational School and Community College in September, allowing for an
increased scope of training courses to be available to clients in the area;
• in May a local physician in Terrace was appointed Medical Consultant to
the Terrace Aid to Handicapped Committee and provided medical consultation at monthly meetings and acted as a liaison between the committee and
the doctors of the community concerning various medical aspects of an
individual's rehabilitation plan.
LABORATORY SERVICES
During the year much time was spent in planning new programs and new
accommodation for the Provincial Laboratories. In May, in preparation for building new facilities at the British Columbia Medical Centre (BCMC) Shaughnessy site,
the Environmental Analysis Group (TEAG) Ltd. submitted to the Department of
Public Works a study titled "Recommendations on Management Decisions, Preliminary Design Requirements, and Functional Program for Physical Facilities for the
Vancouver Laboratory of the Provincial Health Laboratories." By the end of July
the Deputy Minister of Health authorized establishment of a joint committee comprising representatives from the Provincial Laboratories, the Bureau of Special
Health Services, the Department of Public Works, and B.C. Medical Centre, to
undertake detailed planning for the new facilities closely integrated with, and sharing
services with, the facilities for clinical microbiology at the centre.
 EE 58 DEPARTMENT OF HEALTH REPORT,  1975
The year marked the move of the Nelson Branch Laboratory to the Kootenay
Lake District Hospital, Nelson. The new plan envisaged providing work space
large enough to meet the anticipated needs of the three southeastern Health Units—
Selkirk, West Kootenay, and East Kootenay.
The work load rose from 600,000 tests in 1974 to 637,000 in 1975, reflecting
the steadily increasing demand for service in recent years.
Methods for improving the speed of providing Provincial public health laboratory service were studied. It was concluded that regular delivery-courier services
between cities throughout the Province and the Main Laboratories in Vancouver
would cut down the delay in receiving specimens and returning reports. Accordingly, South Central and Northern Interior Health Units were selected for a pilot
study, with expansion to other health units in the future. Use of telecommunications
for reporting laboratory results also received consideration. Since the operation
of the Provincial Laboratories must be computerized, initial studies were begun.
BACTERIOLOGY SERVICE
Diphtheria
During the 12 years 1956 to 1967, only 15 patients with upper respiratory
diphtheria were recorded in British Columbia. In the four years 1968 to 1971,
143 new upper respiratory tract infections with Cory neb acterium diphtheria were
recorded. In the four years 1972 to 1975, the number of isolations of the disease
reached 709. Of these, 493 were located in the upper respiratory tract and 217 in
the skin (one patient had simultaneous respiratory and cutaneous infection).
Enteric Diseases
By culturing close to 18,000 stool specimens, almost 1,000 new cases of enteric
bacterial disease were diagnosed: Salmonellosis (420), shigellosis or bacillary
dysentery (270), and acute gastroenteritis of children (300). Nine isolations of
typhoid fever were diagnosed bacteriologically. During the year, culture of 270
specimens from nonhuman sources yielded 66 strains of Salmonella, indicating how
widespread these pathogenic micro-organisms are in the environment.
Food Poisoning
During the investigation of 144 incidents of suspected food poisoning, microbial
agents were identified on only 10 occasions: Staphylococcus aureus (5), Clostridium
perfringens (4), and Salmonella typhimurium (1). In one incident a child developed
mushroom poisoning after eating Amanita pantherina. In four incidents the provisional diagnosis was botulism, but the final diagnoses were hysteria; overdose of
Anacin (five tablets) and "Coke"; reaction to benztropine mesylate; and hernia.
Tuberculosis
While the demand for microscopic examination for tubercle bacilli and for
mycobacterial cultures of exudates and material other than sputum increased substantially, the increased demand for sputum culture was modest. Requests for
drug susceptibility tests on mycobacterial cultures remained at more than 1,000.
Ethambutol was added to streptomycin, isoniazid, and para-amino salicylic acid in
routine susceptibility tests. Some 300 mycobacterial cultures, other than Mycobacterium tuberculosis, were investigated and mycobacterial strains of eight different
species were identified.
 COMMUNITY HEALTH PROGRAMS
Venereal Diseases
EE 59
The laboratory aspects of the diagnosis and control of gonorrhoea and syphilis
are reported elsewhere. Use of the Automated Reagin Test (ART) as the screening
test for syphilis was continued successfully.
Whooping Cough
In 1971, culture of prenasal and postnasal swabs replaced cough plates in the
laboratory diagnosis of whooping cough. In the five-year period 1971 to 1975,
Bortella pertussis was isolated on 33 occasions from 214 swabs.
WATER MICROBIOLOGY
Water samples, collected from drinking-water sources, recreational waters,
and waters subject to pollution, were received from Governmental agencies at three
levels—Federal, Health and Welfare Canada and Agriculture Canada; Provincial,
Pollution Control Branch, Water Investigations Branch, Fish and Wildlife Branch,
and Health Units of the Department of Health; and municipal, municipalities
throughout the Province. The laboratory procedures carried out included total
coliform test, fecal coliform test, tests for fecal streptococcal group, standard plate
count, and identification of alge.
VIROLOGY SERVICES
Rubella
The epidemic of German measles (rubella) which began early in 1974 continued throughout 1975. This epidemic largely affected a population of unimmu-
nized adolescents and adults. About 90 per cent of the 1975 laboratory-tested
patients were 16 years of age or older, the reason for this being that the immunization
program introduced in 1970 was directed primarily at pre-school and elementary-
school children up to the age of 12 years.
Although an average of only 14 cases of rubella were laboratory proven per
year in the nonepidemic period, in 1974 the number of such cases was 200, and in
1975,588.
Among those whose blood is being tested, special emphasis is directed to pregnant women, newborn infants, and other contacts to proven cases.
Other Virus Diseases
The 200 other viruses indentified in 1975 included influenza A (70), herpes
(45), measles (44), mumps (10), and at least 10 other viruses. The epidemic
strain of influenza virus in British Columbia was type B in 1974 and type A Port
Chalmers in 1975.
TROPICAL AND PARASITIC DISEASES REFERENCE SERVICE
The Tropical and Parasitic Diseases Reference Service, operated by the Provincial Laboratories, provided advice and consultation on preparation for travel to
the tropics and on diagnosis and treatment of tropical and parasitic diseases acquired
by returning travellers and immigrants to Canada. Of particular interest was the
increased demand for examination of blood films for malarial parasites (from 36 in
1974 to 194 in 1975).   Of the 96 patients investigated, 76 had malaria parasites in
 EE 60 DEPARTMENT OF HEALTH REPORT,  1975
the peripheral blood. At the same time the demand for examinations for intestinal
parasites increased substantially from 15,750 in 1974 to 18,300 in 1975. For the
treatment of tropical and parasitic diseases, exotic drugs, not available commercially
in Canada, were supplied for the treatment of 42 patients with parasitic diseases
such as malaria, trichuriasis, filiariasis, and schistosomiasis.
COMMUNITY HUMAN  RESOURCES AND
HEALTH CENTRES
The Community Human Resources and Health Centres is a project jointly
supported and financed by the Department of Human Resources and the Department of Health.   It has three main objectives—
• Community involvement.
• Integration of services.
• Emphasis on prevention.
A task force, called the Development Group for Community Human Resources and Health Centres, acts as a link between the two Government departments and the Community Human Resources and Health Centres. Composed
of six professionals from different disciplines, their functions include management
and consultation.
There are now five Community Human Resources and Health Centres, each
with an elected Board of 10 to 15 members. For the most part the facilities are
complete, having frequently involved only the renovation of existing structures.
The basic services being integrated by the centres include social services,
public health nursing services, primary medical care, and mental health services.
The Orders in Council were passed in December, setting up the Boards and transferring to them the statutory powers for social services, public health nursing services, and mental health services. There are just over 100 multidisciplinary staff
in the five centres, with about one third of those to be seconded from their respective departments. Each centre, administered by a Board-hired co-ordinator, was
beginning to develop multiservice teams.
In the 1975/76 fiscal year the total operating budget for the centres was
$842,967, the Department of Health portion being $716,965.
• Houston Community Human Resources and Health Centre is located in a
one industry community of 3,000, and now provides primary medical care,
public health nursing, social services, and psychological services.
• Granisle Community Human Resources and Health Centre in this mining
community of 2,400 now provides primary medical care, social services,
part-time public health nursing, and is attempting to arrange for dental care.
• Boundary Community Human Resources and Health Centre (Grand Forks
Area) services a poulation of 9,500 in a large geographic area of approximately 100 by 60 miles. The centre has one Board and administrator with
three different locations, Rock Creek, Greenwood, and Grand Forks. Services include primary medical care (Rock Creek), social services, public
health nursing, mental health services, and some probation services.
• James Bay Community Human Resources and Health Centre, serving a
population of 10,000, the only urban centre in the project, is with a community school. The services offered by this centre include community
medical care, social services, day care, family life program, drug program,
 COMMUNITY HEALTH PROGRAMS EE 61
and volunteer services. The centre also acts as a base for probation services, public health nursing, and out-reach programs for manpower and
mental health.
Queen Charlotte Islands Community Human Resources and Health Centre
services an isolated population of 4,600 in the four separate locations of
Sandspit, Queen Charlotte City, Port Clements, and Masset. There is one
regional Board and a common administration, and services include primary
medical care, public health nursing, social services, dental care, physiotherapy, youth preventive programs, and senior citizen visiting. Plans are
now under way to include the services of the United Church Hospital in
Queen Charlotte City.
ACTION  B.C.
In 1974 a nonprofit organization known as Action B.C. was set up under the
Societies Act and funded by the Department of Health. The objective of the organization was "to promote positive health through increased physical activity and
good nutrition." During 1975, Action B.C. concentrated its work in three major
areas—schools, industry, and the community.
At the Pacific National Exhibition Fair and during the subsequent daily program for schools at the PNE, over 19,000 students were involved in an obstacle
course and in Action B.C.'s children's step-test.
One-hour-a-day physical activity programs for each child were initiated by
Action B.C. in two elementary schools in Prince George, and these will be expanded
to many more schools in that city and elsewhere in 1976.
The two-year industrial activity program designed by Action B.C. for the
Vancouver main office staff of Cominco was started in the fall of 1975 and has had
a consistently high participation rate of over 70 per cent. Action B.C. is continuing
to plan, motivate, and provide the leadership for similar programs for many other
companies throughout the Province.
Community activities and events have provided Action B.C. with the opportunity to contact people in all walks of life and to bring to them an awareness of
the potential for an enhanced quality of life. Through the use of the Canadian
Home Fitness Test, developed by Recreation Canada, Action B.C. has tested and
advised over 10,000 adults, more than any other province. The results of this
simple step-test, designed as an indicator of cardiovascular fitness, has enabled
Action B.C. to recognize the pressing need for life-style change which has been the
main focus of our activity counselling sessions.
With the ever-growing interest shown by both professional and public in the
area of preventive health, Action B.C. will continue to act as a catalyst and motivating force to help bring about the changes urgently required in our life-style.
COUNCIL OF PRACTICAL NURSES
The British Columbia Council of Practical Nurses, under the authority of the
Practical Nurses Act, has completed 11 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);
• the College of Physicians and Surgeons of B.C. (one member);
 EE 62
DEPARTMENT OF HEALTH REPORT,  1975
• the Registered Nurses' Association of B.C. (two members);
• the Minister of Education (one member);
• the British Columbia Hospitals' Association (one member);
• the Licensed Practical Nurses Association of B.C. (three members).
During these 11 years, 76 general meetings of the Council were held, as well as a
great many standing and special committee meetings. During Council meetings
over the years, 12,248 applications for licensure were received; the disposition of
these is given in Table 12. Consideration was given to graduates of B.C. College
and Hospital Programs and to a large number of applicants from outside British
Columbia and Canada.
Responsibility for the preparation, administration, and marking of all practical
nurse testing was transferred to the Council by the Department of Education at the
end of this year. To prepare for this function it was necessary to add a part-time
clerk to the Council's staff.
The Council continues to work closely with the Department of Education
through the Council member nominated by that Department, and this year with the
British Columbia Medical Centre through a staff member of its Education Committee who attends meetings of the Council as an observer. This addition co-ordinates
the licensing and new testing functions with the educational responsibilities of the
BCMC.
VOLUNTARY HEALTH AGENCIES
During 1975 the Department 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 socio-economic groups in the population. Over $2,000,000 in grants were
awarded to these agencies for the 1975/76 fiscal year.
 COMMUNITY HEALTH PROGRAMS
EE 63
Table 1—Reported Communicable Diseases, British Columbia, 1971—75
(Rate per 100,000 population)
1971
1972
1973
1974
1975
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Amcebiasis	
Brucell 	
Diarrhoea   of   the   newborn
(£. coli)	
Diphtheria  -	
Dysentery, type unspecified ..
Food infection—
1
........
64
11
126
548
8
6
1,954
1
17
45
91
1,168
200
241
306
5
0.2
2.9
0.5
5.7
24.9
0.4
0.3
89.0
(!)
0.1
0.8
2.0
4.2
53.2
9.1
11.0
13.9
0.2
........
1
	
60
11
72
415
73
16
5
1,894
26
34
22
102
1
84
97
202
454
13
7
0.1
2.7
0.5
3.2
18.5
3.2
0.7
0.2
84.3
1.2
1.5
1.0
4.5
0.1
3.7
4.3
9.0
20.2
0.6
0.3
.....
	
29
51
34
320
36
25
1,755
25
1
47
20
102
1
77
158
212
836
1
1
3
1.3
2.2
1.5
1.39
1.6
1.1
.......
75.8
1.1
0.1
2.0
0.9
4.4
0.1
3.3
6.8
9.2
36.1
0.1
0.1
0.1
2
52
69
91
302
7
	
1,381
11
43
12
66
342
573
203
789
«
	
0.1
2.2
2.9
3.8
12.6
0.3
0.1
57.7
0.5
1.8
0.5
2.8
14.3
23.9
8.5
32.9
0.3
1
1
49
22
97
456
33
962
10
1
33
16
49
476
1,149
184
739
8
0.1
0.1
2.0
0.9
3.9
18.6
Unspecified	
Food intoxication—
Staphylococcal	
1.3
Hepatitis—
Infectious	
39.2
0.4
Leprosy 	
Meningitis—
0.1
1.3
Viral	
0.7
2.0
Rubella 	
Rubeola 	
19.4
46.8
7.5
Streptococcol   throat   infec-
30.1
Tularaemia	
Typhoid    and    paratyphoid
0.3
Western equine encephalitis-
Totals       	
4,792
218.2
3,587
159.7
3,734
161.3
3,951
165.0
4,286
174.4
i Infectious and serum hepatitis combined.
Table 2—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946, 1951, 1956, 1961, and 1966-75
Year
Infectious Syphilis
Gonorrhoea
Number
Ratei
Number
Ratei
1946  	
834
83.0
4.618        1        460.4
1951  	
36
3.1
3,336
286.4
1956    ....
11                  0.8
3,425
244.9
1961	
64
3.9
3,670
225.3
1966     	
71
3.8
5,415
290.8
1967   	
72
3.7
4,706
242.0
1968	
68
3.4
4,179
208.6
1969  ...
45
2.2
4,780
232.0
1970 	
76
3.6
6,070
285.2
1971 ..... ....  	
73
3.4
7,116
325.7
1972.  	
98
4.4
7,921
352.5
1973  ...
101
4.4
8,955                386.6
1974	
146
6.1
9,284                387.6
19752	
174
7.1
9.793                398.6
1 Rate per 100,000 population.        2 Preliminary.
 EE 64 DEPARTMENT OF HEALTH REPORT,  1975
Table 3—Selected Activities of Provincial Public Health Nurses, September 1974
to August 1975, Inclusive1
Expectant parents—
Class attendance by mothers  31,757
Class attendance by fathers  17,222
Prenatal home visits  6,208
Postnatal home visits  15,226
Child health-
Infants—
Conference attendance  58,977
Nursing visits  55,954
Service by auxiliaries  1,646
Pre-school—
Conference attendance  84,229
Nursing visits  26,901
Service by auxiliaries  12,769
Special assessments of infants and pre-schools  18,965
School—
Screening test by public health nurse  206,545
Follow-up by public health nurse  28,974
Service by auxiliaries  95,760
Conferences with students  33,222
Conferences with staff  89,292
Home and office visits  36,724
Adult home and office visits (age 19-64)  111,018
Geriatric home and office visits (over 65)  121,694
Geriatric clinics  461
Family planning clinics  1,108
Family services—
Total visits to homes  255,718
Professional services by telephone  284,219
Immunizations—
Smallpox  92,751
Poliomyelitis    159,408
Basic series of diphtheria, pertussis, and tetanus  161,376
Rubella    26,224
Rubeola  20,082
Other (mostly reinforcing doses)  _ 40,105
Total doses  499,946
Tests—tuberculin, diphtheria, and other     29,155
1 Services provided by public health nurses under the jurisdiction of the Health Department, Public Health
Programs, and do not include services provided by Greater Vancouver, New Westminster City, or the Capital
Regional Health Services.
 COMMUNITY HEALTH PROGRAMS
EE 65
Table 4—Selected Activities of Provincial Public Health Inspectors,
1972-75, Inclusive
Type of Inspection or Activity
1972
1973
1974
1975
(Estimate)
Inspection—
Food premises—
Eating and drinking places  — ...
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
3,109
1,234
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
1,870
2,740
314
3,225
1,535
10,051
2,558
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
480
686
6,140
14,786
3,361
2,107
2,776
541
3,330
1,479
11,435
2,288
Other	
2,066
Factories             	
Industrial camps   	
Community care1..   	
Schools    	
Summer camps   	
Housing    	
Mobile-home parks   	
415
354
2,804
497
338
1,710
2,195
1,531
770
Hairdressing places  	
Farms  	
420
395
470
Water and waste investigation—
Swimming-pools—
Inspection    	
3,106
2,006
447
798
Public water supplies—■
Inspection... 	
Samples  ...
Private water supplies—
1,982
6,778
2,940
3,362
Pollution and survey samples   	
Private sewage disposal    	
829
24,117
415
Plumbing     	
Land use investigation—
814
5,398
14,819
Nuisance investigation—
3,604
1,964
2,898
875
2,258
1,415
i Includes boarding-homes, youth hostels, day-care centres, hospitals, and other institutions.
 EE 66
DEPARTMENT OF HEALTH REPORT,  1975
Table 5-—Number and per Cent of Children Immunized Prior to Entry to
Kindergarten (as at September 1974)
Greater
Vancouver
Capital Region
Remainder of
Province1
Total
Total children in kindergarten
9,270
2,569
21,194
33,033
Type of Immunization
Number 1 Per Cent
1
1
Number I Per Cent
Number
Per Cent
Number
PerCent
Smallpox  	
Diphtheria, pertussis, and tetanus..
5,023
6,372
5,959
5,262
54.2
68.7
64.3
56.8
2,046 |      80.0
1,883 |      73.0
1,819 ;      72.0
1,718 |      67.0
11,143
14,579
14,189
13,387
52.6
68.8
67.0
63.2
18,212
22,834
21,967
20,367
55.1
69.1
66.5
61.7
1 Figures for New Westminster and Coquitlam (School Districts Nos. 40 and 43) not available.
Table 6—Number and per Cent of Grade V Pupils Immunized as at June 1975
Greater
Vancouver
Capital Region
Remainder of
Province
Total
11,223
3,705
29,975
44,903
Type of Immunization
Number
Per Cent
Number
Per Cent
1
Number I Per Cent
1
Number
Per Cent
Smallpox	
7,311
9,468
9,405
7,687
65.1
84.4
83.8
68.5
2,762
3,284
3,293
1,737
75.0
88.0
88.0
47.0
1
21,902 |      73.1
26,068 |      87.0
25,528         85.2
13,732         45.8
1
31,975
38,820
38,226
23,156
71.2
86.5
85.1
51.6
Table 7—Number and per Cent of Grade V Girls Immunized for Rubella
as at June 1975
Greater
Vancouver
Capital Region
Remainder of
Province
Total
5,380
1,721
14,366
21,467
4,766
88.6
1,486
86.3
11,757
81.8
18,009
83 9
 COMMUNITY HEALTH PROGRAMS
Table 8—Pupils Referred for Health Services
EE 67
Capital Region1
Area Served by Health
Department2
Reason for Referral
Referred to
Public Health
Nurse
Referred by
Public Health
Nurse for
Further Care
Referred to
Public Health
Nurse
Referred by
Public Health
Nurse for
Further Care
2,330
1,402
188
716
1,332
2,409
1,357
444
136
332
515
843
25,543
10,727
1,805
5,233
6,882
18,498
13,655
3,086
Emotional  .....
2,221
2,477
Other                                              	
5,488
8,377
3,627
68,688        |        27,932
17.7
7.7
18.2        1             7.4
1 Total enrolment, 47,390.        2 Total enrolment, 376,440.
Table 9—Registrations, Certificates, and Other Documents Processed by
Division of Vital Statistics, 1974 and 1975
Registrations accepted under Vital Statistics Act— I974
Birth registrations  35,393
Death registrations    19,847
Marriage registrations    21,673
Stillbirth registrations  317
Adoption orders    1,704
Divorce orders   6,328
Delayed registrations of birth  410
Registrations of wills notices accepted under Wills Act  34,570
Total registrations accepted     120,242
Legitimations of birth effected under Vital Statistics Act ____ 249
Alterations of given name effected under Vital Statistics Act 282
Change of name under Change of Name Act  1,715
Documents issued by the Central Office—
Birth certificates  78,194
Death certificates  9,085
Marriage certificates  8,220
Baptismal certificates  3
Change of name certificates  1,881
Divorce certificates  263
Photographic copies  10,143
Wills notice certifications  12,609
Total documents issued    120,398
Nonrevenue searches for Government departments by the
Central Office  11,941
Total revenue earned  $488,599
1975
(Preliminary)
35,570
18,860
21,570
410
1,880
7,250
380
37,300
123,220
180
250
1,890
79,340
8,970
8,600
20
2,000
230
10,800
12,530
122,490
11,200
$527,940
 EE 68 DEPARTMENT OF HEALTH REPORT,  1975
Table 10—Case Load of Division for Aid to Handicapped, 1975
Cases under assessment or receiving services, January 1, 1975  1,116
New cases—
Referred to Aid to Handicapped Committees in Vancouver Metropolitan Region and North Fraser Region (11 committees) __._ 589
Referred to Aid to Handicapped Committees outside Vancouver
Metropolitan Region (36 committees)   713
Referred from other sources     34
Total new cases  1,336
Cases reopened (all regions)       328
Total cases provided with service in 1975  2,780
Cases Closed During 1975
Rehabilitated—
Employment placement made by—
Canada Manpower  69
Aid to Handicapped  20
Self   205
Other   144
Total placed in employment  438
Job placements not feasible, restorative services completed  232
Not rehabilitated—
Severity of disability  219
Unable to locate clients  128
Other   418
Total not rehabilitated  765
Other reason—
No disability     8
No vocational handicap     11
Deceased      21
Total other reasons     40
Total cases closed in 1975  1,475
Cases remaining in assessment or receiving services, December 31, 1975  1,305
 COMMUNITY HEALTH PROGRAMS
EE 69
Table 11—Tests Performed by Division of Public Health Laboratories,
1974 and 1975
1974
1975
Main
Nelson
Victoria
Main
Nelson
Victoria
Bacteriology Service
Enteric Section—
Cultures—
Salmonella/Shigella   — -	
Enteropathogenic E. coli    -	
14,431
3,159
219
6,942
4,309
17,440
3,437
15,709
105,353
480
29,992
22,157
1,099
295
568
15,749
1,125
28,694
2,385
7,251
376
2,819
4
181,292
9,285
8,958
5,315
1,973
248
2,071
140
210
126
35,831
2,091
4,406
2,124
340
4.746
1,102
8
7,666
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
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
578,233~
261
4,653
1,365
31
Miscellaneous Section—
Cultures—
139
426
253
25
184
273
3,295
1
54
13
Fungus —     	
N. gonorrhoea  _   	
7,145
955
20
2,219
2,185
128
2,692
8,865
2,396
	
1,713
20
Tuberculosis Section—
	
2,154
Smears—M. tuberculosis   _ 	
Sensitivity tests  ____  	
6
4
1,768
2
2,706
3
Parasites—
3,004
42
3,382
496
61
3,361
490
Water Microbiology Section—
3,820
96
609
3,695
602
379
	
19
Serology Section-
Syphilis—
2,126
17,349
18,096
ASTO
908
693
968
189
864
Virology Service
Virus isolation—■
...
1
	
Serological identification—
Hemagglutination inhibition—
Rubella                              	
Totals,— -  -	
538,083
9,795
600,129
52,251
7,479
51,489
637,201
 EE 70
DEPARTMENT OF HEALTH REPORT,  1975
Table 12—Licensing of Practical Nurses
(Disposition of applications received since inception of program in 1965 to October 31, 1975)
Received  12,248
Approved—
On the basis of formal training  7,421
On the basis of experience only—
Full licence   396
Partial licence   876
  1,272
  8,693
Rejected     1,765
Deferred pending further training, etc.  1,421
Deferred pending receipt of further information from applicants      297
Awaiting assessment at October 31, 1975        72
  12,248
Number of licences issued to October 31, 1975  7,921
Number of practical nurses holding currently valid licences at October 31,
1975   6,150
Table 13—Number of Cases Referred for Hearing Assessment, by Source,
Division of Speech and Hearing, 1975
Referral Source
Total
Physician
PHN
Mental Health
Other
I
1,624          |
709
16
272
2,621
Table 14—Number of Cases Referred for Hearing Assessment, by Type of
Evaluation, Division of Speech and Hearing, 1975
Type of Evaluation
Initial
Assessment
Re-assessment
Hearing-aid
Evaluation
Rehabilitative
Audiology
Other
Total
Number of cases	
i
2,056                    409
1
79
37
40
2,621
Table 15—Hearing Impaired Cases, by Degree and Type of Impairment,
Division of Speech and Hearing, 1975
Type of Impairment
Degree of Impairment
Total of
Mild
Moderate
Severe
Profound
Each Type
Conductive	
Sensorineural	
Mixed	
426
191
21
152
308
57
24
208
41
0
53
8
602
760
127
638
517
273
61
1,489
 1A
O
a
x
  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 first 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:
73
  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.
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 sees patients on an appointment basis 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.
Following rapid expansion of mental health centres throughout the Province
over the past five years, 1975 was characterized by a reorganization of administrative support services to ensure a continued co-ordination of services and planning.
In order to facilitate better liaison between the centres and Victoria headquarters,
it was proposed to appoint a Director for each region. Pending final approval for
appointing permanent directors, existing personnel were asked to assume this
responsibility for specific regions.
Regional reports of the community mental health centres follow:
LOWER MAINLAND REGION
The Lower Mainland Region is comprised of mental health centres located
in Sechelt, Squamish, New Westminster, Whalley, Surrey, Langley, Port Coquitlam, Maple Ridge, Abbotsford, and Chilliwack. During the year, these centres
treated over 2,800 patients. Direct services to patients accounted for nearly two
thirds of the time of the mental health teams.   In addition to these direct services,
75
 EE 76 DEPARTMENT OF HEALTH REPORT,  1975
the centres provided consultation to various community agencies dealing with
emotionally disturbed clients. Staff were increased through the introduction of
12 community psychiatric nurses who provided home care for the adult patient
who might otherwise require admittance to hospital. These nurses were placed
on teams which were responsible for an admission and treatment program for the
seriously disturbed adult, utilizing the facilities of Riverview Hospital. This program was in effect in New Westminster, Whalley, Surrey, Port Coquitlam, Maple
Ridge, and Langley. Psychiatric services were available in all team locations
except Squamish and Chilliwack. In both direct services and in consultation, centre
staff worked closely with local physicians, community public health programs,
Department of Human Resources, the schools, the local hospital, Probation, the
Courts, and many other local groups.
Examples of the types of special projects in which the regional centres became
involved during the year, follow:
In Abbotsford, under the joint sponsorship of the mental health centre and
Fraser Valley College, a variety of workshops, seminars, and study sessions, called
the Adult Development Program, was developed. The program offered an ongoing
opportunity for clients referred to the centre, as well as the public at large, to
participate in a learning experience at the centre. The popularity and benefit of
this approach was soon felt by the greatly increased numbers of people participating, who would not likely attend the mental health centre for traditional therapy.
The Langley team co-operated with the weekly drop-in program at a local
church, for a group of elderly persons from several boarding-homes. At the centre
itself, a weekly drop-in was held for former Riverview Hospital patients.
In Maple Ridge a training course was designed for volunteers in the crisis
centre, to become lay family counsellors. Emphasis was placed on training interested community groups to offer counselling for family problems, or acute emotional crisis situations, in their early stages.
A professional staff member in Sechelt was actively involved in an interagency group, which was developing a youth treatment home to serve eight youths
between the ages of 6 and 15.
A summer play therapy program was sponsored by the Squamish Centre as a
means of dealing with its large case load of children. Three university students
were assigned to act as group therapists, assisted by high school students. The
program brought about marked improvements in the social behaviour of the
children.
The Surrey Centre was asked to provide field work experience for students
from the School of Social Work at UBC, Royal Columbian Hospital, B.C. Institute
of Technology, Vancouver City College (Langara Campus), Douglas College
(Surrey Campus), and Western Washington State University at Bellingham.
The Whalley team was instrumental, with others in the community, in the
establishment of a co-ordinated drug and alcohol project. Funds were received
from the Alcohol and Drug Commission for a community development worker
and counsellor.
OKANAGAN THOMPSON KOOTENAY REGIONS
The Okanagan Thompson Kootenay Regions are served by mental health
centres situated in Kamloops, Vernon, Kelowna, Penticton, Nelson, Cranbrook,
and Trail. Satellite operations were maintained through these centres by way of
travelling clinics to Merritt, Ashcroft, Revelstoke, Keremeos, Salmon Arm, Caws-
ton, Osoyoos, Hedley, Golden, Fernie, Sparwood, Kimberley, Creston, Castlegar,
Salmo, Nakusp, New Denver, Riondel, Grand Forks, and Rossland.
 COMMUNITY HEALTH  PROGRAMS
EE 77
During the year, 2,576 patients received treatment under mental health centre
auspices throughout these regions, a slight increase over the 2,564 seen the previous
year. In all, direct services, i.e., direct patient contact, accounted for roughly 60
per cent of the total time of the professional staff within these regions, the balance
being devoted to indirect services, namely, the development of supportive mental
health related services, community education, and agency consultation, etc. Although the individual centres varied widely in terms of patient groupings served,
the over-all picture indicated that services to the moderately disturbed adult and
child were in heaviest demand.
By the year-end most of the centres were operating with full complements
of staff. In terms of personnel availability, Kamloops, Vernon, Cranbrook, and
Trail suffered from a lack of necessary psychiatric input to meet service demands.
Recruitment of psychiatrists appeared to be a longstanding problem in certain
parts of these regions.
The following represent some of the special projects in which individual
centres became involved throughout the year:
In Kamloops, drop-in centres for both boarding-home operators and long-
term patients were initiated. The Clinical Classroom program for seriously disturbed children was continued. A summer camp program was developed for 42
long-term residential patients, and an employment program for a select group of
residential psychiatric patients was instituted.
An independent-living home was initiated by Boarding-home Program staff
of the Vernon Centre for a select group of residential psychiatric patients. Summer students conducted socialization groups for children lacking in social skills,
activity therapy programs for boarding-home residents, and participated in a research program involving children with special problems.
In Kelowna, the Boarding-home Social Worker initiated a highly successful
activity program for residential psychiatric patients over the summer months.
Consultation services were extended to the newly opened Kelowna Women's Centre,
Child Care Centre, and the Street Worker Program. Adult Education programs
were developed in response to requests from the Kelowna Homemakers' Association and the Home Care Nursing Program. One of the centre's psychiatrists was
appointed to the B.C. Forensic Commission; and consultative services were extended to the Community Court System and the RCMP.
The Penticton Centre involved summer students in a follow-up study on
Human Services available to the Penticton area. This updated the comprehensive
"Penticton Profile" of 1970. Summer students also offered recreational activity
and support to residential psychiatric patients and senior citizens in the Summer-
land area. A work experience program for the retarded was initiated and supervised, and disadvantaged youth in the Keremeos-Cawston area were served by a
summer recreational program. Consultation by centre staff continued to be provided to the South Okanagan Human Resources Society, Aid to the Handicapped,
Penticton Alternate School, Youth Guidance Councils, Homemaker Services, Street
Workers, among others in the Penticton area.
Summer students were involved in six community-based projects in Nelson.
Mental health centre staff worked actively with the Justice Development Commission with a view to initiating an in-depth drug dependency survey, and later, the
establishment of an alcohol and drug preventive and treatment program for the
Kootenays. Training facilities were provided for student nurses and health service workers (Welfare Aides). Parent Effectiveness Training courses were extended to a large number within the community.    Centre personnel continued to
 EE 78
DEPARTMENT OF HEALTH REPORT,  1975
provide consultation to a variety of community services, including the Nelson Community Services Centre, Youth Activities Society, and the Kootenay Society for
the Handicapped.
Child-rearing workshops were conducted for the general public by the Cranbrook Mental Health Centre in conjunction with a local parents' organization.
The centre's psychologist was involved as board member and volunteer trainee
for the newly formed Mental Health Society Drop-in Centre. Centre staff were
instrumental in helping to organize and train community lay counselling groups in
Kimberley and Golden. Weekly educational functions were conducted for a Grandmother Surrogate group. The East and West Kootenay Boarding-home Social
Workers conducted regular boarding-home operation workshops.
Group programs for women discharged from mental health facilities were
initiated by the Trail Mental Health Centre. Summer students provided 30 children with important social and recreational activities. In co-operation with the
CMHA, an LIP program was instigated employing child care workers to work
with seriously disturbed children. Consultation services by centre staff were extended to public health nurses, teachers, family court workers, college and high
school counsellors, social assistance workers, and professionals in other communities. Advisory functions continue to be extended to the CMHA, Kootenay Alcoholism Society, Association for Community Planning, Selkirk Social Service Aide
and Nursing programs, Big Brothers, and many other community organizations.
Boarding-home Program staff were involved in the development of a semi-independent apartment facility in Castlegar. Three research projects were conducted
throughout the summer months—a community mental health attitude survey, a
study of the Trail Alternate School program, and a survey of client evaluations
of centre services.
 COMMUNITY HEALTH PROGRAMS EE 79
Throughout the Okanagan Thompson Kootenay Regions, population growth
was extensive. Accompanying this dramatic growth was a corresponding increase
in service demands on the mental health delivery system.
With staffing complements originally designed to serve less than half the
current population, many of the mental health centres were no longer in a position
to keep pace with community demands. To continue to provide a high standard
of care through the mental health centres, it will be necessary both to relate future
staffing requirements more closely to the escalating population figures, and to define
more precisely the program priorities.
NORTHERN BRITISH COLUMBIA REGION
Community Mental Health Programs in Northern British Columbia are provided by staff from the Fort St. John, Prince George, Williams Lake, Prince Rupert,
and Terrace Mental Health Centres. All centres operate as much as possible on
an open-door policy in which an attempt is made to accommodate requests for
mental health related services. Due to limitations on facilities and staff, the
demands for service on the existing centres were very heavy. Fortunately, a number
of other agencies also provide related services, or different aspects of the same
service, and a close liaison existed with these agencies. In addition, active support
by other community groups and local government was often provided. Community volunteers played an increasingly active role in assisting mental health
centre staff. Staffing in northern parts of the Province continued to pose somewhat of a problem, in that vacancies in some locations were difficult to fill. It
was the general policy to provide periodic services by staff members from either
the nearest mental health centre or from facilities on the Lower Mainland, in those
areas in which it was not possible to locate a full-time local mental health centre.
Efforts were being made to obtain a documentation of the various mental health
related needs in the communities throughout the northern region, in order to facilitate future planning.
Services which were provided by the individual mental health centres reflected
the differences in mental health needs in the respective communities. In Fort St.
John, special programs involved persons with personal crises, those who had acute
problems in interpersonal relationships, and those who had been hospitalized for
mental health related problems. Special programs were also provided for children,
native Indians, and in the area of forensic care.
The Prince George Mental Health Centre emphasized individual, group,
marital, and family programs. A liaison was being developed with the newly established psychiatric ward at the Prince George Regional Hospital, with emphasis on
both in-patient involvement and out-patient follow-up. High priority programs by
the Williams Lake area staff included communication between parent and child,
adults and children with special mental health problems, and a variety of programs
for various community groups. In Terrace, many program activities were shared
with other community resources such as Human Resources, Public Health, Probation Services, Education, Justice Council, volunteers, law enforcement, ministers,
crisis workers, and service clubs interested in mental health activities. Other priority programs included services for adults and follow-up and support services. In
Prince Rupert, mental health programs of special interest included services for
individuals, couples, families, and liaison with other agencies, especially Human
Resources, Education, Probation, and Public Health.
 EE 80 DEPARTMENT OF HEALTH REPORT,  1975
VANCOUVER ISLAND REGION
On Vancouver Island, and the adjacent Powell River area, mental health
centres are located in Victoria, Saanich, Duncan, Nanaimo, Port Alberni, Courtenay, and Powell River. These teams admitted over 2,300 patients to service in
1975. Direct services to patients accounted for nearly two thirds of the time
of these teams. In addition to direct services, centre staff provided consultative
services to a number of community agencies dealing with emotionally disturbed
clients. Five community psychiatric nurses were added to the regional staff. These
included three nurses placed in the Victoria and Saanich centres to assist patients
released from the Eric Martin Institute of Psychiatry, and one each added to the
Nanaimo and Port Alberni centres. In this region, local psychiatric services were
available and many of the areas were virtually self-contained for the treatment of
the seriously disturbed adult. In direct service and in consultation, the teams
worked closely with local physicians, community public health programs, Department of Human Resources, the schools, the local hospital, Probation, the courts,
and numerous other local groups.
With major assistance from the Courtenay Mental Health Centre, the Comox
Valley Mental Health Society opened a halfway house in Courtenay during the
year, serving patients released from the hospital's psychiatric unit, and accepting
people directly from the community who needed a period of supportive care.
The psychiatrist and psychologist of the Duncan team provided daily consultation and support to the psychiatric unit at the Cowichan District Hospital.
A great deal of effort went into the establishment of the unit, which was providing
a viable service at the year-end.
During the year the Nanaimo mental health team, in co-operation with the
Canadian Mental Health Association, expanded the functions of the Nanaimo
Contact Program to include a drop-in clinic for parents of young children; an
activity centre for psychiatric patients; and a co-operative venture in day-care
programming for patients of the Nanaimo Regional Hospital.
The Port Alberni Centre provided a program of group therapy for approximately 50 patients. In addition, the centre had an extensive volunteer program,
both to assist with therapeutic groups and individual services, with nearly 50 persons in volunteer training. Space for these programs was provided in the centre,
in four community churches, and in the local school.
Powell River staff gave a great deal of assistance to the community resources
society, in the establishment of an office and the selection and hiring of a full-time
co-ordinator. This group helped to develop a family life association to train a
core group of counsellors.
The Saanich Centre assisted in the development of the Saanich Peninsula
Guidance Association, the Citizens Counselling Centre, and Cornerstone (an
activity centre for severely emotionally handicapped people).
In Victoria, the addition of two community psychiatric nurses to the centre
enabled them to develop a closer working relationship with the Eric Martin Institute of Psychiatry and with physicians in the community. More service was
being given to clients in their own homes. A further development was the integration of some of the out-patient services offered by the Eric Martin Institute
and the centre.
 COMMUNITY HEALTH PROGRAMS EE 81
THE GREATER VANCOUVER MENTAL
HEALTH  SERVICE
The basic mandate of the Greater Vancouver Mental Health Service, which
was to provide treatment and offer an alternative to hospitalization for the seriously
emotionally disturbed adult, essentially remained unchanged in 1975. The addition of Family and Children's Workers to some of the community care teams
meant that services could be provided to patients' families and children.
By the end of 1975 the Greater Vancouver Mental Health Service consisted
of six community care teams operating in the West End, Strathcona, Mount
Pleasant-Fairview, Richmond, Kitsilano, and the West Side. Additionally, two
teams were in operation in Burnaby, administered by the Central Office but under
the operational control of the Burnaby Mental Health Centre. During the year
the Riverview Out-patient Department was transferred to the GVMHS. It was
renamed the Broadway Clinic and has enabled the Service to develop an integrated
net of community mental health facilities in Greater Vancouver. Venture and
Vista were also transferred to this administration on April 1. Acquiring Venture
provided the GVMHS with 16 beds for short-term crisis patients. Vista continued
in its former role as a rehabilitative residence for female psychiatric patients.
In comparison to 1974, the number of patients in treatment increased dramatically. In October 1974 the GVMHS patient load was 949; at the same date in
1975 there were 2,116* patients being treated by the teams.
The Evaluation and Planning Division carried out a number of ad hoc studies
during the year, which greatly assisted the Central Office in planning the development of future services. For example, the Division carried out a study of the on-
call system, and came up with recommendations which resulted in a more effective
and economical service. A manual was compiled for the use of senior personnel,
which included the pertinent demographic data and social indicators for each service area of the city.
The field work emanating from the students' summer research project was
completed, and at the year-end the results were in the process of being written up.
Studies were being completed in the following areas:
• Patient satisfaction.
• Referral sources.
• Housing and nutrition.
• Recidivism.
• Crossroads (Richmond).
• Riverview Hospital admissions.
Priority was being given to developing a management information system for
the Service. It was imperative that operating data be available to both the Central
Office and the teams, for evaluation and planning purposes.
During the year, collective agreements were jointly negotiated with the Registered Nurses' Association of B.C. and the Registered Psychiatric Nurses' Association of B.C., which were tailored to the needs of the Service, rather than simply
conforming to the contracts negotiated by the Public Service Commission. For
nonunionized employees, the Service followed the master agreement negotiated
between the Public Service Commission and the B.C. Government Employees'
Union.
* Excludes two Burnaby teams.
 EE 82 DEPARTMENT OF HEALTH REPORT,  1975
An employee evaluation system was in the process of being introduced
throughout the Service, and the form and procedures which were to be used were
being developed by a task force composed of team members.
The Community Care Team Audit Committee, chaired by Dr. J. Miles of
the UBC Health Sciences Hospital, met regularly throughout the year. The committee rotated its meetings throughout each team. Patient records were reviewed
and appropriate comments made in writing to the Team Co-ordinator. During the
last year, three suicides were investigated.
A task force report was completed during the year, and a final position statement regarding clinical policies was to be issued to the teams in the immediate
future. The task force did an excellent job of ensuring that sound clinical practices were emphasized, and yet a degree of flexibility was preserved, based on the
uniqueness of the community care team concept.
Citizen participation in the Service continued to be disappointing. Several
key citizens played a vital role in the Board of Management, and in keeping several
of the Citizens' Advisory Committees intact and functioning well. Generally
speaking, however, it was difficult for the majority of the teams to develop and
maintain a viable citizens' component. The Citizens' Council, which was the overall representative body of the Citizens' Advisory Committees, was developing a
frame of reference for both itself and the local committees. The council was also
developing ways of stimulating citizen interest in each service area.
The GVMHS continued to develop a close liaison with the local hospitals,
and there was an arrangement between the West Side Team, the Health Sciences
Hospital, and Vancouver General Emergency to screen and admit any patient requiring hospitalization to the Health Sciences Hospital from the West Side service
area.
A similar arrangement was negotiated between the Broadway Clinic and
Shaughnessy Hospital for the east area of the city. In effect, this meant that patients residing in this area, if requiring hospitalization, would be referred to local
hospitals rather than the Crease Unit of Riverview Hospital.
It was hoped that a similar understanding could be arrived at with the West
End Team, Strathcona Team, and St. Paul's Hospital. As local hospital beds
became available, it was anticipated that all but the patient who was unmanageable
in a local hospital could be cared for within the city.
THE  BURNABY MENTAL HEALTH  PLAN
The Burnaby Mental Health Plan, commonly referred to as Burnaby Psychiatric Services, continued to provide the Province's only integrated and comprehensive urban program of psychiatric resources for adults and children.
In-patient Service—There was greatly increased utilization of the 25-bed
acute psychiatric in-patient unit in 1975, and by the beginning of November the
unit was operating at full capacity. The unit provided Burnaby residents with
effective in-patient treatment and worked very closely with the community care
teams to ensure optimum care.
Adult Day Programs—A major development in the Adult Day Program area
occurred during the year with the opening in October of a second Adult Day
Program in newly renovated space. This program was developed in close cooperation with the existing Day Program (which continued in essentially the same
format), the In-patient Unit, and the community care teams.   It was designed to
 COMMUNITY HEALTH PROGRAMS
EE 83
provide a more gradual, longer-term, social and occupational rehabilitation program for the severely disabled individual who was unable to tolerate the more
demanding atmosphere of the original program, yet who required more than just
out-patient interviews.
Adult Out-patient Services—The three community out-patient psychiatric
teams worked hard to deal with larger and more severely disturbed case loads.
Additional approaches introduced during the year included assertiveness training
groups, a number of activity groups for the severely handicapped, development of
new, specialized boarding-homes in co-operation with the Boarding-home Social
Worker, and a wealth of co-operative contacts with new community resources.
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 for children and families, although the demand consistently exceeded the capacity of the staff. The Children's Day Program received
much needed furnishings and equipment, and was also operating to capacity.
Consultation and Educational Services—The previous extensive range of
consultation and education services to the community was complemented during
the year with the addition of a nursing consultation service to Burnaby General
Hospital, psychological consultation services to the Burnaby General Hospital
Extended-care Unit, and to the Dogwood Lodge intermediate care facility, as well
as a number of staff presentations to other organizations by request. Student
placements for nurses, psychologists, social workers, and occupational therapists
were increased by the addition of medical interns from the Royal Columbian Hospital who received their required psychiatric training in the facility. Each area
of the program held one or more workshops during the past year to examine and
develop their own programs. A number of staff attended various meetings or
workshops offered by local professional and educational groups, or visited other
Lower Mainland Psychiatric Services.
THE  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 outpatient 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:
 EE 84 DEPARTMENT OF HEALTH REPORT,  1975
RESIDENTIAL TREATMENT UNIT
During the year the treatment philosophy of the Residential Unit had to be
adjusted and co-ordinated to meet the needs of the patient clientele, because the
focus of treatment became concentrated on the more severely emotionally disturbed
adolescent, as opposed to the more delinquent type.
Staff reorganization provided for psychiatric, social work, and senior supervisory child care counsellors, to be placed in each of the three cottages, the day
centre, and the intake and assessment team. This staffing pattern allowed each
treatment area certain flexibility and autonomy as regards treatment, and ensured
that supervision and job training for line staff could be concentrated and intensive.
By the year-end the unit had an almost full staff and was operating all programs.
Weekly training programs reviewed and discussed all aspects of child care,
personality growth and development, diagnosis, treatment methods, first aid, and
other aspects pertaining to the care and treatment of disturbed adolescents.
The training programs also accepted field placements from various students
attending university classes. For example, social work students, nurses, art and
crafts, and recreational personnel and child care counsellors from the University of
Victoria and Douglas College spent from one week to one year working clinically
within the Residential Unit, gaining practical experience. During the year the unit
also had a psychiatric resident from the University of British Columbia completing
a child psychiatry residency.
In the year under review, staff concentrated on treating the more seriously
disturbed adolescent, and his or her family. Once assessed, the child was either
recommended for referral back to the community, for residential treatment, or the
Day Centre program. When admitted, the child became involved in cottage life
with peers and staff, which included child care counsellors, social workers, and
psychiatrists. Emphasis was placed on helping the child resolve the difficulties
which necessitated admission; on promoting self-growth and individual responsibility; on enhancing learning and other skills by attending school, activities, vocational and craft classes; and on socialization by slowly reintroducing him back into
the community.
As for the future, thought could be given to extending the services to include
a closed facility where the children with more difficult management problems could
receive treatment. Provision could also be made for the development of an adequately staffed out-patient and aftercare service, so that all aspects of the child's
difficulties could be treated from start to finish in one place, specifically designed,
with trained professional staff. With heavy emphasis already placed on training,
such a comprehensive adolescent service would add immeasurably to the needs of
the community. It would also afford other agencies opportunities for additional
training of their present and prospective staff.
The experience of the past 18 months at the Residential Unit was important,
not only in terms of treating disturbed adolescents and the training of staff, but it
also afforded people with varied professional backgrounds the opportunity to learn
from each other, and to co-ordinate their treatment ideas and philosophies.
What also became apparent was the significant role played by the child care
counsellor in the over-all care and treatment of the adolescent and his family.
Such recognition should be expanded so that training for child care counsellors
could become standardized, and professional status achieved.
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 EE 86 DEPARTMENT OF HEALTH REPORT,  1975
THE PSYCHOLOGICAL EDUCATION CLINIC
The Psychological Education Clinic offered programs in two major areas which
could be described broadly as prevention and treatment. The preventive program
is for those children in the public schools whose behaviour and learning disabilities
made further work with the child by the school impossible. Schools have a variety
of back-up services available to them, and the usual course was for assistance to
come from that source. However, there are some situations when a solution is not
possible and a referral to remove the child is made either directly to The Maples,
or to the local mental health centre. At that time, the clinic's involvement becomes
one of working out a program that will allow the child to remain within the school.
At times the consulting was on behavioural contacting or providing a neuropsychological and learning disability assessment. Consultation is also provided to
individual children, or to the classroom teacher, in an effort to maintain these
children in their schools.
The preventive program took place in many geographical areas throughout the
Province through a travelling clinic. The clinic also set up workshops for a variety
of community groups, primarily in the area of behaviour modification, and offered
courses on parenting and child management.
The other dimension to the clinic was The Maples School, which had six
classrooms and a staff of teachers and psychologists who worked together to assist
the children and their families. The ages of the children ranged from 6 to 13, with
their problems being a combination of learning difficulties and emotional disturbance. The average length of stay was one year, ranging from six months to over
two years. There was a follow-up of the children for one year after they left. The
children and staff attend camps of one week's duration each year.
During the year the clinic became more involved with training programs, and
three teachers were placed in the school for a one-year period, after which time they
would return to their school district better prepared to provide a service for the
disturbed child. -The clinic provided a one-month training program for four
teachers, and provided them with both didactic and experiential sessions. The
clinic also offered a practicum for graduate students in clinical and developmental
psychology.
THE BOARDING HOME PROGRAM
Mental Health Programs has developed a Boarding Home Program which
provides supervised personal care and attention to meet four very important needs
within the community. First, it is for those individuals who require some care but
for whom admission to one of the mental health facilities is not considered to be
necessary. The program is also available for the long-term patient who is discharged
from hospital but continues to require minimal care and who has nowhere else to go.
Thirdly, the Boarding Home Program can be utilized as a means of temporary
assistance for relatives who are caring for a mentally disordered individual in their
home, and who need a respite from the stress endured in such situations. And
finally, its services may be used by discharged patients who need a place in which
to live while taking rehabilitation training.
A review of the program's activities for 1975 follows:
For the Boarding Home Program, 1975 was essentially a year of consolidation
and planning for the future. The placement program proceeded at the same rate as
in other years, with 641 placements made into some 296 boarding-homes. At the
end of the year there were approximately 1,914 persons in boarding-homes under
supervision of Mental Health Programs.
 COMMUNITY HEALTH PROGRAMS EE 87
During the year, 210 residents were discharged from the program to more
independent forms of living arrangements, such as returning to their family, partial
or full employment, or co-operative group-living arrangements. Approximately
134 residents were returned to institutional or psychiatric facilities in general hospitals for further treatment.
Improvement was achieved in such areas as individual rehabilitation, the
development of a few independent group-living resources, and an excellent summer
activity program.
Summer students were employed as activity assistants through the Province,
and the program continued to offer field placements for students from Welfare Aide
training programs. Two summer students completed a survey of Mental Health
boarding-home residents in relation to their capabilities for employment. Action
was pending on this project, which had the long-range goal of the establishment of
an industry in British Columbia designed to employ marginally employable persons
with a variety of abilities.
A well-organized and innovative summer activity program was carried out
jointly by the Boarding Home Program staff of several communities in the Lower
Mainland, as an alternative to a camping program. The boarding-home operators
of the East Kootenays took their residents, together with other retarded persons
living in the community, on a three-week camping tour of British Columbia. In
other areas of the Province, short camping programs were arranged for boarding-
home residents. Staff considered this activity one of the most therapeutically productive available to them.
A highlight of the year was the opening of two unsupervised group-living
homes, and one apartment, for ex-residents of boarding-homes. The residents who
moved to these facilities were managing all aspects of their household operation.
In addition to the development of feelings of pride and self-worth they achieved, it
also represented a considerable saving in public funds allocated to the care of the
handicapped person. The development of these resources in the initial stages was
facilitated by interest and grants of money from several voluntary service organizations in the community, such as the Canadian Mental Health Association, the
Association for the Mentally Retarded, Kinsmen, and the Canadian Legion.
Except in a few specific areas, year-end indications were that the Mental
Health Boarding Home Program had peaked in its need for the personal care level
of beds. Development of the intermediate level of program became the priority,
together with further development of the independent group-living resource for
clients who no longer required supervised boarding-home care.
The approximate distribution of placements made and the case load of the
Boarding Home Program in 1975 were as follows:
Placements Made, Case Load,
1975 December 31, 1975
Region 1 (Kootenays)   27 111
Region 2 (Okanagan-Thompson)  204 618
Region 3 (Fraser Valley)   202 792
Region 4 (Skeena)   27 21
Region 5 (Greater Vancouver)1  23 70
Region 6 (Cariboo-Peace River)   6 21
Region 7 (Georgia Strait)   93 175
Region 8 (South Vancouver Island)  59 106
Totals  641 1,914
1 Burnaby and North Vancouver were the only municipalities of the Greater Vancouver area where placements were made through the Mental Health Boarding Home Program.
 EE 88 DEPARTMENT OF HEALTH REPORT,  1975
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 needs 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:
ADULT PSYCHIATRIC SERVICES
The organizational changes in the Health Department in 1975 did not significantly alter the work requiring the attention of the Co-ordinator of Adult Psychiatric Services. The need for psychiatric consultation at senior levels was so
great that the activities of the Co-ordinator tended to be controlled by the demands
of emergency situations and temporary priorities.
The Co-ordinator continued to be involved in the work of the Board of the
Community Care Services Society, the governing body of the Riverview Hospital,
and served on the Graduate Training Program Committee in Psychiatry at the
University of British Columbia.
He provided an assessment of medical applicants for the Public Service Commission, and maintained a close liaison with the Registrar of the College of Physicians and Surgeons.
During the year the institutions were fully staffed with physicians and psychiatrists, with the exception of Riverview Hospital which had many psychiatric
vacancies. Recruitment to the Public Service was slow, and only a few private
psychiatrists were persuaded to locate in unserviced areas of the Province.
With the Go-ordinator's assignment to Mental Health Programs, there was
a tendency for activities to be focused more narrowly upon those aspects of community psychiatry which fall within the specific frame of reference of the mental
health centres. Contact with the institutions, psychiatric wards of general hospitals,
and other groups dealing with mental health was substantially reduced.
The bulk of the work load involved a considerable number of meetings with
mental health centres, calls for consultation by administrators and psychiatrists,
and a variety of specific psychiatric problems requiring solution. Clinical consultation on a one-day-a-week basis to the Sechelt Mental Health Centre was maintained.
NURSING CONSULTATION SERVICES
During the year the provision of nursing consultation services was directed
toward (a) the completion of projects undertaken the previous year; (b) developments in psychiatric nursing education and services; and (c) the changing role of
mental health-psychiatric nursing consultation, in view of organizational changes
in the Health Department.
The Community Psychiatric Nursing Program Project had been designed to
prepare basically trained nurses for community psychiatric nursing positions in
mental health centres; to assess the effectiveness of the educational program developed for these nurses; and to describe the role responsibilities of these nurses
 COMMUNITY HEALTH PROGRAMS EE 89
after three months in the field. The project findings showed that (a) the program
was effective in training a selected group of nurses for a new job and a new role;
(b) after three months, the job and role were expanding in scope; and (c) the addition of these 20 nurses to 13 mental health centre teams made a definite impact
on the centres' ability to deliver local community mental health services.
A study of the Role and Training Needs of Psychiatric Aides, supported by
the Minister of Health and the British Columbia Government Employees' Union,
was initiated in February 1974 and completed in April 1975. The report provided
information, and made recommendations, concerning the functions and training
requirements of psychiatric aides in Government service.
The state of psychiatric nursing education in the Province was studied by the
Registered Psychiatric Nurses Educational Advisory Committee. It reported that
approximately 1,000 additional psychiatrically trained nurses were required to
maintain existing services in Government facilities, community programs, and the
psychiatric services of general hospitals; that the only existing basic psychiatric
nursing education program in the Province, at the British Columbia Institute of
Technology, was producing an average of 60 new graduates a year. It was anticipated that the British Columbia Medical Centre, through its Nursing Manpower
Committees, would be seeking to resolve this deficiency in the availability of nurses
trained in the specialty of psychiatric nursing.
The Education Centre at Essondale continued to be administered by the Consultant in Nursing. Its facilities were used for a variety of workshops, seminars,
meetings, and classroom courses by 56 groups comprising 4,182 persons, for a
total of 210 sessions. Major users of the centre were Riverview Hospital, the
British Columbia Institute of Technology, the Royal Columbian Hospital, Mental
Health Programs, and the University of British Columbia. Its library facilities of
1,200 volumes and numerous journals and pamphlets were used by 11,000 individuals. Several proposals for the future use of the Education Centre facilities
were under consideration at year-end.
Nursing consultation was provided to the psychiatric hospital nursing services
and community mental health programs of the Health Department; to the mental
retardation services of the Department of Human Resources; to community nursing
education programs of the Department of Education; to various components of the
Public Service Commission; and to professional health care organizations.
As the year was drawing to a close, preliminary steps were being taken to
study the feasibility of expanding the availability of mental health-psychiatric nursing consultation as a resource service to the other programs of the Department of
Health.
SOCIOLOGY CONSULTATION SERVICES
During the year the Consultant in Sociology acted as Regional Program Director for 10 Lower Mainland mental health centres. Work emphasis was on the six
centres adjacent to Riverview Hospital, whose responsibility it was to screen
referrals to the hospital and, when admission was indicated, to admit and treat
patients on the ward, and ensure adequate follow-up upon discharge.
An analysis of the results of the Vancouver Psychiatric Home Treatment
Research Project continued throughout the year, and a number of papers were
prepared. One such paper, "Hospitalization and Hospital Bed Replacement," by
Goodacre, Coles, MaCurdy, Coates, and Kendall, appeared in the Canadian Psychiatric Association Journal, vol. 20 (1975), pp. 7-13. A further report, "The
Evaluation of Hospital and Home Treatment for Psychiatric Patients," by Coates,
 EE 90 DEPARTMENT OF HEALTH REPORT, 1975
Kendall, MaCurdy, and Goodacre, was presented at the 1975 annual meeting of
the Canadian Psychiatric Association.
Program development and planning for community mental health facilities in
the Lower Mainland accounted for approximately 80 per cent of the Consultant's
time. The balance was devoted to commitments generated through membership on
the Community Care Facilities Licensing Board; the Ad Hoc Committee on Long
Term Care; the University of British Columbia Department of Psychiatry/Health
Department Liaison Committee; and the Psychiatric Services Subcommittee of
Hospital Programs Planning Group, which reviewed and recommended on applications from general hospitals for psychiatric in-patient beds and day hospital programs. The Consultant was also chairman of the Statistical Subcommittee of the
Riverview Hospital Planning Committee, established to develop a patient categorization instrument as a basis for determining staffing and physical plant requirements for the hospital.
Effective October 1, 1975, the Consultant in Sociology transferred from
Mental Health Programs to Hospital Programs, to become Director of their
Research Division.
PSYCHOLOGY CONSULTATION SERVICES
In 1975 the Consultant in Psychology became Acting Regional Director for
Northern British Columbia, which includes the mental health centres in Fort St.
John, Prince George, Williams Lake, Terrace, and Prince Rupert. One of the aims
of regionalization was to make a more detailed analysis of mental health related
needs of the various communities within a particular region, and the types of
services needed to deal with these needs. Another objective was to review the
priority of services, in order to continue to provide the most effective services in
any one region with the resources available. Special assignments which related to
these objectives, and which involved the Consultant in Psychology during the year,
included:
• Participation in a Minister's Committee on the Role and Training Needs of
Psychiatric Aides: This committee was appointed to review training programs for psychiatric aides in Government facilities and other programs in
the Province where psychiatric aides are employed, and to make recommendations for the training of psychiatric aides so that they may effectively
carry out their role in the care of the mentally ill and retarded.
• The Community Profile Study: This study was aimed at collecting basic
data about the various communities in British Columbia, in order to provide
a profile which could be used for the better evaluation of health needs, as
well as for a variety of other purposes.
• The Integrated Services Project: Personnel from the Departments of Health,
Human Resources, and Education were seconded to this project to provide
integrated services for children and families in the Greater Victoria region.
These included assessment and diagnostic services for children with mental
health related problems; back-up treatment support for existing treatment
facilities for children; and treatment programs for both children and their
families in communities where such services are not available. In conjunction with the project staff, an analysis was made of the needs of children
in the project's catchment area, the number of children at risk in the various
need categories, and the types of services which best could be provided by
the project in relation to these factors.
 COMMUNITY HEALTH PROGRAMS
EE 91
• Crisis Intervention Emergency Services: With the co-operation of the
various crisis centres in the Greater Vancouver area, a study was made of
crisis intervention emergency services, staffing, training, and administrative
procedures common to this type of operation.
MANAGEMENT ANALYST CONSULTATION SERVICES
During the year the activities of the Management Analyst were focused primarily on community mental health, and two major projects were undertaken in
this area:
The project of highest priority was the development of a new information
system for community mental health.    This system was designed to
• provide management and case information on a regular basis;
• maintain a collection of base data from which to initiate research projects;
• facilitate data access, allowing rapid response to requests for information;
• streamline clerical procedures;
• speed up processing through the use of automation and the scheduling of
activities.
The various components of the system, some of which were manual procedures
and some of which involved computer processing, were to be implemented in
stages.
Assistance was provided to the Greater Vancouver Mental Health Service to
carry out a study and make recommendations on the standardization of forms and
procedures used in the administration of the community care teams. Recommendations resulting from the study included the introduction of some new standard
forms and procedures; the preparation of a procedures manual; the centralization
of the printing and distribution of forms and stationery, and the purchasing of all
supplies; the implementation of a forms control system; improvements to the
methods of transmitting information within the service; and the addition of a
Records Consultant to the Head Office staff.
The Management Analyst continued to be responsible for the design of new
forms and procedures for both mental health centres and the residential facilities.
Assistance was also provided in the development of the Survey of Service,
which was carried out in the mental health centres, and in the preparation of a
research study in the Boarding Home Program under the summer student project.
The Management Analyst represented Mental Health Programs on the Department of Health Information Task Force, and continued to provide liaison with the
Division of Vital Statistics, and Computer and Consulting Services of the Department of Transport and Communications, with regard to data processing.
SOCIAL WORK CONSULTATION SERVICES
The position of Social Work Consultant was filled June 2, 1975, with the
appointment of John B. Farry. As Acting Regional Program Director for the
Kamloops, Vernon, Kelowna, and Penticton Centres, virtually one quarter of the
Consultant's time was devoted to the policy and program concerns within this
region. In this connection, he also participated in the planning and implementation of the Autumn 1975 Regional Meeting (a program hosted by the Kelowna
Mental Health Centre which combined both business and educational interests).
An evaluative study of the Boarding Home Program was conducted by the
Consultant with a view to providing guidelines for its future directions. Items
which were under particular scrutiny included the relationship of the Boarding
 EE 92 DEPARTMENT OF HEALTH REPORT,  1975
Home Program to the mental health centres, case load limitations, future funding
considerations, staffing, and morale. The Boarding Home Study was being reviewed by the Mental Health Programs Planning Committee at the year-end.
Numerous requests for reclassification on the part of psychiatric social workers
at all levels, in combination with a long overdue need to review the entire series,
prompted the establishment of a Series Review Study Committee under the chairmanship of the Consultant. The specific objective of this Committee was to study
current inconsistencies in the present psychiatric social worker series, and submit
recommendations which more accurately reflected the current professional functions
of social workers in the field.
During the year the Consultant was made responsible for developing a comprehensive program in continuing education for the mental health centres. The
committee struck for this purpose combined regional as well as disciplinary representation, and contained plans for future liaison with institutional, university, and
other established continuing educational programs.
The Consultant also served on a number of committees, such as the Planning
Committee, Program Advisory Committee, Community Care Facilities Licensing
Board, and the committee involving Human Resources, Education, and Health
which addressed itself to Special Needs for Special Children.
STATISTICS AND MEDICAL RECORDS
During 1975, this section continued to standardize and computerize the data
collection systems. The use of canned computer programs (e.g., the Statistical
Package for the Social Sciences), improved the retrieval of information in terms
of accessibility and content variability. As a result of this change in retrieval
methods, numerous extensive requests for data were fulfilled, and more detailed
tabulations were included in the Annual Statistical Report.
The realignment of responsibilities, as well as the increased work load within
Mental Health Programs (comprised of 41 out-patient units and four in-patient
units), necessarily demanded a more concentrated effort on behalf of the statistical
staff. Areas focused on and improved were submission schedules, submission
procedures, accuracy of submissions, storage of the master index, and storage of
data on computer. In addition, the data systems for the residential facilities were
maintained. Maintenance involved liaison with the medical records staff and with
the Division of Vital Statistics, providing consultation services, and fulfilling requests for data.
The statistical system for Woodlands and Tranquille was officially transferred
on April 1, 1975, to the Department of Human Resources. Consultation services
were provided throughout the transfer and were continued afterward.
A monthly average of 2,300 statistical forms for Mental Health Programs,
and approximately 400 statistical forms for the residential facilities, were edited by
the statistical staff, before being processed by the Division of Vital Statistics.
Three new units (Secure, Vista, and Venture), under the administration of
the Greater Vancouver Mental Health Service, were incorporated into the statistical system. In addition, the Riverview Out-patient Department (the Broadway
Clinic) came under the administration of GVMHS and was incorporated into the
statistical system. One unit, the Victoria Integrated Services for Child and Family
Development, was removed from the system.
Routine statistical reports were generated throughout the year, including the
Preliminary Patient Movement Report; the Monthly Statistical Bulletin; the 1974
Annual Statistical Report; the Annual Statistics Canada Preliminary Report; the
 COMMUNITY HEALTH PROGRAMS EE 93
Annual Statistics Canada Returns from Institutions, Psychiatric Units of General
Hospitals and Outpatient Programs; and the Statistics Canada Outpatient Monthly
Report. The Annual Statistical Report was changed to reflect the reorganization
of the Department of Health, and the report was expanded in terms of information
content and presentation, i.e., percentages and graphs.
Regional and Provincial meetings were organized to include discussions regarding medical records, clerical procedures, and the statistical system. Visits
were made to most of the mental health centres and community care teams^ in order
to assess the quality of records and upgrade record-keeping standards, to streamline clerical procedures, to reduce statistical backlogs, and to provide orientation
to clerical staff. The Medical Records Consultant, who was transferred from Vancouver to Victoria during the year, evaluated and reported on the medical records
systems within GVMHS.
Several specific projects were undertaken during the year, focusing either on
providing management information or on streamlining the current data systems.
The following are examples of some of the projects: a Survey of Service was conducted to assess the type and amount of service delivery; attempts were made to
develop policies on the transfer and destruction of patient records; a follow-up
procedure was instituted to assess the success of the referral procedure from Riverview Hospital to the mental health centres and community care teams; the development of a statistical system for the Forensic Psychiatric Services was initiated; and
a therapist index card procedure was designed to provide information for Statistics
Canada and to serve as a method for reviewing case loads.
 1
EE 94 DEPARTMENT OF HEALTH REPORT,  1975
Table 16—Patient Movement Trends, Mental Health Facilities, 1972-75
Yearly Sum of Entrie
1 From—
Resident or Case Load
Mental Health Facilities
Oct. 1972
to
Sept. 1973
Oct. 1973
to
Sept. 1974
Oct. 1974
to
Sept. 1975
End of
Sept. 1973
End of
Sept. 1974
End of
Sept. 1975
11,553
2,443
1,911
532
421
86
25
9,110
37
13,901
2,529
2,024
505
413
72
20
11,372
153
110
43
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
15,630
2,388
1,950
438
332
88
18
13,242
352
301
51
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
467
71
2,834
95
420
349
340
187
53
226
542
198
424
152
12,309
3,010
1,976
1,034
656
180
198
9,299
23
15,234
2,630
1,643
987
645
174
168
12,604
27
10
17
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
17,332
Hospital programs... 	
2,361
1,381
980
Valley view	
645
178
157
14,971
46
Burnaby	
BCYDC	
18
37
9,073
8,120
15
524
527
331
157
264
93
330
328
23
9,276
8,175
15
567
465
126
144
315
74
343
399
28
14,925
12,267
Abbotsford	
Burnaby     	
Chilliwack  ,	
Courtenay	
305
1,002
334
338
224
486
Fort St. John 	
492
352
787
348
476
224
267
265
201
417
263
320
121
72
304
687
296
471
263
241
247
210
294
133
66
458
737
411
1,013
231
379
298
265
Powell River	
302
286
134
Saanich  	
555
109
411
124
218
733
605
258
12
872
104
Surrey   	
388
385
226
628
613
357
24
675
614
146
Trail      -   	
304
Vernon  	
760
447
Whalley    ...            	
430
74
2,537
Blenheim House (July 1974)2
76
557
492
215
279
185
773
709
156
150
145
659
293
185
214
Secure (April 1975)2
48
210
178
274
149
152
142
247
103
104
325
West End	
118
99
248
West Side              ...               	
279
BCYDC (out-patient)               	
278
229
121
1 For the residential facilities this includes permanent transfers,
from leave and escapes.
2 Month Centre/Team commenced reporting.
admissions from community, and returns
 COMMUNITY HEALTH PROGRAMS EE 95
Table 17—Patient Movement Data,1 Mental Health Facilities, 1975
Entries
Exits
Mental Health
wi
0J
Facilities
Total
o
rt
C «
Total
u
an
C w,
Co
(A
8"§
se
Ec
J3
le
Q<
OSU.
3
-1
PLrH
O
All mental health facilities	
16,013
15,652
349
12
14,432
12,997
1,016
13
326
Hospital programs	
2,350
1,997
348
5
2,678
1,254
1,090
9
325
Riverview 	
1,971
1,648
319
4
2,224
1,192
936
9
87
379
299
349
270
29
28
1
1
454
333
62
42
154
138
238
Valley view	
153
Dellview	
65
64
1
87
7
16
64
15
13,663
15
13,655
1
7
34
11,754
13
11,743
4
21
Mental health programs
6
1
Total in-patients „ 	
374
366
1
7
357
346
6
4
1
Burnaby	
323
315
1
7
311
300
6
4
1
BCYDC	
51
51
46
46
-
	
13,289
9,900
281
1,056
290
11 397
8,839
198
852
Chilliwack _	
408
Courtenay	
322
188
Cranbrook 	
345
169
Duncan	
358
499
Fort St. John	
354
40
Kamloops 	
238
214
349
226
257
108
Langley 	
Maple Ridge 	
417
504
Nanaimo	
373
384
Nelson	
338
162
New Westminster	
217
260
Penticton  	
284
225
392
397
381
326
Powell River _	
220
285
Prince George	
166
134
Prince Rupert	
266
326
314
161
289
101
Sechelt	
Squamish	
73
26
Surrey 	
373
321
Terrace 	
305
296
Trail 	
182
32
Vernon	
626
916
Victoria	
449
457
Whalley	
434
471
Williams Lake	
94
10
3,216
2,354
Blenheim House (July 1974)2...
86
25
438
470
368
302
196
221
286
142
Richmond 	
Secure (April 1975)2..
106
7
South Vancouver (July 1974)-..
265
102
Strathcona	
770
569
West End	
232
453
173
230
302
204
West Side	
BCYDC (out-patient)	
1 Table compiled from actual data through September 1975, and projected for the remainder of the year.
(Note—In case of centres/teams opened in 1975, table compiled on basis of available data for 1975.)
2 Month centre/team commenced reporting.
  MEDICAL AND
HOSPITAL PROGRAMS
  <
o
o
T
E
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 a health insurance referendum, held in
conjunction with a Provincial general election. Finally, in 1948, the Hospital Insurance Act was passed, establishing a Hospital Insurance Service which provided coverage
for acute care in approved general hospitals.
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:
101
  BRITISH  COLUMBIA REGIONAL HOSPITAL
DISTRICTS ACT
The Act 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 toward the capital cost of hospital projects.
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 its share of the amortization cost in accordance with
section 22 of the Act and each district raises, by taxation, the remainder of the
annual amortization cost required to retire the debentures which are held by the
Financing Authority.
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
regional hospital district is responsible for co-ordinating and evaluating the requests for funds from hospitals within the district, and for adopting borrowing bylaws, subject to approvals and conditions required under the Act, in respect of
either single projects or an over-all program of hospital projects for the district.
In 1975 the 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.
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 in the second paragraph of the preceding commentary regarding the Regional Hospital Districts Act.
103
 EE 104 DEPARTMENT OF HEALTH REPORT,  1975
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.
THE  HOSPITAL INSURANCE ACT
The Hospital Programs of the Department of Health operate 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 and regional
hospital districts toward operating expenses and capital costs.
• 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
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 $1 less than the per diem rate approved for the particular
hospital, and the patient is responsible for paying the remaining dollar.
The Provincial Government pays the dollar-a-day charge on behalf of
Provincial social welfare recipients.
• The wide range of in-patient and out-patient benefits provided under the
Act is described on the following pages.
• 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 percent of the cost of major diagnostic equipment, and 100 per cent of the
cost of equipment which results in proven savings in operating costs.
THE 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:
 MEDICAL AND HOSPITAL PROGRAMS EE 105
•
Public hospitals: Nonprofit hospitals caring primarily for acutely ill persons.
• Private hospitals: This category includes small public 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.
THE 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 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 the British Columbia Hospital Programs
Division. 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 the British Columbia Hospital Programs. Qualified patients are
charged $1 per day, which is deductible when calculating payments to hospitals
from the Division. Nonqualifying residents are charged the hospitals' established
per diem rates, which are 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.
  MEDICAL AND HOSPITAL PROGRAMS EE 107
HOSPITAL CONSULTATION AND INSPECTION
DIVISION
This Division provides consulting services to public and private hospitals in all
aspects of hospital organization, operation, and management. It is 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 a staff consisting of consultants in
hospital administration, biomedical engineering, dietary, laboratory, social services,
management engineering, nursing, and X-ray.
During 1975, consultant services in biomedical engineering and radiology were
added to the staff of the Division and provided a valuable new service to hospitals
of the Province.
PRIVATE HOSPITAL VISITING
The year 1975 saw a marked increase in consultation and inspection service to
private hospitals. In addition to team visits, most private hospitals in the Province
received visits from consultants in nursing and administration. It is intended that
this approach to the inspection of private hospitals will be continued in 1976.
PARTICIPATION IN EDUCATIONAL PROGRAM
Two consultants of the Division became participants in the GAMAT program.
GAMAT was 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.
PUBLIC ADMINISTRATOR
During 1975 the Division was required to provide a member of the staff to act
in the capacity of public administrator for a hospital society in the Province. In
this role he provided direction to the institution while a reorganization of the hospital
board and society affairs took place.
CONSULTATION AND INSPECTION
The ongoing work of consultation and inspection, which was carried out during
the year, involved 149 visits to private hospitals, 137 visits to general hospitals, and
participation in other activities such as Federal-Provincial meetings and task forces
in hospital administration, nursing, dietetics, and pharmacy; attendance in various
roles at intraprovincial advisory groups; patient classification survey, and educational
seminars.
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 in
 EE 108 DEPARTMENT OF HEALTH REPORT,  1975
recent years, the growth of the Province necessitates a continuing review of general
hospital bed requirements. Reports and recommendations for additional hospital
capacity are placed before the Planning Group of Hospital Programs for review
through the Director, who is a member of the group. During the course of the year,
30 hospitals were assessed with respect to future needs.
In 1975 the Director was appointed Chairman of a subcommittee of the
Planning Group dealing with the development of psychiatric in-patient beds and
day hospital programs; he also acted as Chairman of the Riverview Hospital
Planning Committee's Statistical Subcommittee, and was a member of the Community Care Facilities Licensing Board, the Health Department's Ad Hoc Committee on Long Term Care, and the UBC Department of Psychiatry/Health Department
Liaison Committee.
The Division is also responsible for maintaining and compiling 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
diagnoses 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 which all provinces publish, 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 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. During 1975, 10,041 abortions were performed in British Columbia, which represents 28 abortions per 100 hospitalized
live births.
On October 1, 1975, R. H. Goodacre was appointed Director of the Research
Division, replacing D. S. Thomson, who left the Service to become Associate Director of the British Columbia Cancer Control Agency in Vancouver.
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 the year 1975 amounted to $460 million.
The Division also reviews the annual budgets prepared by regional hospital
districts, and works closely with the Hospital Financing Authority and the regional
hospital districts in the financing of hospital capital projects and repayment of
debentures.    During 1975 the regional hospital districts debenture sales to the
 MEDICAL AND HOSPITAL PROGRAMS
EE 109
British Columbia Regional Hospital Districts Financing Authority amounted to
$27 million.
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. 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 a 100-per-cent grant 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 diagnostic
equipment used in pathology, radiology, nuclear medicine, and ultrasound, and
33J/3 per cent grant on all other movable depreciable equipment. In 1975, after
review of approximately 6,800 applications received from hospitals, grants totalling
$6 million were approved on purchases of movable and fixed technical equipment
amounting to approximately $10 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 Program 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, a system of preconstruction
operating budgets is used. 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 budget does not
indicate a reasonable operating cost, it is 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 $360,000 in hospital operating budgets
during the year to enable hospital employees to attend or participate in short-term
educational training courses.
It is estimated that the increase in gross hospital expenditures for the calendar
year ending December 31, 1975, will amount to approximately $92 million over
1974. Salaries increased 26 per cent, accounting for $75 million of the total
increase.
The following is a summary of comparative expenditures of Hospital Programs for the fiscal years 1971-75, inclusive:
1971
1972
1973
1974
1975
$
1,261,940
183,806,933
$
1,400,095
206,667,254
$
1,538,905
235,594,194
$
1,800,229
275,801,859
$
2,438,265
370,769,218
Totals  	
185,068,873
208,067,349
237,133,099
277,602,088
373,207,4831
1 This does not include Special Warrant No. 91 for
total of $158,587.
$116,683, or Special Warrant No. 99 for $41,904, a
 EE 110 DEPARTMENT OF HEALTH REPORT,  1975
FINANCE CLAIMS SECTION
Patient accounts processed during the year were in excess of 2,000 per
working-day, plus over 2,550 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 5,000 claims had to be returned to the hospitals during
the year because they were incomplete or unacceptable, and over 1,800 letters
were written on eligibility, verification, and related matters.
The in-patient claims checkers pre-audit the charges made to Hospital Programs, and ensure that all information shown on each claim is completed so that
it can be coded for statistical purposes, also that it is charged to the correct agency,
such as the Hospital Programs, Workers' Compensation Board, the Department
of Veterans Affairs, or other provinces and territories.
Preliminary figures for 1975 show that more than 465,000 accounts (excluding
out-of-Province) were processed.
The Day-care Surgical Services, Day-care/Night-care Psychiatric Services,
Out-patient Psychiatric Services, and Day-care Diabetic Services accounts increased
in volume to over 9,500 per month in 1975. 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 phsysiotherapy patients was provided and
preliminary figures indicate that accounts for over 330,000 treatments were
processed.
The out-of-Province personnel process 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 1975, over 575
accounts were processed each month, resulting in an estimated total expenditure of
over $4.6 million. The Claims Distribution Centre receives, sorts, and distributes
all the forms and correspondence received in the Hospital Claims Section. Over
11,000 claims, documents, and letters are handled daily.
HOSPITAL CONSTRUCTION AND PLANNING
DIVISION
The Hospital Construction and Planning Division provides 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 continuing inflation, emphasis continued to be placed on using public funds
to the best advantage and deleting any work not considered strictly necessary.
Hospitals' construction programs and grant applications were reviewed with this
objective in mind.
During 1975, 20 major projects were completed in the Province, costing
nearly $20 million. Construction and renovation projects involved a total of 272
acute beds and the upgrading of many service departments. Two of the projects
involved special units—the spinal cord injury unit at Shaughnessy Hospital and
the nuclear medicine laboratory at the Vancouver General Hospital. Seven of the
projects provided a total of 208 additional extended-care beds in new units or
additions to existing units.
As a result of Hospital Program's desire to see construction projects carried
out not only as economically as possible, and with the least amount of delay,
approval was given for two multi-million dollar projects in the Lower Mainland
  EE 112 DEPARTMENT OF HEALTH REPORT,  1975
to be carried out under project management. Client Committees were formed at
both Burnaby General Hospital and Royal Columbian Hospital, New Westminster,
each consisting of representatives from the hospital, the Greater Vancouver
Regional Hospital District, and this Division to administer the project. Project
managers were appointed once schematic drawings had been developed and cost
estimates approved. As the preparation of complete working drawings under the
project management arrangement can overlap the start of actual construction on
the site, much time can be saved and greater control can be effected over capital
costs.
In connection with the above, a new field of involvement has been the cooperation of the Provincial Government with the Greater Vancouver Regional
Hospital District in the provision of multi-storey parking facilities for three major
hospitals in the Lower Mainland area—-Burnaby General, Royal Columbian, and
Lions Gate. Burnaby's project was completed in May and is being operated by
the Greater Vancouver Regional Hospital District. Revenue from the operation
of this and the other two facilities will be used to amortize capital costs.
Another way in which planning time has been shortened is by the use of the
plans of the Overlander Extended Care Hospital, Kamloops, for two similar units
at Delta and Kelowna.
In order to assist hospitals in the preparation of functional programs and
expedite the approval mechanism for major construction projects, a standard
format has been developed by staff of this Division, working with an outside firm.
This guide has been field-tested on one expansion program and staff are in the
process of evaluating the results so that the guideline may be finalized.
During the year a Committee, formed to study Surgical Suite Ventilation,
produced its report. W. H. Cox, Consultant in Hospital Engineering, was a member of this committee, which recommended the division of all operating-rooms into
two categories, depending on the type of anaesthesia used and the adoption of
standards of air supply systems for each type, to ensure the safety of patients and
staff. Several meetings were held with the Provincial Fire Marshal and his staff
with the aim of standardizing the interpretation of fire safety regulations throughout
the Province as set down in the National Building Code. This was necessary
because of the high cost of providing fire alarm systems in both new construction
and existing buildings, to meet the new Code requirements.
The Division worked closely with other Government departments, regional
hospital districts, hospitals, consultants, and agencies. Co-operation was extended
by the medical profession and consulting engineers in the preparation of the
Surgical Suite Ventilation recommendations; Karl Schmidt and Mike Rayburn
contributed their time assessing the advantages of construction management for
hospital construction; and A. Shaw and E. Phillips of the British Columbia Construction Association provided information on construction matters.
A. HOSPITAL PROJECTS COMPLETED DURING 1975
Matsqui-Sumas-Abbotsford General Hospital, Abbotsford—A new 75-bed
extended-care unit was officially opened on March 15, 1975.
Burnaby General Hospital—The new parking structure was officially opened
on May 1, 1975. The facility is being operated by the Greater Vancouver Regional Hospital District.
Chilliwack General Hospital—Phase IV of the addition and renovations,
which consisted of the provision of a six-bed intensive care unit, 18 additional
extended-care beds, and pediatric renovations was completed in early December.
 MEDICAL AND HOSPITAL PROGRAMS EE 113
Cowichan District Hospital, Duncan—A program involving the completion
of 22 additional extended-care beds, for a total of 100, plus air-conditioning the
entire hospital, was finalized in December 1975.
Boundary Hospital, Grand Forks—An addition of 14 extended-care beds
was officially opened on May 12, 1975. An extra bed, for a total of 15, was approved on July 31, 1975.
Fraser Canyon Hospital, Hope—A new laboratory, which was completed on
July 24, 1975, was officially opened by the Minister of Health on November 1,
1975.
Kelowna General Hospital—The completion of the "shell" area of the east
wing of the fourth floor in the acute block, to accommodate 36 extended-care beds
temporarily, was effected in August 1975.
Kitimat General Hospital—On June 21, 1975, a new 35-bed extended-care
unit was opened at the hospital. The unit is situated partly in the formerly unused
portion of the third floor, and its installation necessitated the relocation of the
maternity department.
Langley Memorial Hospital—-The Minister of Health officially opened the
hospital's completed expansion project on June 14, 1975. The expansion includes
an ambulatory care addition, the provision of a new parking-lot, and renovations
to the existing hospital to provide 50 additional acute beds.
Arrow Lakes Hospital, Nakusp—The project was officially opened on March
8, 1975; the new building contains 16 acute beds and replaces the old 15-bed
hospital.
Kootenay Lake District Hospital, Nelson—The Phase II expansion program
was completed in November 1975 and provided for the expansion of day care,
emergency, radiology, and laundry services, plus a new Provincial Laboratory.
Royal Columbian Hospital, New Westminster—A psychiatric day-care unit
of 20 spaces was officially opened on January 24, 1975. The accommodation has
been provided in prefabricated units.
100 Mile District Hospital—Additions and alterations to provide seven additional acute beds and supporting services were completed in December 1975.
Prince George Regional Hospital—Interim renovations to improve radiology
and day-care surgery facilities, provide a doctors' lounge, library and "on-call"
room, classrooms, offices, etc., were completed by the year-end. Twenty-six
psychiatric beds on the third floor north were also completed.
Bulkley Valley District Hospital, Smithers—The completed project was officially opened on May 10, 1975; the addition provides 57 acute beds and replaces
most of those contained in the now demolished original hospital building. The
program resulted in nine additional acute beds, a seven-bed extended-care unit,
and expansion of services.
Trail Regional Hospital—The new combined intensive care/coronary care
and renal unit of 10 beds was officially opened on February 27, 1975.
Vancouver General Hospital—Renovations to provide a nuclear medicine
laboratory were completed in January 1975.
St. Paul's Hospital, Vancouver—The School of Nursing conversion program
was completed in December 1975. The program consists of the provision of staff
lockers, an administration area, educational facilities, and 40 psychiatric beds (10
of these form the "Short Stay Unit," where patients may not remain longer than
five days).
Shaughnessy Hospital, Vancouver—A spinal cord injury unit of 22 beds was
opened by the Minister of Health on May 6, 1975.
 EE 114 DEPARTMENT OF HEALTH REPORT,  1975
Vernon Jubilee Hospital—Phase II, consisting of the conversion of the old
extended-care unit to provide 38 acute beds, was completed in December 1975.
The program also included a new out-patient and diagnostic services wing, education and administrative areas, renovations to provide new physiotherapy and medical records departments, enlargement of postoperative recovery room, and modernization of the children's ward and central sterilizing room.
B. HOSPITAL PROJECTS UNDER CONSTRUCTION AT YEAR-END
Burnaby General Hospital—A major expansion program was 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 a diagnostic and treatment
centre with six holding beds and an intermediate care unit of 50 beds.
Dawson Creek and District Hospital—Stage I will provide for the relocation
of a 24-bed nursing unit from the main floor to the second floor addition on the
west wing of the existing hospital, so that the vacated space can accommodate
ambulatory care and the diagnostic and treatment areas proposed in Stage II.
Delta Centennial Hospital—A new 100-bed extended-care hospital, based on
the same design as the Overlander Hospital, Kamloops.
Fort Nelson General Hospital—An addition to provide seven additional acute
beds and the expansion of diagnostic services.
Fort St. John General Hospital—An expansion program, including ambulatory care, central sterilizing room, radiology and nuclear medicine facilities.
Wrinch Memorial Hospital, Hazelton—A new hospital, providing 27 acute
beds, plus eight in "shell" and four extended-care beds, was being built under
construction management to replace the existing 50-bed hospital.
Overlander Extended-care Hospital, Kamloops—A new 100-bed extended-
care facility was being constructed in North Kamloops.
Royal Inland Hospital, Kamloops—The second phase of the first stage of an
expansion program—the enlargement of diagnostic services, including X-ray,
emergency, laboratory, and dietary departments and provision of 14 acute beds
in "shell."
Keremeos—Construction of a diagnostic and treatment centre and ambulance
garage.
Queen's Park Hospital, New Westminster—New hospital facility providing
300 extended-care beds, 100 of which are to be teaching beds, was under construction adjacent to the 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), and development of new service areas, was being carried out under project management.
Powell River General Hospital—An expansion and renovation program,
including the provision of a four-bed intensive-care unit, and additions to provide
expanded facilities for the radiology, laboratory, and central sterilizing departments, also a new hydrotherapy pool, were nearing completion.
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 service areas.
 MEDICAL AND HOSPITAL PROGRAMS EE 115
Trail Regional Hospital—Stage I of an expansion program, including the
upgrading of the dietary department, improvement of the second floor nursing
station, and air cooling systems was expected to be completed early in 1976.
British Columbia Cancer Control Agency, Vancouver—Temporary structures
were being provided for oncology residents and a cytology records computerization
program.
Holy Family Hospital, Vancouver—During major expansion program to provide a total of 80 activation/rehabilitation beds and 154 extended-care beds,
patients were moved into the new building to allow the original building to be
renovated.
Mount St. Joseph Hospital, Vancouver—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,
a new 150-bed extended-care unit, and the upgrading and expansion of services.
St. Vincent's Hospital, Vancouver—Phase II of the hospital's expansion program involving 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, Vancouver—A 300-bed extended-care unit,
adjacent to the psychiatric unit.
Vancouver General Hospital—The renovation of Willow Pavilion to upgrade
the intensive care nursery, electrical services, etc., to provide improved obstetrical
and gynaecological facilities, is under way. Renovations were also being carried
out to provide for a temporary acupuncture (pain referral) clinic.
Mount St. Mary Hospital, Victoria—Work was under way on an addition to
provide a centralized dietary service and renovate areas in the existing building.
Royal Jubilee Hospital, Victoria—An interim program to upgrade the emergency department was being carried out by hospital staff.
C. TENDERING STAGE AT YEAR-END
Lions Gate Hospital, North Vancouver—Multi-storey parking facility, plus
subgrade work for proposed services' expansion project.
Prince George Regional Hospital—Development of space for educational
needs to support the proposed Diploma Nursing Program.
Queen Charlotte Islands General Hospital—Upgrading mechanical, plumbing, electrical services, water supply, etc.
Children's Hospital, Vancouver—Enlargement of surgical suite and new
ambulatory care facilities.
Vancouver General Hospital—Provision of a day-care surgical facility; installation of E.M.I, (brain) scanner.
D. PROJECTS IN ADVANCED STAGES OF PLANNING
Kelowna General Hospital—Construction of an extended-care unit on a new
site using the Overlander Extended-care Hospital plan. The unit will contain 100
beds, plus 50 which are to be in "shell" form.
South Okanagan General Hospital, Oliver—A 75-bed extended-care unit.
Tofino General Hospital—Expansion of services.
 :;:MS5W*K";::'>':i:?^ (
C#
 MEDICAL AND HOSPITAL PROGRAMS EE 117
E. ADDITIONAL PROJECTS APPROVED AND IN VARIOUS
STAGES OF PLANNING
New facilities—
Acute hospitals—Coquitlam (150), Sparwood (27).
Diagnostic and treatment centres—Delta, Elkford, and Pemberton.
Additional and (or) replacement acute beds—Abbotsford (24 plus 20 semifinished and 54 in "shell"), Cranbrook (42), Duncan (12 psychiatric), Fort Nelson
(7), Kamloops (Royal Inland, 47), Mackenzie (seven plus five in "shell"), Maple
Ridge (58 including some psychiatric), Masset (4), Mission (47), Richmond
(150), Saanichton (75), Vancouver (B.C. Cancer Control Agency, 28; Shaughnessy, 183 paediatrics and 90 obstetrics).
New extended-care facilities—Creston (35), Merritt (10), Mission (50),
Prince George (75), Princeton (10), Coquitlam (75).
Additional extended-care beds—Campbell River (15), Castlegar (15), Comox
(15), Langley (25), Surrey (78), Vancouver (Louis Brier, 56; Metropolitan
Council, 80 plus 75 intermediate and 10 personal care; Sunny Hill, 22), Victoria
(Glengarry, 150).
Expansion and (or) updating of services—Chilliwack, Clearwater, Comox,
Cranbrook, Creston, Dawson Creek, Fort Nelson, 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).
MEDICAL CONSULTATION  DIVISION
The function of this Division is to provide medical consultation to other
departments of Government, to all hospitals, and to the regional hospital districts.
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, the Equipment Committee, and the Functional Programs
Review Committee. Assisting development of out-patient and day-care programs
to supplement and replace in-patient care is an important aspect of this role. The
Division also worked with Community Health Programs to define the roles and
equipment needs of community medical clinics and diagnostic and treatment centres,
and on the development of a new prenatal form in conjunction with the Perinatal
Program of B.C. During the year a Division representative participated in a three-
day visit to Manitoba and Alberta, together with representatives from the Department of Human Resources and Community Health Programs, to study their systems
for financing and delivering long-term care.
The Division maintained liaison with other health agencies such as the College
of Physicians and Surgeons of B.C., the B.C. Medical Association, B.C. Health Association, and the Faculty of Medicine at UBC, and received valuable co-operation
in the resolution of problems relating to medical staff activities. Participation on
the Medical Advisory Committee of the B.C. Medical Association, with advisory
subcommittees to the Government on many subjects, continues to be a useful function. In 1975, new continuing subcommittees on anaesthesia, intensive neonatal
and maternal care, and pulmonary services'were established, together with two new
task committees, one to study the cost benefit of a metabolic screening program,
and another to deal with a fifth open heart surgical review.
 EE 118 DEPARTMENT OF HEALTH REPORT,  1975
The Medical Consultation Division has 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. Efficiency in this area was increased during the year by
the addition of another Medical Consultant. Continuing regular visits by the
Medical Record Librarian Consultant also assist hospitals in maintaining a high
standard of medical documentation. The audit process also involves assessment
of eligibility, whether this be for acute care or some other type of care or insured
benefit. Registered nurses within the Division audited and did the medical coding
of 420,000 admission/separation records and day-care surgical service records.
The coded information is utilized by the Research Division to produce the regional
and hospital profiles necessary to planning and audit functions. At the year-end,
staff were working with Finance Division toward development of an out-patient
form, to permit gathering of similar information about all the other out-patient,
emergency, and day-care services.
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 will become better co-ordinated with
Community Health Programs. During the year, new units for extended care were
established at Abbotsford and Grand Forks; the Aberdeen and Fellburn Private
Hospitals came under coverage; a unit at Kitimat and the Memorial Pavilion, Royal
Jubilee Hospital, were designated for extended care; a number of small extended-
care "holding units" were established within community hospitals throughout the
Province. These institutions receive a regular quarterly review by a special multi-
disciplinary team. This latter function emphasizes a consultative review of the
hospitals to assist in establishing optimal patient programs. During the year, "teach
in" at Comox, involving all the long-term care consultants, was highly successful
and may be offered to other units in the coming year. The review also permits an
individual audit to establish the need and eligibility for continuing care. The
shortage of beds in intermediate care continues to hamper the placement of patients
upgraded to this type of care in the extended-care system. Early in 1975 a policy
of short-term admission of extended-care patients was established, supporting and
encouraging relatives who wish to continue to take care of extended-care patients
in their own homes, but who require occasional holiday or other relief.
During 1975 the Medical Consultation Division continued to have the responsibility of determining eligibility of the applicants for admission to the 663 beds in
the five designated intermediate care homes in the Province. These homes are
visited at least quarterly to contribute to the development of an intermediate care
program in the unit and, secondly, to assess continued eligibility of the residents.
A weighted scale of mental health and social factors, to amplify the present
Province-wide and portable eligibility criteria, was being developed.
The development of an intermediate care program has proven an interesting
challenge. Intermediate care patients who are mentally and emotionally handicapped people are no longer inevitably consigned to mental institutions but may be
cared for in community facilities. Division Consultants held formal and informal
teaching sessions and instruction in various aspects of intermediate care in an effort
to improve the understanding of the philosophy and practice of a good intermediate
care program. They enjoyed good co-operation from the units in a joint endeavour
in this relatively new field of providing care, based on a home, rather than hospital,
model.
 MEDICAL AND HOSPITAL PROGRAMS
ADMINISTRATIVE SERVICES DIVISION
EE 119
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 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 Act;
• Hospital Insurance 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 and associated problems connected therewith.
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.
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
 EE 120
DEPARTMENT OF HEALTH REPORT,  1975
expense proposals and in arranging for the necessary by-laws and Orders in Council
for temporary borrowings and related matters.
Eligibility
The review of all 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.
The Division was involved with the purchase of two private hospitals during
1975, namely, Aberdeen Private Hospital,, in Victoria, and Fellburn Private Hospital, in Vancouver. Following the purchase of these hospitals, arrangements were
concluded to lease the buildings and turn over the operations of the hospitals to
nonprofit hospital societies. At the year-end the purchase of the Priory property
in Colwood was under way.
As the year drew to a close, the Division, in conjunction with the Finance
Division and members of the Federal Department of Health, were reviewing the
Federal-Provincial cost-sharing agreement in an effort to streamline it.
APPROVED HOSPITALS
Hospitals as Defined Under the Hospital Insurance Act Designated by Order in
Council 1391/1958, Effective July 1, 1958 (Revised to June 12, 1975)
PART I
Hospitals defined as such under section 2 of the Hospital Act:
(a) Public Hospitals
Armstrong and Spallumcheen Hospital, Armstrong.
Arrow Lakes Hospital, Nakusp.
Ashcroft and District General Hospital,
Ashcroft.
Bella Coola General Hospital, Bella Coola.
Boundary Hospital, Grand Forks.
British Columbia Cancer Institute of the
Cancer Control Agency of British Columbia, Vancouver.
Bulkley Valley District Hospital, Smithers.
Burnaby General Hospital, Burnaby.
Burns Lake and District Hospital, Burns
Lake.
Campbell River and District General Hospital, Campbell River.
Cariboo Memorial Hospital, Williams Lake.
Castlegar  and  District  Hospital,  Castlegar.
Chemainus General Hospital, Chemainus.
Chetwynd General Hospital, Chetwynd.
Children's Hospital, Vancouver.
Chilliwack General Hospital, Chilliwack.
Cowichan District Hospital, Duncan.
Cranbrook and District Hospital, Cranbrook.
Creston Valley Hospital, Creston.
Dawson Creek and District Hospital, Dawson Creek.
Dr. Helmcken Memorial Hospital, Clearwater.
Enderby and District Memorial Hospital,
Enderby.
Fernie Memorial Hospital, Fernie.
Fort Nelson General Hospital, Fort Nelson.
Fort St. John General Hospital, Fort St.
lohn.
Fraser Canyon Hospital, Hope.
G. R. Baker Memorial Hospital, Quesnel.
Golden and District General Hospital,
Golden.
Grace Hospital, Vancouver.
Kelowna General Hospital, Kelowna.
Kimberley and District Hospital, Kimberley.
 MEDICAL AND HOSPITAL PROGRAMS
EE 121
(a) Public Hospita
Kitimat General Hospital, Kitimat.
Kootenay Lake District Hospital, Nelson.
Lady Minto Gulf Islands Hospital, Ganges.
Ladysmith and District General Hospital,
Ladysmith.
Langley Memorial Hospital, Langley.
Lillooet District Hospital, Lillooet.
Lions Gate Hospital, North Vancouver.
McBride and District Hospital, McBride.
Mackenzie and District Hospital, Mackenzie.
Maple Ridge Hospital, Maple Ridge.
Mater Misericordias Hospital, The, Rossland.
Matsqui-Sumas-Abbotsford General Hospital,
Abbotsford.
Michel-Natal District Hospital, Sparwood.
Mills Memorial Hospital, Terrace.
Mission Memorial Hospital, Mission City.
Mount Saint loseph 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, Pouee
Coupe.
Powell River General Hospital, Powell River.
Prince George Regional Hospital, Prince
George.
Prince Rupert Regional Hospital, Prince
Rupert.
Princeton General Hospital, Princeton.
Queen Alexandra Hospital for Children, Victoria.
Queen Charlotte Islands General Hospital,
Queen Charlotte City.
Queen Victoria Hospital, Revelstoke.
ls—Continued
Rest Haven General Hospital, Sidney.
Richmond General Hospital, Richmond.
Royal Columbian Hospital, New Westminster.
Royal Inland Hospital, Kamloops.
Royal lubilee Hospital, Victoria.
R. W. Large Memorial Hospital, Bella Bella.
St. Bartholomew's Hospital, Lytton.
St. George's Hospital, Alert Bay.
St. John Hospital, Vanderhoof.
St. loseph's General Hospital, Comox.
St. Martin's Hospital, Oliver.
St. 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, The, 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.
Red Cross Outpost Nursing Station, Tatla Lake.
(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.
*Hollywood Hospital Ltd., New Westminster.
Mica Creek Private Hospital, Mica Creek.
* Closed July 18, 1975.
 1
EE 122 DEPARTMENT OF HEALTH REPORT,  1975
PART III
Rehabilitation Hospitals
(Hospital Act, Sec. 25)
G. F. Strong Rehabilitation Centre, Vancou- Queen   Alexandra   Hospital   for   Children,
ver. Victoria.
Gorge Road Hospital, The, Victoria. Shaughnessy Hospital, Vancouver.
Holy Family Hospital, Vancouver. Sunny Hill Hospital for Children, Vancou-
Pearson  Hospital   (Poliomyelitis Pavilion), ver.
Vancouver.
PART IV
EXTENDED-CARE HOSPITALS
(Hospital Act, Sec. 25)
Aberdeen Hospital, Victoria (excluding the Mount St. Mary Hospital, Victoria (exclud-
lower floor area). ing top floor).
Fellburn Hospital, Burnaby. Mount Tolmie Hospital, Victoria.
Glengarry Hospital, Victoria. Pearson Hospital, Vancouver (excluding fa-
Louis Brier Hospital, The, Vancouver. cilities for tuberculosis patients).
Menno Hospital, Abbotsford. Priory Hospital, Colwood (24-bed unit and
Mount St. Francis Hospital, Nelson. 71-bed unit).
Mount St. Joseph Hospital, Vancouver (top           Saanich Peninsula Hospital, Saanichton.
floor).
PART V
Diagnostic and Treatment Centres
Arthritis Centre of British Columbia, The, Gold River Health Clinic, Gold River.
Vancouver. Houston Hospital, Houston.
Cumberland General Hospital, Cumberland.
STATISTICAL DATA
The tables as shown on the following pages represent statistical data compiled
by the Hospital Finance Division. The data show the extent of hospital coverage
provided to the people of British Columbia through the British Columbia Hospital
Programs service.
In 1975 there were 104 public general hospitals, as well as three diagnostic
and treatment centres, approved to accept British Columbia Hospital Programs
patients. Additional care was also provided by six Red Cross outpost hospitals,
two Federal hospitals, three contract hospitals, five public rehabilitation hospitals,
plus one rehabilitation hospital operated by the Provincial Government.
Two specialized out-patient facilities, the Canadian Arthritic Society at their
Vancouver Centre, and the Narcotic Addiction Foundation, provided services in
several facilities throughout the Province. Hospital coverage for patients in the
nonprofit extended-care hospitals and units commenced December 1, 1965, and
by the end of 1975 had increased to 52 extended-care hospitals, which includes
one hospital operated by the Provincial Government.
Data for the year 1975 have been estimated, based on reports submitted by
hospitals to September 30, 1975, and are subject to minor revision when the actual
figures for the year are submitted.
Table 18 shows that 405,598 adult and child patients were discharged
(separated) from British Columbia public hospitals in 1975, an increase of 11,091
or 2.8 per cent over 1974. This table also shows that 95.7 per cent of the total
adult and children patients discharged (separated) from British Columbia public
 MEDICAL AND HOSPITAL PROGRAMS
EE 123
hospitals were covered by Hospital Programs compared to 95.6 per cent in 1974.
Table 19 indicates that in 1975 Hospital Programs service paid public hospitals
in British Columbia for 3,472,971 days of care for adults and children, an increase
of 72,098 days or 2.1 per cent more than in 1974. As shown in Table 20, the
average length of stay for adult and child patients in British Columbia public hospitals during 1975 was 8.56 days and the days of care per thousand population
were 1,421. 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 581 days
of care per thousand population were provided for these patients.
Table 21 is supplemented by Table 22 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 Foundation.
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 18—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—
1970	
371,266
380,651
391,732
395,120
412,500
424,004
36,931
35,101
34,774
34,544
35,566
37,293
408,197
415,752
426,506
429,664
448,066
461,297
355,499
364,452
375,373
377,719
394,507
405,598
95.7
95.7
95.8
95.6
95.6
95.7
35,047
33,732
33,595
33,599
34,665
36,423
94.9
96.1
96.6
97.3
97.5
97.7
390 496
1971	
1972	
1973-	
398,184
408,968
411,318
429,172
442,021
95.7
95 8
19742     -	
1975 »_ _	
Percentage of total, patients separated—
1970 .....	
1971   	
1972  	
1973	
95.9
95 7
19742	
95.8
19753	
	
95.8
1 Includes rehabilitation hospitals.
2 Amended as per final report received from hospitals.
3 Estimated, based on hospital reports to September 30, 1975.
 EE 124
DEPARTMENT OF HEALTH REPORT,  1975
Table 19—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
Patients separated—
1970                       	
3,384,586
3,400,366
3,462,509
3,400,453
3,582,774
3,624,750
I
253.081     1   3.637.667
3,233,553
3,259,097
3,323,252
3,257,106
3,400,873
3,472,971
94.5
95.8
96.0
95.8
94.9
95.8
238,049
216,305
210,764
206,178
206,376
213,698
94.1
95.1
96.2
96.3
96.7
97.1
3,471,602
1971	
1972  	
1973	
227,372
219,158
214,003
213,439
220.182
3,627,738
3,681,667
3,614,456
3,796,213
3.844.923
3,475,402
3,534,106
3,463,284
19742	
19753    	
3,607,249
3,686,698
Percentage of total, patient-days—
1970	
1971 	
1972    	
I
       I
       ]        	
-..-      I        	
I
......      I
94.5
95.8
96.0
1973...                              	
95.8
19742       	
95.0
19753..	
95.9
1 Includes rehabilitation hospitals.
2 Amended as per final report received from hospitals.
3 Estimated, based on hospital reports to September 30, 1975.
Table 20—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 Thousand 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
Institutions
Outside
British Columbia
Adults
and
Children
Newborn
Adults
and
Children
Newborn
Extended-
care
Hospitals
Patients separated—
1970	
1971	
1972	
1973  _
19741	
19752	
Patient-days—
1970	
1971   ....	
1972,	
1973....	
19741	
19752.  	
Average days of stay-
1970 -	
1971_	
1972	
1973	
19741...  	
19752 .,
369,210
379,144
388,747
392,550
404,271
413,254
3,465,504
3,486,671
3,543,587
3,474,733
3.565,198
3,549,882
35,431
34,192
33,878
33,962
34,979
36,757
240,657
218,971
212,549
208,154
208,224
215,648
355,449
364,452
375,373
377,719
394,507
405,598
35,047
33,732
33,595
33,599
34,665
36,423
233,553 238,049
259,097 216,305
,323,252;210,764
,257,106
,400,873
472,971
9.39
6.79
9.10
9.20
6.40
8.94
9.12
6.27
8.85
8.85
6.14
8.62
8.81
5.95
8.62
8.59
5.87
8.56
206,178
206,376
213,698
6.79
6.41
6.27
6.14
5.95
5.87
8,307
87
8,654
109
8,140
39
8,092
34
3,572
78
1,456
59
6,086
450
I
167,339[
168.950J
155,150]
103,064
15,9111
21.20
19.34
20.76
19.17
28.85
10.93
442
264
172
464
300
5.34
4.06
6.77
5.06
5.95
5.08
I
5,454
6,038|
5,234!
6,739
6,190
6,200
55,865
60,235
51,385
62,477
61,261
61,000
10.24
9.98
9.82
9.27
9.90
9.84
297
351
244
329
237
275
2,158
3,224
1,521
2,164
1,384
1,650
7.27
6.34
6.23
6.58
5.84
6.00
1,022
1,495
1,822
2,293
2,449
3,059
531,808
672,099
817,321
1,044,529
1,227,949
1,428,080
520.36
449.56
448.58
455.53
501.41
466.85
i Amended as per final reports from hospitals.
2 Estimated, based on hospital reports to September 30, 1975. Estimated patient-days (including newborn
days) per thousand of population covered by Hospital Programs: 1970, 1,734; 1971, 1,696; 1972, 1,669; 1973,
1,600; 1974, 1,531; 1975, 1,421. (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 thousand population of extended care amounted to 308 in 1971,
372 in 1972, 454 in 1973, 502 in 1974, and 584 in 1975. Population figures are revised according to latest census
figures.
 MEDICAL AND HOSPITAL PROGRAMS
EE 125
Table 21—Summary of the Number of Hospital Programs In-patients
and Out-patients
Total Adults,
Children,
and Newborn
In-patients
Estimated
Number of
Emergency,
Minor Surgery,
Day Care, and
Out-patients
Total
Receiving
Benefits
1970..
1971...
1972...
1973...
19741
19752
405,663
414,831
424,447
428,805
441,699
453,070
235,000
292,850
453,589
792,367
1,045,460
1,256,325
640,663
707,681
878,036
1,221,172
1,487,159
1,709,395
i Amended as per final reports received from hospitals.
2 Estimated, based on hospitals reports to September 30, 1975.
Table 22—Summary of Hospital Programs Out-patient Treatments by Category,
1971-75, Inclusive
1971
1972
1973
1974
1975
Psychiatry—
5,012
7,536
191,113
40,289
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
16,800
33,000
638,000
61,000
2,200
338,000
1,900
Other*       	
48,900
292,850
125,500
151,251
155,184
165,425
453,589
792,367
1,045,460
1,256,325
i Commenced October 1972.       2 Commenced April 1973.       3 Commenced January 1975.
*Other includes   (a)   cancer out-patients,   (b)   rehabilitation  day-care,   (c)   narcotic addiction  out-patients
(1972-75 only).
Table 23—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, 1975x (Excluding Extended-care
Hospitals)
Bed Capacity
Total
250 and Over   100 to 249
50 to 99
25 to 49
Under 25
Patients separated—
405,598
36,423
3,472,971
213,698
8.56
5.87
225,690
17,296
2,035,632
108,083
9.02
6.25
107,518
10,981
833,662
60,737
8.22
5.53
33,797
5,049
349,715
29,422
10.35
5.83
28,469
2,140
198,282
11,179
6.96
5.22
10,124
Newborn	
Patient-days—
957
55,680
Newborn	
Average days stay—
4,277
5.50
Newborn	
4.47
1 Estimated, based on hospitals' reports to September 30, 1975.
 EE 126
DEPARTMENT OF HEALTH REPORT, 1975
Table 24—Percentage Distribution of Patients Separated and Patient-days for Hospital Programs Patients Only, in British Columbia Public Hospitals, Grouped
According to Bed Capacity, 19751 (Excluding Extended-care Hospitals)
Bed Capacity
Total
250 and Over
100 to 249
50 to 99
25 to 49
Under 25
Patients separated—■
Adults and children	
Newborn  	
Patient-days—
Per Cent
100.0
100.0
100.0
100.0
Per Cent
55.64
47.49
58.61
50.58
Per Cent
26.51
30.15
24.01
28.42
Per Cent
8.33
13.86
10.07
13.77
Per Cent
7.02
5.88
5.71
5.23
Per Cent
2.50
2.62
1.60
Newborn 	
2.00
i Estimated, based on hospitals' reports to September 30, 1975.
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 Discharges During 1974" and
"Statistics of Hospitalized Accident Cases, 1974," available from the Research
Division.
 MEDICAL AND HOSPITAL PROGRAMS
EE 127
Chart I—Percentage Distribution of Days of Care* by Major Diagnostic Groups,
Hospital Programs, 1974 (in Descending Order)
Other
2.2%
Skin
1.5% X
Congenital
anomalies
1.6%    N^\
Metabolic diseases 2.4% ^s-N-«
Infective and         _ <c/        w
parasitic diseases ■£• J /o    _
Nervous system
3.8%
Bones
5.4%
Genito- urinary
system
6.7%
Mental
disorders
6.9%
 o
MALES
Accidents 18.5%
Circulatory
system
Digestive
system
Respiratory
system
Neoplasms
18.2%
11.6%
9.7%
9.0%
in minium mil mi
Other                 2.0%
Skin                 1.2% \
inm
■ ■■■■
■■■■■■■iiiiiiiiiiiiiiii
FEMALES
■ II 1 IIIIIIIIIII
Deliveries           13.7%
•	
Accidents           13.1%
Circulatory          ,,„„
system                13.0%
Ill-defined             ^~\ N"s-
conditions          1.6%    \_ •
Infective and                   N>
parasitic diseases  2.1%
•	
Metabolic
diseases               ^..l/o
Nervous system 3.4%
Digestive system 10.3%
Neoplasms            8.9%
Bones                6.0%
Respiratory
system                o.ivc
Genito-urinaiy     „ , „
system                    0.1 Vo
Mental disorders   7.6%
Including rehabilitative care.
 EE 128
DEPARTMENT OF HEALTH REPORT,  1975
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 MEDICAL AND HOSPITAL PROGRAMS
EE 129
Chart III—Percentage Distribution of Hospital Cases* by Type of Clinical Service,
Hospital Programs, 1974
MALES
Adult Surgical 44.5";
Adult Medical 28.3%
Paediatric Surgical        10.3%
Pediatric Medical        10.7%
Psychiatric
4.9%
Rehabilitative Care       1.3%
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIlllllllllllllllIlllilllll
FEMALES
Adult Surgical 42.3%
Adult Medical 21.4%
1
Maternity
17.9%
\    /   .
Paediatric Medical
6.5%
Paediatric Surgical
5.9%
Psychiatric
5.1%
•
Rehabilitative Care
0.9%
 : 1«          ^
' Including rehabilitative care.
 EE 130
DEPARTMENT OF HEALTH REPORT, 1975
Chart IV—Percentage Distribution of Hospital Days* by Type of Clinical Service,
Hospital Programs, 1974
MALES
Adult Surgical 41.9%
-•
Adult Medical
35.9%
Paediatric Medical
7.3%
'  R
V   #
Psychiatric
5.9%
V
Paediatric Surgical
5.0%
Rehabilitative Care
4.0%
 -•
■ ■■■■■■■■■■■■■■■■■■■■■■■■•■■■■■■■■■■■■■■■■■III ■■■■■■■■■■■■■ I ■■■lllllllllllllllllllllll
FEMALES
Adult Surgical 39.8%
\
Adult Medical 29.2%
Maternity
Psychiatric
11.9%
7.3%
Paediatric Medical 5.2%
Rehabilitative Care        3.5%
Paediatric Surgical 3.1%
%S:::i
* Including rehabilitative care.
 MEDICAL AND HOSPITAL PROGRAMS EE 131
Chart V—Average Length of Stay of Cases* in Hospitals in British Columbia, by Major
Diagnostic Groups in Descending Order, Hospital Programs, 1974 (Excluding
Newborns)
Diseases of the circulatory
system
13.9
:§P^%~:^^
Neoplasms
13.2
Certain causes of perinatal
morbidity and mortality
13.2
Mental disorders
12.7
P nHri/^fir*^    nutritional     on^l                                                                                        ....___	
metabolic diseases
12.6
T^iC(u»QCi^c   r»f tVi(u»  TYiiicnilAel'Pl^tol                                                                        	
system and connective tissue
11.9
Congenital anomalies
9.8
nispasps nf trip Hiopstivp                                           	
system
9.0
Accidents, poisonings, and
violence
Diseases of the skin and
9.0
mSK
±HClkJvUJVU    V-l-     VXJlW    JlVl 11 1     U 1 1 VI
9.0
^Y^S:,:M:r\::-:M'C:
PROVINCIAL AVERAGE
LENGTH OF STAY
Diseases of the blood and
blood-forming organs
Diseases of the nervous
system and sense organs
8.4
8.2
Infective and parasitic ^___~.
diseases ™
6.1
6.1
Diseases of the respiratory
system
Diseases of the genito-urinary
system
Complications of pregnancy,
childbirth, and the 5.0
puerperium
Symptoms and ill-defined
conditions
* Including rehabilitative care.     4.8
    Medical Services Commission
On July 1, 1968, the Government established an over-all Medical Services Plan,
which is administered and operated on a nonprofit basis 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 of these services 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.
135
  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
necessarily performed in a hospital as provided under the Medical Care Act of
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 the 31st day of March.
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.
1. 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. No payment for X-rays taken by a
chiropractor; no payment for a chiropractic service performed outside the Province.
2. 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. No payment for X-rays taken by a naturopathic physician; no payment for any naturopathic services performed outside the
Province.
3. Orthoptic treatment—Up to a limit of $50 per patient in any one year and a
maximum of $100 per family in any one year, services for orthoptic treatments
when rendered in the Province of British Columbia to an insured person on the
instructions of, or referral by a medical practitioner, shall be paid under the Plan
at a tariff of fees approved by the Commission, but there shall be no payment for
such services performed outside the Province of British Columbia.
4. 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.
No payment for any physiotherapy services performed outside the Province.
Important—Out-patient physiotherapy services in general hospitals or in
rehabilitative hospitals on referral by a medical practitioner are benefits provided
by the BrHish Columbia Hospital Programs.
5. 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. No payment for X-rays taken by a podiatrist; no payment for any
services performed outside the Province.
137
 '--,. la     ""-..._--s5p
r   1  '  '"'flBB
i ni
^^31
j^^^^ji
"'___   ■       -,;;%.      H    ,
E"V ~";^S *
r*  '                              !"-;'M K
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W ZISS^ i
R"   '"T.       ^j
£     -'^«i
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V
 MEDICAL AND HOSPITAL PROGRAMS EE 139
6. Optometry—Services of registered optometrists are approved for required
diagnostic optometric services to determine the presence of any observed abnormality
in the visual system. There is no payment for any service performed outside the
Province of British Columbia by an optometrist. The Plan does not pay for the
fitting or cost of lenses.
7. 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 orthodontic services provided outside the Province. There is no payment for dentures, appliances, prostheses, or for general dental services.
8. 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. There
shall be no payment for such services performed outside the Province of British
Columbia.
9. Victorian Order of Nurses—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. There shall be no payment for any service performed
outside the Province of British Columbia by a member of the Victorian Order of
Nurses.
SERVICES EXCLUDED UNDER THE PLAN
1. Services which are provided under other Federal or Provincial Acts such
as the National Defence Act of Canada, the Hospital Insurance Act, and the
Workers' Compensation Act of the Province.
2. 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.
3. 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.
4. 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.
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 under the Medical Services Act is available as follows:
• 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.
 EE 140 DEPARTMENT OF HEALTH REPORT,  1975
• 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 rates.
Monthly premiums payable by subscribers are as follows:
If Qualified for—
Full 50 per cent 90 per cent
Premium Subsidy Subsidy
$ $ $
One person     5.00 2.50 0.50
Family of two  10.00 5.00 1.00
Family of three or more  12.50 6.25 1.25
• 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.
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
 MEDICAL AND HOSPITAL PROGRAMS EE 141
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 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 this additional private practice.
In the year 1974/75 the total expenditure on medical services by the Medical
Services Commission was $211,966,988, which was made up of $201,757,831 in the
form of fee-for-service payments and $10,209,157 for salary and sessional payments.
SUBSCRIBER STATISTICS
For detailed statistical tables see Annual Report of the Medical Services
Commission for the Year Ended March 31, 1975.
Table 25—Registration and Persons Covered1 by Premium Subsidy
Level, Medical Services Plan, at March 31, 1975
Subsidy
(Per Cent) Subscribers2 Persons2
90      224,476 367,672
50        28,138 52,768
Nil      793,405 2,022,560
Totals   1,046,019 2,443,000
1 Coverage data do not include members of the Canadian Armed Forces, RCMP, and inmates of Federal
penitentiaries.
2 Subscriber data have been adjusted to agree with the population statistics of the Dominion Bureau of
Statistics and are not comparable to those published in the previous Annual Report.
Table 26—Persons covered1 by Age-group, Medical Services Plan,
at March 31, 1975
Age-groups Persons2
Under 1   29,560
1-4  149,267
5-14  440,473
15-24  473,453
25-44   637,623
45-64  468,079
65-69  78,420
70-79  98,209
80-89     44,951
90 and over  7,573
Unknown   15,392
Total   2,443,000
* Coverage data do not include members of the Canadian Armed Forces, RCMP, and inmates of Federal
penitentiaries.
2 Subscriber data have been adjusted to agree with the population statistics of the Dominion Bureau of
Statistics and are not comparable to those published in the previous Annual Report.
 EE 142
DEPARTMENT OF HEALTH REPORT,  1975
Table 27—Distribution of Fee for Service Payments for Medical Services
(Shareable)1, Medical Services Plan, 1973/74 and 1974/75
Amount Paid
Per Cent of Total
Cost per
Person2
Specialty
1973/74
1974/75
1973/74
1974/75
1973/743
1974/75
$
67,487,760
1,575,525
1,202,646
4,662.309
167,264
6,052,637
6,612,574
40,750
2,875,681
11,734,262
1,046,138
3,641,230
1,130,061
996,843
2,621,390
3,481,484
9,074,018
11,888,791
9,229,333
6,412,213
241,070
85,518
455,552
174,539
2,378,209
$
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
43.59
1.02
0.78
3.01
0.11
3.91
3.98
0.03
1.86
7.58
0.68
2.35
0.73
0.64
1.69
2.25
5.86
7.68
5.96
4.14
0.16
0.06
0.29
0.11
1.54
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
$
28.9647
0.6762
0.5162
2.0010
0.0718
2.5977
2.6449
0.0173
1.2342
5.0362
0.4490
1.5628
0.4850
0.4278
1.1251
1.4942
3.8944
5.1025
3.9611
2.7520
0.1035
0.0367
0.1955
0.0749
1.0956
$
34.1270
0.8170
Neurology 	
Psychiatry 	
0.5524
2.3703
0.0817
2.9239
3.0394
0.0328
Otolaryncology	
|      1.3992
|      5.5348
0.4626
|      1.8215
Plastic surgery    ...
Thoracic surgery	
Urology 	
Paediatrics	
|      0.5520
0.4986
|      1.3358
1.6840
4.6814
5.9920
|      5.3811
3.0613
|      0.1280
Public Health   	
|      0.0303
|      0.1677
0.0857
1.7955
154,817,797
189,162,797
100.00
100.00
66.5203
78.5560
!
t- Medical practitioners' and dental surgery services in hospital, shareable under Medical Care Act, Canada,
and Hospital Insurance Diagnostic Services Act.
2 Based on population as at October 1, as provided by the Dominion Bureau of Statistics (October 1, 1973
= 2,330,000; October 1, 1974 = 2,408,000).
3 Cost per person data for 1973/74 in this Report differ slightly from that given in the 1973/74 Report due to
the change in the population base used. The 1973/74 Report of the Medical Services Commission used plan
population data; the 1974/75 Report uses Federal population data.
Table 28—Distribution of Fee for Service Payments for Insured Services, Non-
shareable1 Additional Benefits, Medical Services Plan, 1973/74 and 1974/75
Type of Service
Amount Paid2
Per Cent of Total
Cost Per Person^
1973/74
1974/75
1973/74
1974/75
1973/74-i
1974/75
$
5,553
160,451
14,474
3,786,597
203,400
1,162,967
157,703
2,720
899,311
2,125,743
107
$
4,721
75,565
12,798
5,747,051
191,174
1,290,244
829
3,928
1,014,628
2,671,380
2,512
0.07
1.88
0.17
44.45
2.39
13.65
1.85
0.03
10.56
24.95
0.00
0.04
0.69
0.12
52.17
1.74
11.71
0.01
0.04
9.21
24.25
0.02
$
0.0024
0.0689
0.0062
1.6251
0.0873
0.4991
0.0677
0.0012
0.3860
0.9123
0.0000
$
0.0020
0.0314
0 0053
2.3866
Naturopathic	
0.0794
0.5358
0 0004
0.0016
Podiatry  .          	
0.4214
1.1094
0.0010
8,519,026
11,014,830
100.00
100.00
3.6562
4.5743
1 Nonshareable by Federal Government.
2 These amounts are fee for service payments paid under the Plan only, and in no way reflect the total for
the services of these practitioners.
3 Based on population as at October I, as provided by the Dominion Bureau of Statistics (October 1973 =
2,330,000; October 1974=2,408,000).
4 Cost per person data for 1973/74 in this Report differ slightly from that given in the 1973/74 Report of
the Medical Services Commission due to the change in the population base used. The 1973/74 Report used plan
population data; the 1974/75 Report uses Federal population data.
   GOVERNMENT HEALTH   INSTITUTIONS
There will continue to be a need for specialized facilities to accommodate
those whose treatment cannot be adequately taken care of through the community-
based services. Therefore, the Department of Health also provides assistance in
the development of facilities and services for those of the mentally ill, the emotionally disturbed, the senile aged, the tubercular, and the profoundly physically
disabled, whose condition requires admission to a specialized treatment facility.
Effective December 1, 1975, a Director of Government Health Institutions
was appointed. 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:
RIVERVIEW HOSPITAL
Riverview Hospital continued as a major component of the Provincial Mental
Health Program, and endeavoured to cope with the changing demands made upon
it as community services evolved. This was a difficult role for any hospital to
fulfil, especially one without adequate facilities and with administrative limitations.
To an increasing degree the hospital served the seriously mentally ill, disabled,
and infirm long-term patients, and the acute short-term patients who could not
be cared for in general hospital psychiatric wards and other community resources.
Therefore, while there was a significant drop in admissions and in the number of
patients in residence, there was a marked increase in the level of care required by
the individual patient.
Clinical services were well maintained, although there was a shortage of
psychiatrists on the staff. This problem could only be countered by placing the
responsibility for the admission and medical care of patients on community psychiatrists, wherever this was feasible. In this way the hospital would become one
of several options open to the physician in handling his patient. This arrangement was working well in the Fraser Valley region, and would be introduced to the
Greater Vancouver area in 1976 and involve the Greater Vancouver Mental Health
Service, the psychiatric units in general hospitals, and Riverview Hospital in a
co-ordinated delivery system.
In September the Riverside Forensic Unit was placed under the administrative
control of the Executive Director of the Forensic Psychiatric Service, and in
December operational responsibility was formally assigned to the Commission.
The unit would continue as a mental health facility in accordance with the Mental
Health Act, and the staff would remain as Public Service employees.
In keeping with the general policy to develop and strengthen community-
based programs, the Riverview Hospital out-patient service in Vancouver and the
Venture and Vista halfway house programs were seconded to the Greater Vancouver Mental Health Service in August in order to augment the community mental health teams and to provide a short-stay hostel for acute cases.
The rehabilitation of patients and preparation for community re-entry continued to be a major emphasis in the mental hospital programs. The Hillside
Program, the Brookside Program, and the Home 10 Program were developed
specifically for this purpose. The patients who remained in hospital, while fewer
in number, had a greater degree of residual disability and required a more prolonged and intensive preparation for community re-entry.    Close liaison with the
145
  GOVERNMENT HEALTH INSTITUTIONS
EE 147
mental health centres and the community care teams was established to assist these
patients in a gradual transition to community living and provide them with the
necessary follow-ups in psychiatric care.
The Intensive Care Unit was developed as a specialized program, providing
intensive psychiatric care for patients, not only from various parts of Riverview
Hospital but also from the psychiatric units of other hospitals such as the Burnaby
Mental Health Centre and the Health Sciences Centre Hospital.
The hospital was granted provisional accreditation in the fall of 1974, and
during the past year attempted to implement the recommendations of the Canadian
Council on Hospital Accreditation. The medical staff by-laws were updated and
a number of changes were introduced in accordance with the Council's recommendations. By the year-end all medical staff had been fully registered by the
College of Physicians and Surgeons of British Columbia.
The Planning Committee, with broad departmental representation, met
regularly to review the current and future function of the hospital. A study to
categorize patients according to their need was under way in conjunction with
newly developed standards, which would enable a rational plan to be developed
for the upgrading, refurbishing, or replacement of the existing buildings.
VALLEYVIEW HOSPITAL
This 726-bed hospital continued to provide service to patients over the age of
70 suffering from mental disorders requiring special management. The majority
suffer from organic brain syndromes associated with aging. In addition, a small
number of patients were admitted suffering from psychotic or neurotic reactions
common to any age-group.
During the year there was a decrease in admissions due in part to temporary
staff shortages in the summer and in part to a decrease in applications for admission.
There was also a drop in the average death rate in the hospital, and increased difficulty in finding suitable community placements for patients capable of discharge.
Contrary to experience in previous years, there was a preponderance of male applications for admission.
Clinical services remained at a high level with an excellent standard of care
being provided by the nursing services. A number of newly negotiated contract
benefits, which were not compensated for by the provision of supplementary staff,
at times placed a serious strain on the nursing resources. An experienced psychiatrist joined the staff during the year and this has resulted in an expansion of services
on the psychiatric ward, with a more meaningful involvement of ward staff in the
psychotherapeutic management of patients.
The anticipated appointment of a nonmedical executive director did not take
place, but it was anticipated that this situation will be remedied early in the new year.
DELLVIEW HOSPITAL
On April 1, 1975, Dellview Hospital was decertified as a mental health facility
under the Mental Health Act, 1964, and designated as a special care facility to meet
the special needs of the psychogeriatric patient who cannot be cared for in the
average intermediate or extended-care unit. The necessary changes in admission
procedure were instituted in accordance with the change of status of the hospital.
There was a decrease in the number of admissions, presumably resulting from
the availability of alternative intermediate and extended-care programs. This
virtually eliminated the waiting-list and permitted the administration to waive the
age-limit in certain suitable cases.
 EE 148 DEPARTMENT OF HEALTH REPORT,  1975
Despite a good level of maintenance, Dellview Hospital remained an old and
inconvenient facility. Nevertheless, a high level of service was maintained and the
addition of a social worker and activity therapist added significantly to the program.
The ability to carry out pre-admission consultation and to return a limited number
of patients to the community was particularly helpful.
PEARSON HOSPITAL
Pearson Hospital provides in-hospital care for tuberculosis patients, persons
with severe respiratory disabilities from poliomyelitis, and extended-care patients.
All these types of patients have been admitted to Pearson Hospital, while the Willow
Chest Centre in-service program has only admitted persons with tuberculosis.
With the declining numbers of people needing to be hospitalized for tuberculosis, both institutions have had fewer of this type of admission, and in July it
was decided to consolidate all of them at Pearson Hospital to provide a more
efficient and economical use of resources. It is expected when renovations at
Willow Chest Centre are complete all in-patient care for tuberculosis will be at the
centre. Two tuberculosis wards at Pearson Hospital will then be utilized for
additional extended-care patients, thus helping to alleviate the need for more such
beds in the Province.
A Patient-Management Liaison Committee established at Pearson Hospital
was successful. The committee encouraged the discussion of mutual concerns and
improvement of communications.
A Director of Social Service and a new Senior Occupational Therapist were
appointed to fill vacancies. The transfer of patients from Willow Chest Centre
resulted in the moving of Nursing, Housekeeping, Dietary, and Activity Services
staff.
In June a new extended-care program admitting young adults was started. The
goal of this project was to provide a suitable milieu for eligible extended-care persons, providing them with a staff oriented to the special needs of such patients. The
selection, care, and encouragement of these patients required considerable time
and effort.
The operation of the various departments proceeded well throughout the year,
despite increasing costs due to economic conditions generally.    In summary,
• the Dietary Service has, by continued testing of products, inventory control,
menu planning, and judicious utilization of staff, kept costs from rising as
much as had been forecast; however, indications are that food costs, despite
price controls, will continue to show a significant increase;
• the Department of Nursing extended the activities of the Interservice Committee, and the multidisciplinary approach to patient care; the Activity
Services Department was also involved in this program;
• the In-Service Education program involved all departments and also had
staff from the Vancouver Dogwood Lodge participate in certain activities;
• the Pharmacy Department extended its drug control program, and a Pharmacy and Therapeutics Committee was established; the work on patient drug
profiles continued;
• the establishment of a laboratory supervisory service, as recommended by
the Provincial Diagnostic Services Committee, was completed and will result
in improved quality control (the Shaughnessy Hospital Laboratory is providing this service);
• the work of the X-ray Department was relatively unchanged until the transfer of Willow Chest Centre patients occurred, but was increasing at the
year-end; the need for new and safer equipment was becoming more urgent;
 GOVERNMENT HEALTH INSTITUTIONS
EE 149
the Social Service Department increased its emphasis toward the extended-
care wards, particularly the Young Adult Program;
the Housekeeping Department consolidated its services and all laundry for
patients and staff was being done at Shaughnessy Hospital;
Community Services involving students receiving training at Pearson Hospital, and participation by members from various departments continued,
and increased in some areas;
the Women's Auxiliary and other groups maintained their interest and
financial support to the patients.
    EMERGENCY HEALTH SERVICES COMMISSION
The Commission was established pursuant to an Act of the Legislature, effective July 1, 1974, with the 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 emergency health services
and to train personnel 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 Program, such as medical involvement in disaster planning, responsibility for Federal stores stockpiled around the Province, and involvement when actual disasters occur.
Development of a Provincial ambulance service was considered the first
priority and, effective July 1, 1974, the Commission assumed financial responsibility for all ambulance services operating within British Columbia, with the exception of those ambulances operated by industry under the requirements of the
Workers' Compensation Board. All residents of the Province are entitled to the
use of an ambulance, where it is a medical necessity, for a charge to the individual
of $5. Charges based on cost are made in the case of certain Federal Government employees, individuals who have not been residents for a period of three
months, and those for whom other agencies assume responsibility.
The acquisition of operators' assets has begun, and may eventually cost approximately $1 million.
Training programs have been developed and, to this date, 80 hours of basic
training have been given to 507 crew, six weeks of more advanced training to 237
crew, and 9 crew members have been trained to the highest level (paramedic),
which is a one-year course. Industrial First Aid tickets were either obtained or
renewed by 1,600 ambulance crew. Instruction has also been provided to pilots
of Provincial Government aircraft regarding the loading and unloading of stretchers,
and the care of patients during transit.
Courses in emergency medicine have been sponsored by the Commission in
Vancouver in the spring of 1975, where more than 300 registrants attended, and
in Prince George and Quesnel, where emergency department personnel, including
physicians and nurses, have been sent to provide advance training in the care of
multiple trauma and in cardiopulmonary resuscitation.
153
 IsL      ,   v      '
' :      '.•*'•-.-«..«»..
I11
If    jB
Mfli
•■:-■ ■ ■
 EMERGENCY HEALTH SERVICES COMMISSION
EE 155
The Commission is producing its own ambulances, based on a van-type
chassis, at a saving of several thousand dollars over a similar vehicle available
commercially. Forty-one new vehicles have been provided to communities around
the Province. In addition, back-up support vehicles have been provided to two
communities, and a further seven communities have been provided with reconditioned vehicles in good condition.
In 1975, as in 1974, two physicians were 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.
A Province-wide network of radio communication has been designed with
the assistance of the Department of Transport and Communications and it is hoped
to commence installation very shortly.
The initial steps have been taken in a program of categorization of hospital
emergency departments. This action will enable the members of the public and
ambulance crew to know exactly the capability of a hospital to provide certain
standards of care in an emergency. An example of this is the decision to categorize the Emergency Department at the Vancouver General Hospital as a tertiary
referral centre for trauma and burns.
The Commission has just under 500 full-time employees involved in ambulance work, with a further 3,000 personnel available for crew on a call-out basis.
By the end of 1975 the ambulance service was experiencing calls at the rate
of approximately 130,000 per year.
  z
o
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o
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u
u
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i
s
  FORENSIC PSYCHIATRIC SERVICES COMMISSION
Although progress during the year was not as rapid in certain areas as the
Commission had anticipated, significant advances were made in the provision of
Forensic Psychiatric Services.
In April, the Human Services Committee of Cabinet approved, in principle,
plans and estimates for a basic Forensic Psychiatric Service. These proposals
stressed the need for adequate assessment and treatment of the mentally ill offender,
while ensuring that his or her civil rights were protected. While certain special
forensic services would be necessary, wherever feasible the individual should be
treated in existing community resources. Specifically, the Commission called for
the transfer of the Riverside Unit at Essondale to the operational control of the
Commission; the establishment of in-patient, out-patient, and consultation services
in Vancouver and Victoria; and the involvement of community mental health
centres in other areas of the Province in the provision of Forensic Services.
In June, Dr. John Duffy, an experienced forensic psychiatrist, was appointed
Executive Director. By the year-end, his work with the Department of the Attorney-
General, the judiciary, and other agencies, had already resulted in the more effective
use of existing services. The administration of the Riverside Unit was formally
passed to the Commission in December. Twenty positions to provide administrative
services, out-patient services, and augment the Riverside operation, had been
approved, effective January 1, 1976. Negotiations with Shaughnessy Hospital,
the British Columbia Medical Centre, and the Eric Martin Institute of the Royal
Jubilee Hospital were proceeding satisfactorily for the establishment of the Vancouver and Victoria centres.
During the year the Commission met approximately twice a month and, in
addition to planning for direct service, also concerned itself in the wide and complex
field of the law and the mentally ill offender.
159
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 .                -   -
  FINANCIAL TABLES AND CHART
Table 29—Expenditure by Principal Categories in the Department of Health
for the Fiscal Year 1974/751
Total Expenditure
in Fiscal Year
Ended March 31, 1975
$
Public Health Services     28,364,123
Mental Health Services     56,821,726
Hospital Insurance Services  373,366,070
The Overall Medical Services Plan of British Columbia __ 224,468,003
Emergency Health Services       6,097,477
Total Health Services
689,117,399
1 Data are shown according to the administrative organization of the Department at the commencement of
the 1974/75 fiscal year.
Chart VI—Expenditure by Principal Categories in the Department of Health
for the Fiscal Year 1974/75
Total Health Services
in 1974/75:
$689,117,399
Emergency Health Services
$6,097,477    1%
Public Health Services
$28,364,123    4%
Mental Health Services
$56,821,726    8%
163
 EE 164 DEPARTMENT OF HEALTH REPORT,  1975
Table 30—Detailed Expenditure by Principal Categories in the Department of
Health for the Fiscal Year 1974/751
Total Expenditure
in Fiscal Year
Ended March 31, 1975
Public Health Services: $
Minister's Office  80,099
Accounting Division  501,036
General Services  2,474,903
Division for Aid to Handicapped  894,448
Development of Alternative Care Facilities  323,612
Hearing-aid Regulation Act  12,287
Grants for Health Agencies  1,639,695
Community Health Services Development  210,517
Local Health Services  15,142,996
Division of Laboratories  1,234,927
Division of Vital Statistics  871,142
Division of Venereal Disease Control  349,268
Division of Tuberculosis Control  1,025,033
Division of In-patient Care  3,407,110
Administration of Cemetery Companies Program  22,240
Action B.C  125,000
Training in the Expanded Role of Nurses  49,810
Subtotal, Public Health Services  28,364,123
Mental Health Services: $
General Administration  845,462
Division of Nursing Education  319,879
Community Services  5,751,374
In-patient Care:
Riverview Hospital and Out-patient Services      21,934,201
Valleyview Hospital        6,258,168
Dellview Hospital       1,485,291
Skeenaview Hospital  124,231
The Woodlands School     11,856,520
The Tranquille School       5,402,303
B.C. Youth Development Centre       2,486,830
Net undistributed stores  340,169
Subtotal, In-patient Care   49,887,713
Forensic Psychiatric Services Commission Act  17,298
Subtotal, Mental Health Services  56,821,726
i Data are shown according to the administrative organization of the Department at the commencement of
the 1974/75 fiscal year.
 DEPARTMENT OF HEALTH EXPENDITURES, 1974/75 EE 165
Hospital Insurance Services:
Aministration   2,438,265
Payments to hospitals—
Claims   357,857,187
Grants in aid of equipment  4,422,898
Capital and debt services  8,647,720
Subtotal, Hospital Insurance Services  373,366,070
The Overall Medical Services Plan of British Columbia:
Benefits—
Medical care  199,371,953
Additional benefits     11,014,830
210,386,783
Adjustment of provision for unpresented
and processed benefit costs        1,580,205
  211,966,988
Administration, licensed carriers (MSA and
CU & C)—
Salaries and employee benefits        2,768,825
General office expenses          1,486,414
Commission Central Administration, Medical
Services Plan—
Salaries and employee benefits        4,099,185
General office expenses       2,038,120
4,255,239
6,137,305
Amalgamation administration expenses—
Salaries and employee benefits        1,409,346
General office expenses   699,125
       2,108,471
Subtotal, The Overall Medical Services Plan of
British Columbia   224,468,003
Emergency Health Services       6,097,477
Total Health Services   689,117,399
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1976
2030-775-9355
 

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