BC Sessional Papers

Ministry of Health ANNUAL REPORT 1977 British Columbia. Legislative Assembly 1978

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 PROVINCE OF BRITISH COLUMBIA
Ministry of Health
ANNUAL REPORT
1977
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1978
  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 Ministry of
Health for the year 1977.
r. h. McClelland
Minister of Health
Office of the Minister of Health,
Victoria, B.C., April 15, 1978.
 Ministry of Health, Victoria, B.C., April 15, 1978
The Honourable R. H. McClelland,
Minister of Health, Victoria, B.C.
Sir:  I have the honour to submit the Annual Report of the Ministry of
Health for 1977.
J. W. MAINGUY
Deputy Minister of Health
 MINISTRY OF HEALTH
The Honourable R. H. McClelland, Minister of Health
J. W. Mainguy, Deputy Minister of Health
C. Key, 1 Executive Director, Health Programs
J. Bainbridge,2 Associate Deputy Minister, Planning and Support Services
PLANNING AND SUPPORT SERVICES
W. DlETIKER
Director of Data Processing
W. F. Locker
Director of Personnel
M. L. Chazottes
Director of Health Education and Information
F. G. Tucker
Consultant in Mental Health
J. S. Bland
Consultant in Geriatrics
*COMMUNITY HEALTH PROGRAMS
*G. R. F. Elliots
Deputy Minister, Community Health Programs
J. H. Doughty H. J. Price
Director of Administration Comptroller
W. D. Burrowes
Director, Division of Vital Statistics
Public Health Programs
K. I. G. Benson
Associate Deputy Minister and Provincial Health Officer
R. G. Scott
W. Bailey
Director, Division of Environmental Engineering
L. M. Crane
Director, Division of Public Health Nursing
A. A. Larsen
Director, Division of Epidemiology
F. McCombie
Director, Division of Dental Health Services
Director, Division of Public Health Inspection
P. Wolczuk
Director, Division of Community Nutrition
G. D. Zink
Director, Division of Speech and Hearing
W. J. Bowmer
Director, Division of Laboratories
C. E. Bradbury
Director, Division for Aid to Handicapped
H. K. Kennedy
Director,   Division   of   Venereal  Disease
Control
Special Health Services
J. H. Smith
Director, Bureau of Special Health Services
L. D. Kornder
i Appointment effective November 1, 1977.
2 Appointment effective September 1, 1977.
3 On retirement leave effective January 31, 1977.
Director, Division of Occupational Health
F. D. Mackenzie
Director, Division of Tuberculosis Control
 Mental Health Programs
A. Porteous
Associate Deputy Minister
M. M. Lonergan D. Fernandez
Consultant in Nursing Planning and Research Officer
Mrs. F. Ireland R. S. McInnes
Co-ordinator, Boarding-home Program Co-ordinator of Mental Health Centres
J. B. Farry A. G. Devries
Consultant in Social Work Consultant in Psychology
British Columbia Youth Development Centre
P. H. Adilman, Director, Residential and Day Unit
D. C. Shalman, Director, Psychological Education Clinic
Greater Vancouver Mental Health Services
J. D. Kyle,6 Executive Director
J. Seager,7 Executive Director
Burnaby Mental Health Services
W. C. Holt, Director
Integrated Services for Child and Family Development (Victoria)
A. Kerr, A cting Director
J. Ricks,8 Director
* Appointment Associate Deputy Minister, Planning and Support Services, September 1, 1977.
5 Appointment effective November 7, 1977.
6 Resigned effective June 16, 1977.
1 Appointment effective October 20, 1977.
8 Appointment effective September 1, 1977.
 * MEDICAL AND HOSPITAL PROGRAMS
*W. J. Lyle»
Deputy Minister, Medical and Hospital Programs
Hospital Programs
J. G. Glenwright
Associate Deputy Minister
P. M. Breel
Senior Director
C. F. Ballam
Senior Medical Consultant
A. C. Laugharne
Director, Hospital Finance Division
J. D. Herbert
Director, Administrative Services
H. R. McGann
Director,  Hospital  Consultation  and Inspection Division
R. H. Goodacre
Director, Research Division
G. F. Fisher
Director, Hospital Construction and Planning Division
8 On retirement leave effective October 12, 1977.
* Note—Changes in the senior administrative echelons of the Ministry coincided with the
retirements of Dr. G. R. F. Elliot, Deputy Minister of Community Health Programs, and W. J.
Lyle, Deputy Minister of Medical and Hospital Programs. The previous branches of Medical
and Hospital Programs, and Community Health Programs, were brought under the administration of an Executive Director, Health Programs. In addition, the Ministry Planning and Support Services were placed under the direction of an Associate Deputy Minister.
Medical Services
D. H. Weir
Chairman
R. B. H. Ralfs
Director, Salaried and Sessional Programs
D. M. Bolton
Senior Medical Consultant
A. W. Brown
Director, Plan Administration
R. A. Munro
Director of Financial Services
Commissions, Etc.
H. F. Hoskin
Chairman, Alcohol and Drug Commission
of British Columbia
D. H. Weir
Chairman,   Emergency   Health   Services
Commission
P. Ransford
Executive   Director,   Emergency   Health
Services Commission
F. G. Tucker
Chairman,  Forensic Psychiatric  Services
Commission
J. Duffy
Executive Director, Forensic Psychiatric
Services Commission
J. Bainbridge*
I. Manning5
Director of Government Health Institutions
J. Bainbridge
Chairman, Provincial Adult Care Facilities
Licensing Board
M. Dahl
Chairman, Provincial Child Care Facilities
Licensing Board
  MINISTRY OF HEALTH  (as from  November  1,   1977)
  TABLE OF CONTENTS
Page
Ye ar in Review  15
Demographic Features   18
Planning and Support Services
Program Development Group  19
Health Education and Information  20
Data Processing  22
Personnel  22
Community Care Facilities Licensing Board  23
Public Health Programs
Introduction  25
Public Health Programs Highlights  26
Communicable and Reportable Disease  27
Health and Our Environment  31
Specialized Community Health Programs  36
Community Public Health Nursing Services  40
Home Care Programs  43
Dental Health Services  45
Nutrition Services  47
Vital Statistics  48
Aid to Handicapped  51
Laboratory Services  52
Action B.C  57
Council of Practical Nurses  58
Voluntary Health Agencies  5 8
Tables—
1—Reported Communicable Diseases, British Columbia, 1973-77  59
2—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946, 1951, 1956, 1961, 1966, and 1971-77  59
3—Selected Activities of Provincial Public Health Nurses, September
1, 1976, to August 31, 1977  60
4—Patients Admitted to Home Care Programs and Nursing Visits Carried Out, 1976  61
5—Number of Patients and Number of Nursing Visits, Home Care
Programs, 1972-76  61
6—Selected Activities of Provincial Public Health Inspection, 1973-77 62
7—Registrations,  Certificates,  and  Other  Documents  Processed by
Division of Vital Statistics, 1976 and 1977  63
8—Case Load of Division for Aid to Handicapped, 1977  64
9—Tests Performed by Division of Laboratories, 1976 and 1977  65
10—Licensing of Practical Nurses  66
11—Number of Cases Referred for Hearing Assessment, by Source,
Division of Speech and Hearing, 1977  66
12—Number of Cases Referred for Hearing Assessment, by Type of
Evaluation, Division of Speech and Hearing, 1977  66
13—Hearing-impaired Cases, by Degree and Type of Impairment, Division of Speech and Hearing, 1977  67
14—Numbers of Community Care Facilities and Capacities, by Permit
Status for the Three Categories of Facility, 1975-77  67
11
 Mental Health Programs Pagb
Introduction  69
Mental Health Programs Highlights  70
Community Mental Health Centres  70
Greater Vancouver Mental Health Service  77
Burnaby Mental Health Services  77
Integrated Services for Child and Family Development, Victoria  79
British Columbia Youth Development Centre, The Maples  79
Boarding-home Program  82
Consultants  83
Tables—
15—Patient Movement Data, Mental Health Facilities, 1977       89
16—Patient Movement Trends, Mental Health Facilities, 1974-77     91
Hospital Programs
Introduction  93
Hospital Programs Highlights  94
British Columbia Regional Hospital Districts Act  94
British Columbia Regional Hospital Districts Financing Authority Act  95
Hospital Insurance Act  9 6
Hospital Act  96
Hospital Rate Board and Methods of Payment to Hospitals  97
Hospital Consultation and Inspection Division  97
Research Division  98
Hospital Finance Division  99
Hospital Construction and Planning Division  101
Medical Consultation Division  106
Administrative Services Division    107
Approved Hospitals  109
Statistical Data  111
Tables—
17—Patients Separated and Proportion Covered by Hospital Programs,
British Columbia Public General Hospitals Only (Excluding Federal, Private, Extended-care, and Out-of-Province Hospitalization)  112
18—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)  112
19—Patients Separated, Total Patient-days and Average Length of Stay,
According to Type and Location of Hospital for Hospital Programs
Patients Only, and Days of Care per 1,000 of Covered Population 113
20—Summary of the Number of Hospital Programs In-patients and
Out-patients, 1972-77  113
21—Summary of Hospital Programs Out-patient Treatments, by Category, 1972-77  114
12
 Page
22—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, 1977 (Excluding
Extended-care Hospitals)  114
23—Percentage Distribution of Patients Separated and Patient-days for
Hospital Programs Patients Only, in British Columbia Public
Hospitals, Grouped According to Bed Capacity, 1977 (Excluding
Extended-care Hospitals)  114
Charts—
I—Percentage  Distribution  of Days  of  Care by  Major  Diagnostic
Groups, Hospital Programs, 1976  116
II—Percentage Age Distribution of Male and Female Hospital Cases
and Days of Care, Hospital Programs, 1976  117
III—Percentage Distribution of Hospital Cases, by Type of Clinical Service, Hospital Programs, 1976  118
IV—Percentage Distribution of Hospital Days, by Type of Clinical Service, Hospital Programs, 1976  119
V—Average Length of Stay of Cases in Hospitals in British Columbia,
by Major Diagnostic Groups, Hospital Programs, 1976 (Excluding
Newborns)  120
Medical Services Coimmission
Introduction  121
Medical Services Commission Highlights  122
Benefits Under the Plan  122
Services Excluded Under the Plan    123
Premium Rates and Assistance  123
Laboratory Approval  124
Professional Review Committees  124
Salaried and Sessional  124
Statistical Tables  125
Tables—
24—Registration and Persons Covered, by Premium Subsidy Level, at
March 31,1977  126
25—Persons Covered, by Age-group, at March 31, 1977  126
26—Coverage, by Family Size, at March 31, 1977  127
27—Distribution  of  Fee-for-service  Payments  for  Medical  Services
(Shareable)  128
28—Distribution of Medical Fee-for-service Payments and Services, by
Type of Service  129
29—Average Fee-for-service Payments, by Type of Practice  130
30—Distribution of Fee-for-service Payments for Insured Services, Non-
shareable Additional Benefits  130
31—Average Fee-for-service Payments, by Type of Practice, Nonshare-
able Additional Benefits  131
32—Summary of Expenditures, 1969/70 to 1976/77  131
13
 Charts— PAGB
VI—Coverage, by Age-group, at March 31, 1977  126
VII—Coverage, by Family Size, at March 31, 1977  127
Government Health Institutions  133
Emergency Health Services Commission  139
Forensic Psychiatric Services Commission  141
Alcohol and Drug Commission  143
MINISTRY OF HEALTH EXPENDITURES, 1976/77
Financial Tables and Chart
Tables—
33—Expenditure, by Principal Categories, in the Ministry of Health for
the Fiscal Year 1976/77  147
34—Detailed Expenditure, by Principal Categories, in the Ministry of
Health for the Fiscal Year 1976/77  148
35—Statement of Working Capital and Financial Position as at March
31, 1977, of The Medical Services Plan of British Columbia  149
36—Statement of Operations for the Year Ended March 31, 1977, of
The Medical Services Plan of British Columbia  150
37—Statement of Changes in Cash Position for the Year Ended March
31, 1977, of The Medical Services Plan of British Columbia  151
Chart—
VIII—Expenditure, by Principal Categories, in the Ministry of Health
for the Fiscal Year 1976/77  147
14
I
 YEAR IN  REVIEW
In 1977, there were significant developments in the health programs of the
Ministry. New arrangements in health matters were worked out between the
Province and the Federal Government. There were some further organizational
changes in the Ministry.
In April, the Premier announced the introduction of a new long-term care
program to commence on January 1, 1978. This comprehensive program would
provide coverage for intermediate and personal care levels, as well as extensive
benefits for care in the home. It was estimated that as many as 17,000 people
would be entitled to receive coverage in care facilities at a cost to them of $6.50
per day for ward accommodation. The charges to patients for services in the
home would be scaled on the basis of income. For the more than 5,000 extended-
care beds, which are already part of the hospital system, the co-insurance charge
was to be raised to $6.50 per day, effective January 1, 1978.
The program places emphasis on maintaining infirm people in their own
homes. A major role in this type of service is played by the 70 societies throughout the Province which provide homemaker services and who have assisted in
recruiting and orienting a reserve of homemakers.
During the year an executive director for the program was appointed
together with long-term care administrators in the 17 health units throughout the
Province and necessary nurses and other staff. Similar arrangements were set up
in metropolitan Vancouver and in the Capital Region.
The assessment of residents already in care facilities was well under way
at the year-end.
The introduction of programs such as the one for long-term care were
assisted by an agreement between the Province and the Federal Government in
1977. Consistent with the Federal Government's general trend to move from
shared-cost programs to block funding, the Federal Government would provide
block payments for certain low-cost alternatives to high-cost care. Services such
as personal care, intermediate care, health aspects of home care, and some
ambulatory services were considered appropriate uses for these funds. The sum
was set at $20 per capita per year. Allocation of the funds is left to the decision
of the Province.
Agreement was reached between Provincial ministries and the Department
of National Health and Welfare on a new Federal-Provincial committee structure
to reflect new priorities and new funding arrangements. It would also reduce the
number of Federal-Provincial committees.
The Government announced a $113.4 million long-range program for hospital
development in Greater Vancouver.
The $113.4 million was in addition to a number of projects, which were
under way, such as the additions being made to Burnaby General, Royal Columbian, Lions Gate, and St. Vincent's Hospitals. Neither did it include the large
extended-care facility in Queen's Park Hospital, New Westminster; the new Health
Sciences Hospital under way at The University of British Columbia, and the
allocation of $45.5 million for the redevelopment of the Vancouver General
Hospital. All involved hospitals in Greater Vancouver were advised what they
could expect in terms of development to meet 1981 needs. The emphasis of the
program was in redistributing facilities and services to meet changes in population
distribution and patterns of care and to upgrade facilities. In setting the target
for beds to population, attention was given to the expected effect of improving
and increasing other services which are appropriate, and less-expensive alternatives
15
 G 16 MINISTRY OF HEALTH REPORT, 1977
to in-patient care in acute hospitals. These include ambulatory programs, as well
as the new long-term care program.
Major alterations were made to the Province's emergency health services to
improve the program, and be of particular benefit to residents of outlying communities and those living in remote areas of British Columbia. The changes
included improved air ambulance service, restored patient escort service, and an
extended ambulance crew training program. A revised fee schedule reduced
charges to patients requiring transport by road or air ambulance, from remote
areas to major treatment centres. Under the revised schedule the maximum that
any patient in British Columbia will pay for long-distance ambulance service
approved by the Emergency Health Services Commission will be $100. Under the
previous schedule, fees were as high as $500 for air ambulance transport. The basic
charge for an ambulance call is $15 for distances up to 40 kilometres (25 miles).
For distances over 25 miles the charge is 13 cents per kilometre (20 cents per
mile) to a maximum of $100.
Transfers of patients from one institution to another, which were formerly
done without charge, are now subject to the basic fee of $15 for distances up to
40 kilometres (25 miles) with the extra charge beyond.
A Provincial dispatch office was established at Victoria to co-ordinate and
arrange all long-distance patient moves within the Province, whether by air or
road ambulance. Decisions as to the most suitable means of transport are made
by the patient's physician, in consultation with the Provincial dispatch centre.
They operate in co-operation with the existing Rescue Co-ordination Centre,
which will continue to be involved in emergency mercy flights.
In June the Government established an Interministerial Youth Committee composed of senior representatives of the Ministries of the Attorney-General, Education,
Human Resources, and Health, to deal with the complex issues involved in the care
and treatment of emotionally disturbed youths and children with special needs. This
Committee reports through the Deputy Ministers' Children's Committee to the
Social Services Committee of the Cabinet, and maintains contact at the local
community level through formally appointed inter-ministerial regional committees.
Initially the program is focusing on "Children in Crisis" so that all available
resources can be brought to bear on the more difficult individual case, and special
program needs can be identified. However, the committee was moving into a number
of areas of mutual concern and there was every indication that it would prove an
effective instrument in co-ordinating and developing special programs for children.
Major improvements have been introduced in the administration of the Province's drug and poison information program, which is jointly operated by the
Ministry of Health and The University of British Columbia.
The changes involve the formalizing of an agreement, and the appointment
of a Management Committee, which will improve the treatment aspects of the
drug and poison information program, and to place greater emphasis on the
preventive aspects.
The purpose of the program is to develop, sponsor, and promote programs
designed to reduce the number of cases of accidental poisonings in the Province,
and assist health professionals in the use of drugs. Hospital emergency departments will be informed, on an ongoing basis, about the composition and toxicity
of products which may cause illness if they are ingested, and the recommended
treatment in such cases.
In August the Government outlined a proposed compulsory treatment plan
for heroin users designed to start late in 1978 or early in 1979. The proposal
called for three years of treatment for each user committed to the program.  The
 YEAR IN REVIEW G 17
treatment plan for the user would be set out by a five-member evaluation panel
which would include two medical practitioners. A variety of facilities and services
would be provided. These would include a 150-bed treatment centre, therapeutic
communities, community clinics and community support services. Most users
would be living in the community and dealt with on an out-patient basis. Some
would spend time in the secure unit but a progression through the types of service
would be expected. Such persons might spend six months in the treatment centre,
a year attending a community clinic, followed by a program of community
supervision for the remainder of the three years.
During the year a new treatment centre for alcoholics was opened, offering
a 28-day treatment program for 32 patients, with emphasis on behaviour and
lifestyle. In December the Maple Cottage Detoxification Centre was opened and
provides 20 beds for an average stay of three days. Both facilities are located in
New Westminster.
New out-patient counselling services were funded in Terrace, Chilliwack,
and Nelson.
Quality classroom and home auditory training equipment is now being
provided to hearing-impaired children in British Columbia, though an interdepartmental program. The new program is a co-operative effort of the Ministries of
Education and Health, and is presently under way in Victoria, Kelowna, Surrey,
Prince George, and Kamloops.
Historically, there has been wide variability in the quality of auditory training
equipment provided to hearing impaired children in British Columbia. Additionally,
some school districts have had extensive problems obtaining quick, reliable servicing of auditory equipment. As a result, many children were wearing improper or
non-functional equipment. These problems are being resolved through the new
program.
During the year the Ministry initiated the first major revision of British
Columbia's Health Act in 30 years. By tradition, the Health Act has been the
cornerstone of Government public health policy.
The Government announced that a portion of the funds from the Western
Express Lottery would be assigned for health research. Policies and procedures
for the allocation of funds to different types of health research were expected to
be completed by the middle of 1978.
In the spring, many of the Victoria offices of the Ministry moved to the new
Richard Blanshard Building. This consolidation reduced from 14 to 6 the number
of separate locations occupied in Victoria and increases the potential for co-ordination and efficiency of programs.
Changes in the senior administrative echelons of the Ministry coincided
with the retirements of Dr. G. R. F. Elliot, Deputy Minister of Community Health
Programs, and W. J. Lyle, Deputy Minister of Medical and Hospital Programs.
Under this change, the previous branches of Medical and Hospital Programs, and
Community Health Programs, were brought together under the administration of
an Executive Director, Health Programs. In addition, the Ministry Planning
and Support Services were placed under the direction of an Associate Deputy
Minister. In August, the Minister announced the appointments of Dr. Chapin
Key as Executive Director and Jack Bainbridge as Associate Deputy Minister,
Planning and Support Services. In his announcement, the Minister paid tribute
to the outstanding contributions to the health services of the Province made over
many years by Dr. Elliot and Mr. Lyle. He referred also to the admirable way in
which they had assisted toward the melding of the Health Ministry, which not
long ago was virtually four separate organizations.
 G 18 MINISTRY OF HEALTH REPORT,  1977
DEMOGRAPHIC FEATURES
It was noted in the 1976 Department of Health annual report that the preliminary census population count of 2,406,212 for British Columbia, recorded at
the mid-year, was subject to an upward revision. The final population count was,
in fact, some V/i per cent higher than the preliminary figure, being 2,466,608.
The rates of the various vital events for 1975 calculated on the corrected population figures were consequently lower and these are used in the discussion which
follows.
The preliminary birthrate in 1977 was 14.7 per 1,000 population, slightly
above the final 1976 rate of 14.5, which was the lowest recorded for 40 years.
The marriage rate was 8.4 per 1,000 population in 1977, somewhat below the
1976 figure of 8.7, thus continuing the downward trend in the rate which commenced in 1972.
After a period of relatively stable death rates from 1970 to 1975, there was a
decline in the rate to 7.6 in 1976 and a further decline in 1977 to a record low of
7.5 per 1,000 population.
Heart disease, the leading cause of death in the Province, showed a mortality
rate of 248 per 100,000 population in 1977. While this was a slight increase over
the 1976 rate of 246, it remained almost 20 per cent below the figure at the end
of the 1960's.
The mortality from cancer was also higher in 1977, a rate of 164 per 100,000
population having been established compared to 160 in 1976. Thus the rates
in the last three years continued to exceed the level of about 155 which had been
maintained for the previous six years.
Cerebrovascular lesions of the central nervous system evidenced a decline in
mortality this year, the second year in succession. The rate per 100,000 population was 74, compared to 78 last year and 83 in 1975.
The sharp decline in accident mortality which occurred in 1976 was not sustained in 1977, although the rate of 64 per 100,000 population was still well below
the rate of 83 recorded in 1974. There was an increase in motor-vehicle accident
fatalities in 1977, but they represented only 43 per cent of all accident deaths,
compared to 46 per cent in 1976. Mortality from falls as a proportion of all
accident mortality was also down slightly this year to 18 per cent, compared to
20 per cent in 1976. On the other hand, deaths from poisoning represented 9 per
cent of accident deaths this year, but only 7 per cent in 1976. Drownings made
up about 9 per cent of accident deaths in both years.
The rate of suicides in 1977 was 18 per 100,000 population, and thus continued at the same high level as in 1976.
The infant mortality rate continued the decline noted in the last four years
and in 1977 reached a record low of 13.0 per 1,000 live births, compared to 14.3
in 1976 and a rate of 21.4 for 10 years ago. The decline this year was a result of
lower rates for younger infants, mortality among those more than a month old
having increased somewhat.
 PLANNING AND SUPPORT SERVICES (/)
Ul
During 1977 these services came under the direction of Jack Bainbridge on m *
his appointment as Associate Deputy Minister. V^
The specialist functions throughout the Ministry, such as personnel, data j
processing, finance, management engineering, health education and information, -^
as well as policy and program development, will be brought together to assist the f^
established programs and to develop new policies and programs where indicated. *^
At the year-end these arrangements were under development, and in the meantime ■■■
the functional advisers within this group continued to provide both specialist ad- IrJ
vice and specific services to the Ministry generally.
PROGRAM DEVELOPMENT GROUP
Health and the Minister of Human Resources.
• With the evaluation report behind them, the centres were concentrating
more on program and organizational development at the year-end.
• The first terms of the original Board of Directors of the four centres expired in November 1977 and new boards were elected in November.
In the summer of 1977 the Development Group for Community Human Resources and Health Centres commenced its involvement in the planning and development of the Province's new Long-term Care Program.
In October of 1977 the Group was transformed into the Program Development Group, responsible to J. Bainbridge, Associate Deputy Minister, Planning
and Support Services. While still maintaining responsibility for the Human Resource and Health Centres, the Group has been assigned responsibilities in planning,
policy development, and initiation of major programs within the Ministry of Health.
In relation to the Long-term Care Program, the Program Development
Group, in conjunction with other branches of Health and the Ministry of Human
19
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In 1977 the Program Development Group experienced some significant events Q
and underwent considerable transformation. Earlier in the year, this Group was
known as the Development Group for Community Human Resources and Health
Centres, and it maintained over-all planning, program and monitoring responsibility ^
for the four pilot centres in Houston, Granisle, Queen Charlotte Islands, and James
Bay (Victoria).
The 1977 highlights for this program include:
• Completion of the Audit Committee's report on the Human Resources and
Health Centres. This committee, with representation from the Registered
Nurses Association of B.C., the British Columbia Medical Association, the
British Columbia Association of Social Workers, the Faculty of Commerce
at UBC, Ministry of Health, and Ministry of Human Resources, visited
each of the centres (twice) and reviewed all available financial and statistical data pertaining to the centres. In summary, the committee concluded
that the centres were making significant progress toward their stated
objectives; that the centres provided significant improvements in service
to the communities concerned; and that the centres appeared to be cost-
effective. The report recommended that the centres be continued for at
least three more years and that the Government give serious consideration
to expanding this concept to other suitable communities. These recommendations of the Audit Committee were accepted by the Minister of -^9
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 G 20 MINISTRY OF HEALTH REPORT, 1977
Resources, played an integral role in the following areas, working with the staff
of Public Health, Mental Health, and Hospital Programs:
(a) General planning and organizing of the new program.
(b) Co-ordination of policy development.
(c) Determining and negotiating resource requirements for the program.
(d) Recruitment and appointment of key staff positions involved in the
administration of the program.
(e) Orientation of new field and administrative staff in the program.
HEALTH  EDUCATION AND INFORMATION
The Division of Health Education and Information continued to develop its
role of a centralized consultative and service operation for the Ministry of Health
and its associated commissions.
During the year the division added two professional writer/researchers to the
staff. Creative art services were provided on a continuing basis for the first time,
and the centralized Ministry of Health library continued its task of sorting and
cataloguing books brought in under the new system.
HEALTH EDUCATION
Since health education centres on improving communications about health
matters and motivating people to participate in activities to improve life-styles,
the programs within the community are being directed to this end.
Use of mass media for increasing public awareness of health-related issues
and services at the community level is the most economic and feasible approach.
With this in mind, community TV and radio programs and printed materials were
produced in response to local needs. Subjects included alcohol use, teenage
pregnancy, venereal disease, and parenting. Shopping-centre mall displays focusing on immunization, safety and stress, nutrition, and heart disease resulted in a
good deal of public attention and increased the awareness of available services.
During the past year there were also several workshops, seminars, group
discussions, lectures, and public meetings to deal with life-style problems. Presentations concerning the problems of life-style were utilized by professional groups,
school districts, church and community groups.
A major event was the development and completion of the seat-belt demonstration project in Duncan, Nanaimo, and Courtenay. With the 1977 summer
student program, a health education clown troupe was active during the summer
months providing tips on safety, nutrition, cigarette smoking, and fitness to various
toddlers and elementary school groups.
Communication was kept open with both Simon Fraser University (Department of Kinesiology) and University of Victoria (Department of Education) with
regard to education and health, lectures being presented in both centres.
In keeping with the provision of health services for all ages, Health Education
co-operated in a Task of Aging series offered from Parksville to Black Creek.
Demands from more remote areas led to school programs in Sayward and a dental
program on Read Island, both assisted by a volunteer physician and dentist.
The division's health educator attached to the Division of Venereal Disease
Control took an active part in initiating two series of radio commercials alerting
the public to the spread of gonorrhcea. This campaign, and the telephone information service accompanying it, are described in greater detail in the Special Health
Services section of this annual report.
 Richard Blanshard Building in Victoria now houses many departments of the Ministry
of Health.  B.C. Hydro Building at right will also accommodate various ministry operations..
Upper Island Health Unit of Public Health Programs organized and co-ordinated
display which dramatically demonstrated need for seat belts.
 Radiation Protection Service of the Ministry of Health has been co-operating with the
Canadian Forestry Service to X-ray wood samples to measure ability of nails to withstand
corrosion where wood has been specially treated with chemicals.
Audiometric aide observes ability of hearing-impaired child to respond to instructions
to place coloured pegs in appropriate holes.
 PLANNING AND SUPPORT SERVICES G 21
INFORMATION SERVICES
This section is responsible for the preparation of speeches, press releases,
television and film scripts; editing texts for leaflets, brochures, handbooks, and
instructional manuals; developing exhibits, displays; posters; and involvement in
printed material required by the Ministry.
The section prepared 64 press releases in 1977 and researched and wrote
more than 35 speeches for the Minister and senior staff. The staff were also involved in special projects which included promotion of the Long-term Care Program and preparation of mental health careers material for school counsellors.
Production of the Ministry's consolidated annual report was also a responsibility
of Information Services.
The pamphlet Cigarettes and Your Health proved to be a popular preventive
health measure. More than 150,000 copies were in circulation by the year-end.
Other pamphlet subjects included retirement planning, speech pathology and
audiology as careers, the need for immunization at all ages, the identification and
control of diabetes, medical and hospital benefits for travellers, and several nutrition publications.
It was expected that there would be a substantial increase in the section's work
load when the videotape production centre comes into operation in 1978. A ministerial bimonthly staff publication was also under consideration at the year-end.
AUDIOVISUAL SERVICES
The division's Audiovisual Section continued to give service to ministry staff
in the field and at head office. Divisional audiovisual staff were involved in the
detailed planning of the new audiovisual production centre, which will function as
a Government production centre and will be accessible to all ministries. Production of high-quality videotapes will be possible and these will cover a wide variety
of subjects. In-service training and public information material will be video-taped
for use as required in the Province.
The photographic service provided by the division experienced a busy year
and received assistance from the summer student employment program. This service produced a number of slide-tape shows for use by head office staff. Staff
photographers visited many field offices to prepare audiovisual support material.
A major effort by the Audiovisual Section was the production, in co-operation
with the Division of Community Nutrition, of 13 new television shows in "The
Senior Chef" series. By the end of the current year the series was being shown
on television outlets in Vancouver, the Lower Mainland generally, and Vancouver
Island. Plans for expansion of the service to other parts of the Province in the
spring of 1978 were well in hand. In conjunction with the series a cookbook was
produced for distribution to the public.
The acquisition of more sophisticated audiovisual equipment in the field has
necessitated a formalized approach to the training of field staff in its use. A Province-wide instructional tour was launched during the early summer and was concluded in the fall. The reaction of staff was encouraging and consideration was
being given to continuance of the workshops on a regular basis.
In general, the Audiovisual Section acted as consultants to the Purchasing
Commission in the specification and acquisition of audiovisual equipment, and
assisted in the implementation of the policy of standardization for this equipment
throughout Government.
 G 22 MINISTRY OF HEALTH REPORT, 1977
The Film Library was renamed the Audiovisual Library and continued to provide a film lending, repair, and maintenance service. During the year it was officially transferred to the Audiovisual Section from the Ministry's stockroom operation.
DATA PROCESSING
The Ministry's major objectives in the appointment of a Director in Data
Processing were:
(1) to control equipment acquisition and optimize its utilization;
(2) to centralize expertise;
(3) to set standards;
(4) to build and maintain a health data base.
However, the formation of the B.C. Systems Corporation during 1977 necessitated a delay in some of the initial planning of the Data Processing support service, and the role of the Director became that of liaison between the Ministry and
the new corporation.
During the transition year the Director initiated a project to establish system
development standards and upgrade the skills of the programmers and analysts
on the staff of the Medical Services Plan. He also introduced a project management system to control computer projects throughout the Ministry. The B.C.
Systems Corporation planned to adapt a modified version of this system for use
throughout Government.
With the completion of the training of the MSP computer staff, the project
management system was used to undertake a complete redesign of the Medical
Services Plan's computer systems, to provide better management control and effect
a reduction in operational costs.
At the year-end, plans were under way to transfer the subscriber inquiry system of the Medical Services Commission from the IBM computer to the new
Honeywell computer, which is being used on the recommendation of the Treasury
Board's computer consultant.
Consultative assistance was also provided during the year to Hospital Programs, which provided funds to 12 major hospitals in the Province for the provision of a computer system to improve the efficiency of their administrative operations. By the year-end, computer systems had been installed in six of the hospitals
and several of the subsystems were in operation.
A study was also undertaken to review the laboratory computer systems in one
private laboratory and three general hospitals, with the objective of selecting a
standard laboratory computer system for use in hospitals over the next three to four
years.
During the year the Director continued to serve as Chairman of the Data Base
Task Group.
PERSONNEL
The reorganization of the Ministry under a single Deputy Minister had a direct
effect upon the personnel structure as established since January 1976.
The former dual headquarters personnel divisions, each reporting to a Deputy
Minister, were being combined under the Director of Personnel, who in turn is a
member of the Planning and Support Group, and reports to Jack Bainbridge,
Associate Deputy Minister.
 PLANNING AND SUPPORT SERVICES
G 23
Bargaining fee-schedules with fee-for-service, sessional and salaried physicians
represented by the British Columbia Medical Association, and with dentists, and
other health care professional groups, was a major ministerial personnel activity.
The newly developed Government Employee Relations Bureau, and Treasury
Board Staff Organization, brought a new and continuing need for close co-operation
and co-ordination between these bodies and the Ministry, and the year saw Personnel become the ongoing link with these agencies in many areas'of contact.
The Director of Personnel serves on an Advisory Committee to the Government Employee Relations Bureau, allowing input from the Ministry of Health in
Provincial personnel matters.
COMMUNITY CARE FACILITIES LICENSING BOARD
PROVINCIAL CHILD CARE FACILITIES LICENSING BOARD
This was a very active year for the Provincial Child Care Facilities Licensing
Board and staff. There was a 34.5-per-cent over-all increase in capacity in licensed
child care facilities in the last two years. A marked increase of 250 was recorded
in new applications for licences.
At the year-end a final draft of the new Child Care Regulations was with the
Ministry of the Attorney-General for legal approval before submission to the
Executive Council for passage.
Amendments to the Summer Camp Regulations were also being processed.
There has been an increase of 12.5 per cent in camp capacities over the last
two years. The Board held two successful meetings in 1977 outside Victoria, in
Prince George and Burnaby.
PROVINCIAL ADULT CARE FACILITIES LICENSING BOARD
There has been an increase of 12.7 per cent in the total capacity of all adult
care facilities from 1975 to 1977.
The new Adult Care Regulations under the Community Care Facilities Licensing Act were gazetted in May 1977 and are in good use in the service.
The Board was commissioned to launch the new Long-term Care Program
by January 1, 1978.
Long-term Care Administrators were appointed to each Health Unit area
in the Province so as to supervise assessments and placements of those requiring
care. Divisions of other ministries were assisting in reviewing and approving new
adult care facilities which eventually will be part of the long-term care system.
The Board held its March meeting in the City of Vancouver Health Department office.
  Public Health Programs
Public health legislation in British Columbia dates back to 1869
when statutory authorization was given for a Provincial Board of
Health. However, active administration of public health services in
the Province by the Board did not get under way until the last decade
of the 19th century. By 1946 the services had developed to the point
where full departmental rank was warranted and in that year the
Department of Health and Welfare was established.
Public Health Programs is now one of the two major administrative subdivisions of Community Health Programs (the other being
Mental Health Programs) and is charged with providing a wide
range of preventive, treatment, and environmental control services and
with promoting positive health. These services are made available to
the public through certain centralized facilities and a network of 17
local health units covering the non-metropolitan areas of the Province.
Greater Vancouver and the Capital Regional District have their own
health organizations, which are not under the jurisdiction of the Provincial Health Department, but which receive certain consultative
and specialized services together with financial assistance from the
Provincial Government. These two administrations collaborate very
closely with the Provincial Health Department in disease prevention
and control, and in program implementation.
Statutory support for the operation of Public Health Programs
comes mainly via the Health Act, and pursuant regulations, and the
Public Schools Act. These statutes confer powers on the Minister of
Health, the local Medical Health Officer, and the local board of
health for dealing with matters of public health.  The local board of
health may be either a municipal council (covering municipal areas
which may also draw up 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:
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25
 G 26 MINISTRY OF HEALTH REPORT,  1977
PUBLIC  HEALTH  PROGRAMS HIGHLIGHTS
• The largest dental extern program ever undertaken in the Province was initiated
in July with 12 dentists and their staff providing treatment services to approximately 40 communities without resident dentists.
• Dental staff in health units provided elementary-school children with preventive
dental health educational and motivational lessons and demonstrations. These
students also participated in utilizing the self-applied fluoride paste and rinse
on a twice-a-year basis. Dental inspections were performed on these students
and telephone follow-ups were made to parents wherever dental problems
existed.
• Through the health unit Birthday Card Program, 3-year-old children in 46
school districts received free dental examinations and counselling from their
family dentists.
• Considerable work has been done over the past 12 months on developing Canadian Drinking Water Quality Standards in co-operation with the other provinces
and Federal Government. Regulations have been drafted under the Health Act
relating to drinking-water quality.
• There was a substantial increase in the number and capacity of licensed child
care facilities.
• Technical improvements in kidney dialysis equipment have made it possible to
increase the number of patients able to undergo peritoneal dialysis at home.
• An organ donor program is being developed in co-operation with the Motor
Vehicle Branch. The purpose of this is to encourage more people to record
their wish to donate their organs in the event of sudden death so as to meet the
increasing need for human organs for transplant.
• The continued presence of carriers of diphtheria in the Province's population continues to give rise to concern as many of them are capable of passing on the
germ to other people. Maintenance of a satisfactory immunization level in the
population therefore continues to be of importance.
• There was a substantial increase in number of legal changes of name under the
Change of Name Act, due in part to the broadening of the provisions of that
Act. There was also a 10-per-cent increase in Wills Notices accepted, continuing
the long-term upward trend.
• There was a sharp increase in the number of laboratory tests carried out in the
area of environmental biology resulting from increased concern with water
quality on the part of the Division of Environmental Engineering.
• Speech therapy services to schools were expanded as a result of a co-operative
agreement between the Ministries of Health and Education.
• There was increased demand on Public Health Nursing services for group learning sessions from the public, particularly in the areas of prenatal and parenting
classes.
• A special study was conducted in the Nanaimo area to consider alternate methods
of delivering health services to schools and to examine the needs for such services.
• The final report and recommendations of the Vision Care Task Force were
presented to the Minister of Health in November and are under review.
 PUBLIC HEALTH PROGRAMS G 27
COMMUNICABLE AND REPORTABLE DISEASE
This year saw another sharp increase in the number of cases of malaria
diagnosed, a recurrence of diphtheria after a few years' respite, and very little
reported influenza.
The increase in malaria is mainly a reflection of the massive recurrence of this
disease in India, and most of the 300 people who had an attack of malaria in
British Columbia this year were originally infected in India. It is possible for
malaria to spread in British Columbia, but this is most unlikely for many reasons.
The major problem appears to be a failure of travellers to take prophylactic
medication while visiting an endemic area.
While only seven cases of clinical diphtheria were reported this year, 148
healthy carriers were identified, all of whom were capable of giving diphtheria to
any unimmunized contact. As long as these sporadic outbreaks of diphtheria
continue, the importance of immunization in infancy and throughout childhood
cannot be over-stressed.
The outbreak of swine influenza in humans predicted by American health
authorities failed to materialize anywhere in the world. Indeed, there were probably fewer cases of influenza of any type in North America than usual last winter.
In British Columbia about 237,000 doses of swine influenza vaccine were
purchased and stockpiled as insurance. About 187,000 doses of combined
A/Victoria and A/New Jersey (swine) influenza vaccine were also obtained and
offered to persons of all ages with a chronic illness and to persons over age 65.
About 9,000 doses of this vaccine were used. The unused vaccine of both types
is still in good condition and is being stored in Vancouver ready for use, should an
outbreak of swine influenza occur in 1978.
The crash program to produce tremendous quantities of swine influenza
vaccine in both the United States and Canada might appear at first glance to have
been a costly failure. However, it was the consensus of experts on this continent
that the outcome of an epidemic, should one develop, would be so severe that
exceptional preparatory measures were warranted. Furthermore, there were a
number of plus factors. We know now that it is possible to carry out a continent-
wide influenza immunization program should an epidemic similar to the one that
took place after the World War I ever threaten us in the future. The organizational
and production problems have been faced and overcome, and we can anticipate
fewer problems in the future. There is good reason to believe that the occasional
temporary paralysis (Guillain-Barre syndrome) that followed influenza immunization is not unique to this vaccine, but would likely occur with equal frequency
following any mass vaccination program.
Although smallpox is still prevalent in two countries in Africa (Ethiopia and
Somalia), the likelihood of this disease being imported into Canada has decreased
to the point where smallpox vaccination is now recommended only for a few
high-risk personnel in diagnostic laboratories and specialized isolation facilities.
Very few countries now require Canadians to be immunized as a condition of entry.
Two major trends in communicable disease control, which could soon
become serious problems, were brought into sharp focus this year. The first, is the
decreasing number of manufacturers producing immunizing agents. Special
arrangements may become necessary in order to maintain a source of some life-
saving low-volume products and the increasing cost of the agents.
 G 28 MINISTRY OF HEALTH REPORT, 1977
Secondly, immunizing agents had previously been relatively inexpensive, but
in the last few years prices have been rising steadily and the Ministry has been
advised to expect another increase of 125 per cent in 1978. Public Health staff
are being called upon to attempt to further reduce wastage, to avoid over-immunization, and to modify programs where this can be done safely.
RHEUMATIC FEVER PROPHYLAXIS PROGRAM
Five hundred and seventy young people who have had an attack of rheumatic
fever are receiving prophylactic antibiotics, provided by the Ministry to prevent a
recurrent attack of this disease. The prophylaxis may be either an injectable antibiotic, which is given once a month, or tablets taken twice daily.
HYPOGAMMAGLOBULINEMIA PROPHYLAXIS PROGRAM
Eighteen children and young adults who were born without the ability to
produce sufficient antibodies to ward off infections are receiving prophylactic
immune serum globulin provided by the Ministry. This program is operated in
conjunction with the Faculty of Medicine, UBC, who assist with diagnostic and
consultative advice.
POISON CONTROL PROGRAM
This year more than 7,000 poisoning incidents were reported by hospitals
to the B.C. Poison Control Centre in Vancouver, and there is no doubt that many
more cases were not reported. When this program was started 15 years ago, most
reported poisonings were truly accidental and nearly always involved pre-school
children. By contrast this year, only 30 per cent of reported cases were young
children, while another 30 per cent represented attempted suicides. There was
also an increase in drug abuse cases.
The Poison Control Centre which provides medical consultation to physicians
and hospitals is now operative from 9 in the morning to 10 at night and plans are
under way to provide this service on a 24-hour basis.
A formal agreement has been drawn up between the Ministry of Health and
The University of British Columbia whereby this program will be operated jointly
by these two agencies under the direction of a joint management committee.
ORGAN DONOR PROGRAM
Because the need for human organs for transplant is constantly increasing,
the Ministry of Health, with the help of the Motor Vehicle Branch, have embarked on a program to encourage more people to consent to donate their organs
in the event of their sudden death.
A folder explaining the need will be sent out with every new and renewal
driver licence by the Motor Vehicle Branch. Along with the folder will be a wallet-
sized consent card, and a distinctive sticker for the prospective donor to place on
his driver's licence. The consent forms and sticker are also available at all Public
Health and Motor Vehicle Branch offices throughout the Province.
TUBERCULOSIS CONTROL
The number of new active cases continues to decline slowly year by year and
the incidence of tuberculosis in British Columbia is very close to the national
average.   An important reason why it is not lower is the large immigrant popula-
 PUBLIC HEALTH PROGRAMS G 29
tion in this Province. Many immigrants come from areas where tuberculosis is
common and have already been infected. They have a high risk of this infection
later developing into active disease.
The major efforts of the division continue to be directed at providing the best
possible treatment of known cases, investigation of contacts of infectious cases, and
preventive treatment for potential cases in well-recognized high-risk groups. A
nurse co-ordinator has been appointed to provide closer liaison between divisional
headquarters and the health units.
Extensive use is being made of the new anti-tuberculous drugs. The increased
drug cost is partially offset by the resultant shortened total treatment time, including
briefer hospital stays for those requiring admission. A constant problem has
been the unco-operative recalcitrant patient and, here, the new drugs are very
helpful, since the necessary treatment period may be reduced by as much as 50
per cent. As many cases as possible are treated on an ambulatory basis, with as
little disturbance of their usual daily routine as is consistent with good treatment
and control of spread of the disease.
VENEREAL DISEASE CONTROL
Infections that are transmitted by sexual contact have traditionally been referred to as venereal diseases. This term has become too limited in light of the
increasing number of diseases now known to be commonly spread by sexual
contact. Consequently, a new term encompassing some 15 infections at the
present time has come into use, namely, sexually transmitted diseases, or STD.
These infections manifest themselves in the patients either by producing a
discharge with accompanying pain or itching, or by showing as a skin lesion.
Although the infections themselves may be only irritating, the complications in
the untreated may lead to serious infections, sterility, or other widespread infections throughout the body. It is, therefore, necessary to institute control measures
ensuring that adequate diagnostic and treatment facilities are available, that laboratory facilities for diagnosis are available, and that facilities for interviewing for
contact information and for bringing contacts to treatment are provided throughout
the Province.
A central agency is maintained to transmit contact information throughout
the Province and to other control centres throughout the world. There appears
to be changing attitudes among young, single adults (the group mostly involved),
who have developed a greater concern for their own personal health, and that of
their friends. They more frequently bring their own contacts in for treatment,
so that investigative, contact-tracing measures are less required. Although most
physicians and laboratories do report their cases, these diseases still carry a strong
social stigma and many infections are treated in a rather clandestine way in an
attempt to protect the identity of those involved. It is therefore extremely difficult
to carry out effective control measures because only part of the problem is known.
Of all the sexually transmitted diseases, non-gonococcal urethritis, or NGU,
is by far the most prevalent. This disease entity which has an incubation period of
one to four weeks is caused by at least two infectious agents which are large viruses.
They are also thought to be the cause of some erosive lesions in the female, and
eye and lung infections in babies. Because of the difficulty in culturing these
viruses, a co-operative study is being undertaken with the Department of Medicine
at The University of British Columbia to study these viruses and the diseases they
produce.
 G 30 MINISTRY OF HEALTH REPORT, 1977
Gonorrhoea, the next commonest sexually transmitted disease in the male,
has increased in incidence since 1969, but the upward trend was halted, at least
temporarily, in 1977, the incidence being approximately the same as in the previous
year. There has been a world-wide epidemic of gonorrhoea thought to have been
caused by the change in sexual attitudes of single adults. With a more responsible
attitude developing in this group of the population, the disease may now be coming
under control. The problems in control are first, that most females who harbour
the infection are asymptomatic, and, second, it is considered by many males to be a
minor inconvenience only and with the strong desire to suppress any knowledge
of having acquired this infection, it is grossly under-reported. Hence, the control
program reaches only a proportion of those infected. However, without the control
program in place the incidence and cost of this infection would be much higher.
The commonest infection causing a discharge in females is moniliasis. It is
a disease caused by an organism which is partly yeast and partly fungus. In the
male it causes ringworm-like lesions.
Trichomonas is a parasitic infection of the female causing a discharge and
marked irritation. There is only one specific treatment and there is now concern
that this may be a potential cancer-causing agent. It is, therefore, necessary to
prove the infection and monitor the dosage in order to use the smallest dose
possible.
Syphilis continues to be a disease which spreads through the male homosexual population. It seems impossible, even with effective treatment and good
control measures, to eradicate this infection. It is, however, well controlled in
the heterosexual population.
Herpes simplex or cold sores not only occur on the lips but a separate strain
commonly occurs on the genitalia. This is a painful lesion that can spread in moist
locations in the body and tends to recur at regular intervals. There is no known
treatment that is effective for this infection and the concern is that it could recur
in a woman at childbirth and infect the baby.
In order to inform the population at risk, especially young adults, about the
signs and symptoms of these infections and to encourage them to seek treatment,
an educational program has been launched. The health educator for the division,
along with members of the Division of Health Education and Information, have
produced a series of radio advertisements and have participated in radio and television shows. To support this program a series of pamphlets and posters has been
produced suitable for use in the schools, health units, and physicians' offices. The
nurses in the Pine Clinic in Vancouver continue to provide educational support in
the Vancouver schools.
The division operates the main venereal disease clinic in the Vancouver
Provincial Health Building, which is also open Friday and Monday evenings until
7.30 and Saturday mornings from 10 a.m. to 1 p.m. In addition, support is provided for other clinics at New Westminster, Victoria, Kamloops, Prince George,
Prince Rupert, Dawson Creek, and Fort St. John which are operated by the local
health units, and through the Alternate Clinic Program clinics are operated at
Kelowna, Quesnel, Williams Lake, Vernon, Salmon Arm, South Vancouver, and
Richmond. As well, a grant is provided to the City of Vancouver to operate the
Pine Clinic, which is a storefront clinic providing service for young adults.
 PUBLIC HEALTH PROGRAMS G 31
THE PUBLIC HEALTH NURSE AND DISEASE CONTROL
The need for attention to communicable and non-communicable disease control continues.
• The number of immunizations and tests given rose slightly to 433,000 in 1976;
however, a high level of immunity must be maintained if the threat of new
outbreaks of communicable disease is to be minimized.
• Despite an increase in publicity during 1976, the need for protection against
communicable diseases continues and further efforts are required to motivate
the public into action.
• A more permanent "Immunization Record" form for individuals is being considered and responsibility for its care and maintenance would rest with each
individual.
• Identification of venereal disease cases, contact tracing, treatment, and education
continue to use considerable nursing time. Contact interviewing must motivate
the individual not only to have treatment himself but to get others under care as
well.
• Cancer and diseases of the heart and circulatory system were again the major
diagnoses for patients on the Home Care Program.
HEALTH AND OUR ENVIRONMENT
ENVIRONMENTAL ENGINEERING
General
For the purpose of administering the program of the Division of Environmental Engineering, the Province is divided into nine areas consisting of groups of
two to four health units geographically grouped, where possible, and served by
one centrally located Regional Engineer. Most of the Regional Engineers are
located in the field and are thus readily accessible to Medical Health Officers
and others.
The staff carries out the technical functions of the Division assigned under
the Health Act and offers technical and consultative support to Medical Health
Officers, Government agencies, municipalities, and individuals on matters relating
to water supplies, swimming-pools, sewage disposal, solid-waste management,
sanitation, and training of water and wastewater personnel.
Description of Functions
Waterworks—The division reviews, for approval, all plans for waterworks
systems, including municipalities, regional districts, improvement districts, utilities,
and private systems.
Sewage works—The division reviews, for approval, all plans for public sewage
works where the flows are less than 5,000 gallons per day with ultimate disposal
to the ground.
Swimming-pools—The division reviews, for approval, plans and specifications
for all swimming-pools .except private backyard pools, with emphasis placed on
physical safety and sanitation standards.
Sanitation—The division offered many more hours of technical support than
usual this year to the Division of Public Health Inspection, primarily as a result of
new technology being continually introduced in connection with private sewage-
disposal systems and package sewage-treatment plants.
 G 32 MINISTRY OF HEALTH REPORT, 1977
Pollution control permits—The division, on behalf of the Minister, receives
copies of pollution control applications from the Pollution Control Branch. Comments are obtained from the local health authorities by the engineers who formulate
an assessment of each application.
Operation
Waterworks systems, and in particular water quality, have been designated
the number one priority item for the division. This policy has evolved in the light
of the greater number of recognized health hazards associated with water supplies,
the recent Safe Drinking Water Act in the United States, and the gradual but
continual encroachment into watershed areas used for drinking-water supplies.
The division has prepared a brochure entitled Waterworks Systems Guidelines
which provides the very basic information concerning minimum design standards
and requirements for approval of plans submitted.
In addition, Waterworks System Regulations have been drafted which will
provide in more detail the minimum requirements for water systems and water
quality necessary for the protection of public health.
The introduction of the Guidelines and Regulations will provide a high
degree of consistency within the Ministry of Health relating to plan review and
public health requirements for drinking-water quality control.
The data processing system greatly assisted the Division with data storage
and retrieval of information as part of a surveillance and control program for
drinking-water supplies in the Province. The division continued a comprehensive sampling program to obtain new data on all drinking-water supplies.
With the high priority being given to waterworks systems and associated
problems, the engineering staff devoted more time on watershed surveys, advising
water system operators, discussing water development with municipalities, improvement districts, and others.
It was recognized that there was some duplication of plan review for certain
types of systems that also came under review of the Water Rights Branch. A
series of meetings began with the Ministry of Environment in an attempt to
co-ordinate our respective procedures. The final results should provide a uniform
Governmental approach to the approvals for all waterworks systems in the Province.
Participation in Related Activities
In addition to their normal duties during the year, the Environmental Engineering staff offered direct assistance to other Government agencies, municipalities,
regional districts, and other specialized groups.
Statistical Information
In the prime activity area, the division processed 771 certificates of approval
for 1,033 known water systems. This compares to 688 certificates in 1974, 639
in 1975, and 710 in 1976.
There were only three certificates issued for sewerage systems since small
collection systems are usually not economically practical.
During the year the division processed 85 certificates for swimming-pool
approvals.  This compares to 115 in 1974, 81 in 1975, and 83 in 1976.
Once again, one-day swimming-pool operator courses were offered at seven
centres in British Columbia this year. The manual for pool operators prepared
by the division was given to each of the 308 persons who attended the courses.
This was an opportunity when the Regional Engineer and the health unit staff
worked together to provide a useful service to the public. The enthusiastic assistance offered by the local health unit staff was very much appreciated.
 PUBLIC HEALTH PROGRAMS G 33
PUBLIC HEALTH INSPECTION
The public's increasing concern for protection of the environment has placed
a heavy demand on the Public Health Inspectors of this Province.
Land Use
In order to determine the significance of the Land Use Control Program, a time
study was carried out during the months of March and April 1977. The time study
included six health units and involved 31 Public Health Inspectors, approximately
one third of the total number of inspectors within the Ministry of Health. The
information obtained from the study is being used to estimate the time and money
spent on land use control in various health units and it has been found that the
average time spent by a Public Health Inspector on land use activities is 30 per cent
of his total working-time.
Referring to the table on Public Health Inspectors' activities, on page 62,
it is noted that the number of private sewage disposal inspections has increased by
over 33 per cent. Also, significant to note is that there has been a steady increase
in the number of subdivision inspections and this year there was a 14-per-cent
increase over 1976.
Water Quality
A Water Quality Information System has been established so that the Ministry
may be better informed of the quality of drinking-water provided by water purveyors. A computer system has been adopted for the collection and analysis of
data related to the chemical and micro-biological quality of water. The number
of inspections of public water supplies has increased by over 25 per cent from the
previous year and the number of water samples taken from these sources has
shown an increase of over 29 per cent as shown in Table 6.
Food Safety
A committee of Public Health Inspectors has been given the job of reviewing
the Food Premises Regulations and has submitted their recommendations with
proposed amendments to the Ministry for its consideration.
The Director of the division met with the representatives of the Provincial
and Federal Ministries of Health and the Canadian Restaurant and Foodservices
Association in Ottawa to review changes to the National Sanitation Program for
food-service workers.
Training Programs
In co-operation with the British Columbia Institute of Technology and the
Public Service Commission, the division sponsored an in-service training seminar
on Public Health Law and Administration for 25 Chief Public Health Inspectors,
in Victoria, last February.
Several Public Health Inspectors attended the annual meeting of the Canadian
Public Health Association in Vancouver, where a number of important resolutions
were passed, one, in particular, relating to the approval of food-vending and dishwashing equipment by a national organization.
The Director of the Division of Public Health Inspection, as a corresponding
member of the Board of Certification of Public Health Inspectors for the Canadian
Public Health Association, directed two examination boards in British Columbia.
In all, 22 Public Health Inspectors obtained their certificates. The Provincial and
Municipal Health Departments have co-operated in providing the necessary six
months' field training, provided in the form of on-the-job experience. Special
studies undertaken by the students have proven valuable to local communities.
 G 34 MINISTRY OF HEALTH REPORT, 1977
Twenty-eight students from the Public Health Inspectors course at BCIT were
employed by the Ministry for the summer months and seconded to Provincial
health units for training.
This division continues to maintain a very close liaison with Federal, Provincial,
and municipal agencies in order to co-ordinate its varied activities in environmental
health.
DIVISION OF OCCUPATIONAL HEALTH
The Division of Occupational Health provides health services to Provincial
Government employees throughout the Province and acts in an advisory capacity
to both Government and non-Government organizations. Efforts of the division
continue to be directed toward ensuring a safe, healthy work environment and to
facilitate the placement of individuals in work compatible with their physical and
mental abilities. Emphasis is placed on primary prevention of illness. Areas of
expertise within the division include medical, nursing, radiation protection, alcoholism rehabilitation, and employee physical fitness.
A continued increase in demand for occupational health services was evident
in 1977. The relatively high rate of musculoskeletal injuries found in Provincial
Government hospitals at Essondale and Woodlands received special attention with
the institution of pre-placement assessments for high-risk personnel. More efficient
and more effective utilization of occupational health services in these locations has
been achieved through increased liaison with union and management groups.
This year saw the introduction of greatly expanded Workers' Compensation
Board Industrial Hygiene Regulations which will require far more effort in monitoring the work environment for a number of different hazards. In this respect, a
continued liaison with Government Safety Officers has become even more necessary
in assessing and dealing with problem areas. A hearing conservation program for
noise-exposed employees has been greatly expanded to comply with the more
stringent regulations. In addition, a toxic chemicals control program has been
initiated to monitor the large numbers of chemicals in daily use by many Provincial
Government employees.
Physician participation on various advisory and Governmental committees
continued throughout the year. Problems of major concern included insecticides,
polychlorinated biphenyls, water and air-borne asbestos, and fluoride pollution
from the production of aluminum.
The replacement of the existing sick leave policy with a new short and long-
term sickness insurance scheme will, for the first time, present a feasible opportunity for epidemiological research into the incidence and prevalence of illness in
the tremendous variety of occupational categories found in the Provincial Government. Extremely valuable information should be available within a few years
from this source.
The Radiation Protection Service continues to monitor sources of ionizing
radiation within the Province. Participation in a mammography quality assurance
program in collaboration with the U.S. Bureau of Radiological Health is now taking
place with the objective of optimising radiation dose and diagnostic quality.
Since uranium mining is being considered in several places in British Columbia,
the Radiation Protection Service is acting in an advisory capacity as regards radiation health hazards. This involvement will increase considerably should uranium
mining and processing become operational.
A special survey of 384 microwave ovens used in commercial eating establishments in the Province revealed considerable microwave radiation leakage,
 PUBLIC HEALTH PROGRAMS G 35
particularly with older models. Detailed results of this survey were presented to
the Canadian Public Health Association meeting in June of this year.
Several radiation exposures and suspected over-exposures were investigated
during the year.   None proved serious.
The activities of the Radiation Protection Service during 1977 are summarized
as follows:
Radiation surveys (X-ray, radioisotopes, and microwaves) 	
Consultations and visits	
Talks and lectures	
1977 1976
Radioisotopes leak tests
Analysed water samples
Air samples (fallout) 	
1,261
1,018
305
388
27
25
350
511
183
95
52
The Employee Development Service continued its work as a diagnostic and
motivational counselling program, working closely with medical services of Occupational Health. Its purpose is to provide counselling support for Government
employees who are in difficulty on the job due to what are usually considered their
more personal problems. These employees and their families are ordinarily referred to either the Alcohol and Drug Commission system of care or some other
appropriate community treatment resource.
Training and counselling for Government management, personnel officers,
supervisors, and shop stewards in the art of early identification (through job performance), thorough documentation, and appropriate referral procedures is also
a major part of the program.
The program was initiated three years ago and since then approximately 4,500
supervisors and shop stewards from most Government ministries have attended
almost 300 training seminars. Close to 8,000 employees have attended shorter
educational sessions. Credibility for the program would appear to be on the increase as evidenced by an increase in the number of employees referring themselves
to the service. An informal evaluation study indicates that, to date, 71 per cent of
the 250 employees referred have returned to satisfactory job performance. By
far the greatest number of employees referred to the program are suffering from
alcoholism or alcoholism combined with the abuse of prescription drugs. Of
these, 63 per cent continue to maintain their sobriety.
The dollar costs of this program are returned many fold in terms of improved
work performance. Over the past three years we estimate that this program alone
has generated a minimum dollar return to the Provincial Government of $500,000.
Employee Development Services is frequently consulted by other Government
bodies (Federally and Provincially), as well as by private business on the implementation of occupational alcoholism programming. The training manual is being
used increasingly as a model and a resource in many areas here in Canada and the
United States where troubled employees are being assisted by other concerned
employers.
April 1977 saw the opening of a second small fitness centre in the Richard
Blanshard Building, headquarters for the Ministry of Health in Victoria. Facilities
include a basement e,xercise area in addition to covered bicycle parking in the
garage, and showers, change area, and lockers on the first floor adjacent to the
Occupational Health Unit. These facilities provided an opportunity for the building occupants to cycle or run to work, or exercise over the lunch hour. (A July
survey indicated 4 per cent of the building's occupants cycle-commuting to work
 G 36 MINISTRY OF HEALTH REPORT,  1977
on a regular basis.) Some 15 per cent of the employees in the building were
attracted into the programs at the spring opening-time.
The Physical Activity Centre continued to offer formal and informal individual
programs and two group classes to employees in the Legislative Precinct area.
One hundred and fifty employees are involved in programs at this location.
Many activities cater to a further 125 employees. Activities include yoga and
running, exercise and run, recreational fitness, strength training, aquatic fitness,
and ladies exercise to music. Classes were conducted in office locations and in
rented public facilities.
A Fitness Education project was offered to employee groups on request. This
included physical activity counselling on a group basis, following a fitness appraisal
which measured personal levels of strength, suppleness, and stamina. Employee
groups tested include the Ministries of Recreation and Conservation (110); Highways, Vernon (40); Education Correspondence and Special Services (40); Pollution Control Branch (30); Tillicum Lodge (25); and Human Resources, Field
Offices (20). The same service was provided on an individual basis to a further
250 employees.
Additional services include a bimonthly newsletter, health library, handout
material, film series, and educational seminars.
Nutrition counselling was available on group or individual basis. This service was provided at both the Physical Activity Centre and the Blanshard Building.
Counselling was arranged on request or by referral from the occupational health
nurse or physician. An extensive Behaviour Modification of Obesity Program
was instituted offering a 10-week series aimed at weight loss. Thirty employees
graduated from this program, which was also available on a group or individual
basis.
SPECIALIZED COMMUNITY HEALTH  PROGRAMS
MEDICAL SUPPLY SERVICE
In 1968 a service was opened to provide home dialysis for patients having
renal failure. Equipment was obtained and a warehouse opened to provide the
necessary supplies. With the opening of this warehouse, the name of the organization was changed from the Kidney Dialysis Service to the Medical Supply Service.
On July 1, 1977, the warehouse operation was transferred to the Central Supply
Service at Essondale, B.C., and is now called the Central Supply Service, Medical.
The remaining organization has had to revert to its original name in order to avoid
confusion and is again called the Kidney Dialysis Service.
The number of patents in end-stage renal failure in the Province continues to
increase each year, resulting in pressure on all of the facilities to accept more
patients. There are now 80 patients at home receiving hsemodialysis. This number remains fairly constant as there are patients coming off this program because
they have received a kidney transplant or because their home situation has become
unsuitable and they have had to return to hospital.
The number of patients on home peritoneal dialysis has increased from 15 to
23. This has resulted from a technical improvement with the introduction of a
piece of equipment called a "cycler." With this equipment it is necessary to dialyse
eight hours, five days a week with this method, and whereas formerly dialysis was
accomplished manually by hanging bags, warming the solutions, and staying awake
to run the solutions which require changing every 20 minutes, a long, tedious
procedure, the introduction of the cycler which automatically warms the solution
and cycles it through its processes allows the patient to sleep during this procedure.
 PUBLIC HEALTH PROGRAMS G 37
The Willow renal unit started functioning in January 1977. It is designed
as a limited care unit. That is, although it overcomes the necessity of having an
assistant and adequate accommodation in the home, it still requires the patient to
carry out his own dialysis to the extent that he is capable. Patients who have been
trained to do dialysis at home are very capable and require little assistance at the
renal unit. Those who are from the hospital centres have had little training and
require more assistance. This experience is showing that there are really two levels
of care and that with an increasing patient load it may be necessary to separate
these patients.   There are now eight patients being dialysed in this centre.
The Kidney Dialysis Service has two technicians to service the 80 home
patients' machines and the Willow Dialysis unit equipment. As this Province is
located far from the suppliers of this equipment, these technicians must have
mechanical and electronic training and experience.
Nutritional supplements were started in order to provide additional calories
for children on dialysis so that they would attain a relatively normal stature. These
high-calorie supplements must be low in protein, potassium, and sodium. There
are now 10 children receiving these supplements. However, the greatest need
for these supplements is to prevent patients from going on to kidney dialysis, as it
is possible to delay dialysis for a period of months through this special diet. There
are now 41 pre-dialysis patients receiving the diet supplement and thus staying
off dialysis. In addition, there are now 10 dialysis patients on this diet in an
attempt to improve their health status.
Through the leadership of the Hemophilia Society, a home treatment program
for haemophiliacs was established in this Province in 1972. The Kinsmen Rehabilitation Foundation has supported a Haemophilia Assessment Clinic. The Red
Cross provides the blood fractions to prevent bleeding and the Medical Supply
Service has provided the necessary administration supplies. The Assessment
Clinic has been strengthened by adding a half-time nurse-co-ordinator and a part-
time physiotherapist. The clinic provides consultations by hsematologists, orthopaedic surgeons, paediatricians, and dentists. There are now 38 patients with
Factor 8 deficiency and five patients with Factor 9 deficiency on this home treatment program. Not only do these patients receive more individual care to prevent
bleeding but the need for hospitalization is reduced.
Crohn's disease is non-specific inflammation of the small intestine in which the
patient cannot absorb sufficient food during periods of flare up of this disease.
It is necessary for patients to be fed intravenously during these periods. There
are now five patients being fed intravenously and there are an additional two
patients receiving special dietary supplements. This is an extensive procedure
costing up to $1,500 a month during the periods of total intravenous feeding. By
training these patients to perform this procedure at home they are able to carry
it out at their own convenience and continue leading a relatively normal life.
Otherwise, hospitalization would be required. This home program is therefore
of marked benefit to the patient and an economical method of providing service.
MERCY FLIGHTS
The Ministry again arranged for "mercy flights" to transport seriously ill or
injured persons by air to a hospital or other treatment centre. When such flights
become necessary, available aircraft from a variety of sources may be called, upon,
including the Provincial Government, the Canadian Armed Forces, and the
Canadian Coast Guard. Emergency Health Services Commission now have a
dispatcher on duty 24 hours each day and that person is assuming more of the
 G 38 MINISTRY OF HEALTH REPORT,  1977
functions previously carried out by the Rescue Co-ordinating Centre. When a
rescue flight is requested, a medical assessment of the need is made by a medical
officer of Special Health Programs who also acts in a co-ordinating capacity between
the patient's physician, the providers of the aircraft, and the receiving hospital.
At this point, it might be appropriate to thank the personnel who have manned
the Rescue Co-ordinating Centre over many years for their contribution to health
care in this Province.
SPEECH THERAPY
Ministry of Health Speech Pathology services focused on comprehensive
treatment programs for individuals with communication disorders, thereby preventing further consequences of the speech and language problems. These services
were provided to clients in all age categories throughout the Province from local
Health Unit Speech and Hearing Clinics. Expansion of services to school populations this year resulted from a co-operative agreement with the Ministry of Education. The Program for Communication Disorders was extended on a contract for
service agreement to seven school districts within five local health unit geographic
areas. Additional school districts will be served following evaluation of those
initial pilot projects.
All program services were provided to communicatively handicapped populations within a framework of standardized guidelines. These policies have resulted
in increased effectiveness and consistency of client services throughout the Province.
Twenty-two speech pathologists provided services from 17 local health unit clinics.
Additionally, 14 speech pathologists initiated the school services pilot projects in
September/October 1977.
Program staff in health unit clinics reported an average of 115 clients per
month were referred (throughout the Province) for speech pathology services.
Following individual assessments, 66 per cent of these clients were recommended
for treatment programs. A monthly case-load average of 375 communicatively
handicapped individuals received weekly/biweekly treatment programs throughout
the Division of Speech and Hearing; 15 per cent of all treatment cases were dismissed each month; 74 per cent of staff time was devoted to direct client treatment;
and 13,600 individual therapy sessions were conducted last year. This is a significant increase in direct remediation of communication disorders.
Local staff are utilizing advanced techniques and procedures in a variety of
program areas which have improved the quality and effectiveness of service to speech
and language handicapped individuals throughout British Columbia, and 50 per
cent of all treated cases were reported to have achieved their therapy goals upon
dismissal.
HEARING CONSERVATION PROGRAM
The Division of Speech and Hearing continues to provide a comprehensive
community Hearing Conservation Program in selected areas of the Province.
Adherence to scientifically supported conditions for service delivery, as well as
constant professional consultation and co-ordination with local Medical Advisory
Committees, insures effective and efficient audiological services to these communities.
Audiologists in regional centres have developed and administer a wide range of
audiological services, maintaining rigid standards in service delivery. They have at
their disposal the necessary support for the development and maintenance of high
quality service, as follows:
(1) A Central Research, Development, and Repair Laboratory is available for immediate repairs to equipment, for solving all technical
problems as they arise, and for co-operative research and development.
 PUBLIC HEALTH PROGRAMS G 39
(2) Professional consultative staff guide the audiologist in the development of a complete range of services and are available to answer all
professional queries.
(3) A stock supply and inventory system facilitates the control and
ordering of equipment and materials.
Audiological services include
(1) the High Risk Hearing Register for identifying neonates with hearing
impairment;
(2) the school hearing screening program which provides for assessment,
follow-up, referral, and rehabilitation;
(3) assessment of all hearing parameters for pre-school children and
adults and necessary remedial services;
(4) hearing-aid evaluation, selection, fitting, follow-up counselling, and
repairs and provision of accessories and batteries;
(5) noise analysis, control, and delivery of hearing conservation services;
(6) school auditory training equipment evaluation, selection, installation,
instruction, and maintenance.
The school Auditory Training Equipment Program is a co-operative effort
between the Ministries of Education and Health. This is an example of how cooperation between Government ministries and agencies can result in more effective
and efficient delivery of services to the hearing impaired.
The Division of Speech and Hearing also has co-operative agreements with
(1) Ministry of Human Resources;
(2) Division for Aid to the Handicapped, Hospital Programs, and other
Ministry of Health agencies;
(3) Department of Veterans Affairs (Federal);
(4) Department of National Health and Welfare (Federal).
Cost/benefit accountability, contributions from charitable organizations, and
adherence to strict standards for programming and service delivery continue to
insure both an effective and efficient Hearing Conservation Program for selected
communities.
In summary, the addition of programs such as Clinical Audiological Services,
Clinical Speech Pathology Services, and Contractual Speech Pathology Services to
Public Schools; the addition of corresponding staff for the above programs; and
renovation or construction of clinical facilities are major developments. During
the calendar year 1977, such major program developments have occurred, or are
in progress, in 75 per cent of the local Health Unit programs (Health Units 1, 3,
4,5,7,8,10, 11, 13, 14, 16, 17, 18).
VISION SERVICES
During the year, consultative services were provided by the Provincial Orthop-
tist to over 200 public health nurses, aides, and summer students. Visits were
made to 11 main health unit offices and 12 branch offices.
Priority for screening continues to be placed on the pre-school-aged child.
Discussions with related eye care professionals and results of special pre-school
vision programs confirm that 5 per cent of pre-school children have some eye
problem. The best time for visual care is early in the pre-school years when eye
defects can still be corrected with best results. Defects such as crossed eyes and
amblyopia can lead to permanent loss of vision in the affected eye, if not detected
and treated preferably by age 6.
 G 40 MINISTRY OF HEALTH REPORT, 1977
As of September 1977, almost every branch office had been provided with a
"learning module" for vision screening. The module contains an overview of the
Vision Screening Program, information and procedural guidelines for both stereop-
sis and visual acuity, as well as samples of resources available for education of
children, teachers, parents, etc.
An interesting study was undertaken in the summer to establish the outcome
of referrals from the kindergarten vision screening program. The number of
children reported on was 22,913, of which 21,570 (94.1 per cent) were screened.
There were 1,294 (5.6 per cent) suspected vision defects, of which 520 (40.2 per
cent) were previously known, while 765 were newly suspected problems. The
follow-up results are being evaluated and a final analysis will be completed shortly.
The establishment of a Vision Care Task Force in April 1976 was a significant
event in the field of eye care. The task force was established to undertake the
study of the present vision care provided to the people of British Columbia, and
to make recommendations for its modification and improvement, where such improvement could be seen. The final report and recommendations of the task force
were presented to the Minister in November 1977 for his consideration.
COMMUNITY PUBLIC  HEALTH  NURSING SERVICES
Traditionally the health of the family and its individual members is the primary
concern of the community health nurse. This focus on the family and the insights
and understanding gained from interacting with its members can form the basis for
sound, comprehensive nursing and effective public health intervention.
Community health nurses combine professional nursing skills with the knowledge of public health practice. Their contacts with the people in British Columbia
begin with the newborn and continue with a variety of services throughout the life-
cycle of the residents. In a great range of activities the community health nurse
uses the basic principles of prevention, case finding, positive health teaching, promotion of patient and family self-motivation and direction, continuity of care, concern for total family, and collaboration with a multidisciplinary health team. As
she builds nursing care on the family's own strengths and abilities and supplements
their actions only when the problem is too much for them to handle alone, the
nurse is constantly aware of the opportunity to reinforce family strengths and to
better equip the family to deal with future problems of health care and family
management.
The almost limitless opportunities offered the community health nurse to
affect the health of the community make it immediately clear that all useful services
cannot be provided. It is necessary to establish a priority system based on the
likely impact of nursing service in a given situation, the realities of the nurse supply
and demand, and the availability of other community resources. Requests and
demands for services from an increasingly large population and a public more
health-conscious than previously have placed considerable pressure on the field
staff of public health units. In order to maintain a high quality of service and to
build up and maintain optimum level of health for the expectant mother, the new
baby, the infant, and the pre-school child during the times which are critical in their
development, it has been necessary in some areas to reduce services in schools
where other resources are more readily available. The reductions in services have
been made reluctantly and only after consideration of total area needs and priorities.
Modifications have also been made in other programs to make their delivery more
 Young child is tested to determine whether both eyes arc used together.
Early detection of defects can prevent permanent damage.
Physiotherapist (standing) tests fine motor development in child during special
"circus" for children at Simon Fraser Health Unit.
 Travelling nutrition exhibit, one of many displays now being organized, drew lively
attention for children, teenagers, and adults in 1977.
One of the most popular participation exhibits at the 1977 Pacific National Exhibition
was Action B.C.'s obstacle course for children.
 PUBLIC HEALTH PROGRAMS G 41
efficient without loss of quality; services which were less productive of results have
been discontinued and wide use has been made of volunteers to supplement nursing-
time.
MATERNAL AND CHILD HEALTH
Perinatal
A positive approach is fundamental to maternal health, but special attention
must be given to the needs of the expectant mother, her family, and the specific
health hazards of pregnancy. Making services available to expectant parents in
all areas of the Province has been a primary consideration of the community health
nurses, but the proper use and evaluation of these services has been equally
important in determining the effectiveness of the communities' perinatal programs.
• The majority of expectant parents in British Columbia attend Expectant
Parent Classes prior to the birth of their first baby.
• Approximately 16,500 expectant mothers and fathers in areas outside
Greater Vancouver and the Capital Region attended a series of four to
eight classes each.
• Both parents attended classes in about 70 per cent of all series given.
• Special classes were given where appropriate for single parents, adopting
parents, and other groups with particular needs.
• Emphasis in classes was on positive maternal and family health, growth and
development of the baby, physical and emotional changes during pregnancy,
coping with the normal stresses of pregnancy, the role of nutrition in good
health, and preparing for the new family and birth of the baby.
• Classes provided an opportunity for the community health nurse to monitor
the condition of the expectant mother and her family throughout the pregnancy and to identify the need for additional support or care.
• A public health nursing consultant from the Ministry of Health is working
with representatives of Vancouver and Capital Region Community Health
Services and the B.C. Medical Association to prepare a Manual for Expectant Parents.
Infant and Pre-school
The infant and pre-school years are recognized as a critical time in the growth
and development of the child, and progress is dependent in a large measure upon
the quality of nurturing the family is able to provide. High priority is therefore
given to the program by community health nurses.
• The nurse is a health counsellor to a family and as such is able to establish
a relationship with the family which is conducive to effective health education and the provision of support where needed.
• Community health nurses visit over 95 per cent of newborns and their
mothers in their homes shortly after hospital discharge.
• Length of hospital stay has been reduced for many new babies and their
mothers as they are being discharged early to Home Care Programs for
close follow-up care. Family separation and disruption is thereby kept to a
minimum.
• Requests for attendance at Child Health Conferences have placed heavy
demands on the time of health unit nurses and in some areas there is a four-
week wait for appointments.
 G 42 MINISTRY OF HEALTH REPORT,  1977
• Infants and pre-schoolers were seen on approximately 130,000 visits to
Child Health Conferences outside the Greater Vancouver and Capital Regional areas.
• Home visits were made by nurses to 93,000 infants and pre-schoolers for the
purpose of health assessment, disease prevention, identification, and follow-
up of defects and disorders, monitoring of "at risk" situations, family support,
and health and safety education.
• Over 22,500 children between the ages of 1 and 5 years received special
assessments, e.g., Denver Developmental Screening for growth and development, etc.
• Health assessments, supervision, and education were provided to pre-school
children in nursery schools, day care centres, and kindergartens.
School
Less community health nursing-time was spent in schools owing to continuing
monetary restraints with the resulting reduction in the amount of nursing-time
available. It is recognized that preventive services are most effective in the infant
and pre-school years, so that services provided to this group should benefit future
school populations.
School health services were modified so that available time could be spent in
those activities considered to be most productive.
• To achieve this, a subjective review of the present program was made by
collecting data on the use of available nursing-time and the extent to which
services provided meet existing needs.
• High priority was given to the following services: Immunization, vision and
hearing screening in Kindergarten and Grade I; identification and follow-up
of defects detected through screening programs or student-nurse contact;
health counselling of individual students and school-home liaison. To maintain these services it was necessary to reduce routine screening of pupils
beyond Grade I. In some areas routine visits by the nurse to specific schools
were replaced by visits on request only.
• A study to measure the effectiveness of present vision screening methods and
ascertain the outcome for students identified for further investigation and
referral was initiated and is continuing.
• A review of the use of nursing-time in a senior secondary school was undertaken in the Nanaimo School District where the services of a full-time public
health nurse were provided through school district funds. It was observed
that the senior high school can be an excellent setting for appropriate and
timely health education programs. It was less clear by whom the most
efficient and economic health services can be provided in this setting.
• A committee, including representatives from the Ministries of Education and
Health, was formed and is at present exploring means of improving the
delivery of health services in schools to meet current need.
FAMILY, ADULT, AND GERIATRIC SERVICES
A family focus is the emphasis in the work of the community health nurses, as
inter-relationships between family members have a great influence on family health.
• Young and middle-aged adults are generally more able to cope with problems
as they arise; however, nursing activities included preventive health teaching
to enable the family to maintain its health, anticipating guidance and coun-
 PUBLIC HEALTH PROGRAMS G 43
selling, crisis intervention at times of individual or family stress, and care
for those with specific illnesses or disabilities.
• Adults with special conditions, e.g., diabetes, cardiac, or kidney ailments,
etc., received the attention of both the public health and home care nurses.
• Educational projects and discussion groups dealt with the problems of
obesity, stress, fitness and exercise, smoking, accident prevention, and
nutrition.
• Special attention and priority were given to families and individuals under
emotional or mental stress, e.g., attempted suicide, child abuse, catastrophic
illness, family disorganization, etc.
• Increased attention was given to the special needs of the elderly, with emphasis on the maintenance of their independent and contributing role in the
family and community.
• Counsel, health supervision and assessment, physical care, and assistance
in the use of community resources were provided in greater quantity to older
persons.
• The elderly and their families were given assistance in adjusting to and
choosing alternate methods or special facilities for care when required.
• Assessments gave attention to the physical, emotional, and social needs of
elderly people.
• Licensing and supervision of all community care facilities, e.g., nursing-
homes, boarding-homes, day care centres, etc., was carried out by public
health staff and consultation was provided to operators and staff.
HOME CARE PROGRAMS
The Ministry's Home Care Program is available to all residents of the Province who are within reasonable access to a public health office. The program is
administered by a Home Care Co-ordinator from the local public health unit who
works closely with private physicians and all local health and social services.
• The program has two parts:
(a) Hospital replacement—for persons who, without home care, would
require admission to an acute hospital.
(b) Non-hospital replacement—for persons who do not require acute
hospital care but need nursing and other services in order to remain
in the home with adequate care.
• Patients are admitted to the program on referral by their private physicians.
• Patients on "hospital replacement" receive all necessary services, e.g., nursing, physiotherapy, homemaker, social work, meals-on-wheels, medication,
equipment, etc., at no cost to themselves. These services are arranged for,
co-ordinated, and paid for by the Home Care Program. Service is available
seven days a week from 8.30 a.m. to 11 p.m.
• Although "hospital replacement" services are available to approximately
80 per cent of the population, it is urgently required in the remaining areas
of the Province in order that patients may be cared for in the home when
it is the appropriate setting and that acute hospital beds may be made
available to those who need them.
 G 44 MINISTRY OF HEALTH REPORT, 1977
• "Non-hospital replacement" services are available throughout the Province
and provide nursing care and supervision to the patient and a limited
amount of physiotherapy. There is no cost to the patient for these; however, where other services, e.g., homemaker, medication, etc., are required,
payment is the responsibility of the patient. Services are available seven
days a week.
• The same Home Care Program staff members provide care to both "hospital
replacement" and "non-hospital replacement" patients and work closely
with the family to promote support of patient's care regimen, rehabilitation,
and safety, reduction of patient and family stress, and a co-ordination of
community and family care efforts.
• At the requests of patients and families, many more terminally ill patients
are remaining in their homes on the Home Care Program instead of being
transferred to acute facilities. Nurses have been able to help the families
deal with the problems of terminal illness and the feelings of loss and grief
surrounding the death of the patient.
• Statistics for 1977 are not yet available, but in 1976 there were 39,704
patients admitted to the Home Care Program throughout the Province.
This volume has tripled since 1972.
• Included in the services provided by the Home Care Program in 1976 and
paid in full by the Ministry through Public Health Programs were
Nursing (visits) 596,413
Physiotherapy  (visits) 4,417
Homemaker (hours) 29,770
Meals-on-wheels (meals) 2,130
Medication for (patients) 6,859
Equipment and medical supplies for (patients) 6,996
• Full computerization of the Home Care Program data began on May 1,
1977, thereby facilitating a more complete review and evaluation of the
program.
COMMUNITY PHYSIOTHERAPY SERVICES
Physiotherapy service was available during 1977 in 10 Provincial health units
through 14 offices. This service was provided by the equivalent of 12 full-time
physiotherapists and included both preventive and treatment services.
The community physiotherapy services are being developed in the health units
to provide a full range of physiotherapy and associated services relative to the needs
of the area.   The program has four major features:
(1) Treatment service—Provided under the Home Care Program to
patients in their home setting.
(2) Consultative/advisory service—For patients, families, physicians,
community health nurses, and the community at large. Under this
aspect of the program, service is offered in the form of general
assistance and referral in such matters as diagnosis and treatment,
provision of equipment, and establishment of community health
programs.
(3) Preventive services—Where the physiotherapist participates in community programs such as scoliosis screening, homemaker training
programs, and physical fitness in schools.
 PUBLIC HEALTH PROGRAMS G 45
(4) Maintenance and follow-up—Provides  an ongoing audit of the
patient's level of independence and function within the community.
During 1977, a total of 18,126 direct physiotherapy treatment services were
given under the Home Care Program.   Some 8,106 of the treatments were rendered
under the comprehensive hospital replacement day home care program, which
covers a full range of support and professional services to the patient.
DENTAL HEALTH SERVICES
The staff of the Division of Dental Health Services comprises six dental
officers, 13 dental hygienists, and 23 dental assistants. It is recognized that this
staff cannot provide effective dental health programs in all school districts served
by the Provincial health units. Therefore, it is the current policy to carry out
effective programs in selected school districts or parts of them, rather than to have
ineffective programs with a larger geographical coverage. To recruit and train
competent staff to provide total coverage is expected to take several more years.
THREE-YEAR-OLD BIRTHDAY CARD PROGRAM
The 3-year-old birthday card dental program continued to operate in 46 of the
66 school districts served by the Provincial health units. By this program some
9,000 young children received from their family dentists an examination and
counselling at no direct cost to the parents. These children represented 56 per
cent of all those to whom cards were mailed by the local health unit. Acceptance
was highest in the Okanagan Region at 84 per cent, where there is a good ratio of
dentists to population and experienced staff to carry out telephone follow-up for
non-responders. The lowest in acceptance rate was in the Kootenays at 45 per
cent, where neither of these conditions pertained. An intensive follow-up procedure has been initiated in some regions in order that participation rates may be
improved in the next year.
SCHOOL DENTAL PROGRAM
Dental hygienists and dental assistants provided dental hygiene instruction,
education, and motivation to almost 72,000 elementary school-children. Of these,
some 62,000 took part in using the self-applied fluoride paste and rinse provided
on a twice-a-year basis. In addition, 38,250 of the 62,000 students in the school
program received a dental inspection, with 10,623 telephone follow-ups made to
parents in order to encourage them to take their children to the family dentist.
The health units of Greater Vancouver and of the Capital Regional District
continue to operate effective school dental health programs, assisted by grants-in-
aid from this Ministry. In addition, during these past three years, the Ministry
has funded a summer dental clinic at the Dental School of The University of British
Columbia. Patients are pupils of Greater Vancouver and the Lower Mainland
requiring much needed and extensive dental care. Treatment and counselling is
provided by senior dental students and dental hygiene students under the supervision of members of the Faculty of Dentistry. This summer, 919 children benefited from this clinic. The value of the services provided is conservatively estimated
as more than twice that of the grant provided.
 G 46 MINISTRY OF HEALTH REPORT,  1977
DENTAL EXTERN PROGRAM
The largest program of this type was initiated in July of this year with 12
externs and their dental hygienists, and assistants working out of six mobile vans,
one trailer, three sets of portable equipment packages, and in a permanent facility
in Prince Rupert. Last year, dentists staffing these mobile clinics visited 30 communities without resident dentists and completed treatment for over 5,400 patients
on a fee-for-service basis. Under this program these figures are expected to be
much higher when the extended program is completed in June.
In order to provide treatment services to other underserviced areas, the College of Dental Surgeons of British Columbia has also provided and equipped a
dental clinic at Kaslo. This is in addition to the facilities they continue to operate
at Masset, Queen Charlotte City, and Mackenzie, the latter now having the services
of two dentists.
CHILDREN'S HOSPITAL
An orthodontic treatment centre has been built at the site of the Children's
Hospital in Vancouver. Its purpose is to provide ongoing treatment and consultative services to the Cleft Lip-Palate Program for those 20 years of age and under.
Recruitment of a recognized specialist in this field is under way to direct the operations of this clinic.
OTHER ACTIVITIES
The oral cytology program has operated since 1969 with the co-operation of
the British Columbia Cancer Institute and the College of Dental Surgeons of British
Columbia, who issue cancer diagnostic kits to each dentist newly registering in this
Province. In the period 1969-75, a total of 1,896 smears was submitted to the
institute for diagnosis. No less than 34 of these specimens, a ratio of 1:56, were
confirmed as having been derived from early cancerous lesions.
To evaluate the dental health status of the children of British Columbia,
Province-wide dental surveys have been conducted in the years 1958-74 and have
demonstrated a steady improvement in the dental health of those children. This
past year a new, more sophisticated and computerized methodology has been
developed in co-operation with the Research Section of the Division of Vital Statistics. It is planned that in 1980 this methodology will be carried out Province-wide
on a random sample of all children of specific age-groups and in sufficient number
to provide statistically significant results. Consideration of a similar survey of the
adult population will also be made.
A one-week in-service training program for all staff dental hygienists was held
in September. Topics presented were Provincial policies, programs, and standards
and classroom teaching skills (through lectures, practical demonstrations, and
videotaping of these classroom presentations). Hygienists representing each regional team presented many innovative visual aids, ideas, and suggestions useful for
school dental programs.
Recent surveys indicated that the dentist population ratio for British Columbia
is 1:1779. In addition, approximately 47 per cent of British Columbians are now
covered by group dental insurance plans or are provided with dental services through
welfare, armed services, or in the case of native Indians, through Medical Services.
 PUBLIC HEALTH PROGRAMS G 47
NUTRITION SERVICES
Major thrust in the areas of maternal and infant nutrition, education of young
children, and public awareness of the role of nutrition in cardiovascular disease
gathered momentum during 1977.
Individual prenatal counselling for nutritionally at-risk pregnant women was
initiated in the six health units with nutritionists. Women in these areas were
screened initially when they entered early prenatal classes. Only 11 per cent of the
women had adequate diets; the other 89 per cent of the women required some follow-
up due to dietary inadequacies observed in screening. Eighteen per cent were
referred for intensive counselling by a nutritionist. Over 80 high-risk mothers have
received nutritionist services in these first months of operation. The data indicated
a widespread and serious risk in a most vulnerable portion of our population. The
need for a formalized prenatal nutrition counselling service was once again illustrated.
The Infant Nutrition Guide for Professionals has been distributed widely to
dietitians, nutritionists, general practitioners, family physicians, and paediatricians
in British Columbia. Several thousand additional requests have been received from
health professionals across Canada and in the United States and England. This
publication deals with several new issues in community nutrition such as discouraging the use of skim milk for infants and encouraging the delayed introduction of
solid foods. Two new publications designed for parents were made available on
infant nutrition. Two slide series on infant feeding were developed for use by community health nurses in teaching infant nutrition concepts to new mothers. A
Perinatal Nutrition Conference was sponsored for over 100 health professionals in
Penticton by the nutritionist and staff of South Okanagan Health Unit.
A pilot survey on breast feeding was conducted in three health units to determine the extent of programs offered, the attitudes of public health personnel, and the
knowledge and attitudes of mothers. The study report suggests that public health
personnel become more involved in the promotion of breast feeding as few such
programs are available, that physicians should actively encourage mothers to breast
feed, and that many mothers would welcome the supportive influence of their peers
at breast-feeding classes.
The national Food Consumption Patterns Report released in 1977 revealed
that the decline in sound eating habits begins at school-entry age. As a result,
nutrition education efforts for preschool and young children were intensified. Several
workshops for day care workers and supervisors were conducted throughout the
Province. Publications on nutrition in family day care were distributed to day care
mothers. The nutritionist in Simon Fraser Health Unit has developed a series of
"Active Health Nutrition Units" which have been introduced to 62 per cent of the
schools in that area. Planning for a pilot project in selected Prince George elementary schools is currently under way to demonstrate the effect of a nutrition education
program on the food habits of elementary school-children. A weight-control program for adolescents was conducted in July and August by the nutritionist in the
Boundary Health Unit.
A heightened interest by schools in nutrition programs was noticed in 1977.
Many schools, in health units where nutritionists are located, sought professional
advice on food policies. This is considered to be an exciting and important change
in attitude that undoubtedly will have great impact in the long term.
As it was found that elevated serum cholesterols occurred in twice as many
British Columbia men aged 20-39 than on the national average, the Ministry of
 G 48 MINISTRY OF HEALTH REPORT, 1977
Health has elected to take an aggressive leadership role in this matter. During the
year, the Division was responsible for a ministerial statement on diet and cardiovascular disease. The statement recommends specific dietary goals for British
Columbians which, if practised, will assist in the reduction of cardiovascular
disease risk.
Major public information programs included Nutrition Week, Nutrition Buy-
lines, and the Senior Chef. Nutrition Week, scheduled for October 17-22, featured
public seminars, displays, and nutrition events in schools and hospitals. The week
proved to be a success with all health units experiencing increased requests for
nutrition education materials and information. The Nutrition Buyline, a weekly
newspaper column produced by the Division, continued to expand its coverage to
more than 1,300 media outlets in the Province. The Senior Chef, a unique series of
13 half-hour colour television programs designed for senior citizens, received considerable attention this year with over 100 broadcasts taking place and over 30,000
cookbooks distributed in the past six months. Requests for copying rights for the
series have been received from Saskatchewan, New York, and California.
Service to the public through work with other Governmental ministeries remains
a major part of the divisional activities. For example, nutritionists provide special
diet counselling for those who cannot obtain this service through hospital programs.
In-service education is provided for home care nurses and for homemakers in the
Long-term Care Program. Nutrition sections are taught in Manpower job readiness
and upgrading programs. A manual was developed on nutritional standards for
operators of adult residential facilities in the community care facilities and Long-
term Care Programs. Nutrition education became a regular component of the
Crossroads Treatment Program for alcoholics in South Okanagan Health Unit,
with both the nutritionist and counsellors advising on the role of nutrition in
rehabilitation and practical food money management.
Within the new Community Care Facilities Licensing Act, provision was made
for nutritional standards. This new responsibility will require that an inspectional
and consultative service for these institutions be established in the Nutrition Division.
The health unit program continued to be the major focus for in-service education of the public health staff. Local contacts with community colleges, the media
schools, recreation centres, weight-reduction groups, and medical practitioners are
strengthened at this level. The general public continues to use the health unit
nutritionist as a source of reliable nutrition information in their communities. Six
health units have nutritionists: South Okanagan Health Unit (Kelowna), South
Central Health Unit (Kamloops), Central Fraser Valley Health Unit (Maple
Ridge), Boundary Health Unit (Surrey), Simon Fraser Health Unit (Port Coquitlam), and Cariboo Health Unit (Williams Lake).
A seventh position in Central Vancouver Island Health Unit remains vacant
at this time.
VITAL STATISTICS
The Division of Vital Statistics administers the Vital Statistics Act, the Marriage Act, the Change of Name Act, and the Wills Act (Part II), and provides a
centralized biostatistical service to various community health programs within the
Ministry and to certain voluntary agencies. The division issues a statutory annual
report of vital statistics.
 PUBLIC HEALTH PROGRAMS G 49
REGISTRATION SERVICES
The total number of registrations accepted under the specified Acts remained
substantially unchanged in 1977. Death and marriage registrations decreased
slightly, while registrations of wills' notices maintained the continuous upward
trend of the past 30 years.
There was a substantial increase in the number of name changes effected under
the Change of Name Act. An amendment to this Act which became effective on
March 25 made provision whereby a married woman may retain or revert to her
previous surname by statutory procedure.
The numbers of registrations of vital events, and the number of certificates
and other documents issued therefrom under the Acts administered by the division,
for the years 1976 and 1977, are shown in Table 7.
BIOSTATISTICAL SERVICES
The task of computerizing the division's complex data processing operation,
previously based on IBM unit record equipment, was virtually complete by the end
of the year. The final stages of the conversion program, commenced in 1974 by
the Computing and Consulting Services Branch, have been taken over by the newly
established B.C. Systems Corporation, which commenced operations on November
1, 1977.
In addition to the dedicated work done by the Systems and Programming staff,
the division's research staff have become increasingly involved as the conversion
program nears completion. They have had to work closely with the systems
analysts in the development of the new specifications, to become conversant with
computer techniques and capabilities, and to familiarize themselves with various
program packages available, so as to save programming time and cost in producing
needed tabulations.
The Health Surveillance Registry, located in Vancouver, comprises a general
register of handicapped conditions among children and adults, as well as a distinct
cancer register and a register of congenital anomalies and genetic defects. An
annual report is issued on the operations of the registry as a whole, as well as a
separate statistical report on cancer. The registry is served by four consultants,
in genetics, paediatrics, cancer, and record linkage respectively.
Substantial progress was made during the year in expanding the registry case
load and extending the sources of ongoing ascertainment of new cases. About
2,500 new cases of chronic disabilities were completed from reports submitted by
the Health Division of the Ministry of Human Resources, a source which was
tapped for the first time in 1975. A procedure for continuous registration of cases
through the Canadian National Institute of the Blind was established, and over
1,500 new cases were registered from this source. A similar arrangement is being
worked out with Childrens' Diagnostic Centre and the Vancouver Childrens' Hospital, and has resulted in another 1,400 new registrations. Discussions were held
with the Pacific Region Medical Services Division of Health and Welfare Canada
with a view to increasing the ascertainment of registerable conditions among the
native Indian population.
The Cancer Register, which is a specialized unit of the Health Surveillance
Registry, receives notifications of live cases of malignant neoplasms from hospital
pathology laboratories, from private physicians, and from the Cancer Control
Agency of B.C. Information on neoplasms ascertained at death is derived mainly
from the Vital Statistics registration system.
 G 50 MINISTRY OF HEALTH REPORT, 1977
During the year a committee, including representatives of the Ministry of
Health and of the Cancer Control Agency of B.C., made recommendations for
closer association between the Cancer Register and the Cancer Control Agency
with a view to developing a unified data system which could contribute more effectively to cancer treatment and research in the Province.
Data were supplied to a number of registering agencies, and a wide variety of
departmental and other inquiries for registry statistics were dealt with. Research
officers also provided statistical information and advice to physicians and other
research workers in connection with research projects on specific conditions.
Several research papers utilizing registry data were accepted for publication during
the year.
The registry was host to a number of visitors from other provinces, and from
the United Kingdom, Australia, Japan, and Cuba.
Two research officers, one from each of the Vancouver and Victoria research
office staff, continued to serve as members of the executive committee of the Perinatal Program of British Columbia which, during the year, became a subcommittee
of the Medical Advisory Committee to the Ministry of Health. Both officers were
active in providing statistical data and advice and assisted in the development of
a package of perinatal records designed for use in British Columbia hospitals.
Substantial progress was made in the division's computerized record linkage
project, in which the Medical Genetics Department of The University of British
Columbia collaborates. This work was interrupted in November by the sad and
untimely death of Dr. Ben Trimble, consultant in record linkage, who had directed
the work since its inception in 1974.
The Victoria research office serves as the division's agent in the dissemination and analysis of demographic data derived from the Vital Statistics registration
system, and also provides biostatistical services to other agencies within and outside
the Ministry.
In the field of mental health statistics, the division relinquished the processing
of statistics relating to mental health institutions administered by the Director of
Government Health Institutions, and those administered by the Ministry of Human
Resources, but continued to assist in the processing of statistics relating to the operation of mental health centres.
Statistical advice and data processing services were provided to the Division
of Dental Health Services. Further progress was made in the development of a
new dental survey methodology. The results of the Port Alberni mouth rinse
study conducted in local schools were analysed and confirmed the beneficial effects
of the program in reducing the incidence of dental caries among students. Results
from a mouth rinse study in the Lower Fraser Valley were also analysed and a
paper co-authored by a member of the Research Section was accepted for publication in the Journal of Community Dentistry and Oral Epidemiology.
Assistance was given to the Division of Aid to the Handicapped in the design
and execution of a house-to-house survey of handicapping conditions in the New
Westminster area, and in the analysis of the results.
The division's statistical services to the Division of Tuberculosis Control were
maintained, including the preparation of tables for the annual report on tuberculosis.
Evaluation of an anti-smoking education program for elementary schoolchildren in the South Okanagan Health Unit was completed during the year. Data
from a sample of over 300 children indicated an increase in knowledge of the effects
of smoking in relation to lung function, and the increased resolve to avoid smoking
 PUBLIC HEALTH PROGRAMS G 51
in later years. Further progress was made in the evaluation of the community
asthma program initiated in the same health unit in 1976. Results to date confirm
the effectiveness of this program, particularly in the form of decreased absences
from school.
The division collaborated in a study of trichinosis among wild life in the
Kootenay area, and in the preparation of a paper on the results, which was accepted
for publication.
The Victoria research office also provided data processing services and statistical consultation to the Divisions of Epidemiology, Venereal Disease Control, Environmental Engineering, Public Health Inspection, the G. F. Strong Rehabilitation
Centre, and to several Health Unit Directors; and dealt with a wide variety of
ministerial and other inquiries for statistical data.
AID TO HANDICAPPED
This year has been one of re-evaluation for the Division of Aid to the Handicapped. One outcome has been a decision to introduce greater decentralization
in the division's program.
Thus, effective December 1, 1977, Regional Consultants and local Aid to
Handicapped Committees will make the final decision in terms of selection and
training of clients for their particular regions on a trial basis and full decentralization will follow on April 1, 1978, if the experiment works satisfactorily.
In the future, Aid to Handicapped hopes to localize programs further and to
develop community-based rehabilitation through the use of information obtained
from summer survey projects in every region. A pilot survey was carried out in
New Westminster this past summer.
FIELD OPERATIONS
The total number of local Aid to Handicapped Committees that have been
established throughout the Province by the division declined over the past year
from a peak number of 53 to a low of 39.
The Skeena area has been closed since August 1976 and Northern Interior
since July 1977. In Victoria, the Rehabilitation Counsellor resigned in March
1977 and a replacement has just been recently appointed.
On the brighter side, the vacant position at Trail serving both the East and
West Kootenays was filled in May. The Richmond area has been reopened to an
active status and Burnaby has been given more attention in 1977 by this division.
To enhance the effectiveness of field operations and the success of rehabilitation programs, Aid to Handicapped maintenance allowances were increased and
relocation allowances made available to those individuals required to move in
order to attend rehabilitation programs. Pre-referral interviews have been implemented by some field staff. At these sessions, the prospects of vocational rehabilitation are discussed with the client prior to a referral being made in writing. At
present, this is being done in Vancouver, Burnaby, New Westminster, Port Coquitlam, Mission, and Maple Ridge.
In New Westminster the division has worked closely with Ministry of Human
Resources, Public Health, and Mental Health personnel to establish the Howard
Chadwick Residence at the New Westminster YW/YMCA. The Howard Chadwick Residence has been licensed under the Boarding-home Program and is
authorized to allow 20 physically or mentally handicapped adults to partake in a
 G 52 MINISTRY OF HEALTH REPORT, 1977
social and life skills program. The intended result is to allow each individual to
gain sufficient skills or support to undertake independent living in a community.
The program is unique to the division in that clients may now be referred to the
Lower Mainland area from other parts of the Province for specialized programs.
The ongoing programs at the "Y" and individual counselling by special "Y" staff
have added to the rehabilitation alternatives available to the Aid to Handicapped
Committees and their clients.
Community Programs supported by the Division for Aid to Handicapped
include
(1) Canadian National Institute for the Blind—salary subsidy for two
Vocational and Employment Counsellors;
(2) Western Institute for the Deaf—financial support provided for operations in the Vancouver area;
(3) Vocational Orientation Program for patients at the Vancouver
General Hospital—extension for one year;
(4) Goodwill Enterprises for the Handicapped—salary subsidy for professional rehabilitation staff and fees for Aid to Handicapped clients
continued;
(5) Opportunity Rehabilitation Workshop—through new management,
has changed its function to primarily a vocational assessment centre
with financial support for professional staff and a fee for service
to cover the cost of daily operations continued;
(6) advances have been made to Community Colleges to assist with
the creation and running of community-based programs for the
disabled.
NEW WESTMINSTER SURVEY
During the months of June, July, and August the division conducted a survey
in the city of New Westminster to establish the health, education, and work needs
among individuals between the ages of 14-60.
The survey was funded by the Province of British Columbia Working in
Government Program. Expert assistance on research techniques and principles
was provided by the Division of Vital Statistics. Twenty summer students were
employed and supervised by two Aid to Handicapped Consultants.
Final results of the survey are not available at this time; however, over 10,000
questionnaires were completed and 1,493 of the individuals involved were identified
as having at least one disability.
For those people who requested follow up by an Aid to Handicapped Consultant, referrals were taken and interviews conducted. Vocational rehabilitation
is now in the planning or active stage in these instances.
It is hoped that the final results of the survey will allow the division to respond
more directly to the needs of New Westminster. Similar surveys in other communities are being planned for the future.
LABORATORY SERVICES
The Provincial Laboratories provide public health laboratory services for the
diagnosis, investigation, and control of communicable diseases and for amelioration
of the environment. These services include laboratory tests for bacteriology,
mycology, parasitology, virology, environmental microbiology, and related immunology, and serology, which are performed by physicians, hospitals, and agencies
at all three levels of government.
 PUBLIC HEALTH PROGRAMS G 53
The work load of the Division of Laboratories increased 4 per cent between
1976 and 1977. In Table 9 the numbers of tests performed in 1977 at the Main
Laboratories and the Branch Laboratories in Nelson and in Victoria are compared
with the corresponding numbers for 1976. Increases in work performed occurred
in examinations for intestinal parasites (5 per cent), miscellaneous bacteriology
(6 per cent), and water bacteriology (24 per cent). Decrease occurred in serology
(4 per cent).
During 1977, tests for the diagnosis of infections with Bbrdetella pertussis
and Streptococcus (Group A) by immunofluorescent techniques were added to the
procedures performed at the Provincial Laboratories.
BACTERIOLOGY
Corynebacterium Diphtherle
The number of laboratory-confirmed cases and carriers of diphtheria decreased from 83 in 1976 to 72 in 1977.
Hemophilus Influenza H. Parainfluenza
The number of patients with H. influenza; infection increased from 15 in 1976
to 32 in 1977.   H. parainfluenza; isolates increased from three in 1976 to 13 in
1977.
Neisseria Gonorrhcea
In 1977 the number of gonorrhoea cultures yielding N. gonorrhoea; was 4,000.
This was a decrease of 10 per cent compared with the number of cultures positive
in 1976.
In 1977, a total of 5,709 genital smears sent for microscopic examination
showed gonococci—an increase of 3 per cent compared with 1976, when 5,541
smears showed gonococci.
Neisseria Meningitidis
The number of isolates of N. meningitidis rose from 128 in 1976 to 168 in
1977. Of these 168 strains, 141 were from sputum and 27 from other sources
including blood, cerebrospinal fluid, and genito-urinary tract. The serogroups of
75 strains were A (3), B (8), C (12), X (5), Y (9), Z (11), 29E (19), and
135 (8).
Opportunistic Pathogens
The number of opportunistic pathogens identified increased more than 20 per
cent from 1,775 in 1976 to 2,239 in 1977. The three most common organisms were
Acinetobacter calcoaceticus, Escherichia coli, and Acinetobacter Iwoffi.
Anaerobic Bacteria
Of the 320 strains of anaerobes identified, the three most common were
Clostridium perfringens, Peptococcus asacchurolyticus, and Peptostreptococcus
an&robius.
Enteric Bacteria
The number of specimens submitted for culture for Salmonella, Shigella, and
enteropathogenic Escherchia coli (EEC) increased by 1 per cent. First isolates
from 798 persons included Salmonella (346), Shigella (170), and EEC (282).
The 346 Salmonella isolates belonged to 49 types. Included were 15 strains of
S. typhi. The most common Salmonellae from human sources were S. typhimurium
andS. typhimurium var. Copenhagen (112), S. enteritidis (51), 5'. heidelberg (18),
S. san diego (18), S. infantis (28), and S. muenchen (9).   S. inganda was isolated
 G 54 MINISTRY OF HEALTH REPORT, 1977
for the first time in Canada; S. coleypark and S. pensacola for the first time in British
Columbia. Non-human sources yielded 343 Salmonella isolates from chickens,
turkeys, cattle, cats, pigeons, horses, prawns, pigs, shrimp, sheep, gila, fish meal,
environmental swabs, and potato salad. Of the 23 types identified, the most common were S. typhimurium and S. typhimurium var. Copenhagen (89), S. infantis
(130), S. saint paul (13), S. newington (26), S. thompson (12), and S. agona (14),
and S. newport (29).
The 170 Shigella strains included Sh. sonnei (110), Sh. flexneri (56), Sh.
boydii (3), and Sh. dysenteric. The most common enterpathogenic Esch. coli
(EEC) were 026 (51), 0128 (50), 018 (26), 0126 (31), 0111 (28), 0127 (15),
and 055 (18).
Mycobacterium Tuberculosis
The number of specimens cultured for Mycobacterium tuberculosis decreased
by 4 per cent from 32,058 in 1976 to 30,834 in 1977, but the number of microscopic examinations increased by 11 per cent from 25,373 in 1976 to 28,066 in
1977. M. zulgai was isolated for the first time in British Columbia from a joint
aspirate.
Requests for antimicrobial drug susceptibility tests decreased from 1,010 in
1976 to 974 in 1977.
Bacterial Serology
Bacterial antibodies were demonstrated at Reference Laboratories in 31 serum
specimens: Neisseria gonorrhoea (21), Bordetella pertussis (5), Listeria monocytogenes (2), Brucella, Francisella, and Yersinia.
Serological tests for the diagnosis and control of febrile illnesses decreased by
5 per cent from 11,600 in 1976 to 11,000 in 1977.
Screening tests for syphilis decreased by 3 per cent from 180,000 in 1976 to
175,000 in 1977. The demand for the Microhaemagglutination-Treponema pallidum (MHA-TP) decreased 19 per cent from 6,800 in 1976 to 5,500 in 1977, and
the Fluorescent Treponemal Antibody-Absorption (FTA-ABS) test decreased 14
per cent from 6,700 in 1976 to 5,700 in 1977.
During 1977, exudates from 328 patients were examined by darkfield microscopy and by the Direct Fluorescent Antibody-Treponema pallidum (DFA-TP)
technique.   In 19 patients (6 per cent) the examinations were positive.
PARASITOLOGY
The number of specimens submitted for examination for parasites increased
by 19 per cent from 22,001 in 1976 to 26,225 in 1977. Parasites were found in
4,993 specimens, or 19 per cent of those examined.
Intestinal Parasites
The numbers of faeces specimens showing protozoal parasites in 1977 were
Usually considered pathogenic—Giardia lamblia (1,275) and Entamoeba
histolytica (166).
Generally considered nonpathogenic—Entamoeba coli (1,116), Endo-
limax nana (978), lodamoeba butschlii (149), Chilomastix mesnili
(69).
Pathogenicity uncertain—Entamoeba hartmanni (107), unidentified Entamoeba cysts (66), and damaged cysts (83).
The number of faeces specimens showing helminth eggs in 1977 were Trichuris
trichiura (872), hookworms (600), Clonorchis sinensis (394), Ascaris lumbri-
coides (217), Hymenolepis nana (93), Enterobium vermicularis (93), Tricho-
 PUBLIC HEALTH PROGRAMS G 55
strongylus spp. (23), Schistosoma mansoni (21), Diphyllobothrium latum (4),
Tania spp. (4), Metagonimus spp. (3), Schistosoma hcemotobium (3), Fasciola
hepatica (2).
Hookworm larvae (61) and larvae resembling Strongyloides stercoralis (55)
were also seen.
The following mature helminths were identified: Ascaris lumbricoides (36),
Enterobius vermicularis (6), proglottids of Tcenia saginata (5), and unidentified
(2), Diphyllobothrium latum (4), Strongyloides stercoralis (2).
The larva of Dermatobia hominis was obtained by skin biopsy of a man
returning from Guatemala.
The number of anal swabs examined for Enterobium vermicularis (pinworm)
was 1,150, which was similar to the number in 1976.
Six ectoparasites were identified: Phthirus pubis (1), ticks (3), and nits (2),
Dermacentor andersoni (2), and Ixodes pacificus.
Blood Parasites
The number of blood films examined for malaria parasites increased by 59 per
cent from 440 in 1976 to 701 in 1977.  The number of patients investigated rose
by more than 200 per cent from 177 in 1976 to 394 in 1977.
Serology
Parasite antibodies were demonstrated at the Institute of Parasitology (or
other reference laboratories) in 90 serum specimens: Helminth—Ascaris (2), visceral larva migrans (18), Trichinella (5), Filaria (14), Paragonimus, Schistosoma
(*14), Fasciola, Echinococcus (4); Protozoa—Entamoeba histolytica (9), Leish-
mania (2), Trypanosoma, Plasmodium, Toxoplasma (17).
Requests for recently introduced Indirect Hemagglutination (IHA) and
Indirect Fluorescent Antibody (IFA) tests for Toxoplasma increased from 467 in
1976 to 806 in 1977.
MYCOLOGY
Dermatophytes
The number of specimens yielding dermatophytes increased by 9 per cent
from 461 in 1976 to 509 in 1977.   The dermatophytes most frequently isolated
were Trichophyton rubrum, Trichophyton mentagrophytes, and Microsporum canis.
Systemic Fungi
Coccidioides immitis was isolated from lung biopsy of two patients.   Crypto-
coccus neoformans was grown from cerebrospinal fluid of one patient.
Fungal Serology
Fungus antibodies were demonstrated at reference laboratories in 24 serum
specimens: Histoplasma (18), Coccidioides (2), Cryptococcus (2), and Aspergillus (2).
ENVIRONMENTAL MICROBIOLOGY
The number of water samples examined by the coliform test increased by
22 per cent from 32,178 in 1976 to 39,366 in 1977. Of these samples, 3,480 were
also examined by the completed coliform test; an increase of 17 per cent from the
previous year (2,963 in 1976). There was an increase of 33 per cent in the number of 5/5 confirmed test results for drinking-water samples from 394 in 1976 to
524 in 1977.   The faecal coliform test was done on 9,716 samples (6,809 in 1976).
 G 56 MINISTRY OF HEALTH REPORT, 1977
This increase of 43 per cent was due in part to an 83-per-cent increase in the number of bathing-beach samples, submitted and examined by the faecal coliform test
(3,307 in 1977 compared with 1,805 in 1976). The Standard Plate Count was
done on 3,249 samples. This was an increase of 5 per cent from 3,108 in 1976.
The number of samples examined and reported for algae identification was one
(four in 1976).
In the spring of 1976 the Department of Lands, Forests, and Water Resources
and the Department of Health implemented a new water analysis service, namely,
Public Analyses, for the residents of this Province. This service is provided at a
subsidized cost of $5 for chemical and bacteriological analysis of private water
supplies, only to determine its suitability for domestic purposes. From May 1,
1976, to September 30, 1976, 211 samples were submitted to the Division of
Laboratories for the coliform test. During this same period in 1977, 256 samples
were submitted (a 21-per-cent increase), for a total number of 652 samples from
October 1, 1976, to September 30, 1977.
During this past year the new computerized laboratory/requisition report
form was introduced and is being used by only two health units of the Ministry of
Health, and by two branches of the Ministry of the Environment for results to be
entered into the computer system.
With the introduction of a Province-wide courier system for shipment of
samples to the laboratory, a marked reduction in transit time (compared with the
mail system) has been noted. This system has proved to be of benefit in the water
microbiology section in the shipping of large numbers of those samples requiring
refrigeration during transit.
VIROLOGY SERVICE
The 516 viruses isolated or identified serologically were influenza, parainfluenza, and respiratory syncytial viruses (121), adenoviruses (22), mumps and
measles viruses (33), rubella virus (12), enteroviruses (52), herpesvirus (251),
mycoplasma (15), cytomegalovirus (7), rotavirus (1), varicella-zoster (1),
LGV (1).
Influenza Viruses
The influenza season began in late January 1977, when Influenza A/Victoria
was isolated and seroconversions to influenza A were demonstrated. In March
the first Canadian isolate of the new strain of influenza A/Texas/77 was made from
a patient in Surrey. During the first week of August 1977 a group of Australian
soldiers arrived at Canadian Forces Base Esquimalt with symptoms of influenza.
There was a total of 91 primary cases (Australians) in an 18-day period. Among
Canadian Forces personnel there were 20 secondary and five tertiary cases. Influenza A/Texas/77 has been isolated from five of these soldiers, with an additional
98 showing antibodies to the A/Texas strain.
Rapid Diagnosis of Viral Infections
With the use of instruments such as the ultracentrifuge and the electron microscope the Virology Service can now diagnose many viral diseases in a matter of
minutes or hours where previously days or weeks may have been required. Virus
infections during pregnancy which are capable of causing congenital defects in the
developing foetus, e.g., rubella, cytomegalovirus, and herpes simplex are now diagnosed using these techniques.
 PUBLIC HEALTH PROGRAMS G 57
EVENTS IN 1977
Branch Laboratories
The Nelson Branch Laboratory was reopened on December 7, 1976, with
Mrs. Alvina Malone, technologist-in-charge, and service was provided to the Selkirk (No. 2), West Kootenay (No. 3), and East Kootenay (No. 1) Health Units
during 1977 with the help of a second technologist.
The Victoria Branch Laboratory at Royal Jubilee Hospital continued to provide on contract good service to the Capital Regional District.'
Visits
At the request of the Health Officers' Council, the Director and Associate
Director of the Laboratories continued their visits to health units in 1977 to discuss
with attending and laboratory physicians the services and role of the Public Health
Laboratories in the control of communicable disease.
ACTION B.C.
For Action B.C., 1977 has been the busiest year ever. It continued to promote and create opportunities for life-style change through increased physical
activity, sound nutrition, and positive living habits. With the mobile unit, the
small core team covered the Province from Vancouver to Fort St. John, the Queen
Charlottes to the Kootenays. The main areas of emphasis have remained schools,
industry, and the community.
During the year, with the help of Action B.C., nine school districts, namely,
Prince George, Dawson Creek, Abbotsford, Nanaimo, Langley, West Vancouver,
Revelstoke/Golden, and Coquitlam were involved in a daily physical education
program for their students and many staff. By the year's end several more districts
had expressed the intention to become involved in this movement toward the twin
emphasis of "a healthy mind and a healthy body." Combined with the activity
program, Action B.C. introduced (following the 1976 PNE Pilot Project) a computerized 24-hour nutritional evaluation which provides an analysis of the daily
intake of any individual's food. This proved immensely popular, both in schools
and the community, where over 15,000 printouts were processed. By 1978 a
seven-day analysis will be available for all those who want a more in-depth study
of their food habits. Throughout the Province some thousands of teachers and
parents were involved in learning and assisting with the fitness testing procedures
which took place in the schools. The materials, in-service training, and regular
help provided by Action B.C. to the schools ensures that the program has a long-
term effect. Many of the benefits are apparent in lessening of delinquency, lowering of absenteeism, and in all cases a general sense of well-being which increases
with a healthy, active environment.
Industry is an area which is gradually awakening to many of these benefits.
The realization that there is a decided advantage (both socially and economically)
to having a healthy staff was providing Action B.C. with an increasingly large number of requests from firms and agencies, both large and small.
Action B.C. provides on-site fitness testing, health hazard appraisals, nutrition analysis, and a counselling session. Employees are encouraged to go on
group or individual programs, and Action B.C. trains the leaders and provides a
retest after an appropriate time has elapsed.   Industry has shown they have other
 G 58 MINISTRY OF HEALTH REPORT, 1977
needs which Action B.C. can fulfil. These fall in the areas of stress reduction,
relaxation, and pre-retirement counselling. Aerobic dancing has also proved popular with the men and women of all ages.
In the community at large, the mobile unit proved invaluable in providing
services throughout the Province. Fitness Festivals, which give a wide public exposure to a variety of healthy life-styles, will continue to be a major focus in community work. Action B.C.s attendance at conferences in the roles of testers, meal
planners, and activity organizers is always popular.
In the Ministry of Health's display at the PNE during the year, 20,000 people
participated directly in the fitness testing, nutrition analysis, and children's obstacle
course.
The Action B.C. Perinatal Nutrition Program, which is operated from the
Burrard Health Unit in Vancouver, made a highly successful contribution to the
health of mothers and babies.
Health units continued to play an important part in helping Action B.C. make
contact with the communities and learn their specific problems.
In 1978, Action B.C. hopes to expand its teen-age smoking cessation program,
the seven-day nutrition printout, and add more school districts on daily physical
activity programs.
COUNCIL OF PRACTICAL NURSES
The British Columbia Council of Practical Nurses, under the authority of the
Practical Nurses Act, has completed 13 years of its mandate under this Act. The
10 members of the Council are appointed by Order of the Lieutenant-Governor in
Council on the basis of nominations by the
• Minister of Health (two members);
• College of Physicians and Surgeons of B.C. (one member);
• Registered Nurses' Association of B.C. (two members);
• Minister of Education (one member);
• British Columbia Health Association (one member);
• Licensed Practical Nurses' Association of B.C. (three members).
During council meetings over the years, 14,541 applications for licensure were
received; the disposition of these is given in Table 10. Consideration was given to
graduates of college and hospital programs in the Province and to a large number of
applicants from outside British Columbia and Canada. Of these, licences were
issued to 374 British Columbia graduates and to 244 applicants trained outside the
Province.
VOLUNTARY HEALTH AGENCIES
The Ministry of Health continued to give financial support to a wide range of
voluntary health agencies. The majority of these agencies provide service to persons suffering from chronic debilitating conditions who have special needs beyond
the scope of health services routinely available, and to certain disadvantaged socioeconomic groups in the population. Over $2.7 million in grants was awarded to
these agencies for the 1977/78 fiscal year.
 PUBLIC HEALTH PROGRAMS
G 59
Table 1—Reported Communicable Diseases, British Columbia, 1973-77
(Rate per 100,000 population)
Disease
Amcebiasis..
Brucellosis  —
Diarrhcea   of  the   newborn
(£. coli)  	
Diphtheria
Dysentery, type unspecified.
Food infection—
Salmonellosis—	
Unspecified.— -	
Food intoxication—
Staphylococcal	
Botulism  _	
Hepatitis—
Infectious  _	
Serum  —
Leprosy	
Meningitis—
Bacterial-
Viral	
Pertussis	
Poliomyelitis-
Rubella	
Rubeola	
Shigellosis	
Streptococcal  throat   infection and scarlet fever.—	
Tetanus  	
1973
Number
of
Cases
Trichinosis  _	
Tularaemia.- 	
Typhoid   and   paratyphoid
fever	
Totals-
29
51
34
320
36
25
1,755
25
1
47
20
102
1
77
158
212
836
Rate
3,734
1.3
2.2
1.5
13.9
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
1974
Number
of
Cases
Rate
1975
Number
of
Cases
Rate
1976
Number
of
Cases
52
69
91
302
7
1,381
11
43
12
66
342
573
203
789
161.3
3,951
0.1
2.2
2.9
3.8
12.6
0.3
0.1
57.7
0.5
1.8
0.5
2.8
"l4.3
23.9
8.5
32.9
0.3
165.0
1
1
49
22
97
456
33
962
10
1
33
16
49
476
1,149
184
739
0.1
0.1
2.0
0.9
3.9
18.6
1.3
39.2
0.4
0.1
1.3
0.7
2.0
19.4
46.8
7.5
30.1
|      0.3
4,286 I 174.4
52
11
93
321
3
745
12
47
11
77
69
181
120
698
2
2,450
Rate
0.1
2.1
0.5
3.8
13.2
0.1
30.7
0.5
1.9
0.5
3.2
~H
T-.4
4.9
28.7
0.1
0.3
100.8
1977
Number
of
Cases
1
2
57
7
70
307
884
15
40
14
45
1
78
310
101
539
1
2,482
Rate
0.1
0.1
2.3
0.3
2.8
12.3
0.1
35.4
0.6
1.6
0.6
1.8
0.1
3.1
12.4
4.0
21.6
0.1
0.4
99.4
Table 2—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946, 1951, 1956, 1961, 1966, and 1971-77
Year
Infectious Syphilis
Gonorrhoea
Number
Ratel
Number
Ratei
1946     - ..            _..     .
834
36
11
64
71
73
98
101
146
174
106
70
83.0
3.1
0.8
3.9
3.8
3.4
4.4
4.4
6.1
7.1
4.3
2.8
4,618
3,336
3,425
3,670
5,415
7,116
7,921
8,955
9,284
9,793
9,728
9,800
460.4
1951	
286.4
1956                 	
244.9
1961	
225.3
1966	
1971	
290.8
325.7
1972	
352.5
1973	
386.6
1974 ....	
1975	
387.6
398.6
19761 _	
19772  _   	
394.4
392.4
1 Rate per 100,000 population.       2 Preliminary.
 G 60 MINISTRY OF HEALTH REPORT, 1977
Table 3—Selected Activities of Provincial Public Health Nurses,
September 1,1976, to August 31,19771
A. Maternal and child health—
Expectant parent classes, series enrolment—
Mothers      9,773
Fathers       6,697
Total class attendance     48,043
Prenatals—number of home visits  4,825
Postnatals and new infants—number of home visits  22,574
Infants—
Number of visits to Child Health Conferences  57,978
Number of home visits  42,770
Pre-school—
Number of visits to Child Health Conferences  69,360
Number of home visits    27,337
Special assessments—infant and pre-school    22,530
School—
Screening tests  190,544
Follow up  24,033
Conferences with students  24,533
Conferences with staff  68,781
Home visits      30,762
B. Family, adult, and geriatric (excluding Home Care Program)—
Adult (ages 19-64 years)—number of visits  119,929
Adult (ages 65 and over)—number of visits  121,461
Geriatric clinic attendance    271
Family planning clinic attendance  752
Community care facilities—number of visits  5,794
Mental retardation—number of home visits  1,499
Mental health (preventive counselling)—number of home visits  5,345
Mental illness—number of home visits .  4,578
Family problems—number of home visits    7,951
C. Disease control—
Immunizations—number given    406,512
Tests (tuberculosis, diphtheria, and other)  26,781
Venereal disease—number of visits    6,896
Tuberculosis—number of visits    5,591
Infectious hepatitis—number of visits    1,755
Chronic disease—number of visits  12,812
D. Total-
Home visits by public health nurses  233,125
Professional services by telephone  257,422
i Statistics provided are for activities of Provincial public health nurses only and do not include activities
of public health nurses employed in Greater Vancouver, New Westminster, and Capital Regional District areas.
 PUBLIC HEALTH PROGRAMS
G 61
Table 4—Patients Admitted to Home Care Programs and Nursing Visits
Carried Out, 1976
Area or Program
Number of
Patients
Number of
Nursing Visits
9,859
5,381
429
11,128
12,907
184,562
79,782
6,027
201,865
124,177
Totals 	
39,704
596,413
Table 5—Number of Patients and Number of Nursing Visits, Home Care
Programs, 1972—76
Year
Number of
Patients
Increase
Number of
Nursing
Visits
Increase
Number
Per Cent
Number
Per Cent
1972	
13,711
18,925
24,153
34,621
39,704
38.6
27.6
43.3
14.7
218,038
274,978
342,813
496,198
596,413
56,940
67,835
153,385
100,215
1973      '■
1974	
1975	
1976	
5,214
5,228
10,468
5,083
26.1
24.7
44.7
202
 G 62 MINISTRY OF HEALTH REPORT,  1977
Table 6—Selected Activities of Provincial Public Health Inspection, 1973—77
Type of Inspection or Activity
1973
1974
1975
1976
1977
Inspection—
Food premises—
Eating and drinking places	
9,668
1,962
1,064
437
280
2,442
546
274
1,603
1,946
1,567
418
365
387
318
1,801
1,516
518
917
1,516
5,716
2,431
2,692
1,543
22,585
528
772
5,395
11,719
3,440
1,370
2,740
314
1,535
3,225
10,051
2,553
1,512
561
305
3,139
1,013
300
1,672
2,199
1,344
600
370
400
352
2,094
1,153
430
890
1,496
5,370
2,665
3,717
563
26,251
430
686
6,140
14,786
3,361
2,107
2,776
541
1,479
3,330
11,107
2,392
2,045
343
317
3,013
544
266
1,653
2,015
1,249
666
396
367
388
2,613
1,791
445
720
1,915
6,663
2,953
3,179
722
24,367
384
1,518
5,259
14,208
3,350
1,769
2,763
813
1,284
3,226
10,525
2,366
1,972
156
348
2,464
587
312
1,308
1,355
1,138
474
396
309
300
2,126
1,626
425
616
1,861
7,790
3,221
3,273
512
26,608
320
4,726
6,255
13,749
3,370
1,373
2,345
609
1,255
2,819
13,713
3,434
Other	
2,028
Factories	
117
278
2,437
Schools  _  	
Summer camps -
771
286
1,516
Mobile-home park.   _	
860
977
Other housing	
Hairdressing places -
Farms  	
504
628
253
505
Water and waste investigatior—
Swimming-pools—
Inspection	
2,770
2,307
544
597
PubUc water supplies—
2,343
10,050
Private water supplies—
Inspection	
3,350
3,616
742
34,797
232
Other sewage control	
Land use investigation—
Subdivisions.	
Site inspections —
Nuisance investigation—
4,579
7,119
12,650
3,468
1,755
Other (pest, etc.)	
3,258
827
1,583
3,145
i Includes boarding-homes, youth hostels, day care centres, hospitals, and other institutions.
 PUBLIC HEALTH PROGRAMS
G 63
Table 7—Registrations, Certificates, and Other Documents Processed by
Division of Vital Statistics, 1976 and 1977
Registrations accepted under Vital Statistics Act—
Birth registrations 	
Death registrations 	
Marriage registrations
Stillbirth registrations _
Adoption orders 	
Divorce orders 	
Delayed registrations of birth	
Registration of wills notices accepted under Wills Act
Total registrations accepted 	
Marriage certificates 	
Baptismal certificates 	
Change of name certificates
Divorce certificates 	
Photographic copies	
Wills notice certification 	
Total items issued
1976
36,806
19,137
22,080
372
1,794
9,036
289
40,877
Legitimations of birth effected under Vital Statistics Act	
Alterations of given name effected under Vital Statistics Act
Change of name applications granted under Change of
Name A ct	
Materials issued by the Central Office—
Birth certificates	
Death certificates	
298
275
2,054
89,120
9,527
10,141
7
2,095
319
12,007
12,663
Nonrevenue searches for Government ministries by the
Central Office     15,531
1977
36,930!
18,740!
20,990!
330
2,240!
7,980i
293
45,607
130,391        133,110
279
283
3,050i
95,243
9,866
10,887
21
3,131
331
12,608
12,334
135,879        144,421
Total revenue
-$539,472
14,905
$594,7501
i Preliminary.
 G 64 MINISTRY OF HEALTH REPORT, 1977
Table 8—Case Load of Division for Aid to Handicapped, 1977
Cases under assessment or receiving services, January 1, 1977  1,243
New cases—
Referred to Aid to Handicapped Committees in Vancouver
Metropolitan Region and North Fraser Region (11
committees)   527
Referred to Aid to Handicapped Committee outside Vancouver Metropolitan Region (37 committees)  481
Referred from other sources  	
Cases reopened (all regions)   214
Total new referrals considered for services (including reopened)   1,222
Total cases provided with service in 1977  2,465
Cases Closed During 1977
Rehabilitated—
Employment placement made by—
Canada Manpower     54
Aid to Handicapped       7
Self  160
Other   104
Total placed in employment      325
Job placements not feasible, restorative services completed      341
Not rehabilitated—
Severity of disability   120
Unable to locate clients  133
Other  360
Total not rehabilitated      613
Other reason—
No disability  2
No vocational handicap  14
Deceased  6
Total other reasons       22
Total cases closed in 1977  1,301
Cases remaining in assessment or receiving services, December 31, 1977  1,164
 PUBLIC HEALTH PROGRAMS G 65
Table 9—Tests Performed by Division of Laboratories, 1976 and 1977
Item
1976
Main
Nelson i
Victorias
1977
Main
Nelson    Victoria
Bacteriology Service
Enteric Section—
Cultures—
Salmonella/Shigella	
Enteropathogenic E. coli _
Food poisoning .—	
Miscellaneous Section—
Cultures—
C. diphtheria!	
Haemolytic Staph./Strep 	
Miscellaneous 	
Fungus.
IS1, gonorrhoea!..
Smears—N. gonorrhoea! 	
Immunofluorescence—TV. gonorrhoea!..
Animal virulence	
Tuberculosis Section—
Cultures—M. tuberculosis..
Smears—M. tuberculosis....
Sensitivity tests	
Atypical mycobacteria..
Animal inoculation	
Parasites—
Faxes 	
Pinworm swabs  _	
Malaria blood film  	
Water Microbiology Section—
Presumptive/Confirmed coliform test-
Completed coliform test 	
Faecal coliform test _	
Faecal streptococcal test	
Standard plate count  	
Other tests (algas, shellfish)	
Serology Section—
Syphilis—
Screening  	
Confirmatory..
ASTO	
Widal, Brucella, Heterophile antibody..
Immunofluorescence _	
Toxoplasmosis 	
Virology Service
Virus isolation—
Tissue culture	
Rubella _  	
Embryonated egg 	
Mouse  _	
Serological identification—
Haemagglutination inhibition—
Rubella  _ 	
Other viruses  	
Complement fixation  	
Neutralization 	
Electron microscopy _	
Totals  _ _.
Combined totals 	
,022
236
242
,938
,018
,158
,661
,201
,893
,526
178
,058
,373
,010
326
618
,001
,138
440
,178
:,963
>,809
8
,113
4
186
13
7
4
2.
,246
,890
,284
,398
266
467
3,531
243
1,271
325
51,707
4,553
7,866
3,796
184
167
157
2,174
29
2,212
304
4,785
1,333
34
3,025
129
12
8,320
1,782
1,894
1,575
2,907
4,170
891
414
4,3492
893
951
596,139 |      5,198i|    37,464
638,801
12,933
3,536
271
1,879
4,444
28,077
3,957
25,192
100,127
5,802
146
30,834
28,066
974
312
597
26,225
1,150
701
39,366
3,480
9,716
3,249
1
180,564
5,646
6,977
4,082
8,378
806
5,016
158
414
134
54,368
7,825
11,468
8,167
420
137
33
413
37
302
1,030
18
2,807
405
5,374
1,063
30
2,416
159
7
8,212
688
2,128
1,898
2
3,330
5,973
325
1,305
618
1,027
625,457 |      5,182 |    34,555
665,194
i Nelson Branch Laboratory was closed for two months.
2 Victoria Branch Laboratory transferred syphilis serology to Main Laboratory.
 G 66
MINISTRY OF HEALTH REPORT, 1977
Table 10—Licensing of Practical Nurses
(Disposition of applications received since inception of program in 1965 to December 6, 1977)
Received   14,541
Approved—
On the basis of formal training	
On the basis of experience only—
Full licence	
._ 8,799
Partial licence
396
876
1,272
Rejected  	
Deferred pending further training, etc.	
Deferred pending receipt of further information from applicants-
Awaiting assessment at December 6, 1977	
10,071
1,968
1,955
455
92
Number of licences issued to December 6, 1977
14,541
9,392
Number of practical nurses holding currently valid licences at December
6, 1977      6,580
Table 11—Number of Cases Referred for Hearing Assessment, by Source,
Division of Speech and Hearing, 1977
Referral Source
Item
Physician
Public Health
Nurse
Other l
Total
4,636
714
451
5,801
1 High-risk hearing register, public health clinics, etc.
Table 12—Number of Cases Referred for Hearing Assessment, by Type of
Evaluation, Division of Speech and Hearing, 1977
Type of Evaluation
Item
Initial
Assessment
Reassessment
Hearing-aid Evaluation
and Rehabilitative
Audiology
Other
Total
3,078
1,190
1,440
93
5,801
 PUBLIC HEALTH PROGRAMS
G 67
Table 13—Hearing-impaired Cases, by Degree and Type of Impairment,
Division of Speech and Hearing, 1977
Type of Impairment
Degree of Impairment
Total of
Mild
Moderate
Severe
Profound
Each Type
803
1,067
71
159                        4
1,050                   666
163          1          122
228
18
966
Sensorineural 	
3,011
374
1,941
1,372
792
246
4,351
Number of hearing-impaired   4,351
Number of normals assessed  _  1,450
Number assessed .  _   5,801
Table 14—Numbers of Community Care Facilities and Capacities, by Permit
Status for the Three Categories of Facility, 1975-77
A. ADULT CARE FACILITIES
Year
Interim Permit
Licences
Surrendered
Final Count
Facility
Capacity
Facility
Capacity
Facility
Capacity
Facility
Capacity
1975	
59
53
51
1,792
1,291
1,734
453
449
465
14,534
15,085
15,008
130
78
30
1,928
1,281
511
382
424
486
14,398
1976   	
15,095
1977   	
16,231
B. CHILD CARE FACILITIES
1975	
155
2,229
909
16,786
267
4,130
797
14,885
1976 	
192
2,694
929
16,869
308
4,034
813
15,529
1977	
235
3,063
1,005
17,866
75
900
1,165
20,029
C. CAMPS
1975_
1976_
1977-
59
5,395
75
5,942
16
819
118
54
4,814
83
6,868
6
129
131
58
4,905
82
6,979
1
50
139
10,518
11,553
11,834
  Mental Health Programs
On October 12, 1872, just 14 months after British Columbia's
entry into Confederation, Mental Health Programs had its beginnings
when the Royal Hospital in Victoria was designated as the Provincial
Asylum. The management of the institution was placed under the
jurisdiction of Mental Health Services in the Provincial Secretary's
Department, where it remained until 1959, at which time it was
transferred to the Department of Health and Welfare and became
known as the Mental Health Branch.
With the change in name to Mental Health Programs in 1975,
as part of the reorganization of the Department of Health, the branch
transferred the operation of the various mental health institutions to
the Division of Government Health Institutions, and became solely
responsible for the development of mental health services at the community level.
A review of the year's operations of the various community
services throughout the Province appears on the following pages:
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69
 G 70 MINISTRY OF HEALTH REPORT,  1977
MENTAL HEALTH  PROGRAMS HIGHLIGHTS
• There were over 11,000 admissions for service in the Province's 31 mental
health centres. The year-end case load was over 12,600 persons. While direct
treatment services consumed the bulk of staff time, many community services,
such as consultation and education, were also provided.
• Admissions to the Greater Vancouver Mental Health Service totalled over 2,300
and the year-end case load was over 2,600.
• A comprehensive computerized Management Information System, which incorporates Goal Attainment Scaling, was instituted in all mental health centres and
community care teams. This system will provide routine feedback regarding
case-load and work-load data, problems addressed, and attainment of therapy
goals. In addition, the system is designed to allow large-scale data collection
for research purposes.
• The implementation of a detailed planning process resulted in a definition of
10 basic mental health service programs. These 10 programs will be used in
planning for in-service education, budgeting, and local needs assessment.
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 on an appointment basis sees patients who
have been referred by the family doctor or the district public health or welfare
 MENTAL HEALTH PROGRAMS G 71
services. When necessary, after seeing the patient, the clinic may refer the patient
back to the family doctor, in some cases to school authorities, or on occasion may
recommend admission to a residential treatment facility. Treatment by the clinic
team is usually given in close co-operation with the family doctor, the health unit,
or other agency.
During 1977, emphasis was placed on making Community Mental Health
Programs as efficient as possible, both through internal streamlining and externally
through better co-ordination with various community agencies. Staff worked very
hard to attempt to meet community demand for services.
Regional reports of the community mental health centres follow:
VANCOUVER ISLAND REGION
The Vancouver Island Region was serviced by mental health teams located in
Courtenay, Powell River, Duncan, Nanaimo, Port Alberni, Victoria, and Saanich.
In addition, Integrated Services provides direct and indirect service primarily to
children located in the Capital Regional District (see page 79).
During the year the number of cases carried by teams in the Vancouver
Island Region totalled 2,342. The number of new cases opened in the region
was 2,151.
A large proportion of services provided by Vancouver Island centres related
to direct treatment, with the remaining time spent in consultation and indirect
services such as community education.
Outlying rural areas of the region continued to be serviced by travelling
clinics, the areas most notable being the extreme northern end of Vancouver
Island, including Port Hardy, and the Tofino-Ucluelet area, which was serviced by
the Port Alberni Mental Health Centre.
The Courtenay Centre, in conjunction with the North Island College, was
active in providing training to those people involved in mental health related
activities. A survey of community needs was initiated in the Campbell River area
with a view to addressing community problems.
The Port Alberni Centre continued its efforts to facilitate the establishment
of a small in-patient psychiatric unit to service the catchment area. Group treatment services to adolescents and adults continued to be a primary direct service
strategy.
The Nanaimo Mental Health Centre was embarking on a program emphasizing
services to pre-school-age children. This program was being operated on a team
basis in conjunction with other statutory and non-statutory agencies. Necessarily,
the centre increased the provision of direct service consultation.
The Duncan Mental Health Centre continued to provide a complete range of
direct services. The centre was especially active in the development of a Volunteers' Bureau to relate to the need of the mentally ill within the catchment area.
The participation of the centre in inter-agency Liaison Team Meetings continued
to be a significant service provided by the centre.
During the past year the Victoria Mental Health Centre obtained the services
of a psychiatrist who related significantly to the Eric Martin Institute, adding to
the flexibility of service delivery. The centre was active in the provision of field
work placement for a variety of professional disciplines, including the provision
of training in the area of art therapy. A growing relationship with the Canadian
Mental Health Association resulted in a significant growth in the psychiatric
boarding-home program.
 G 72 MINISTRY OF HEALTH REPORT, 1977
The Saanich Centre, as a result of pressing community need, emphasized the
provision of direct service in the area of crisis and transitional intervention. With
the very significant help provided by student nurses from the University of Victoria,
the centre completed a survey of abnormal parenting in the Capital Regional
District.  This report had significant implications in the planning of services.
At the year-end the Powell River Centre benefited from the addition of a part-
time psychiatrist to their area. This enabled the centre's psychiatrist to emphasize
community consultation and provide input related to mental health programming
needs.
LOWER MAINLAND REGION
The Lower Mainland Region comprised teams located at Sechelt, Squamish,
Abbotsford, New Westminster, Whalley, Surrey, Langley, Port Coquitlam, Maple
Ridge, and Chilliwack. On a regional basis a total of 3,644 patients actively
received services from mental health centre teams, effective the end of September
1977.   A total of 2,595 patients initiated services during the past year.
The Sechelt Centre emphasized direct treatment services in the primary area
of family and marital problems. The centre integrated well into the community it
serves, with significant programs achieved through its involvement with the Sechelt
Inter-Agency Committee.
The Squamish Centre, as in Sechelt, responded primarily to direct service
clinical needs. The local management team in the area served as a vehicle for the
facilitation of community mental health programming on a broad program basis.
At the year-end, a psychiatrist was retained by the centre to provide sessional
services.
The Chilliwack Mental Health Centre, as in many other areas, continued to
show an increase in the number of self-referrals accepted for treatment services.
A minimum waiting-period was regarded as a significant attribute to the service. A
Creative Centre, largely developed and supervised by the mental health centre,
provided a wide range of services to individuals experiencing emotional problems.
An expansion of the Boarding-home Program occurred in the Abbotsford
area as a full-time boarding-home social worker was added to the complement of
the centre.
Approximately 85 per cent of staff time at the Langley Centre was spent in
direct-treatment services. The remainder of the time was expended on community
involvement and education. A close relationship was maintained with Riverview
Hospital as the centre psychiatrist was shared with that facility. A regular program
of activities was provided by nursing staff to those patients experiencing more
chronic disorders.
The Maple Ridge Centre and its subofnce in Mission, served a population of
42,000. The increasing number of self-referrals bore witness to the growing community acceptance of the centre. A large boarding-home population of 240
patients in 12 boarding-homes necessitated the centre developing an effective
Independent Living Program, and a full range of occupational and recreational
services for residents of the program.
Increasing population growth in the Surrey area increased the need for the
Surrey Centre to provide training to lay and professional groups in the community.
This added to the capability of the community to deal with its own diversified
needs. Productive and co-operative relationships were developed with Surrey
Memorial Hospital, and Peace Arch Hospital, with instructional sessions on
psychiatric care to nursing staff.
 MENTAL HEALTH PROGRAMS G 73
The Port Coquitlam Centre continued its expansion of group programs,
ranging from assertiveness training to parenting procedures. The pressure of new
referrals necessitated this added service. The centre's teenage summer program
made a significant contribution to community demand of a service to adolescents.
The Whalley Mental Health Centre, through the services of its psychologist,
worked on the development of a screening battery for school-age children, with
the objective of preventing emotional disturbance in later life. A close liaison
with Riverview Hospital necessitated the development of an excellent chronic care
program, largely through the efforts of the nursing staff.
The New Westminster Centre developed a group therapy program for patients
receiving long-acting psychotropic medication. The opportunity for shared dialogue among people snaring a common experience resulted in an increased ability
to keep patients within their own community. The centre arranged a Caregiving
Workshop, which is available on request to professionals in the community. This
workshop provided a basic orientation to new staff in the community, with respect
to the basic principles of the helping process.
OKANAGAN-THOMPSON REGION
During 1977 the Consultant in Social Services continued to function as the
Acting Program Director for the Okanagan-Thompson Region.
Monthly administrative meetings were instituted throughout 1977 in order
to bring about a more comprehensive planning basis for the four mental health
centres within the region and more opportunity for the Directors to compare
operational notes on ideas with regard to program content and procedures.
This past year has seen a greater emphasis placed upon collaboration with
other ministries and non-Governmental agencies. To this end the Okanagan-
Thompson based mental health centres assisted in the sponsorship of an interministerial workshop on children's services in which 75 people from virtually every
relevant agency participated. The object of the exercise was to assess the region in
terms of its priorities in the delivery of services to children, and to identify areas
in which improvement is necessary in programs and planning required.
Over all, client referrals have increased by about 20 per cent during this past
year. Increased work loads have resulted in longer waiting-periods for services,
and a depletion in the indirect services offered to the communities concerned.
Of the 31 mental health centres serving the Province under the auspices of Mental
Health Programs, the Kamloops, Vernon, Kelowna, and Penticton Centres are
shown to fall within the top seven in terms of clients served per mental health
worker.
In the Kamloops Mental Health Centre, direct services encompassing treatment for individuals, children, couples, and families have chiefly characterized the
case load during the year. Travelling clinics are still being maintained on a monthly
visitation basis to the communities of Merritt and Ashcroft and on a "on request"
basis to Clinton, Lytton, and Lillooet. The total catchment area represents a
population of roughly 85,000 persons.
Highlights for the Kamloops Centre for 1977 include the development of a
contractual arrangement with community pharmacists to provide medication for
patients directly under the care of the centre, a very full continuing education
program for professional staff, and a very active summer student program serving
the interests of patients within the boarding-home system.
The Vernon Mental Health Centre staff continued to service the communities
of Vernon, Lumby, Armstrong, Enderby, Salmon Arm, Sicamous, and Revelstoke
 G 74 MINISTRY OF HEALTH REPORT, 1977
during 1977. This covered a catchment area population of about 75,000 people.
The mental health satellite project in Revelstoke (consisting of one resident mental
health nurse) has now been placed under the administrative control of the Vernon
Centre and is funded by the Community Care Services Society.
Individual, group, family, and marriage therapy with emphasis on reality-
oriented brief or crisis services typify the case load of the Vernon Centre over the
past year. In all, 744 new clients were admitted to these programs during this
period. Indirect services have involved consultation to schools, a wide span of
educational programs for both the professional and lay communities, as well as
supportive services offered to the multiple sclerosis group, the new Mental Patients
Association, and the Transition House for Separated Women.
Despite the full complement of professional staff, service demands, particularly
in the area of family and marital therapy, have been almost overwhelming for the
Kelowna Mental Health Centre in the last year. The waiting-period between date
of referral and initial therapeutic contact had exceeded four months by mid-year.
Opportunities for group marital therapy were developed in an attempt to cope
with patient referral overload but, regrettably, services to couples requesting individual marital therapy had to be all but eliminated during the process.
Highlights of the Kelowna Centre's program in 1977 included the hiring of
four well-qualified summer students. The additional services these students offered
included marital therapy, crisis intervention, and a host of recreational and social
activities for our chronically disabled clientele. Other highlights involved the
opening of a day hospital service within the community, increased professional
consultation to schools, the election of the occupational therapist as regional representative to the Program Advisory Committee, a very full and comprehensive continuing education program, and specialized consultation to the Cross-Roads
Centre, Elizabeth Fry Society, Family Life Committee, and the Friends of Rape
Victims.
Statistical reports reveal that as early as four years ago the Penticton Mental
Health Centre staff were experiencing the effects of overload and greater demands
of services from the region than the centre could possibly provide. This situation
remains unchanged up to December 1977, with the Penticton staff carrying the
heaviest patient load per professional within the Provincial mental health system.
Requests for marital and family therapy combine with a heavy chronic
mentally ill case load to characterize the types of clientele serviced chiefly by the
mental health centre.
Featured among the highlights of the centre's operation this year are the
founding of a day care support program, under the auspices of the Penticton
General Hospital, the development of a Morning Out for Moms Program in Summerland, and extension of recreational opportunities for the mentally and emotionally handicapped of Penticton and Summerland. The communities of Osoyoos,
Oliver, Keremeos, and Princeton have also been served on a regular basis by the
Penticton staff this year.
KOOTENAY REGION
Mental health centres in Cranbrook, Nelson, and Trail serve the Kootenay
Region. Travelling clinics provide services to the surrounding communities of
Golden, Fernie, Sparwood, Kimberley, Creston, Castlegar, Salmo, Nakusp, New
Denver, Riondel, and Rossland. In addition, a suboffice of the Trail Centre,
located in Grand Forks, provides services to that community and surrounding
area. The population of the entire Kootenay Region is in excess of 127,000.
 MENTAL HEALTH PROGRAMS G 75
The three centres in the Kootenay Region had a combined average case load
of over 1,100 clients each month. An average of 58 new cases were opened each
month, adding to a steadily increasing demand for direct intervention services.
While direct service to individuals and families continued to receive the major
portion of staff time, considerable primary prevention services have been provided.
The following are examples of such services:
At the Trail Centre, numerous school conferences, meetings with psychiatric
unit staff, case and educational discussions with probation officers, social service
personnel, physicians, school counsellors, ministers and volunteers, were held. A
consultative role is essential for a centre with a small staff since is adds to community service co-ordination and fosters the accessibility of mental health related
programs to all segments of the community.
In the area of community and professional education, centre staff provided
screening, orientation, and ongoing training of mental health volunteers.
In addition, both programs were provided with presentations, orientation,
and reference material dealing with the mental health programs and specific centre
services. A workshop was provided to Kinnaird Junior Secondary School teachers
on adolescence. Castlegar parent groups, Kiwanis, and Rotary Annes requested,
and were given, talks on the same topic. Three senior high school classes were
provided with basic information through lectures on mental health problems.
Parenting skills sessions were provided to a small group of single-parent mothers
having serious personality and child management problems. The centre initiated
and co-ordinated a community agency workshop focusing on interagency communication and the co-ordination of local services to children.
The Trail Centre stressed the need for increased assessment and treatment
services to children and families, the provision of adequate follow-up care to
chronically disabled adults, the provision of preventive educational-therapeutic
parenting and marital programs, the value of effective research, and evaluation of
services.
In Nelson, toward the year-end, there was considerable redirection of effort
toward community development and education. Close co-operation and liaison
were maintained with all social agencies such as Ministry of Human Resources,
Public Health, Correctional units, and schools in all three school districts served
by the centre.
A number of in-service education programs for groups in the community were
offered, together with nurse training programs, child care courses, and consultation
to various non-statutory agencies.
The Aid to Handicapped Committee was recommenced after being abandoned
for several years in the area and is most valuable in finding solutions for socially,
emotionally, and economically handicapped individuals.
The centre effectively supported a number of resources and community
development committees such as the Justice Development Committee, ACCESS,
Community Resources Board, and the Childhood Treatment Program. The crowning achievement of the year was the opening of ACCESS (Alcohol Treatment
Centre), sponsored by the Drug and Alcohol Commission.
A short-stay residential home is projected for the near future.
Much effort was spent toward developing a meaningful chronic care program
for the catchment area. At year-end a public health nurse was assigned to some
aspects of chronic care, and the boarding-home worker was able to turn her
attention toward that goal.
The centre provided training at various levels for social service and nursing
students, in addition to a summer student program involved in assisting the Kootenay Society for The Handicapped Workshop, and Willowhaven private hospital,
 G 76 MINISTRY OF HEALTH REPORT, 1977
for a variety of special cases. The Youth Activity Centre, originally initiated by
the mental health centre, continued to function with minimal support.
More effort was extended this year in indirect community programs at the
Cranbrook Mental Health Centre. The nurse and social worker taught parenting
skills with the aid of the STEP group program. It was planned to continue this
course on a permanent basis three times a year, revolving group leadership among
each staff. The social worker committed himself to teaching several segments of
a family life course at the local college.
The psychologist became extensively involved in family month this year and
headed a committee to advertise and develop programs, as well as appearing several
times on a local open-line radio show and local television station. Staff participated in other local community education events such as a local woman's
conference and a school sex education program.
NORTHERN BRITISH COLUMBIA REGION
The Northern Mental Health Region includes mental health centres in Williams Lake, Prince George, Fort St. John, Terrace, and Prince Rupert. In addition,
a satellite mental health unit is located in Kitimat which is administered by the
Terrace Mental Health Centre. The various mental health teams also travelled to
Ocean Falls, Bella Coola, Bella Bella, Quesnel, the Queen Charlotte Islands,
Netlahatla, Kitkatla, Port Edwards, Fort Simpson, Hartley Bay, Hazelton, 100
Mile House, Dawson Creek, and Fort Nelson on a regular basis. Due to time and
resource restrictions the various travelling clinics were only able to deal with the
most serious problems and mostly aimed at assisting various community groups
and agencies in identifying their needs, in achieving priority for these needs, and
to seek solutions based on the efforts and strengths of the community itself. As the
year ended, plans were being consolidated to place full-time additional personnel
in Dawson Creek, Quesnel, Smithers, Burns Lake-Vanderhoof area, and the Queen
Charlotte Islands. The services of the various mental health centres relate to a
variety of services provided under the 10 mental health programs. These include
an assessment and diagnostic program, a community education program, a community support program, a consultation program, a counselling program, a group
therapy program, an individual therapy program, a rehabilitation program, a research and evaluation program, and a residential program.
Due to the combined efforts of the mental health centres' staff and the B.C.
Division of the Canadian Mental Health Association, active community participation took place through a variety of volunteer programs, especially in Williams
Lake, Fort St. John, and Terrace.
During the past year a comprehensive evaluation of local mental health needs
and required services were evaluated for the communities in which mental health
centres are located. The information will be used to improve co-ordination of
services, and in future budgeting for mental health needs in the region. Other
changes include a revised statistical and accountability system which was initiated
in the last part of this year. New services provided by mental health personnel
include a crisis and counselling program in Williams Lake, various community
education and support programs such as workshops for foster parents, parent
effectiveness courses, and teacher effectiveness training. A co-operative venture
between a local newspaper in Prince George and representatives of various agencies,
including mental health, was a weekly column on various aspects of social and
health services.
 MENTAL HEALTH PROGRAMS
G 77
GREATER VANCOUVER MENTAL HEALTH SERVICE
The Greater Vancouver Mental Health Service (GVHMS) completed its fifth
year of operation in the summer of 1977 and is an integral part of the mental
health delivery system for the area. The service is responsible for the operation of
eight community care teams providing direct patient care in the community to a
current case load of approximately 2,800 patients. Additionally, the Greater
Vancouver Mental Health Service operates the following support facilities: Venture,
a 10-bed short-stay crisis residence and a four-bed half-way house for men; Vista,
an 11-bed half-way house for women; Blenheim House, a treatment program for
disturbed pre-school children and their families; and Se-Cure, a program for
agoraphobia. The GVMHS is participating in the development of sheltered workshops in order to provide additional support systems for patients living in the
community.
The primary mandate of the GVMHS is to provide direct treatment services to
the seriously mentally ill person in the community, and to provide service to
disturbed families and children within available resources. The effectiveness of the
service has been validated through a series of evaluative studies conducted by the
Research Department. A Management Information System has been developed
to provide information on case management and program implementation. Time
spent in various key clinical activities is constantly monitored. Case loads, work
loads, and cost data are printed out. Cost efficiency is reported and the amount of
services received by each patient is listed. This Management Information System
provides additional evaluative and planning data. The GVMHS has a Clinical
Records Department which is responsible for the maintenance of a high standard
of comprehensive, accurate, and up-to-date confidential clinical records of client
care. These systems help to maintain a high performance standard for each team
and facility.
Each community care team is working to capacity with an average patient load
of 250-350. An essential part of the program is to act as a broker on behalf of
the patient. This makes it vital to establish and maintain good working relationships with other agencies in the community, especially public health, Human
Resources, Department of Manpower, local hospitals, and police. The teams use
the community resources and programs in their area as a vital component of the
treatment planning. Through the clinical expertise of the teams' multi-disciplinary
staff, the GVMHS is able to provide a high standard of community psychiatric
care. Programs are being developed which will enhance a delivery system of
community mental health which is unequalled in Canada.
BURNABY MENTAL HEALTH  SERVICES
Burnaby Mental Health Services continues to be British Columbia's only
regionalized, decentralized, integrated, and comprehensive program of psychiatric
services for adults, families, and children who are resident in this community.
In-patient unit—The 25-bed acute psychiatric in-patient unit treated large
numbers of seriously disturbed patients, usually with brief hospitalization and
without loss of ties with family, friends, and community. Although the unit is
small, rapid intensive treatment maintained a high turn-over allowing service to a
larger population than might otherwise be expected with the limited number of beds.
 G 78 MINISTRY OF HEALTH REPORT, 1977
We are grateful for the kind assistance and co-operation of Riverview Hospital
Intensive Care Unit, and Vancouver General Hospital Emergency Department for
the occasional care of dangerous unmanageable patients.
Adult Day Programs—Burnaby continued to offer two distinct Adult Day
Programs—an intensive five-day-per-week milieu program designed to produce
major behavioural change and a part-time more gradual re-educative and socially
rehabilitative program. New ventures this year included a gardening group on a
plot rented from the Ministry of Agriculture, which proved very beneficial to a
group of shy, withdrawn patients, and formal "courses" for patients in cooking,
nutrition, and social skills.
The One-day Workshop for Psychiatric Day Programs in British Columbia,
begun by the unit last year, has now become an annual event, and this year many
of the staff attended a successful second meeting in February at the Eric Martin
Institute, Victoria.
Adult Out-patient Programs—The three geographic Adult Out-patient Programs have continued to consolidate their position in the community, treating the
acutely disturbed, as well as participating in the rehabilitation of the chronically
mentally ill.  This year the accommodation of the south team was improved.
The Burnaby Department of Human Resources has reorganized its services on
a regionalized, decentralized plan, similar to the one which Burnaby Mental Health
Services has been following for several years. Accordingly, revisions were being
made to team boundaries to reduce confusion and improve co-operation with this
important human service.
Children's Out-patient Services—The Children's Out-patient Services struggled bravely with enormous community demand and a shortage of trained personnel, which was somewhat alleviated late in the year by recruitment of a
psychologist, a social worker, a nurse, and a co-ordinator for the pre-school,
largely to replace previously vacant positions. A week-end of camping for the
pre-school children and their families provided an additional therapeutic resource,
and the popular summer program for children was offered again this year with the
assistance of summer students.
Burnaby Mental Health Services continued to consult with community groups
and organizations, including Burnaby physicians, Canadian Mental Health Association, Burnaby Health Department, Burnaby General Hospital, Burnaby Pre-
Schools, Dogwood Lodge, Burnaby Achievement Centre, Parents in Crisis, etc.
Many of the staff members have been asked to serve on advisory boards for community organizations, which was a gratifying recognition of the skills and service
they provided the community.
Educational placements for students continued to be offered in registered
and psychiatric nursing, psychology, social work, and occupational therapy, and
to physicians serving a rotating internship.
The regular monthly in-service program of education was augmented this
year by the June Provincial Community Mental Health Programs meeting, by a
workshop on goal attainment scaling and new statistical procedures, and by attendance of many of the staff at sessions of the World Federation for Mental Health
Congress in August at UBC. This last opportunity was made available through
the generosity of the Provincial Ministry of Health and its support of this conference. In addition, a number of staff have had their competence recognized by
being asked to provide workshops and teaching sessions, both locally and in various
parts of the Province. Staff were also active in independent attendance at professional workshops, seminars, and courses to improve their knowledge and skills.
 MENTAL HEALTH PROGRAMS G 79
INTEGRATED SERVICES FOR CHILD AND
FAMILY DEVELOPMENT, VICTORIA
During the year, Integrated Services expanded its emphasis on treatment
services to children with the development of four basic teams, providing service
in the areas of Early Child Development, Community Support Programs, Assessment and Consultation, and School Age Treatment Programs.
The training of professionals in fields related to mental health continued to
be a significant service provided by Integrated Services.
Integrated Services received 488 referrals during 1977, of which 391 cases
were accepted. Referrals came from general practitioners, medical specialists,
Human Resources, school districts, parents, probation, and police, and public health
and mental health centres.    Open cases as of December 1977 numbered 250.
Cases carried by the Early Child Development Team were treated in two
four-week programs and one six-week program. A total of 15 pre-school children
with behavioural problems attended daily therapeutic programs.
In conjunction with School District No. 61, two demonstration project workshops were conducted for teacher-counsellors. These workshops aimed at developing skills in identification and remediation of learning problems. Teacher-counsellors received eight half-day sessions, during which they were given on-the-spot
demonstrations and training. A total of eight teacher-counsellors participated,
along with eight children selected for demonstrable problems needing remediation.
In collaboration with the Ministry of Health's Education and Information
Division, a series of half-hour tapes was produced on parent effectiveness techniques. These were designed to model new skills for parents while fostering
discussion of problems. The tapes are used in training groups for parents and
can also be duplicated by other agencies.
A survey of service needs for children in the Capital Regional District was
conducted, partly as a service to all agencies and partly for internal planning. This
survey focused on deficits within the spread of services, and specified populations
of clients being seen by most of the child-oriented agencies around Victoria.
Integrated Services has constantly been required to supply speakers and
workshop leaders for a wide variety of community groups.
BRITISH COLUMBIA YOUTH  DEVELOPMENT CENTRE,
THE MAPLES
RESIDENTIAL AND DAY CENTRE PROGRAMS
The adolescent Residential and Day Centre Programs are located in Burnaby.
They continued to provide a variety of services which include comprehensive
consultation, assessment and treatment of psychological, social, and learning
problems in adolescents. There are three self-contained residential cottages which
provide living accommodations in separate wings for boys and girls who require
intensive treatment on a round-the-clock basis. Treatment in the cottage is carried
out in a warm, homelike atmosphere by a team of child care counsellors who are
under the direction of a senior child care counsellor and are supported by psychiatric and social work staff.   The Day Centre Program provides treatment for
 G 80 MINISTRY OF HEALTH REPORT, 1977
adolescents who require support and counselling, yet are able to live either at
home or in other suitable community facilities. They attend the centre on a daily
basis. In addition, the centre serves as a transitional stage of treatment for some
adolescents in the move from cottage to community. It also provides extended,
intensive assessment for some adolescents prior to admission to the cottages. The
day centre treats adolescents who require less structure in their daily life and can
assume more responsibility than those in residence.
While in treatment the adolescents live in a milieu which promotes interpersonal relationships, personal growth, life skills, and responsibilities. Staff serve as
healthy role models by encouraging age-appropriate activities such as school,
athletics, recreation, and arts and crafts. Problem areas are worked on in individual, group, and family therapy.
All adolescents in the residential cottages and day centre attend school on
the grounds on a regular basis. Most of the adolescents in care have experienced
difficulty in the regular school system because of behavioural, emotional, or learning problems. They suffer primarily from a lack of basic educational skills. In
our school there are special programs for adolescents having difficulty with reading, writing, mathematics, as well as other basic skills. The adolescents are given
a comprehensive educational assessment and are then placed in individual programs that allow them to progress at their own rate. Educational staff work closely
with cottage and day centre staff to ensure that therapeutic and educational goals
are co-ordinated and complement one another. When indicated, some adolescents
attend classes in nearby community schools. A major goal is to equip adolescents
with the skills necessary to re-enter the regular school system, to attend vocational
training courses, or to achieve job placement.
A variety of age-appropriate activities and programs are provided for the
adolescents in care. These programs are designed to enhance a sense of accomplishment, self-worth, and independence. A gymnasium, swimming-pool, and arts
and crafts centre are located on the grounds. Regular activities in these areas are
provided for the adolescents by child care and residential staff. Special individualized programs such as art and dance therapy, drama, gymnastics, and swimming
are designed to improve motor and expressive skills. Socialization is an important
goal in the activity's program. Camping, ski-ing, movies, social events, and regular
outings promote and develop social skills by bringing the adolescents into contact
with the community.
Residential and Day Centre Programs ensure high standards of clinical
practice by providing an ongoing, in-service training program leading to a diploma
in child care. The planning and implementation of this program is under the
direction of a training co-ordinator who works with the unit psychiatrists, social
workers, psychologists, and child care counsellors in developing a curriculum
which stresses an integrated approach to the treatment of adolescents. The in-
service training program aims at skill development in child care and includes the
following: Milieu, family, individual, and group therapy; interpersonal and group
dynamics; assessment, supervision, cottage management, and administration; and
personality growth and development. The unit is also affiliated with The University
of British Columbia and provides field training to students from the University of
Victoria and Douglas College. Field placement training is provided to psychiatric
residents and students in social work, child care counselling, nursing, psychology,
education, and recreational therapy.
Private physicians, psychiatrists, school counsellors, social workers, probation
officers, and those working in mental health centres refer their clients to the
Residential and Day Centre Programs.   Once received, the referrals are assigned
 MENTAL HEALTH PROGRAMS G 81
to an interdisciplinary team for assessment and diagnostic recommendation. With
the exception of seasonal lulls and staffing shortages, intake and admissions have
remained steady. We continued to concentrate on treating the more seriously
disturbed adolescent and his or her family.
During the fiscal year from April 1, 1976, to March 31, 1977, the Residential
and Day Centre Programs of the B.C. Youth Development Centre received 161
referrals. Of these referrals, 140 assessments were completed. At the beginning
of the fiscal year there were 34 adolescents in residence and nine adolescents in
the Day Centre Program. During the fiscal year, 54 admissions were effected
to the residence. Twenty-four admissions were effected to the day centre for a
total of 78 admissions to the two programs during the year. In all, during the
fiscal year, 88 adolescents were in receipt of residential treatment and 33 adolescents were in receipt of treatment in the Day Centre Program. In all, 83 adolescents were assessed but not admitted to either the Residential or Day Centre
Programs for the following reasons:
(1) Inappropriate for either program.
(2) Withdrawn at the request of the referring agency.
(3) Refusal by client and/or their families.
In addition to those in the Residential or Day Centre Programs, 55 adolescents
were receiving after-care services.
PSYCHOLOGICAL EDUCATION CLINIC
The Psychological Education Clinic provides a specialized therapeutic environment to assist children who are finding it impossible to cope in the school
system. Problems that these children present are a combination of severe learning
disorders and emotional difficulties. There are facilities for 50 children between
the ages of 6 and 13. This past year a total of 63 children attended the program.
All of these children have pronounced problems in their school, community, and/or
home setting. Following an intake procedure which includes a school visit and
home visit, the children who are accepted are placed according to chronological
age in small groupings on a ratio of five children to one teacher. Their academic
program is individually adjusted based on a success-oriented approach using
positive reinforcement. The cognitive and emotional needs of the child are
continually monitored and altered according to the current functioning level. In
addition to the essential school subjects and the social interaction milieu of the
program we include a series of camping experiences. The usual length of time
for these outings is four days and either consist of an individual class or the whole
school together.    Much is learned and modified through this intensive contact.
Children stay in the school program for varying lengths of time ranging from
a few months to several years. The Clinic is designated a relatively short-term-stay
facility and over the years the length of stay has ranged from between 10 to 17
months. The over-all average length of stay in the school is just under 13 months.
Following the return to community school contact is maintained for several months
and a follow-up questionnaire sent out to determine the maintenance of behaviour
and academic progress.
An important component of the school program is the requirement that all
parents agree to participate in a treatment or counselling relationship. The family
work is the responsibility of the psychological staff that is employed. Occasionally
when medication is considered desirable, the psychiatric staff of the adjacent
 G 82 MINISTRY OF HEALTH REPORT, 1977
Burnaby Mental Health Children's Team provides aid. This past year has seen
single-family units, in addition to bringing several families together in a group,
to discuss child management techniques, among other things. This format will be
continued in the future.
In response to a request from the Ministry of Education, a one-month training
program was offered for teachers who are already in the field, but are not sure
how to work effectively with the emotionally disturbed and learning disabled child
in their classroom. A one-month intensive session for four teachers at a time was
provided, consisting of both didactic and experiential presentations. This session
can be followed up with a workshop in the teacher's local area by one of the staff
travelling there to assist them in consolidating their new knowledge.
BOARDING-HOME PROGRAM
The year 1977 was extremely active in the Mental Health Boarding-home
Program in respect of future planning. This was an outcome of the announcement
by the Government of the provision of a Long-term Care Program in the Ministry
of Health, effective January 1, 1978. This new program is a major step forward
in the provision of residential and home health care, making such care available
to all residents of British Columbia at an equal, minimum-user charge. Much of
the Boarding-home Co-ordinator's time throughout the year was devoted to
planning for the place of the Mental Health Boarding-home Program in Long-
term Care, as well as to serve on committees researching and working to devise
structures for the implementation of the Long-term Care Program, and to serve as
a mental health liaison person to the Provincial Adult Care Facilities Licensing
Board.
A decision was reached that the Mental Health Boarding-home Program is a
specialized part of the Long-term Care Program, but will continue to be administered by Mental Health Programs, co-ordinating and co-operating with the
Long-term Care Program at the community level.
Another decision reached was that the Ministry of Human Resources would
continue to assume responsibility for the funding of the mental retardation residential program, rather than place this funding under Long-term Care, and that the
Ministry of Human Resources would gradually assume program and supervisory
responsibility for the mental retardation portion of the Mental Health Boarding-
home Program.   Planning for this changeover began late in the year.
Statistics made available during the year demonstrated that the continued
development of the Boarding-home Program, and particularly the development of
half-way house resources, has reduced the usage, by individual patients, of expensive psychiatric beds in local general hospitals. This reduction of usage has been
quite startling. For example, one woman had 403 days of hospitalization in a
two-year period prior to boarding-home placement, and only one-day hospitalization in a three-year period following placement. The Boarding-home Program is
having as significant an impact on the rate of recidivism to hospital of persons
referred to the program directly from the community as it had previously on the
rate of recidivism of persons referred from the mental health institutions.
There was 492 placements made to the program during the year, and the case
load at the end of the year was 2,083, as compared to 1,978 at the end of 1976.
In all, 187 persons were discharged from the program to more independent living
situations.    Only 88 persons required rehospitalization in a psychiatric unit of a
 MENTAL HEALTH PROGRAMS G 83
general hospital or a mental health institution, and such rehospitalization was
mainly of very short duration. Turnover in the case load continued to increase
significantly, related to the development of more sophisticated treatment techniques, and to the use of the program for a younger age-group of persons referred
directly from the community as a prevention of the development of chronicity.
Such persons can be helped to regain their confidence by a fairly short period of
stay in a resource offering an appropriate program.
During the reporting year a committee, composed of Boarding-home Program
personnel, was formed to write standards which would be applicable throughout
the Province for the Occupational Therapy Program of the Boarding-home Program.  The committee presented its report to administration in December.
Occupational therapists and activity workers, assisted by volunteers, students,
and LIP workers, continued to provide activity programs for boarding-home residents. These programs are designed with specific aims in mind for each resident,
and with the over-all goal of integration of the resident into those community
activities which are established for the general population. Residents participate
on a voluntary basis. Community volunteer groups and individuals provided a
valuable contribution to this element of the Boarding-home Program.
The approximate distribution of placements made and case load of the
Boarding-home Program in 1977 were as follows:
Placements Made, Case Load,
1977 December 31,1977
Region 1 (Kootenays)  18 118
Region 2 (Okanagan-Thompson)   168 724
Region 3 (Fraser Valley)   185 856
Region 4 (Skeena)  21 21
Region 5 (Greater Vancouver)1   18 81
Region 6 (Cariboo-Peace River)  14 17
Region 7 (Georgia Strait)   37 170
Region 8 (South Vancouver Island)___ 31 96
492 2,083
i Burnaby  and North Vancouver were the  only municipalities  of the  Greater  Vancouver  area  where
placements were made through the Mental Health Boarding-home Program.
CONSULTANTS
Staff consists of consultants embracing the various mental health disciplines.
Their varied responsibilities include the provision of consulting services to the
field staffs; conducting studies regarding the Province's need in terms of facilities,
programs, and treatment services; maintaining liaison with other Governmental,
community, and nonprofit agencies; co-ordinating the recruitment of professional
personnel; the provision of continuing educational seminars and workshops; and
involvement in research projects.
A brief report of the work undertaken by each of the disciplines during the
year follows:
NURSING CONSULTATION
The 1977 calendar year opened with the relocation of the Consultant in
Nursing's office from Victoria to the Burnaby Psychiatric Services complex. The
purpose of the move was to improve the efficiency and effectiveness of available
 G 84 MINISTRY OF HEALTH REPORT, 1977
time for nursing consultation services. An added incentive was to improve the
accessibility of the Nursing Consultant to the majority of nurses in mental health
and related agencies.
The year was filled with a wide range of diverse activities designed to fulfil
the Consultant's responsibilities and achieve the goals of mental health nursing
consultation. Althought many were of a maintenance nature, others broke new
paths, provided new information, and occasionally suggested more effective ways
than formerly of bringing services to people.
In this regard, it was a distinct contribution to mental health service delivery
to complete the Revelstoke Mental Health Project which developed an innovative
mental health nursing service to patients/clients of the Queen Victoria Hospital,
the Revelstoke physicians, and the community's support services. The report of
the project should provide useful guidelines for other communities in the Province.
A second project also provided information useful to community mental
health services. This was a study of the Role and Functions of the Community
Psychiatric Nurse Position in Mental Health Centres which focused on changes
in the use and expectations of the nurse in this position.
A third nursing study was still under way at year-end. It sought to determine
the need for psychiatrically trained nurses in the Province and the obstacles to the
fulfilment of that need.
Activities during the year were not only focused on the nurse in mental
health/psychiatric nursing practice and the services provided by the nurses. There
was an increasing awareness of the need to focus on competence. In this regard
both nursing associations continued to work with increasing intensity on their
respective projects. The Consultant in Nursing was privileged to participate in
two such projects as they applied to the mental health field. The Psychiatric
Nurses' Association of Canada completed its first draft of a Statement of Standards
of Practice for the Registered Psychiatric Nurse, and the Consultant, as a member
representing employers on the British Columbia component of the Standards
Committee, was privileged to participate in a national meeting which developed
guidelines for testing the validity of the standards. In a similar vein, the Registered Nurses' Association of British Columbia moved vigorously into an awareness
phase of a Quality Assurance Program for Nursing Practice and conducted two
workshops, for 70 mental health and community psychiatric nurses on structure,
process, and outcome standards for nursing practice in this specialty.
Much of the Consultant's time was allocated to over 20 committees with a
prime goal of ensuring that a broad, professional mental health nursing viewpoint
was made available for the operation of Government directed and/or financed
mental health services. One event emanating from committee work was the
presentation of a panel of experts on The Implementation of the Mental Health
Act in the Variety of Psychiatric Services in the Province. The viewpoints expressed
by users of the Act from many parts of the Province highlighted the need for
changes in the light of the development of a diversity of services since the Act was
promulgated.
Psychiatric nursing education programs underwent marked changes in administration and in curriculum organization at both the B.C. Institute of Technology
and at Douglas College. The Consultant's involvement with both programs encompassed a great deal more than advisory committee responsibilities, as requests
were met for input into studies, lectures, planning, and evaluation at both educational institutions. It was satisfying and noteworthy that interest in and applications
for entrance into both programs exceeded the spaces available for a historically
first time.
 MENTAL HEALTH PROGRAMS G 85
Mental health nursing consultation services were provided informally and
formally to general hospitals requesting such. A telephone exchange of opinion
and information was marginally fruitful. Visits were made to the psychiatric
services of five hospitals. The purposes, generally, were to gather data, examine
resources, and facilitate problem-solving in the areas of administration, education,
personnel, and clinical programs. Reports were provided to the administrations
concerned and follow-up discussions were held when requested.
Other activities included the provision of critiques for a wide variety of
proposals and papers submitted by ministries other than Health and Education,
institutions, agencies, and individuals. All of these enabled the Consultant to
further her own knowledge and to stretch her own resources of knowledge and
experience. It was therefore very satisfying to have the opportunity to visit two
segments of the community mental health services in Manitoba, at Selkirk and
Brandon, as an experience that replenished and enriched the Consultant's perspective on community mental health care.
SOCIAL WORK CONSULTATION
During 1977 the Consultant in Social Services continued to carry the additional
responsibilities of Co-ordinator of Continuing Education for Mental Health Programs and that of Acting Program Director for the Okanagan-Thompson Region.
Throughout this past year, consultation and direction were provided to
numerous mental health centres throughout the Province on matters of clinical
significance and the over-all delivery of services to the mentally ill. This exercise
has been an important aspect of the Consultant's role since social workers represent
the largest single professional group engaged in the delivery of mental health
services within the Province of British Columbia.
The Consultant continued to work with the Series Review Committee in its
objectives to have the entire social work classification system revised in accordance
with new developments within the field, and to have position titles altered to reflect
more precisely the professional activity of social workers within the mental health
system. To this end the Series Review Committee has been co-ordinating its efforts
with the Classification Division of the Government Employee Relations Bureau,
and the personnel officers in both Mental Health Programs and Government health
institutions with a view to the development of a more workable classification scheme.
At year's end the Series Review Committee had completed its work of writing new
job descriptions in accordance with the structure of the new classification series.
The Committee on Social Work Education completed its task of establishing
linkage with the two B.C. Schools of Social Work which provide clinical content
for graduate students contemplating a career in mental health. The committee was
satisfied with the curriculum content at The University of British Columbia in terms
of its relevance to mental health. The School of Social Work at the University of
Victoria has been evaluated as an undergraduate course of studies with no immediate relevance to mental health per se, except in the sense of preparing the student
for graduate studies. The school has no immediate plans for a graduate clinical
program.
The Committee on Social Work Education has been asked to assist the
Continuing Education Committee in its plans to devise an appropriate continuing
education program for mental health social workers commencing in the fall of 1978.
 G 86 MINISTRY OF HEALTH REPORT,  1977
The Continuing Education Committee, functioning under the chairmanship of
the Consultant in Social Services, assisted roughly two thirds of the mental health
centres with their unit-based educational programs this past year. Utilizing largely
mental health staff, most regions of the Province were offered training programs
designed to enhance practice skills.
Over 200 staff of the Greater Vancouver Mental Health Services and Mental
Health Programs attended a Provincially sponsored Mental Health Conference
at The University of British Columbia in June 1977. In addition to Provincial
and regional meetings, workshops dealing with services to children, legal issues in
mental health, research, and the Boarding-home Program constituted a very full
and busy conference.
The Consultant was in regular attendance as a member of the Child Care
Facilities Licensing Board during this past year. Aside from the usual licensing
items, the board was additionally occupied in the drafting of new child care facilities
regulations which are to be submitted for legislative approval early in 1978.
The announcement of a Provincially based Long-term Care Program resulted
in the Consultant in Social Services being asked to serve on the Executive Board
as Mental Health Programs' representative. Considerable work has been accomplished in developing the program to date and for mental health in particular,
redesigning the Boarding-home Program to fit this new structure. A workshop
for boarding-home staff was held in November 1977 to assist the staff with functional problems associated with the integration of the two programs.
In early December a disciplinary workshop was held for clinical social workers
of the Greater Vancouver Mental Health Services and Mental Health Programs.
Several leading educators were invited to conduct workshops dealing with the
development of problem-solving mechanisms for groups, psychiatric work-ups in
social work practice, parenting skills, and the bettering of mental health boarding-
home operations.
The Consultant was also required to attend as a regular member of Mental
Health Programs' working committees, such as the Program Advisory Committee,
Planning Committee, Legislative Committee, and other ad hoc working groups.
PSYCHOLOGY CONSULTATION
Specific involvements of the Consultant in Psychology included the question
of legislation and mandate for community mental health services and centres.
As part of this review, information of trends and practices of the other provinces
and American states were collected and analysed for relevant information. The
latter will be utilized to help in the review of existing legislation and/or regulations
pertaining to community mental health programs.
Other areas of involvement by the Consultant in Psychology, togther with the
Consultants in Social Work, Nursing, and Psychiatry, included a review of existing
clinical policies with the aim of proposing modifications wherever necessary to
reflect contemporary standards. One aspect consisted of analysing staff roles to
determine whether it is possible to identify areas of commonality between the
different disciplines as well as areas of role differences. Similarly, standards of
practice are being reformulated wherever necessary to ensure the maintenance of
high-quality services to the consumer. In conjunction with this, a review is being
done of the various skills required to implement the various mental health programs. One of the aims is to prepare information packages and training packages
in specific program areas at both the journeyman and advanced levels.
 MENTAL HEALTH PROGRAMS G 87
The development of new mental health programs is an area of special concern.
In order to keep informed about new trends and developments elsewhere, mental
health newsletters and publications from various provincial and state mental health
departments are received on a regular basis. Together with other literature from
professional journals, it has been possible to maintain up-to-date information
regarding services and concerns which might be relevant or applicable to our own
programs.
The development of new mental health programs is closely related to the
determination of mental health needs in the various catchment areas. The procedure that was developed in co-operation with a number of mental health centres
is now in the process of being standardized for application to the various mental
health centres throughout the Province.
Other areas being reviewed include the summer student program and the
possibility of internship and field placements.
Liaison with other Government ministries, agencies, and community groups
is an important aspect of the responsibilities of the Consultant in Psychology. New
responsibilities include the development of volunteer services within Mental Health
Programs. Additional areas of special involvement are related to the role definition
of psychologists in community mental health programs and the recruitment of
community psychologists. Attempts are being made to streamline the whole
recruitment procedure with the aim to shorten the time it takes to fill vacant positions. Temporary responsibilities included the assignment of Acting Regional
Program Director for Northern British Columbia. The Province has been divided
into five mental health regions for the purpose of facilitating liaison between regions
and Victoria, the development and implementation of mental health programs in
the various mental health centres, and the identification of needs in the catchment
areas of the various centres. The aim is to appoint full-time Regional Directors
as soon as such positions have been approved.
MANAGEMENT ANALYST CONSULTATION
The Services of the Management Analyst were directed more specifically to
Mental Health Programs during 1977, and work for the Government health institutions was phased out by mid-year, when personnel at Riverview Hospital assumed
responsibility for these services.
The assignment of a programmer analyst to assist with the development of
the Information Systems resulted in this being a most productive year. The focus
of activity was on the implementation of the Client Information System, an automated data gathering and treatment evaluation system which provides feedback to
staff members in the centres and teams on a regular basis. The implementation
process was staggered over several months to allow time for training sessions in
all facilities. As of November 1, all mental health out-patient units in the Province
were using the new system.
While this was in progress, a Service Information System was being developed
to provide field staff and the various levels of management with service delivery
information on a regular basis. This system, which interfaces with the Client
Information System, is scheduled for implementation in 1978.
The assistance and support of the Statistician, Research and Planning Officer,
and Records Consultant in the development and implementation of these systems
were much appreciated.
 G 88 MINISTRY OF HEALTH REPORT,  1977
RESEARCH AND PLANNING
The Research and Planning Officer was involved in a number of short-term
evaluation studies, implementation of a new Management Information System,
consultation to field staff regarding research projects, and long-range planning.
In general, 1977 was a year of continued development and expansion of this
relatively new position.
Evaluation studies were completed on a suicide-prevention service in Vancouver, a mental health worker project in Revelstoke, and the community psychiatric
nurse position in Mental Health Programs. In addition, an assessment of community awareness of mental health centres in the Capital Regional District was
completed; and an analysis of physician referrals to British Columbia mental
health centres was conducted. Other research efforts included the presentation of
a paper on development of community-based services in urban areas at the 1977
Canadian Psychological Association Conference, and the acceptance for publication
of a paper on a post-hoc planning model.
Planning efforts resulted in the development of a statement of 10 basic mental
health service programs which are available through every mental health centre.
The objectives of these programs are to be stated in terms amenable to evaluation
research. Other planning efforts include work toward the development of a
mandate, and work on numbers and locations of required new staff.
The Research and Planning Officer was involved in the designing and implementation of the new Management Information System for Mental Health
Programs. This included conducting Goal Attainment Scaling workshops for the
professional staff at each of the 31 mental health centres. A Goal Attainment
Scaling Procedure Manual was written for distribution to all professional staff.
Other activities included dissemination of research information from professional journals to field staff, consultation to field staff on research projects and
data analysis, involvement in inter-ministerial committees dealing with Long-term
Care Program data collection, school health services, and co-ordinating the Mental
Health Programs orientation sessions for new staff.
In addition to the above activities, the Research and Planning Officer serves
as the Acting Regional Program Director for the Kootenays Region.
STATISTICS AND MEDICAL RECORDS
During 1977 the Statistical Section continued to be responsible for the collection, processing, and distribution of data on clients who received services in the 31
mental health centres and the 10 community care teams of the Greater Vancouver
Mental Health Service. However, the major work of the section this year has centred around the conversion from the old statistical system to the Client Information
System. Implementation of the Client Information System necessitated travel by
the Statistician and the Medical Records Librarian, with other Mental Health
Programs headquarters staff, to each of the centres involved in the conversion, to
instruct field personnel in the use of the system. Full implementation was achieved
by the fall of 1977. There remain only four units—British Columbia Youth Development Centre, Burnaby In-patient Unit, Vista, and Venture—whose records are
processed by the Mental Health Programs Statistical Section but who are not on
the Client Information System. Because these units do not fit the model for
which the system was designed, a subsystem appropriate to their record-keeping
needs is planned.
 MENTAL HEALTH PROGRAMS
G 89
Statistical Forms and Routine Reports
Changes in the responsibilities of the Statistical Section made retraining of
statistical clerks necessary. The Statistical Section's responsibility for the new
Client Information System includes verifying forms, compiling data, submitting
computer reports, and supporting field personnel in the use of the system. Due
to the more detailed recording under the new system, the reports provide more
information than was possible under the old system. Standardization of the data
collection system and computer recording is expected to facilitate accurate recordkeeping and will provide more data for research into mental health needs in the
Province.
Data Retrieval
In addition to routine listings, analyses, and reports, including the Annual
Statistical Report for 1976, a variety of requests coming from the field and headquarters staff, other Government ministries, and university faculty were processed. These included an analysis of the Integrated Services for Child and
Family Development case load, examination of patient movement in facilities operated by Government health institutions between 1971 and 1976, and several programs to examine case loads in terms of problem and treatment to answer questions
raised by the Federal Social Services Act.
Projects undertaken during the year included the transfer of responsibility to
the Ministry of Human Resources for the statistics for their retardate facilities and
to Government health institutions of responsibility for the statistics for their institutions.
The statistician played an active role on several committees and participated
in the Federal-Provincial Working Party on Mental Health Statistics.
Liaison with the Division of Vital Statistics and Statistics Canada was maintained throughout the year.
Medical Records
The Clinical Records Committee completed the writing of release of information policies and is currently devising a standardized system of record-keeping.
A program of microfilming client records over 7 years old was undertaken
in co-operation with the Central Microfilm Bureau.
Time was also spent in orientating a number of new clerical staff and participating in clerical staff workshops.
Table 15—Patient Movement Data,1 Mental Health Facilities, 1977
Mental Health
Facilities
Entries
Total
.a-o
Q <
3^
Is
Exits
Total
£ a
U rt
PlcH
All mental health facilities-
Hospital programs	
Riverview	
Geriatric facilities..
Valleyview.	
Dellview	
Skeenaview..
14,281
1,422
1,422
369
266
69
34
13,918
1,130
1,130
343
241
69
33
302
272
272
25
24
1
61
20
20
1
1
15,823
1,528
1,528
411
307
68
36
14,670
778
778
82
69
1
12
828
682
682
117
111
5
1
58
13
13
267
55
55
212
127
62
23
i Table compiled from actual data through September 1977 and projected for the remainder of the year.
(Note—In cases in centres/teams opened in 1977, table compiled on basis of available data for 1977).
 G 90                                  MINISTRY OF HEALTH REPORT, 1977
Table 15—Patient Movement Data,1 Mental Health Facilities, 1977—Continued
Mental Health
Facilities
Entries
Exits
Total
3
o
is
a<
to
>
,* It
ss
BStt.
tu  £
C CJ
§"8
u rt
o  k.
0.H
Total
M
s>
«
u
CO
S
CO
u
I-I
o '£
C  0)
o-H
o
0
Mental Health Programs2	
10,228
814
366
56
351
41
10,183
769
349
56
339
25
5
5
5
40
40
12
12
16
11,558
794
358
51
348
37
11,374
720
317
51
328
24
29
29
29
45
45
12
20
13
—
BCYDC     	
Venture (August 1975)3	
Vista (August 1975)3	
Total out-patients	
11,676
9,203
228
126
183
103
93
267
226
236
276
209
135
148
113
336
372
40
241
260
289
288
309
344
232
357
189
193
121
301
111
65
368
309
212
539
388
311
420
265
2,262
56
385
273
241
145
116
161
369
247
269
211
13,090
10,459
307
127
219
241
99
323
241
231
475
120
461
455
121
213
540
150
159
480
301
83
220
177
183
307
191
100
172
315
115
44
424
345
209
679
468
413
636
115
2,436
33
400
255
152
161
188
171
423
305
348
195
Abbotsford	
Burnaby*	
Burnaby Central (March
1977)3	
Burnaby Children's (March
1977)3	
Burnaby Day-Program (March
1977)3   ._	
Burnaby North (February
1977)3	
Burnaby South (January
1977)3	
Duncan -	
Fort St. John	
Grand Forks (November
1976)3	
Kitimat (July 1977)3	
Langley  	
Maple Ridge	
Penticton  	
Port Alberni .'	
Port Coquitlam	
Powell River 	
Sechelt    	
Terrace4 	
Trail     	
Vernon	
VISC (August 1976)3	
Whalley	
Broadway Clinic... -	
Mount Pleasant _ 	
Secure (April 1975)3	
South Vancouver (July 1974)3.„
West End	
West Side _	
BCYDC (out-patients)	
i Table compiled from actual data through September 1977 and projected for the remainder of the year.
(Note—In cases in centres/teams opened in 1977, table compiled on basis of available data for 1977).
2 Subtotal does not include community care teams.
3 Month centre/team commenced reporting.
* Burnaby Mental Health Centre divided into teams for statistical reporting purposes.    Kitimat divided
from Terrace Mental Health Centre for statistical reporting purposes.
 MENTAL HEALTH PROGRAMS G 91
Table 16—Patient Movement Trends, Mental Health Facilities, 1974-77
Yearly Sum of Entries
1 From—
Resident or Case Load
Mental Health Facilities
Oct. 1974
to
Sept. 1975
Oct. 1975
to
Sept. 1976
Oct. 1976
to
Sept. 1977
End of
Sept. 1975
End of
Sept. 1976
End of
Sept. 1977
15,737
1,924
1,924
438
332
88
18
10,431
413
301
51
45
16
12,962
9,846
264
1,015
15,623
1,612
1,612
427
302
97
28
10,820
674
319
45
269
41
12,910
9,941
331
975
15,278
1,432
1,432
386
270
81
35
11,139
800
351
57
347
45
12,660
10,067
283
876
128
72
65
194
170
245
277
210
169
143
127
368
455
20
247
316
289
372
287
241
239
341
208
193
131
340
120
76
375
328
211
612
389
271
434
245
2,321
61
371
264
224
140
136
183
388
252
302
272
17,466
1,392
1,392
980
645
178
157
12,557
61
18
28
8
7
15,033
12,375
305
1,002
17,803
1,244
1,244
930
609
177
144
12,823
61
17
30
8
6
15,568
12,661
350
1,253
17,445
Hospital programs	
Riverview  _. 	
Geriatric facilities - 	
1,150
1,150
909
581
185
143
12,690
77
23
BCYDC     	
35
Venture (August 1975)3	
Vista (August 1975)3	
9
10
Total out-patients	
15,309
12 506
Abbotsford _	
296
Burnaby Central (March 1977)3	
240
Burnaby Children's (March 1977)3	
127
17
Burnaby North (February 1977 )3	
	
469
344
237
401
762
419
Burnaby South (January 1977)3	
344
276
297
349
370
334
338
224
486
600
352
787
302
258
328
254
331
208
380
426
455
179
251
207
563
65
Cranbrook	
Duncan _	
Fort St. John	
Grand Forks (November 1976) 3	
253
377
496
696
613
681
Kitimat (July 1977)3   	
107
226
415
356
354
200
294
417
377
222
159
293
287
147
67
360
308
192
664
425
226
394
319
454
228
381
393
388
205
167
178
396
133
35
345
333
220
669
418
30
463
75
2,764
46
417
262
250
202
132
252
593
237
373
205
348
737
411
1,013
231
379
298
265
302
286
134
555
109
104
614
146
304
760
447
277
783
372
266
273
508
214
306
256
396
96
548
100
59
727
279
372
701
452
181
387
100
2,806
80
692
286
214
248
83
203
365
281
354
101
384
634
360
428
362
290
486
47
577
Sechelt	
79
726
Trail ..._	
374
637
VISC (August 1976) 3	
238
Whalley	
467
71
2,944
78
432
351
310
187
53
226
648
238
421
172
430
74
2,537
76
659
293
185
214
48
210
325
248
279
121
279
239
2,696
104
703
294
260
Richmond.	
Secure (April 1975)3 	
228
58
South Vancouver (July 1974)3    	
192
342
West End                  	
236
West Side—	
279
BCYDC (out-patients) 	
107
i For the residential facilities, this includes permanent transfers, admissions from community, and returns
from leave and escapes.
2 Subtotal does not include community care teams.
3 Month Centre/Team commenced reporting.
* Burnaby Mental Health Centre divided into teams for statistical reporting purposes.    Kitimat divided
from Terrace Mental Health Centre for statistical reporting purposes.
  -S
<
tt
o
o
Hospital Programs
Prior to the introduction of the British Columbia Hospital
Insurance Service on January 1, 1949, the Province had been interested in developing a comprehensive program for many years. In 1932
the findings of a Royal Commission had recommended that a compulsory health insurance maternity plan be considered, and in 1936 a
Health Insurance Act had been placed on the statutes but never
proclaimed. In 1937, British Columbians voted in favour of health
insurance in a referendum held in conjunction with a Provincial
general election. Finally, in 1948, the Hospital Insurance Act was
passed, establishing a Hospital Insurance Service which, when implemented on January 1, 1949, provided coverage for acute care in
approved general hospitals.
The funding of the operating costs of the service (Hospital
Programs) was a 100-per-cent responsibility of the Province until
1958 when the Federal Government agreed to share on a Canada-
wide basis approximately 50 per cent of the approved cost of certain
hospital services. Subsequent to March 31, 1977, Hospital Programs
was brought under the Federal-Provincial Fiscal Arrangements and
Established Programs Financing Act, 1977, when shared-cost arrangements under the Hospital Insurance and Diagnostic Services Act were
terminated.
In March 1975 the name of the service was changed to Hospital
Programs as part of a reorganization of the Ministry of Health.
The following pages contain individual reports of the divisions
which comprise the administrative structure of Hospital Programs,
and brief reviews of pertinent legislation and statistical data.
a.
o
O
z
93
 G 94 MINISTRY OF HEALTH REPORT, 1977
HOSPITAL PROGRAMS HIGHLIGHTS
• Gross operating expenditures for public general, rehabilitation, and extended-
care hospitals for the calendar year 1977 amounted to $560 million.
• In all, 387,949 eligible adult and child patients were discharged in 1977, a
decrease of 2,692 or 0.69 per cent less than in 1976; 95.8 per cent of all patients
discharged were covered by Hospital Programs.
• Hospital Programs was responsible for 3,278,476 days of care for adults and
children in public hospitals, a decrease of 64,696 days or 1.94 per cent less than
1976.  The average length of stay was 8.45 days.
• In 1977, 26 major hospital projects were completed, involving an estimated
$96.8 million. This construction program included the following new extended-
care hospitals: The University of British Columbia (300 beds), Queen's Park
(300 beds), and Delta (100 beds). In addition, three diagnostic and treatment
centres were opened at Eikford, Pemberton, and Cumberland. The latter unit
was built in conjunction with a 50-bed intermediate care unit.
• At year-end there were 5,315 extended-care beds in the Province and there were
approximately 955 additional extended-care beds under construction or in planning stages; of these about 100 additional beds were expected to come into
operation during 1978.
• During 1977 the regional hospital districts debenture sales to the B.C. Regional
Hospital Districts Financing Authority amounted to $61 million.
• Grants totalling $10 million were approved toward purchases of movable and
fixed technical equipment amounting to approximately $16 million. Over 8,000
applications for such grants were received from hospitals.
Over 2,000 patient accounts and 2,300 emergency-service and minor-surgery
accounts were processed daily by Hospital Programs.
Over 9,600 out-of-Province hospital accounts were processed, resulting in an
estimated total expenditure of over $6.7 million.
During 1977, over 16,000 day care dialysis treatments for renal failure were
given.
Over 156,000 accounts were processed for Day Care Surgical Services, Day
Care/Night Care and Out-patient Psychiatric Services, Day Care Diabetic Services, and Dietetic Counselling Services.
•
•
•
BRITISH COLUMBIA REGIONAL HOSPITAL
DISTRICTS ACT
The Regional Hospital Districts Act provides a mechanism for financing the
capital cost of hospital buildings and equipment. The Act provides for the division
of the Province into large districts to enable regional planning, development, and
financing of hospital projects under a formula which permits substantial financial
assistance from the Provincial Government.
 HOSPITAL PROGRAMS G 95
Each regional hospital district is, subject to the requirements of the Act, able
to pass capital expense proposal by-laws authorizing debentures to be issued
covering the total cost of one or more hospital projects. Once a proposal has
been approved by the Minister of Health the district is able to proceed to arrange
both temporary financing and long-term financing on a favourable basis. The
long-term financing is provided by the Regional Hospital Districts Financing
Authority (see below), which purchases debentures issued by the various districts
as required.
Each year the Provincial Government pays through Hospital Programs from
the Hospital Insurance Fund a portion of the principal and interest payments
required on the debentures issued by the Regional Hospital Districts' Financing
Authority in accordance with section 22 of the Act. The balance of the principal
and interest requirements are raised by the district through taxation.
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 districts'
borrowings for hospital construction projects after deduction of any items which
are the districts' 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 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 comprised the board of the regional district (incorporated under the Municipal Act)
which has the same boundaries as the regional hospital district. The board of
each regional hospital district is responsible for co-ordinating and evaluating the
requests for funds from the hospitals within the district, and for adopting borrowing
by-laws subject to approvals and conditions required under the Act, in respect to
either single projects or an over-all program for hospital projects in the district.
In 1975 the British Columbia Regional Hospital Districts Act was amended
to increase the discretionary amount which a regional hospital district can raise
annually for unforeseen capital expenditures if specified by the Minister to
$200,000, or the product of one quarter of a mill, whichever is the greater.
BRITISH  COLUMBIA REGIONAL HOSPITAL DISTRICTS
FINANCING AUTHORITY ACT
The British Columbia Regional Hospital Districts Financing Authority Act
establishes a Provincial Government authority similar to the one set up to assist
school districts in financing their projects. The functions of the authority are
referred to briefly above.
In 1975 the purposes of the authority were expanded to permit assistance
to medical and health facilities and community, human resources, and health
centres and any other community, regional, or Provincial facilities for the social
improvement and welfare of the community or the general public good. Also,
the authority was permitted to purchase debentures from incorporated bodies other
than regional hospital districts, provided they are authorized under any Act or their
charter or their memorandum of association to issue debentures for the financing
of projects permitted under the Act.
 G 96 MINISTRY OF HEALTH REPORT,  1977
HOSPITAL INSURANCE ACT
The Hospital Programs branch of the Ministry of Health operates under the
authority of the provisions of the Hospital Insurance Act, which also authorizes
the establishment of the Hospital Insurance Fund, from which grants are made to
hospitals toward operating expenses and capital costs. Grants are also made to
regional hospital districts toward capital expenditures made to hospitals.
• Generally speaking, every permanent resident who has made his home in
British Columbia during the statutory waiting-period is entitled to benefits
under the Act.
• Reimbursement to public general hospitals is based on an approved annual
budget; for accounting purposes, per diem rates are used for medically
necessary in-patient care rendered to qualified British Columbia residents
who are suffering from an acute illness or injury, and those who require
active convalescent, rehabilitative, and extended hospital care. The payment made to a hospital by Hospital Programs from the Hospital Insurance
Fund amounts to $4 less than the per diem rate, and in the case of extended-
care patients under 19 years of age, $1 less than the per diem rate, approved
for that particular hospital. The patient is responsible for paying the
remainder. The Provincial Government pays the above-noted daily $4 or
$1, as applicable, on behalf of Provincial social welfare recipients.
• The wide range of in-patient and out-patient benefits provided under the
Act is described below.
• Qualified persons who are temporarily absent from British Columbia are
entitled to certain benefits for a period which ends at midnight on the last
day of the twelfth month following the month of departure.
• In addition to the payment toward operating costs, paid to hospitals as
described above, hospitals and regional hospital districts receive grants of up
to 60 per cent of approved costs of construction or acquisition of hospital
facilities, one third of the cost of minor movable equipment, 75 per cent
of the cost of major diagnostic equipment, and 100 per cent of the cost of
equipment which results in proven savings in operating costs.
HOSPITAL ACT
One of the important functions of Hospital Programs is the administration of
the Hospital Act. The Deputy Minister of Medical and Hospital Programs is also
the Chief Inspector of Hospitals for British Columbia under the Act.
The Hospital Act controls the organization and operation of hospitals, which
are classified as follows:
• Public hospitals: Nonprofit hospitals caring primarily for acutely ill persons.
• Private hospitals: This category includes small hospitals, most of which are
operated in remote areas by industrial concerns primarily for their employees, and licensed nursing-homes which are not under hospital insurance coverage.
• Rehabilitation and extended-care hospitals: These nonprofit hospitals are
primarily for the treatment of persons who require long-term rehabilitative
and extended hospital care.
 HOSPITAL PROGRAMS
G 97
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 cost.
Policies to be used in the allocation of the total funds provided are approved
by the Government. The Hospital Rate Board reviews the detailed revenue and
expenditure estimates forwarded by each hospital and applies the policies in
establishing approved budgets.
Approximately 96 per cent of all in-patient hospital accounts incurred in
British Columbia are the responsibility of Hospital Programs. Cash advances to
hospitals are made on a semimonthly basis, so that hospitals are not required to
wait for payment until patients' accounts are submitted and processed by Hospital
Programs. Qualified patients are charged $4 per day, and in the case of extended-
care patients under 19 years of age, $1 per day, effective June 1, 1976, which is
deductible when calculating payments to hospitals from the division.
Nonqualifying residents are charged the hospitals' established per diem rate,
which is all-inclusive, that is, the daily rate covers the cost of all the regular hospital
service, such as X-ray, laboratory, operating room, etc., provided to patients, in
addition to bed, board, and nursing care.
HOSPITAL CONSULTATION AND INSPECTION  DIVISION
This division provides consulting services to public and private hospitals, and
to other divisions of Hospital Programs and the Ministry of Health, in all aspects of
hospital organization, operation, and management. It is also responsible for an
inspectional program to ensure that minimum standards of care, safety, and licensure are met.
The services of the division are provided by teams consisting of consultants
in hospital administration, biomedical engineering, dietetics, clinical laboratory,
management engineering, nursing, social services, and X-ray.
 G 98 MINISTRY OF HEALTH REPORT, 1977
During the year the ongoing work of consultation and inspection saw the
continuation of the "team approach" to visiting. In all, 145 visits were made to
general hospitals and 310 to private hospitals. Three members of the division
participated in 13 "GAMAT" sessions, the program developed by the British
Columbia Health Association to provide education for hospital society trustees,
emphasizing their role and responsibilities. Personnel hours and work load
statistics from the hospitals' 1976 Hospital Services Form 1 submissions were
analysed to produce a current Provincial productivity profile.
The division's Management Engineering Unit was involved in planning the
move and development system within the Ministry's new building in Victoria. It
was also active in promoting the principles of materials management as it affects
both design and space allocation in new hospital construction. Assistance was
provided to the special consultant of Pharmacare in developing new systems for
drug delivery and a new Central Supply Service (pharmaceuticals, medical and
surgical) for the Ministries of Health and Human Resources.
The Senior Consultant in Dietetics became President of the B.C. Dietetic
Association and served as a member of two Federal Task Forces—one of these
involved work load measurement for Departments of Dietetics, and the other for
revision of construction standards regarding dietetic facilities. A diet manual
developed by the B.C. Dietetic Association was distributed to all hospitals in the
Province. A menu planning guide was developed for institutions providing long-
term care for the elderly. Slide/tape presentations on dishwashing and vegetable
preparation and cooking were also developed. Work sampling studies were
carried out for the development of a Staffing Methodology for Departments of
Dietetics.
The year 1977 was an assessment year for Nursing's Patient Classification and
Staffing by Workload Index, a project done in co-operation with the Surrey Memorial, Victoria General, and Vancouver General Hospitals.
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 levels.
In spite of a greater emphasis being given to alternatives to acute in-patient beds,
the population growth of the Province necessitates a continuing review of general
hospital bed requirements. Reports and proposals for revised hospital capacity are
placed before the planning group of Hospital Programs for review, and if approved,
are submitted to the Minister for approval. During the course of the year, 30
detailed studies of hospital requirements for both acute and extended-care beds
were completed, including those resulting in the establishment of the Greater
Vancouver Regional Hospital District 1981 acute-care bed matrix report.
The division also compiles statistical data relating to all hospitalization in the
Province. The admission/separation records submitted by the hosptals for each
patient form the basis of this information.   All diagnoses and operations are coded
 HOSPITAL PROGRAMS G 99
according to the Eighth Revision of the International Classification of Diseases
Adapted (ICDA). Through this classification system, the incidence of disease is
analysed by age, sex, geographical location, as well as other variables.
In connection with morbidity analysis, the division publishes a number of
annual reports. The Statistics of Hospital Cases Discharged includes the standard
morbidity tables consistent with other provinces, and which affords an opportunity
to make interprovincial comparisons of hospital data. The Statistics of Hospitalized
Accident Cases, which is also prepared annually, provides a broad analytical
coverage of hospitalized accident cases by circumstance, type of accident, and
nature of injury. A report of the Day Care Surgery in British Columbia Hospitals
is also prepared by the division for purposes of showing the potential and development of this type of service. First published in 1973, the publication Acute Chemical Dependency was updated during the year to include data on hospitalized
cases from 1969 to 1976. In addition to these reports, the division supplies data
to many agencies, both inside and outside of the Government. The demand for
hospital morbidity data continues to grow and has become particularly useful in
the planning of specialized hospital services.
The division also maintains a reporting system for therapeutic abortions
performed in hospitals in the Province.
HOSPITAL FINANCE DIVISION
The Hospital Finance Division is responsible for the assembling of relevant
information and the preparation of data for the use of the Hospital Rate Board in
its review of the annual and pre-construction 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 1977 amounted to approximately $560 million.
The division also reviews the annual budgets prepared by regional hospital
districts, and works closely with the British Columbia Hospital Financing Authority and the regional hospital districts in financing of hospital capital projects and
repayment of debentures. Total regional hospital district debenture sales to the
British Columbia Regional Hospital Districts Financing Authority amount to $308
million, of which $54 million was added during 1977.
Another function of the Finance Division is the processing of admission/
separation records (accounts), which hospitals submit for each patient, and approving for payment all acceptable claims and the coding for residential data, etc.
Also included are out-patient, day-care, and out-of-Province accounts.
The division is also responsible for the approval of grants to assist hospitals
in the purchase of equipment. The equipment grant structure is such that Hospital
Programs pays 100 per cent on approved equipment, where the equipment purchase
will result in the recovery of capital costs in a reasonable time through savings in
approved staffing; 75 per cent on major diagnostic equipment used in pathology,
radiology, nuclear medicine, and ultra sound; and 331/* per cent on all other
movable depreciable equipment. In 1976, after review of approximately 8,000
applications received from hospitals, grants totalling $10 million were approved
on purchases of movable and fixed technical equipment amounting to approximately $16 million.
 G 100
MINISTRY OF HEALTH REPORT, 1977
The division also assists in administering the Federal/Provincial Agreement
under the Hospital Insurance and Diagnostic Services Act. This involved the
preparation of annual claims for the period up to March 31, 1977, and the disbursement of Hospital Programs funds in a manner that maximized the Province's
reimbursement under the agreement. Subsequent to March 31, 1977, shared-cost
arrangements under the Hospital Insurance and Diagnostic Services Act were
terminated and Hospital Programs was brought under Federal-Provincial Fiscal
Arrangements and Established Programs Financing Act, 1977.
In order to ensure that plans for new hospitals or hospital additions are
prepared with economical and efficient operation in mind, pre-construction operating estimates are completed by hospitals at the final sketch plan stage. It is
essential that the estimated operating costs of the new hospital, or new addition,
compare favourably with other hospitals actually in operation. Where the hospital's
pre-construction operating estimates do not indicate a reasonable operating cost,
it may be necessary for the hospital board to revise its construction plans to ensure
efficient and economical operation. Once a satisfactory pre-construction 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 $420,000 in hospital operating budgets
during the year to enable hospital employees to attend or participate in short-term
educational training courses.
The following is a summary of comparative expenditures of Hospital Programs
(including capital) for the fiscal years ended March 31, 1973-77, inclusive.
1973
1974
1975
1976
1977
$
1,538,905
235,594,194
$
1,800,229
275,801,859
$
2,438,265
370,927,805
$
3,556,066
483,107,890
$
3,619,325
Payments to hospitals.	
536,939,951
Totals.	
237,133,099
277,602,088
373,366,070
486,663,956
540,559,276
FINANCE CLAIMS SECTION
Patient accounts processed during the year were in excess of 2,000 per working-day, plus over 2,300 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 5,600 claims had to be returned to the hospitals
during the year because they were incomplete or unacceptable, and over 1,600
letters were written on eligibility, verification, and related matters.
The In-patient Claims Section pre-audits the charges made to Hospital Programs and ensures that all information shown on each claim is completed so that
it can be coded for statistical purposes, and that it is charged to the correct agency,
such as Hospital Programs, Workers' Compensation Board, the Department of
Veterans Affairs, or other provinces and territories. The In-patient Claims Section
returned over 2,500 claims for clarification of information. Preliminary figures for
1977 show that more than 450,000 accounts (excluding out-of-Province) were
processed.
 HOSPITAL PROGRAMS
G 101
The day care surgical services, day care/night care psychiatric services, outpatient psychiatric services, day care diabetic services, and dietetic counselling
accounts increased in volume to over 13,000 per month in 1977. Payment for
out-patient physiotherapy patients was provided and preliminary figures indicated
that accounts for over 380,000 treatments were processed. During the year, renal
dialysis treatments were made available for out-patient treatment of chronic
renal failure, and figures indicated that over 16,000 treatments were given in 1977.
During the year the service continued to provide a quarterly statistical run of day
care surgical services for the hospitals of the Province.
The Out-of Province Section processes all claims for hospital accounts incurred
by British Columbia residents in hospitals outside the Province. This requires
establishing eligibility and the payment of claims. During 1977, over 800 accounts
were processed each month, resulting in an estimated total annual expenditure
of over $6.7 million.
The Claims Distribution Centre receives, sorts, and distributes all the forms
and correspondence received in the Hospital Claims Section; approximately
13,000 claims, documents, and letters are handled daily.
HOSPITAL CONSTRUCTION AND PLANNING DIVISION
During 1977 this division continued to provide a consultative service to
hospital boards planning new acute or extended-care hospital facilities, diagnostic
and treatment centres, and additions or alterations to these buildings. Due to
continued inflationary trends, emphasis was placed on using public funds to the
best advantage and deleting any work not considered strictly necessary. All
construction programs and applications for grants toward minor building improvements submitted to the branch were reviewed with this in mind.
The increased hospital construction activity was demonstrated by the fact
that 26 major projects were completed in the Province during 1977, an approximate
increase of 30 per cent over 1976, and the capital cost of constructing these facilities almost tripled. Some of the reasons for the significant increase in capital
costs were the increased number of major projects being undertaken, plus the cost
of inflation, as well as the impact of the new building and fire codes. Some of these
major projects included the completion of the new addition to provide 176 additional beds and enlarged service departments at Burnaby General Hospital; the
additions and renovations project completed at Mount St. Joseph Hospital, Vancouver, which provided an additional 90 acute and 94 extended-care beds; and
two new 300-bed extended-care units in the Greater Vancouver area—one at
Queen's Park, New Westminster, and the other on the campus of The University
of British Columbia. Both these extended-care facilities will be used for teaching
purposes. These four projects in the Greater Vancouver Regional Hospital District
accounted for over $56 million of the total capital expenditures in 1977. Further
details of these and other projects are included at the end of this report.
The changeover to metric measurement for construction projects starts
officially on January 1, 1978. This division was already receiving plans in metric
measurement and the transition appeared to be moving smoothly.
The program to provide intermediate and personal care coverage in the
Province commenced January 1, 1978, which was expected to greatly increase
the work load of this division.
 G 102 MINISTRY OF HEALTH REPORT, 1977
This division was very appreciative of all the help received from the Provincial
Fire Marshal's Office during the year, particularly in arriving at acceptable but
economical solutions to the many problems encountered in meeting building and
fire code requirements. During the year, three major projects involving upgrading
fire alarm systems, installing fire walls and doors, etc., were undertaken to meet
current fire code requirements. These three projects at the Royal Inland Hospital
(Kamloops), Shaughnessy, and Sunny Hill Hospitals in Vancouver, would result
in an over-all capital cost of just under $2 million.
During the year the first insurance guidelines were issued in an attempt to
standardize insurance requirements on all hospital construction projects. It was
hoped that not only would these guidelines provide assistance to administrators
but also effect some economies in premiums.
The division continued to have a representative on the Joint Technical Planning Committee, a committee consisting of members of Government and the
construction industry working together on mutual problems. This committee had
been responsible for the standardization of contract documents, a firm price policy,
and improved tendering procedures. An offshoot of this committee was the Construction Mediation Council, which had been most successful during the year in
reducing the adversary elements between the owner and the contractor. The
Mediation Council was able to resolve a number of disputes quite successfully,
therefore avoiding the necessity of their going to arbitration or to court. The
services of the Council was available for any disputes arising on Government-
funded construction projects.
The additional work load created for the division by the large projects delayed
the acute care guidelines and the revision of the extended-care guidelines. The new
Government policy of allocating capital funds for hospital construction over five-
year periods for trie first time makes regional hospital districts and hospital boards
aware of the total funds which are available for their project.
PROJECTS COMPLETED DURING 1977
Burnaby General Hospital—On September 30, 1977, the Minister of Health
officially opened the new addition. The project raised the acute rated capacity to
414 beds, which was a reduction in the approved capacity of 494 acute beds. The
reduction was in compliance with the bed matrix for the Greater Vancouver Regional Hospital District.
A renovation project was still under way at the hospital.
Cumberland—A new intermediate care unit of 50 beds and a diagnostic and
treatment centre with six holding beds were opened in June 1977.
Delta—On January 28, 1977, the Minister of Health officially opened the
new 100-bed extended-care hospital.
Eikford—A new diagnostic and treatment centre with three holding beds was
officially opened by George Haddad, M.L.A., on May 21, 1977.
Fort Nelson General Hospital—The new north addition, which includes
emergency, laboratory, and administration offices; and the new south addition,
which includes a new pediatric suite, central stores, and space later to be used as
a Physiotherapy Department, were opened by the Minister of Health on November
4, 1977.   Renovations were still under way at the hospital at the year-end.
Wrinch Memorial Hospital, Hazelton—On May 11, 1977, the Minister of
Health officially opened the new hospital, which contains 27 acute beds, plus eight
in "shell" and four extended-care beds.
 Queen's Park Extended Care Hospital, New Westminster, is one of the many projects
completed in 1977. The facility provides 300 beds.
Cardiac catheterization laboratory at St. Paul's Hospital, Vancouver, was opened to
patients in lanuary   1977.   The  laboratory  is  equipped  to  carry  out  several   types  of
angiograms, and the procedures are recorded on both still and movie films,
reference.
 Medical Services Plan stores physician claim cards on microfilm cartridges in
background, each holding 13,000 claim cards.
SOCIAL   SEBViC
■\7*T Of THE TE/1M   SIMCC *3*
Riverview Hospital, a major Government institution, arranged an informative
staff "open house" in the spring of 1977.
 HOSPITAL PROGRAMS
G  103
Royal Inland Hospital, Kamloops—Stage I, Phase II, of an expansion and
renovation program, providing for the expansion of diagnostic services and 14 beds
in "shell," was completed in July 1977.
A project fulfilling requirements of the Fire Marshal, including improvements
to the 1911 and 1945 wings, was completed in October 1977.
Kelowna General Hospital—A new 100-bed Cottonwoods Extended-care
Unit was officially opened by the Minister of Health on October 20, 1977.
Nanaimo General Hospital—A project to complete a "shell" area for a 12-
bed intensive care unit was completed in November 1977. Only nine beds were
to be placed in service initially.
Queen's Park Hospital, New Westminster—The new 300-bed extended-care
hospital, of which 100 beds are for teaching purposes, was officially opened by the
Minister of Health on October 14, 1977.
Pemberton—On June 28, 1977, the Minister of Health officially opened the
new Pemberton Diagnostic and Treatment Centre. The centre has three holding
beds.
Powell River General Hospital—A project to replace the steam and condensate return lines between the hospital and the MacMillan Bloedel Limited mill
was completed late in 1977.
Queen Charlotte Islands General Hospital—A project to upgrade mechanical
and electrical services was completed in 1977.
Mater Misericordice Hospital, Rossland—The first extended-care patients were
admitted to the renovated second floor area on May 12, 1977.
Mills Memorial Hospital, Terrace—The completion of the additions and
alterations program, as well as 16 psychiatric beds and six day care psychiatric
spaces, was marked by opening ceremonies on July 11, 1977. The first patients
were admitted to the unit on August 17, 1977.
Tofino General Hospital—An expansion and renovation program including
emergency laboratory and radiology departments was completed at the end of 1977.
Vancouver
Children's Hospital—The temporary expansion of the Surgical Suite was
completed in April 1977 and the Cleft Palate Unit in the latter part of 1977.
Mount St. Joseph Hospital—On May 18, 1977, the Minister of Health officially opened the completed expansion and renovation project at the hospital. The
project provided an additional 70 acute and 94 extended-care beds for a total rated
capacity of 161 acute and 150 extended-care beds. However, in consequence of
the Greater Vancouver Regional Hospital District bed matrix, the new acute
rated capacity will be 151 beds.
St. Paul's Hospital—Alteration and improvements to diagnostic and treatment
and service areas were completed in February 1977.
St. Vincent's Hospital—Phase II of the hospital's expansion program was
completed late in 1977. The project involved 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 services.
 G 104 MINISTRY OF HEALTH REPORT,  1977
University of British Columbia Health Sciences Centre—The new 300-bed
extended-care hospital was officially opened by the Minister of Health on July 12,
1977.
Vancouver General Hospital—The new Surgical Day Care Facility and the
renovations of the Heather Pavilion D-Floor operating-rooms were completed in
July 1977.
Renovations to the Burn Unit in the Fairview Pavilion were completed in
October 1977.
Preliminary work on the new Emergency Department (site clearance, etc.),
was completed in August 1977.
Victoria
Glengarry Hospital—Phase I, excavation, to provide an additional 150
extended-care beds was completed toward the end of 1977.
Mount St. Mary Hospital—A kitchen renovation and addition project was
completed at the hospital in 1977.
Royal Jubilee Hospital—Interim renovations to upgrade Emergency Department were completed in October 1977.
PROJECTS UNDER CONSTRUCTION AT YEAR-END
Matsqui-Sumas-Abbotsford General Hospital—Phase I of an addition project
—(a) a surgery department addition and (b) the provision of 20 psychiatric beds—
was under way at the hospital at the year-end. The project would eventually provide an additional 129 acute beds.
Burnaby General Hospital—Renovation part of a major expansion project.
Dawson Creek District Hospital—Stage II, including the expansion of the
administration area, day care surgery, emergency, and radiology.
Fort Nelson General Hospital—Renovations include modification to the boiler
and emergency generator rooms, female staff facilities, kitchen, laundry, cafeteria,
radiology, and other general renovations.
Langley Memorial Hospital—An extended-care unit to provide 75 beds.
Mission Memorial Hospital—Provision of an extended-care unit of 50 beds.
Royal Columbian Hospital, New Westminster—A major expansion consisting
of an addition of 54 beds for an eventual capacity of 463 acute beds. The reduction
from the originally approved capacity of 525 acute beds was brought about by the
implementation of the bed matrix for the Greater Vancouver Regional Hospital
District.
Lions Gate Hospital, North Vancouver—The Northern (Services) expansion
project.
South Okanagan General Hospital, Oliver—Construction of a 75-bed extended-
care unit.
Eagle Ridge Hospital & Health Care Centre, Port Moody—Phase I of a project
which would eventually provide 110 acute beds and 75 extended-care beds. The
first phase included site clearance.
Saanich Peninsula Hospital—Construction of a 75-bed acute-care addition.
Michel-Natal District Hospital, Sparwood—A new 27-bed acute hospital.
 HOSPITAL PROGRAMS G 105
Vancouver
Shaughnessy Hospital—Fire protection upgrading project.
Sunny Hill Hospital for Children—A fire protection upgrading project.
UBC Health Sciences Centre—Construction of a new 240-bed acute hospital.
Vancouver General Hospital—Preliminary work on the new Emergency Department project, with excavation.
Victoria
Glengarry Hospital—Phase II of a project to provide an additional 150
extended-care beds at the hospital.
Victoria General Hospital—Renovations to the Radiology Suite.
TENDERING STAGE AT YEAR-END
Prince George Regional Hospital—75-bed extended-care unit.
PROJECTS IN ADVANCED STAGES OF PLANNING
Castlegar and District Hospital—Completion of "shell' area for 10 additional
extended-care beds.
St. Joseph's General Hospital, Comox—Expansion of diagnostic and treatment
facilities.
Creston Valley Hospital—Enlargement of the Emergency Department.
Cowichan District Hospital, Duncan—Alterations to existing Intensive Care/
Coronary Care Unit.
Lady Minto Gulf Island Hospital, Ganges—Expansion of services and the
addition of 10 extended-care beds.
Royal Inland Hospital, Kamloops—Stage II, addition and replacement of acute
beds plus necessary services.
Mission Memorial Hospital—37 acute-bed addition.
Prince George Regional General Hospital—Stage II, improvement of central
power plant.
St. Mary's Hospital, Sechelt—Expansion of services.
Trail Regional Hospital—Phases II and III, services expansion, fire protection,
and electrical upgrading.
Vancouver General Hospital—New Emergency Department (Stage II).
ADDITIONAL PROJECTS APPROVED AND IN VARIOUS
STAGES OF PLANNING
New facilities (acute hospitals)—Delta (75), Port McNeill (10), Port Moody
(110), Victoria General Hospital North (300 beds on a new site).
Additional and/or replacement acute beds—Abbotsford (129, including 15
activation/rehabilitation and 20 psychiatric beds under way), Cranbrook (42 deferred), Duncan (12 psychiatric), Mackenzie (seven plus five in "shell"), Maple
Ridge (53), Nanaimo (26), Richmond (76), Salmon Arm (12), Surrey (24),
Vancouver—Cancer Control Agency of B.C. (44), New Children's/Grace (200
pediatric, 90 obstetrical), St. Paul's (replacement beds).
New extended-care facilities—Creston (35, deferred), Merritt (10, deferred),
Parksville (55), Port Moody (75), Princeton (10, deferred).
 G  106 MINISTRY OF HEALTH REPORT, 1977
Additional extended-care beds—Campbell River (15, deferred), Comox (15),
Salmon Arm (15), Surrey (78), Vancouver (Metropolitan Council, 40 plus 40
intermediate care), Shaughnessy (150 veterans), Sunny Hill (22), Vernon (38),
Victoria (St. Mary's Priory, 51).
Expansion and/or updating of services—Chilliwack, Clearwater, Cranbrook
(deferred), Fort St. John, Maple Ridge, Nanaimo, Penticton, Prince George, Richmond, Surrey, Tahsis, Vancouver (St. Paul's, Shaughnessy, Sunny Hill, Vancouver
General), Victoria (Royal Jubilee, Victoria General South).
MEDICAL CONSULTATION  DIVISION
The function of this division is to provide medical consultation with Hospital
Programs, with other departments of the Government, with hospitals at all levels
of care, and with regional hospital districts. For example, within Hospital Programs,
in addition to medical consultation, the division assists in planning and implementation of new services by having representatives on the Planning Group, Equipment
Committee, and the Functional Program Review Committee of Hospital Programs.
The division continued to maintain liaison with other health agencies such as
the College of Physicians and Surgeons of British Columbia, the B.C. Medical Association, B.C. Health Association, and the Faculty of Medicine at UBC. Understandably, in a province with more than a hundred hospitals, problems relating to
medical staff activities occur and these organizations provided valued assistance in
the resolution of difficulties. Participation on the Medical Advisory Committee of
the B.C. Medical Association with advisory subcommittees to the Government on
many subjects continued to be a useful function.
Medical Consultation Division has the responsibility for a general auditing of
the quality of medical care for hospitals. This function is performed by a central
review of discharge diagnoses and related information, patterns of care, hospital role,
and by on-site visits. Regular visits by the Medical Record Librarian Consultant
assist hospitals in maintaining a high standard of medical documentation. The audit
process also involves assessment of eligibility for acute care or other types of care
or insured benefit. During 1977, registered nurses within the division audited and
medically coded approximately 460,000 admission/separation records, and 70,000
day care surgical services records. The coded information was utilized by the
Research Division to produce both the regional and hospital profiles necessary for
planning and audit functions.
The Medical Consultation Division has the responsibility for both the program
and eligibility status of extended-care patients. The Central Registry for Long-term
Care applications was developing a computer application to handle all data requirements arising from long-term care program assessment material. In the meantime,
the manual filing system continued to manage the hospital waiting-lists. Starting in
1978, these lists will be based on the local assessment teams' evaluation of eligibility
criteria and social circumstances. This procedure will be an extension and an improvement of the initial assessment begun in some areas of the Province several
years ago. Any applicant for long-term care would be assured of immediate assistance, together with guidance toward the appropriate facility, should institutional
care be necessary.
During 1977 there was an increase of approximately 1,000 in the number of
extended-care beds available in the Province, bringing the total to slightly over
5,300.   New units were opened in Kamloops (100 beds), in the Greater Vancouver
 HOSPITAL PROGRAMS
G 107
Regional Hospital District (794 beds), and in Rossland (18 beds), together with
smaller "holding units" designated for extended care in various community hospitals.
A further 175 new extended-care beds would be available for patients in 1978; over
700 more were in various stages of approved planning or construction at year-end.
These institutions receive a regular quarterly review by a special multi-disciplinary team. This function emphasizes a consultative review of the hospitals to
assist in establishing optimal patient programs. The review also permits an individual audit to establish the need and eligibility for continuing care. The policy of
short-term admission of extended-care patients proved to be very useful, supporting
and encouraging relatives who wish to take care of extended-care patients in their
own homes, but who require occasional holiday or other relief.
During 1977 the Medical Consultation Division continued to have responsibility for determining eligibility for applicants for admission to the five designated
intermediate care homes in the Province, totalling 663 beds. These homes were
visited regularly to contribute to the development of an intermediate-care program
in the unit and, secondly, to assess the continued eligibility of the residents. On
January 1, 1978, these responsibilities will be transferred to the Adult Care Facilities
Licensing Board, and its long-term care administrators, who are based in health
units around the Province as part of the new Long-term Care Program.
The new Long-term Care Program benefits to be effective January 1, 1978,
will also mean that extended care will be a part of continuum of long-term care provided by the Province. However, meeting the needs for care of those residents
who are incompatible with the usual units because of mental and emotional handicaps, would still present a challenge to all concerned. It was hoped that this type
of care, particularly in larger communities, can be suitably provided within special
extended-care programs being developed.
ADMINISTRATIVE SERVICES DIVISION
The division provides a variety of administrative services to the other divisions
of Hospital Programs and to outside agencies. These services include the following:
ADMINISTRATION
The personnel function, including payroll, recruitment, promotion, and labour
relations matters.
The review of requisitions and vouchers for all divisions, including travel
expenses and requisitions for supplies and equipment.
The receipt and deposit of all incoming cheques.
The handling and distribution of all hospital forms and the sorting and distribution of mail.
The co-ordination of the preparation of the annual estimates for Hospital
Programs.
The preparation and publication of the Hospital Programs Bulletin.
The preparation  and  distribution  of information  pamphlets  for Hospital
Programs.
 G 108 MINISTRY OF HEALTH REPORT, 1977
LEGISLATION
The drafting of legislation, regulations, and Orders in Council related to the
various statutes administered by Hospital Programs. In performance of these
duties the division works closely with the Ministry of the Attorney-General.
Statutes which relate to the division's activities include
• Hospital Insurance A ct;
• Hospital Act;
• Regional Hospital Districts Act;
• British Columbia Regional Hospital Districts Financing Authority Act;
• Medical Centre of British Columbia Act;
• Practical Nurses 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 share in the
capital stock of private hospital corporations.
The co-ordinating of the acquisition and disposal of hospital sites and private
hospitals.
In conjunction with the Land Registry Office, control over the property of
hospitals and private hospitals to ensure that the property records are suitably endorsed so that land transfers may not be made until they are approved under the
Hospital Act.
FEDERAL-PROVINCIAL HOSPITAL ARRANGEMENTS
The drafting and processing of the necessary amendments to the Federal-
Provincial Agreement and associated matters.
During the year, revised financial arrangements were agreed to with the Federal
Government and, commencing April 1977, shared cost arrangements under the
Hospital Insurance and Diagnostic Services Act were terminated.
REGIONAL HOSPITAL DISTRICTS
In conjunction with officials of other divisions, other Government ministries,
and the various regional hospital districts, the division assists in processing capital
expense proposals and in arranging for the necessary by-laws and Orders in Council
for temporary borrowings and related matters.
ELIGIBILITY
The review of applications for benefits made by or on behalf of persons admitted to hospitals.
The maintenance of uniform standards of eligibility in all hospitals and the
provision of assistance to hospitals in training admitting staff.
The handling of applications to the Health Insurance Supplementary Fund.
 HOSPITAL PROGRAMS
THIRD-PARTY LIABILITY
G 109
This section is responsible for the review of all hospitalization reports for
patients admitted to hospitals with accidental injuries. This also includes the processing and verification of the reimbursement from public liability companies for
hospital expenses paid on behalf of accident victims. During the year ended
March 31, 1977, a total of $3,609,575.19 was recovered through the process.
APPROVED HOSPITALS
Hospitals as Defined Under the Hospital Insurance Act Revised to June 23, 1977
(A)  PUBLIC HOSPITALS (ACUTE CARE)
A. Maxwell Evans Clinic, Vancouver.
Armstrong & Spallumcheen Hospital, Armstrong.
Arrow Lakes Hospital, Nakusp.
Ashcroft and District General Hospital,
Ashcroft.
Bella Coola General Hospital, Bella Coola.
Boundary Hospital, Grand Forks.
Bulkley Valley District Hospital, Smithers.
Burnaby General Hospital, Burnaby.
Burns Lake and District Hospital, Burns
Lake.
Campbell River & 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 District Hospital, Fernie.
Fort Nelson General Hospital, Fort Nelson.
Fort St. John General Hospital, Fort St.
John.
Fraser Canyon Hospital, Hope.
G. R. Baker Memorial Hospital, Quesnel.
Golden and District General Hospital, Golden.
Grace Hospital, Vancouver.
Kelowna General Hospital, Kelowna.
Kimberley and District Hospital, Kimberley.
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 Misericordiae Hospital, The, Rossland.
Matsqui-Sumas-Abbotsford General Hospital, Abbotsford.
Michel-Natal District Hospital, Sparwood.
Mills Memorial Hospital, Terrace.
Mission Memorial Hospital, Mission.
Mount Saint Joseph Hospital, Vancouver.
Nanaimo Regional General Hospital, Nanaimo.
Nicola Valley General Hospital, Merritt.
Ocean Falls General Hospital, Ocean Falls.
100 Mile District General Hospital, 100
Mile House.
Peace Arch District Hospital, White Rock.
Penticton Regional Hospital, Penticton.
Port Alice Hospital, Port Alice.
Port Hardy Hospital, Port Hardy.
Powell River General Hospital, Powell
River.
Prince George Regional Hospital, Prince
George.
Prince Rupert Regional Hospital, Prince
Rupert.
Princeton General Hospital, Princeton.
Queen Charlotte Islands General Hospital,
Queen Charlotte City.
Queen Victoria Hospital, Revelstoke.
Rest Haven General Hospital, Sidney.
Richmond General Hospital, Richmond.
Royal Columbian Hospital, New Westminster.
Royal Inland Hospital, Kamloops.
Royal Jubilee Hospital, Victoria.
R. W. Large Memorial Hospital, Waglisla.
St. Bartholomew's Hospital, Lytton.
St. George's Hospital, Alert Bay.
St. John Hospital, Vanderhoof.
St. Joseph's General Hospital, Comox.
Saint Mary's Hospital, New Westminster.
 G 110
MINISTRY OF HEALTH REPORT,  1977
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, 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) REHABILITATION HOSPITALS
G. F. Strong Rehabilitation Centre, Vancouver.
Gorge Road Hospital, The, Victoria.
Holy Family Hospital, Vancouver.
Pearson Hospital (Poliomyelitis Pavilion),
Vancouver.
Queen Alexandra Hospital for Children,
Victoria.
Sunny Hill Hospital for Children, Vancouver.
(C) EXTENDED-CARE HOSPITALS
Delta Centennial Hospital, Delta.
Fellburn Hospital, Burnaby.
Juan de Fuca Hospital, Victoria.
Louis Brier Hospital, The, Vancouver.
Menno Hospital, Abbotsford.
Mount St. Francis Hospital, Nelson.
Mount Saint Joseph Hospital  (top floor),
Vancouver.
Mount St.  Mary Hospital   (excluding top
floor), Victoria.
Overlander Extended Care Hospital, Kamloops.
Pearson Hospital (excluding facilities for
tuberculosis patients), Vancouver.
Pouce Coupe Community Hospital. Pouce
Coupe.
Queen's Park Hospital, New Westminster.
Saanich Peninsula Hospital, Saanichton.
(D) DIAGNOSTIC AND TREATMENT CENTRES
Arthritis Centre of British Columbia, The,
Vancouver.
Cumberland General Hospital, Cumberland.
Eikford and District Diagnostic and Treatment Centre, Eikford.
Gold River Health Clinic, Gold River.
Houston Hospital, Houston.
Keremeos Diagnostic and Treatment Centre,
Keremeos.
Pemberton    and    District   Diagnostic   and
Treatment Centre, Pemberton.
(E) 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.
(F) FEDERAL HOSPITALS
Canadian Forces Station Hospital Holberg, San Josef.
Canadian Forces Station Hospital Masset, Masset.
(G) PRIVATE HOSPITALS
Cassiar Asbestos Corporation Private Hospital, Cassiar.
Mica Creek Private Hospital, Mica Creek.
 HOSPITAL PROGRAMS
G 111
STATISTICAL DATA
The tables below represent statistical data compiled by the Hospital Finance
Division, showing the extent of hospital coverage provided to the people of British
Columbia through Hospital Programs.
In 1977 there were 103 public general hospitals as well as six diagnostic and
treatment centres. In addition, care was also provided by six Red Cross outpost
hospitals; two Federal hospitals; two contract hospitals; five public rehabilitation
hospitals, plus one rehabilitation hospital operated by the Provincial Government.
There was also the specialized out-patient facility of the Canadian Arthritic Society
at their Vancouver Centre, who provide services in several facilities throughout
the Province. Hospital coverage under the Hospital Insurance Act for patients in
the extended-care hospitals and units commenced December 1, 1965, and by the
end of 1977 had increased to 61 extended-care units, which includes one facility
operated by the Provincial Government.
Data for the year 1977 have been estimated, based on reports submitted by
hospitals to August 31, 1977, and are subject to revision when the actual figures
for the year are submitted.
Table 17 shows that 387,949 adult and children patients were discharged
(separated) from British Columbia public hospitals in 1977, a decrease of 2,692
or 0.69 per cent less than 1976. This table also shows that 95.8 per cent of the
total adult and children patients discharged (separated) from British Columbia
public hospitals were covered by Hospital Programs. Table 18 indicates that, in
1977, Hospital Programs was responsible in British Columbia for 3,278,476
general hospital days of care for adults and children, a decrease of 64,696 days
or 1.94 per cent less than in 1976.
As shown in Table 19, the average length of stay for public hospitals adult
and children patients in British Columbia during 1977 was 8.45 days and the days of
care per 1,000 population was 1,432. These figures, which show a continuation
of the trend of decreased length of stay, were a result of a more effective utilization
of hospital beds and ambulatory services. For comparison purposes, the data for
extended-care hospitals were not included in the above observations, although an
additional 639 days of care per 1,000 population were provided for these patients.
Table 20 is supplemented by Table 21 because the number and volume of
ambulatory services covered by Hospital Programs expanded considerably. It
should be noted that psychiatric, diabetic, and renal dialysis day-care services are
provided only in a limited number of hospitals. Services listed under "Other" are
related to special out-patient services provided by the Cancer Control Agency of
B.C., G. F. Strong Rehabilitation Centre, and the Narcotic Addiction Services
(transferred program to Public Health in April 1977). The growth of ambulatory
services reflected a trend toward the broader provision of hospitaUbased 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.
 G 112
MINISTRY OF HEALTH REPORT, 1977
Table 17—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—
1972   	
391,732
395,120
412,500
415,805
408,278
404,984
34,774
34,544
35,566
36,538
36,117
36,872
426,506
429,664
448,066
452,343
444,395
441,856
375,373
377,719
394,507
398,279
390,641
387,949
95.8
95.6
95.6
95.8
95.7
95.8
33,595
33,599
34,665
35,700
35,292
36,132
96.6
97.3
97.5
97.7
97.7
98.0
408,968
1973 - 	
1974	
1975	
19762	
411,318
429,172
433,979
425,933
19773	
424,081
Percentage of total patients
separated—
1972
95.9
1973
	
95.7
1974	
	
95.8
1975
95.9
19762.   _	
	
95.8
19773	
	
	
96.0
1 Includes rehabilitation hospitals.
2 Amended as per final report received from hospitals.
3 Estimated, based on hospital reports to August 31, 1977.
Table 18—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
Adults
and
Children
Newborn
Total
Covered by Hospital
Programs
Adults
and
Children
Newborn
Total
Patient-days—
1972 	
1973....
1974.-
1975...
19762_
19773-
3,462,509
3,400,453
3,582,774
3,565,532
3,488,179
3,413,413
219,158
214,003
213,439
213,846
207,316
206,330
3,681,667
3,614,456
3,796,213
3,779,378
3,695,495
3,619,743
Percentage of total patient-days—
1972  _ 	
1973	
1974	
1975	
19762..
19773..
3,323,252
3,257,106
3,400,873
3,413,630
3,343,172
3,278,476
96.0
95.8
94.9
95.7
95.8
96.0
210,764
206,178
206,376
207,471
201,111
200,487
96.2
96.3
96.7
97.0
97.0
97.2
3,534,106
3,463,284
3,607,249
3,621,101
3,544,283
3,478,963
96.0
95.8
95.0
95.8
95.9
96.1
i Includes rehabilitation hospitals.
2 Amended as per final report received from hospitals.
3 Estimated, based on hospital reports to August 31, 1977.
 HOSPITAL PROGRAMS
G 113
Table 19—Patients Separated, Total Patient-days and Average Length of Stay
According to Type and Location of Hospital for Hospital Programs Patients
Only, and Days of Care per 1,000 of Covered Population
Total
(Excluding
Extended Care)
Adults
and
Children
Newborn
B.C. Public
Hospitals
Adults
and
Children
Newborn
Other
B.C. Hospitals,
Including Federal
and Private
Adults
and
Children
Newborn
Institutions
Outside
British Columbia
Adults
and
Children
Newborn
Extended-
care
Hospitals
Patients separated-
1972 ,	
1973	
1974	
1975	
19761	
19772	
Patient-days—
1972	
1973	
1974	
1975	
388,747
392,550
404,271
406,000
400,675
396,556
3,543,587
3,474,733
3,565,198
33,878
33,962
34,979
36,059
35,832
36,546
212,549
208,154
208,224
19761	
19772	
Average days of stay—
1972	
1973	
1974	
1975	
3
3
3
3,486,573|209,631[3
3,424,979|204,156|3
3,346,531|203,199|3
375,353
377,719
394,507
398,279
390,641
387,949
,323,252
,257,106
,400,873
33,595
33,599
34,665
35,700
35,292
36,132
210,764
206,178
206,376
19761-
19772..
9.12|
8.85|
8.81|
8.59|
8.551
8.44
6.27
6.14
5.95
5.81
5.70
5.56
,413,630|207,471
,343,172|201,111
,278,476 200,487
8.85
8.62
8.62
8.57
8.56
8.45
6.27
6.14
5.95
5.81
5.70
5.55
8,140
8,092
3,572
1,425
475
475
168,950
155,150
103,064
15,517
1,647
1,647
20.76
19.17
28.85
10.89
3,47
3.47
39
34
78
72
80
80
264
172
464
336
390
390
6.77
5.06
5.95
4.67
4.88
4.88
5,234
6,739
6,190
6,296
9,559
8,132
51,385
62,477
61,261
57,426
80,160
66,408
9.82
9.27
9.90
9.12
8.39
8.17
244
329
237
287
460
334
1,521
2,164
1,384
1,824
2,655
2,322
6.23
6.58
5.84
6.36|
5.77|
6.951
1,822
2,293
2,449
3,022
3,592
3,751
817,321
1,044,529
1,227,949
1,357,352
1,498,797
1,584,183
448.58
455.53
501.41
449.16
417.26
422.34
i Amended as per final reports from hospitals.
2 Estimated, based on hospital reports to August 31, 1977. Estimated patient-days (including newborn)
per 1,000 of population covered by Hospital Programs: 1972, 1,669; 1973, 1,600; 1974, 1,531; 1975, 1,512;
1976, 1,474; 1977, 1,432. (Because the Armed Forces, Royal Canadian Mounted Police, and some other groups
are not insured under the Provincial plan, the actual incidence of days would be somewhat higher than shown.)
In addition, estimated patient-days per 1,000 population for extended care amounted to 372 in 1972, 454 in
1973, 502 in 1974, 555 in 1975, 603 in 1976, and 639 in 1977. Population figures according to latest census
figures.
Table 20—Summary of the Number of Hospital Programs In-patients and
Out-patients, 1972—77
Total Adults,
Children,
and Newborn
In-patients
Estimated
Number of
Emergency,
Minor Surgery,
Day Care, and
Out-patients
Total
Receiving
Benefits
1972	
1973     _	
1974  	
1975               	
19761 __ 	
19772  	
424,447
428,805
441,699
445,081
440,099
436,853
453,589
792,367
1,045,460
1,191,650
1,228,723
1,297,510
878,036
1,221,172
1,487,159
1,636,731
1,668,822
1,734,363
i Amended as per final Reports received from hospitals.
2 Estimated, based on hospital reports to August 31, 1977.
 G 114
MINISTRY OF HEALTH REPORT, 1977
Table 21—Summary of Hospital Programs Out-patient Treatments by Category,
1972-77
1972
1973
1974
1975
1976
1977
Psychiatry—
Out-patient 	
Day care	
Minor and emergency _.
Day care surgery	
Diabetic day carei	
Physiotherapy2	
Dietetic counselling3 _._..
Renal dialysis, day care*....
Others	
Totals	
7,955
8,131
267,203
44,633
167
8,943
9,277
408,925
50,089
885
162,997
125,500    |      151,251
12,771
19,737
503,492
55,920
1,493
296,863
155,184
17,915
34,219
571,055
62,019
2,354
338,583
5,937
159,568
22,352
40,392
542,223
66,663
3,426
368,867
10,218
10,481
164,101
25,290
46,336
575,000
75,580
4,296
380,462
13,630
18,351
158,565
453,589    |
 I
792,367    |   1,045,460
I
1,191,650
1,228,723
1,297,510
1 Commenced October 1972.
2 Commenced April 1973.
3 Commenced January 1975.
* Commenced June 1,1976.
5 Other includes (a) cancer out-patients,  (fi)  rehabilitation day care,  (c)  narcotic addiction out-patients
(transferred program to public health in April  1977).
Table 22—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, 1977x (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 	
387,949
36,132
3,278,476
200,487
8.45
5.55
189,691
14,485
1,737,544
81,776
9.16
5.65
109,032
11,352
855,023
64,146
7.84
5.65
48,601
6,874
342,543
35,207
7.05
5.12
28,354
2,451
185,527
15,129
6.54
6.17
9.934
970
Patient-days—
Adults and children _. 	
50,196
4,229
Average days stay—
5.05
Newborn —
4.36
i Estimated, based on hospital reports to August 31, 1977.
Table 23—Percentage Distribution of Patients Separated and Patient-days for Hospital Programs Patients Only, in British Columbia Public Hospitals, Grouped
According to Bed Capacity, 1977x (Excluding Extended-care Hospitals)
Bed Capacity
Total
250 and Over
100 to 249
50 to 99
25 to 49
Under 25
Patients separated—
Per Cent
100.0
100.0
100.0
100.0
Per Cent    |
48.90        |
40.09        |
53.0
40.79
Per Cent
28.10
31.42
26.08
32.0
Per Cent
12.53
19.02
10.45
17.56
Per Cent
7.31
6.78
5.66
7.55
Per Cent
2.56
Newborn
Patient-days—
Adults and children	
Newborn	
2.68
1.53
2.11
i Estimated, based on hospital reports to August 31, 1977.
 HOSPITAL PROGRAMS
G 115
CHARTS
The statistical data shown in the following charts prepared by the Research
Division are derived from admission/separation forms submitted to Hospital Programs. Readers interested in more detailed statistics of hospitalization in this
Province may wish to refer to "Statistics of Hospital Cases Discharged During
1976" and "Statistics of Hospitalized Accident Cases, 1976," available from the
Research Division.
 G 116
MINISTRY OF HEALTH REPORT, 1977
Chart I—Percentage Distribution of Days of Care'1', by Major Diagnostic Groups,
Hospital Programs, 1976 (in Descending Order)
Including rehabilitative care.
 HOSPITAL PROGRAMS
G 117
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 G 118
MINISTRY OF HEALTH REPORT, 1977
Chart 111—Percentage Distribution of Hospital Cases,* by Type of Clinical Service,
Hospital Programs, 1976 (in Descending Order)
Adult Surgical 44.7%
Adult Medical 29.8%
Pediatric Medical       10.3%
Paediatric Surgical 9.4%
Psychiatric
5.1%
Rehabilitative Care       0.7%
Adult Surgical 42.1%
Adult Medical 22.5%
Maternity
18.3%
Paediatric Medical 5.9%
Psychiatric
Paediatric Surgical 5.1%
Rehabilitative Care       0.6%
5.5%
Including rehabilitative care.
 HOSPITAL PROGRAMS
G 119
Chart IV—Percentage Distribution of Hospital Days,* by Type of Clinical Service,
Hospital Programs, 1976 (in Descending Order)
Adult Medica
Paediatric Medical 6.9%
Psychiatric
Pediatric Surgical 4.3%
Rehabilitative Care       3.2%
;       . /  ::.rt:     :: :     v.
Adult Surgical
39.3%
Adult Medical
30.6%
Maternity
Psychiatric
Paediatric Medical 4.6%
Rehabilitative Care       3.3%
FEMALES
* Including rehabilitative care.
 G 120
MINISTRY OF HEALTH REPORT, 1977
Chart V—Average Length of Stay of Cases* in Hospitals in British Columbia, by Major
Diagnostic Groups, Hospital Programs, 1976 (in Descending Order) (Excluding
Newborns)
Diseases of the circulatory
system
Mental disorders
Neoplasms
Endocrine, nutritional, and
metabolic diseases
Diseases of the musculoskeletal
svstem and connective tissue
Certain causes of perinatal
morbidity and mortality
Diseases of the skin and
subcutaneous tissue
Diseases of the digestive
system
Congenital anomalies
PROVINCIAL AVERAGE
LENGTH OF STAY
Accidents, poisonings, and
violence
Diseases of the blood and
blood-forming organs
Diseases of the nervous
system and sense organs
Infective and parasitic
diseases
Diseases of the genito-urina
system
Diseases of the respiratory
system
Symptoms and ill-defined
conditions
Complications of pregnancy,
childbirth, and the
puerperium
Including rehabilitative care.
 Medical Services Commission
On July 1, 1968, the Government established an over-all Medical
Services Plan, which is administered and operated in accordance with
the Medical Services Act and regulations, under the supervision of
the Medical Services Commission. The commission is empowered
to function as the public authority appointed by the Government of
the Province to be responsible to the Minister in respect of the
administration and operation of the plan established under the regulations.
The Medical Services Plan of British Columbia provides a prepaid medical services plan upon uniform terms and conditions for all
residents of the Province and their dependants. Insured services under
the plan are paid for insured persons regardless of age, state of health,
or financial circumstances, provided the premiums fixed by the commission are paid. Payment for the services provided is made, on a fee-
for-service basis, according to a tariff of fees approved or prescribed
by the commission, or on a salaried, sessional, or contract basis at levels
approved by the commission.
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121
 G 122 MINISTRY OF HEALTH REPORT, 1977
MEDICAL SERVICES COMMISSION HIGHLIGHTS
During the past year the commission continued its endeavour to provide a high
quality of service to residents of the Province, with emphasis on prompt payment
of physicians and improved relations with the public and health professions.
The total expenditure for insured benefits under the Medical Services Plan
rose 7.12 per cent to $300,467,866 in 1976/77 from $280,509,129 in 1975/76.
The increased costs to the Medical Services Plan are a result of upward
revisions to the fee schedule, increased utilization of benefits, changes in the
practitioner/population ratio, and increased population.
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 preformed in a hospital as provided under the Medical Care Act
(Canada). A contribution from the Federal Government is payable to the Province
toward the cost of these insured services.
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. 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.
Chiropractic—Payment for the services of a registered chiropractor is limited
in any one year to a total of $75 per patient under the age of 65 years and $100
per patient 65 years of age or over. There is no payment for X-rays taken by a
chiropractor.
Naturopathic—Payment for services of a naturopathic physician is limited in
any one year to a total of $75 per patient under the age of 65 years and $100 per
patient 65 years of age or over. There is no payment for X-rays taken by a
naturopathic physician.
Orthoptic treatment—Payment for orthoptic treatment is limited to $50 per
patient in any one year and a maximum of $100 per family in any one year when
rendered to an insured person on the instructions of, or referral by, a medical
practitioner.
Physiotherapy—Payment for the services of a registered physiotherapist on
the instructions of, or referral by, a medical practitioner where performed other
than in general or rehabilitative hospitals, is limited in any one year to a total of
$75 per patient under the age of 65 years and $100 per patient 65 years of age or
over. Out-patient physiotherapy services in general hospitals or in rehabilitative
hospitals on referral by the medical practitioner are benefits provided by the British
Columbia Hospital Programs.
 MEDICAL SERVICES COMMISSION G 123
Podiatry—Payment for services of a registered podiatrist is limited to $50 per
patient in any one year and a maximum of $100 per family in any one year when
rendered other than on the instructions of, or referral by, a medical practitioner
within the year.  There is no payment for X-rays taken by a podiatrist.
Optometry—Services of registered optometrists are approved for required
diagnostic optometric services to determine the presence of any observed abnormality in the visual system. The plan does not pay for the fitting or cost of lenses.
Orthodontic—Service provided by a dental surgeon for an insured person 20
years of age or younger and which is consequentially necessary in the care of a
cleft lip and/or cleft palate is paid only where that service arises as part of or
following plastic surgery repair performed by a medical practitioner. There is no
payment for dentures, appliances, prostheses, or for general dental services other
than those referred to under basic medical services involving certain medical
procedures of dental surgeons, where necessarily performed in a hospital.
Special nursing—Special nursing services of a registered nurse are paid, including the cost of board, to a maximum of $40 per patient in any one year, but only
where such services are deemed advisable by a medical practitioner.
Under existing arrangements, the services of a member of the Victorian Order
of Nurses, acting under or with an attending medical practitioner, are paid under
the plan at a rate of $2 net per visit to a maximum of $40 per patient per year, but
this limit does not apply to the administering of injections on the instructions of a
physician.
No payment is made for any of the additional benefits when the service is
performed outside the Province of British Columbia.
SERVICES EXCLUDED UNDER THE PLAN
Services which are provided under other Federal or Provincial Acts such as
the National Defence Act (Canada), the Hospital Insurance Act, and the Workers'
Compensation Act of the Province.
Pathology, radiology, and/or electrodiagnostic services performed within the
Province at a laboratory that, at the time the service is rendered, is not an approved
laboratory for the performance of the service.
Services which are not considered to be medically required by the patient,
e.g., cosmetic services, examinations at the request of a third party, medico-legal
services, advice by telephone, travel charges of a practitioner.
While unexpected medical services arising when an insured person is temporarily absent from British Columbia are covered at British Columbia rates, prior
authorization in writing from a medical director of the plan is required where the
insured person elects to seek medical attention outside the Province, otherwise
payment may not be made under the plan.
PREMIUM RATES AND ASSISTANCE
For those persons having maintained a permanent residence in British Columbia for the 12 consecutive months immediately prior to making application, and
who otherwise qualify as eligible under the Medical Services Act Regulations,
premium assistance is available as follows:
5
 G 124 MINISTRY OF HEALTH REPORT,  1977
(a) Applicants who were not liable to pay income tax in the 12 months
ending December 31 of the previous year qualify for a subsidy of
90 per cent of the full premium rate.
(b) Applicants whose taxable income in the 12 months ending December
31 of the previous year did not exceed $ 1,000 qualify for a subsidy
of 50 per cent of the full premium rate.
Monthly premiums payable by subscribers, effective July 1,
1976, are as follows:
If Qualified for—
Full 50 per Cent 90 per Cent
Premium Subsidy Subsidy
.       $ $ $
One person     7.50 3.75 0.75
Family of two  15.00 7.50 1.50
Family of three or more ___- 18.75 9.37 1.87
(c) Temporary premium assistance is available for a three-month period
under unusual circumstances which, by reason of illness, disability,
unemployment, or financial hardship render an eligible person unable to pay his currently required premiums for coverage under the
plan. Temporary premium assistance is at 90 per cent of the full
premium rate.
LABORATORY APPROVAL
A six-member Advisory Board on Laboratories, appointed by the commission,
continues to provide advice and recommendations to the commission pertinent to
its determination of approval of laboratories for the performance of insured services
under the regulations set down by the Lieutenant-Governor in Council in September
1971. The commission is responsible for ensuring the reasonable availability of
quality laboratory services for insured persons throughout the Province, of controlling the expansion of facilities or provision of new facilities until there is
reasonable utilization of existing facilities, and of requiring that, where approved
public facilities provide service of equal quality and availability, priority consideration be given to the services provided by such approved public facilities.
PROFESSIONAL REVIEW COMMITTEES
As in the past, the commission has continued to work closely with the peer
review committees of physicians and other practitioners providing services under
the plan.
The commission provides data to the professional licensing authorities or other
relevant practitioner bodies with respect to the volume and type of services rendered
under the plan and various other statistical information on an annual basis. The
commission also provides various statistical information to them on a request basis.
SALARIED AND SESSIONAL
While most medical sei
service basis, there is, neve
salary or sessional fee basis.
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
 Telephone inquiries to the Medical Services Plan offices are handled by operators in
the registration and premium billing division who have immediate access to computer files.
Three of the 11 computer terminals are shown above. This unit receives approximately
20,800 telephone inquiries a month.
Alcohol and Drug Commission staff provide basic lay-counsellor training for local
community groups wishing to provide help to people with alcohol and drug problems.
Couple in background adopt patient and counsellor roles, while camera at left records
session on videotape for later playback and analysis.
  MEDICAL SERVICES COMMISSION
G 125
Apart from the Provincial Government, which employs physicians in this way,
there are many other organizations within the Province which make arrangements
with physicians to provide insured services on this basis and arrange with the
Medical Services Commission for reimbursement of their costs.
When the Medical Services Commission reimburses an organization which
employs a doctor performing insured services on a salaried basis, a payment is
made to the organization for the shareable portion of the doctor's salary, that is,
the proportion of the salary which represents the time he spent on providing
insured services to individuals. An additional amount is paid to cover the relevant
overhead costs of the organization employing the doctor.
A sessional fee is a payment of a set amount of money for the part-time
services of a physician for half a day (three and one-half hours) and the sessional
fee includes, where pertinent, a payment for overhead, which goes to the physician
because of his continuing overhead costs in his additional private practice.
In the year 1976/77 the total expenditure on injured services by the Medical
Services Commission was $300,467,866, which was made up of $285,587,456 in
the form of fee-for-service payments and $14,880,410 for salary and sessional
payments.
STATISTICAL TABLES
STATISTICAL HIGHLIGHTS
The total expenditure for insured benefits under the Medical Services Plan
rose 7.12 per cent to $300,467,866 in 1976/77 from $280,509,129 in 1975/76
(see Table 32).
The per capita cost for insured benefits rose 5.82 per cent over the previous
year (population, October 1, 1975 = 2,458,000; October 1, 1976 = 2,488,000).
The per capita cost of insured benefits shared by the Federal Government rose
5.46 per cent over the previous year.
The per capita cost of insured benefits not shared by the Federal Government
rose 12.23 per cent over the previous year.
Contributions to the Medical Services Commission under the Medical Care
Act (Canada) and Hospital Insurance Diagnostic Services Act is estimated to be
$124,450,000 or 43.9 per cent of the shareable cost (see Table 32).
Administration costs were 4.2 per cent of the total costs in 1976/77 (see
Table 32).
The increased costs to the Medical Services Plan are a result of upward
revisions to the fee schedule, increased utilization of benefits, changes in the
practitioner/population ratio, and increased population.
 G 126
MINISTRY OF HEALTH REPORT, 1977
SUBSCRIBER STATISTICS
Table 24—Registrations and Persons Covered,1 by Premium Subsidy Level,
at March 31,1977
Subsidy
(Per Cent)
90  _
50 ....
Subscribers
        247,869
        27,603
Nil       815,296
Totals   1,090,768
Persons
398,303
51,711
2,053,484
2,503,498
Table 25—Persons Covered, by Age-group, at March 31,1977
Age-group
Under 1
1-4 	
5-14 .....
15-24 ...
25-44 ...
45-64 ...
65-69 ...
70-79 ...
80-89 _
90 and over
Unknown 	
Total
Persons
31,296
143,221
425,266
478,702
679,677
490,586
86,014
105,935
45,599
8,400
8,802
2,503,498
1 Coverage data do not include members of the Canadian Armed Forces, RCMP, and inmates of Federal
penitentiaries.
Chart VI—Coverage, by Age-group, at March 31, 1977
5-14 15-24 25-44
Age-group
45-64 65 and Over Unknown
 MEDICAL SERVICES COMMISSION
Table 26—Coverage, by Family Size, at March 31, 1977
G  127
Family Size
(Persons)
Number of
Families
1       470,918
2       251,172
3
4
5
6
7
9 or more
118,133
140,138
69,297
27,070
9,042
3,135
1,863
Total    1,090,768
Chart VII—Coverage, by Family Size, at March 31, 1977
I
Family Size (Persons)
■
 G 128
MINISTRY OF HEALTH REPORT, 1977
FEE-FOR-SERVICE PAYMENTS
Medical Practitioners and Dental Surgery in Hospital
(Shareable under Medical Care Act (Canada) and Hospital Insurance Diagnostic Services Act)
Table 27—Distribution of Fee-for-service Payments for Medical Services
(Shareable)
Specialty
Amount Paid*
1975/76
1976/77
Percentage of Total
1975/76      1976/77
Cost per Personz
1975/76        1976/77
General practice 	
Dermatology  	
Neurology 	
Psychiatry	
Neuropsychiatry  	
Obstetrics and gynaecology.	
Ophthalmology	
Otolaryngology 	
Eye, ear, nose, throat —
General surgery	
Neurosurgery 	
Orthopaedic surgery	
Plastic surgery- 	
Thoracic surgery	
Urology  	
Paediatrics  	
Internal medicine	
Radiology	
Pathology.	
Anassthesiology. ~ _.
Physical medicine	
Public health	
Dental surgery in hospital	
Osteopathy  	
Unclassified 	
Totals	
105
2
1
7
9
9
4.
16
1
6
1,
1.
4,
5,
14.
18
18
9
$
,0#>,418
,863,102
,879,674
,241,146
255,350
,423,996
,499,490
,378,720
67,808
,236,333
,487,416
,100,443
,924,550
534,638
234,210
207,397
,729,605
,791,569
,512,358
,562,753
349,134
37,125
797,895
267,524
,839,927
121,268,241
3,267,459
2,215,236
8,107,158
270,201
10,591,056
10,793,888
4,802,170
78,040
17,445,619
1,470,098
7,350,110
2,211,734
1,790,910
4,676,948
6,373,353
18,031,588
21,331,364
22,930,983
10,559,120
387,558
82,323
1,042,896
253,008
5,418,988
245,282,581    |    282,750,049
 I	
42.83
1.17
0.77
2.95
0.10
3.84
3.87
1.79
0.03
6.62
0.61
2.49
0.78
0.63
1.72
2.12
6.00
7.66
7.55
3.90
0.14
0.02
0.33
0.11
1.97
100.00
42.89
1.16
0.78
2.87
0.10
3.75
3.82
1.70
0.03
6.17
0.52
2.60
0.78
0.63
1.65
2.25
6.38
7.54
8.11
3.73
0.14
0.03
0.37
0.09
1.91
$
42.7422
1.1648
.7646
2.9460
.1039
3.8340
3.8647
1.7814
.0276
6.6055
.6051
2.4819
.7830
.6243
1.7226
2.1186
5.9925
7.6451
7.5315
3.8905
.1420
.0151
.3246
.1088
1.9691
100.00
99.7895
48.7422
1.3133
.8904
3.2585
.1086
4.2569
4.3384
1.9301
.0314
7.0119
.5909
2.9542
.8890
.7198
1.8798
2.5616
7.2474
8.5737
9.2166
4.2440
.1558
.0331
.4192
.1017
2.1780
113.6455
i Includes only those payments which have been made during the respective fiscal periods.
2Based on population as at October 1, as provided by the Dominion Bureau of Statistics (October 1, 1975 =
2,458,000; October 1, 1976=2,488,000).
 MEDICAL SERVICES COMMISSION
G 129
Table 28—Distribution of Medical Fee-for-service Payments and Services,
by Type of Service
Type of Service
Number of Services*
Amount Paid*
1975/76
1976/77
1975/76
1976/77
General Practitioners
840,991
4,750,866
2,015,474
504,508
117,426
52,857
1,588,357
921,305
5,138,438
1,928,602
532,592
120,128
51,652
1,615,598
$
14,755,705
41,781,369
11,165,550
11,130,950
1,949,202
696,007
7,285,156
$
17,833,752
49,650,511
Subsequent office visit	
11,644,309
12,920,042
2,176,642
742,415
8,347,479
9,870,479
10,308,315
88,763,939
103,315,150
Specialists
Consultation.               	
818,317
7,101
410,533
511,561
872,218
8,705
446,491
597,871
27,138,260
219,769
3,032,591
4,052,763
31,708,063
292,389
3,725,470
5,232,490
Subtotals	
1,747,512
1,925,285
34,443,383
40,958,412
Other Medical
1,972,565
52,326
455,903
678,922
1,196,817
5,888,239
1,279,209
208,876
16,173
12,602
1,950,739
56,577
473,023
711,401
1,245,188
6,429,943
1,301,000
203,227
16,543
14,183
12,428,983
7,533,653
34,101,129
10,080,800
18,418,583
24,042,481
6,661,863
5,597,453
527,837
2,682,477
13,307,831
Obstetrics	
8,530,339
Surgery   '	
37,591,620
11,598,083
20,834,883
X-ray _	
29,576,147
7,486,805
Psychotherapy	
6,245,203
610,518
2,695,058
11,761,632
12,401,824
122,075,259
138,476,487
Totals	
23,379,623
24,635,424
245,282,581
282,750,049
i Includes only those services which have been paid during the respective fiscal periods.
 G 130 MINISTRY OF HEALTH REPORT, 1977
Table 29—Average Fee-for-service Payments, by Type of Practice1
Type of
Practice
Number of Active
Practitioners
1975/76
1976/77
Average Payments
1975/76        1976/77
Median Payment^
1975/76
1976/77
I
General practice  	
Dermatology  	
Neurology... — 	
Psychiatry- 	
Neuropsychiatry	
Obstetrics and gynaecology-
Ophthalmology   	
Otolaryngology  	
General surgery	
Neurosurgery  _	
Orthopaedic surgery  	
Plastic surgery-
Thoracic and cardiovascular surgery-
Urology _ 	
Paediatrics _ _	
Internal medicine  	
Anaesthesia  .	
Physical medicine  —	
Osteopathy-
Surgery, general practice3	
Paediatrics, general practice3	
Internal medicine, general practice3..
1,461
33
23
104
2
102
115
51
161
19
76
24
13
46
53
143
170
5
4
43
22
18
1,598
36
28
123
2
112
114
52
166
17
86
25
12
48
57
183
179
5
5
42
22
14
63,680
80,513
82,550
60,483
127,108
87,414
82,783
88,011
81,268
77,072
79,121
79,901
126,949
91,589
66,544
79,408
57,721
58,352
62,781
59,124
63,241
52,311
69,272
90,458
82,162
60,817
134,678
91,443
95,006
96,052
84,846
82,405
86,192
87,955
157,909
96,862
76,568
87,192
59,632
68,067
50,492
67,609
69,169
59,353
63,991
76,170
82,485
61,883
127,108
85,142
81,112
86,383
77,791
71,803
75,735
75,861
137,141
86,612
61,754
77,143
56,978
60,640
47,240
60,737
57,400
48,158
68,367
88,257
79,584
61,367
134,678
91,068
90,735
95,224
82,583
83,530
81,870
84,907
149,854
87,559
72,601
81,650
61,169
63,302
29,325
60,359
66,437
54,647
I
1 Type of practice is based on practice being carried out, rather than on certification.
2 Includes only those physicians whose services on a fee-for-service basis grossed $20,000 or more.
3 These are special classifications created for statistical purposes.   Physicians in these categories are certified
specialists, but derive 50 per cent or more of their income from general practice services.
ADDITIONAL BENEFITS
Fee-for-service Payments, Nonshareable by Federal Government
Table 30—Distribution of Fee-for-service Payments for Insured Services,
Nonshareable Additional Benefits
Amount Paid1 2
Percentage of Total
Cost per
Person3
1975/76
1976/77
1975/76
1976/77
1975/76
1976/77
$
2,869
24
14,180
6,948,718
282,599
2,458,833
81
4,448
1,279,644
3,632,256
73,830
52,048
$
3,284
0.02
0.10
47.11
1.92
16.67
0.03
8.67
24.63
0.50
0.35
0.02
0.08
45.51
2.08
18.08
0.03
9.14
24.11
0.50
0.45
$
0.0012
.0051
2.8270
.1150
1.0003
.0018
.5206
1.4777
.0300
.0212
$
0.0013
13,604
8,117,112
371,719
3,225,027
5
5,405
1,630,866
4,300,985
88,528
80,872
.0055
3.2625
.1494
1.2962
Orthoptic.	
.0022
.6555
1.7287
.0356
Unclassified	
.0325
Totals        -	
14,749,530
17,837,407
100.00
100.00
6.0006
7.1694
1 Includes only those payments which have been made during the respective fiscal periods.
2 These amounts are fee-for-service payments made under the plan only, and in no way reflect the total for
the services of these practitioners.
3 Based on insured population at October 1, as provided by the Dominion Bureau of Statistics (October 1,
1975 = 2,458,000; October 1, 1976 = 2,488,000).
 MEDICAL SERVICES COMMISSION
G 131
Table 31—Average Fee-for-service Payments, by Type of Practice,
Nonshareable Additional Benefits
Type of Practice
Number of Active
Practitioners
Average Payment1
Median Payment
1975/76
1976/77
1975/76
1976/77
1975/76
1976/77
Chiropractic	
Naturopathic	
Physiotherapy-	
174
8
62
27
132
180
9
80
29
135
$
38,476
32,514
33,276
42,384
26,354
43,328
39,571
35,178
53,452
29,833
$
36,267
32,254
27,519
45,592
25,401
$
40,258
37,528
24,483
54,833
28,889
i Includes only those practitioners whose payments from the British Columbia Medical Services Commission
grossed $10,000 or more. It must be emphasized that these payments in no way represent the practitoners* total
income or net income.
Table 32—Summary of Expenditures, 1969/70 to 1976/77
(Calculated on an Accrued Basis)
Medical
Fee-for-Service
Salaried and
Sessional
Additional
Benefits
Administration
Total
1969/70	
1970/71	
$
105,700,011
122,818,267
127,000,505
139,532,341
159,614,356
190,452,494
250,026,093
268,496,7491
$
3,677,387
4,375,798
4,788,365
6,022,920
7,991,062
10,424,602
15,437,520
14,880,4101
$
6,929,779
6,611,815
5,534,520
7,897,244
8,963,080
11,089,892
15,045,516
17,090,707
$
5,687,035
6,030,059
6,567,847
7,320,137
8,581,794
12,501,015
12,659,521
13,040,063
$
121,994,212
139,835,939
1971/72	
1972/73	
1973/74	
1974/75	
143,891,237
160,772,642
185,150,292
224,468,003
1975/76
293,168,650
1976/77  	
313,507,929
lThe Federal contribution applicable to 1976/77 is projected to be $124,450,000 or 43.9 per cent of total
payments for shareable costs.
  z
o
IS)
z
Government Health Institutions
Although the emphasis in mental health care is on community-
based services, there will continue to be a need for specialized facilities
to accommodate those whose treatment cannot be adequately taken
care of at the community level. Facilities for specific types of care have
been developed under Government agencies. These include facilities
and services for those of the mentally ill, the emotionally disturbed,
and the senile aged, as well as the tubercular and the profoundly
physically disabled whose condition requires admission to a specialized
treatment unit.
Effective November 7, 1977, I. Manning was appointed as Director of Government Health Institutions. These institutions comprise
Riverview Hospital and Valleyview Hospital (Essondale), Dellview
Hospital (Vernon), Pearson Hospital, and the Willow Chest Clinic
(Vancouver).   A brief report of these facilities follows:
z
iu
3
>
O
(7
133
 G 134 MINISTRY OF HEALTH REPORT, 1977
RIVERVIEW HOSPITAL
The continuing drive toward accreditation of Riverview Hospital by the
Canadian Council on Hospital Accreditation was the focus of a great deal of activity
in all departments throughout the year. While progress was made, the Council
surveyors made a number of recommendations for improvements needed to enable
the hospital to meet or exceed the accreditation standards. At the year-end an
active Accreditation Committee was at work under the leadership of the Director
of Nursing.
The extent of the customary practice of secluding patients who have become
disturbed was reviewed in the accreditation survey, and scrutiny of the policy by
Nursing and Medical staffs was under way. Through these concerted efforts, a
substantial reduction in the use of seclusion rooms was anticipated, with various
approaches of a more therapeutic nature being more widely used instead.
Material progress was made on a previous accreditation recommendation that
the two laboratory areas be unified, and a contract for this work was awarded in
October.
A number of significant changes occurred in the organization of treatment
services during the year. Because of a long waiting-list for the admission of
patients suffering from chronic organic brain syndrome, this program was relocated
in the Centre Lawn Unit and was expanded from 40 to 86 beds. An assessment
team involving a physician and senior nurse assessed all patients referred for this
program from the local area.
A corresponding relocation and centralization of all acute psychiatric services
to the Crease Unit was accomplished. Participation of senior psychiatric staff in
the Inter-hospital Co-ordinating Committee improved communication between the
hospital and other psychiatric services in the Vancouver area. The most urgent
referrals from these units had been for the admission of patients considered too
disturbed to be handled in the general hospital. In order to provide a satisfactory
service for these patients, Ward West-4 of the Crease Unit was developed as an
intensive care special admitting ward. The regionalization of patients admitted from
non-Vancouver areas was preserved in this move.
Surgical and general medical services, of both an acute and long-term nature,
were centralized in the North Lawn Unit. To accommodate the needs of this service,
renovations in the North Lawn Building were planned, in order to relocate the
surgical consultation services and the Radiology Department in that area.
Close liaison with the assessment teams for intermediate and extended care
facilities was established, in order to facilitate transfer to these facilities of patients
no longer requiring the more intensive and specialized services provided at Riverview Hospital.
The Medical Staff Organization continued its activities, including the function
of monitoring the quality of care. In this connection the Psychiatric Audit Committee developed criteria for treatment of particular psychiatric conditions as an aid
to the audit process.
The Department of Nursing also pursued its audit work, and developed and
implemented a program of nursing histories and nursing care plans for each patient.
Revision of Nursing Policy Manuals was also undertaken, and an over-all Hospital
Policy Manual was developed.
The first steps in a long-range plan for the aged hospital plant were taken
during the year, and discussions were under way late in the year for its resumption,
in liaison with the British Columbia Buildings Corporation.
 GOVERNMENT HEALTH INSTITUTIONS G  135
VALLEYVIEW HOSPITAL
Valleyview Hospital, located on the Essondale site in Coquitlam, provides
620 in-patient beds to those over 70 years of age with psychiatric problems that
cannot be handled elsewhere in the community.
In preparation for the introduction of the Long-term Care Program on January
1, 1978, efforts at Valleyview have been made to expand the acute psychiatric
treatment wards of the hospital and to extend its training facilities to assist the
community-based care facilities for the aged. Plans were also under way to
reorganize and expand activation services in order to embark upon an outreach
program.
During 1977 the Valleyview volunteer auxiliary was incorporated under the
Societies Act. Two "firsts" were achieved with the appointment of the first male
president of any hospital auxiliary in British Columbia, and the opening of the first
auxiliary Gift Shop in any Government hospital.
The changes in health care facilities in the Lower Mainland affected the mix
of patients in Valleyview. During the year, many patients who had been stabilized
in their psychiatric condition, but still had physical maladies, were discharged to
extended-care beds. Difficulty was still being experienced in accommodating
patients ready for discharge but who required only intermediate or personal care.
The patient population at the end of 1977 was far more ambulatory than at the
beginning of the year, as many bed patients were placed in extended care, and new
patients from the community filled the beds in Valleyview.
During 1977, Valleyview admitted 242 patients from the community; 70 were
discharged; 110 were released on leave, and 119 died in hospital.
DELLVIEW HOSPITAL
Dellview Hospital is a special care facility under the Government Health
Institutions, providing for the needs of geriatric patients over 70 years of age who
suffer from mental illness.
The Minister of Health visited the hospital during September and announced
that Dellview would be transferred to a society administration of one form or
another.
Medical services continued to be provided through the part-time services of a
physician, with dental services available through a local dentist using the hospital's
dental suite. Psychiatric support was available through the Vernon Mental Health
Centre, while physiotherapy, pharmaceutical, radiological, and regional laundry
services were available under contract from Vernon Jubilee Hospital. Twenty-five
new head gatch beds were purchased during the year and made nursing the elderly
considerably easier.
All patients received swine flu and Victoria 'A' vaccine early in the year with
no adverse effects noted. The incidence of flu was much less than in the past
several years.
In-service programs were very active with a total of 112 programs and 468
session. Films, cassette tapes, cassette and slide presentations were used. There
were lectures on safety, fire, housekeeping, dietary, nursing procedures, diagnostic
procedures, nursing upgrading, drug therapy, aggression, behaviour modification,
diabetes, strokes, respiratory care, metric system, body mechanics, and Workers'
Compensation.
 G  136 MINISTRY OF HEALTH REPORT,  1977
Educational programs held included Wheelchair Seminar; History Taking
Counselling and Interviewing; Defensive Driving; Care for the Elderly; Safety
Program for the Ministry of Highways and Public Works; and St. John's Industrial
First Aid.
During the year Public Works was very active on the hospital premises,
with the moving of the hospital administration to their new Administration
Building; installing insulation; and the painting of three wards. This created a
temporary reduction in bed count, but new, bright, well-maintained wards made it
well worth the additional effort of patient relocations within the hospital. Consequently, admissions were down somewhat from previous years. At the year-end
all male applicants had been admitted, but a fair delay was being experienced by
the continuing increase in female patient applications.
The Dietary Department maintained a very satisfactory service, providing
many little extras for patient parties and outings throughout the year.
Housekeeping maintained an excellent standard throughout the year, in spite
of all the construction activity in the hospital.
An "Open House '77" was held during September and was well attended by
the local community. The Dellview Social Club was very active hosting a number
of dances and sporting events.
An intensive remotivation program was implemented for 25 female patients
in the Annex. The program was designed to promote independence, self-help, and
self-esteem in the patient. Along with this program a day care program was started
in the Annex for patients from the main wards who could gain from the behaviour
modification program. Both programs were very successful, with many patients
recovering old skills in cooking, baking, personal hygiene, and independent thought
and actions.
The Summer Student Employment Program provided employment for 23
students. With the assistance of these students a full and varied activities program
was implemented. Every patient, except the seriously ill, was included and took
an active part in the program. Their activities included picnics at local lakes,
barbecues, outings to local parks, shopping trips, entertainment by local choirs,
visits to private homes, cherry-picking, and tours of local orchards during blossom-
time.
The Occupational/Recreational Therapy Department initiated and maintained
a wide variety of programs, including bowling, movies, bingo, parties, dances, arts
and crafts, remedial exercises, pub therapy, and in general did much to brighten
the patient-day. During the year a new station wagon was purchased by the
hospital, which greatly increased patient outings.
During December a number of local choirs toured the hospital, entertaining
the patients with Christmas carols.
During the Patients' Christmas Party, one full evening of entertainment was
presented by seven separate groups of performers who toured through the hospital,
performing in each ward.
PEARSON HOSPITAL AND WILLOW CHEST CENTRE
During the year, Pearson Hospital continued to provide in-hospital care for
tuberculosis patients; persons with severe respiratory disabilities, primarily from
poliomyelitis; and extended-care patients where the emphasis is on the younger age-
group.   Willow Chest Centre In-patient Unit continued to be vacant, pending
 GOVERNMENT HEALTH INSTITUTIONS
G 137
completion of major renovations, following which the tuberculosis patients at
Pearson Hospital would be moved to Willow. This was expected to take place
during March or April of 1978.
At Pearson Hospital the numbers of both polio and tuberculosis patients
dropped significantly, and allowed the consolidation of patients from two wards
each into one ward of each. This reduction coincided with planned upgrading of
toilet and washroom facilities which, when completed, will result in an additional
78 extended-care beds being available.
During the year a pilot project was organized to assess the value of an outpatient therapeutic program for persons eligible for intermediate or extended care.
The goal of this program is to prevent or delay hospitalization through allowing the
patient and the family to deal more effectively at home with the problems related to
physical disabilities. Indications were that the program was quite successful and
was meeting a real need in the community. At the year-end, full establishment of
the program on a continuous basis was being recommended. This is a team program
involving Occupational Therapy, Physiotherapy, Nursing, and to a lesser degree
Dietary and Social Services.
Additional involvement in community health care was the subject of considerable planning during the year. Architectural drawings and models were
prepared, and funds have been requested, for the converting of the old auditorium
into an education centre. The hospital was already involved in educational programs which were available to community hospitals, but planned to expand this
role, to provide additional programs to health care workers and families of the
disabled in the community. A basic no-frills approach was envisioned, which would
involve teaching of the elementary aspects of caring for the physically disabled
either in hospital or at home.
Progress was made in 1977 within the areas of Nursing care and Nursing
administration. An extensive study of charting systems and evaluation of the
quality of care commenced. New treatment approaches were initiated, particularly
in respect to prevention and management of decubiti ulcers. Considerable effort
was expended on staff development, as well as in completing and preparing for the
implementation of the reorganization study of this department.
In regard to medical care, a number of staff changes were made, including the
appointment of Dr. M. Seraglia as Medical Co-ordinator, and the obtaining of the
services of a psychiatrist, a gynaecologist, and a dentist.
During the year the Director of Dietetics, and the senior dietary consultant
from the Hospital Consultation Division, updated their earlier report on the proposed construction of a new main kitchen required to modernize the preparation
and the distribution of food within the hospital, as well as to significantly reduce
the high cost of the present out-dated labour-intensive system.
Commencing May 1, 1977, all meat, fish, and poultry have been purchased
from the Central Butcher Shop at Riverview. Good service and reduced costs
resulted.
Starting in April, all maintenance and repair work on hospital vehicles was
done at Central Transport, Riverview Hospital, with reduced costs and responsive
service.
Electronic safety procedures were commenced and testing equipment purchased, with the assistance of the consultant Biomedical Engineer from Hospital
Programs.
The co-operation received from Public Works was very good and considerable
upgrading of the physical plant was accomplished.
 G 138 MINISTRY OF HEALTH REPORT, 1977
Within the Social Service Department the past year saw an even greater
involvement of staff in team and community activities, with a resultant improvement
in the quality of service delivered to the patient. There was renewed interest and
assistance from Handicapped Resources, Alcoholics Anonymous, Vancouver School
Board, Vancouver City College, the Canadian Paraplegic Association, the Multiple
Sclerosis Society, and others.
The Laboratory was granted accreditation, for the first time, by the Joint
Committee on Accreditation for Diagnostic Services. Later in the year, A. Drever,
Senior Technician, received a certificate of merit from the American Pathology
Association Quality Control Program.
The X-ray Department was redecorated with a much cheerier atmosphere
being presented to the patients. The obtaining of a surplus X-ray unit from Riverview was being pursued, in order that safety and quality of work can be improved.
Drug profiles have been completed on four wards and it was hoped to continue
establishing them on the remaining wards. A costing system was set up so that
more accurate costing could be carried out for the four in-patient programs within
the hospital, rather than on an averaging basis as was done previously. This confirmed that drug costs for the extended-care patients had been reduced.
The Personnel Department was very active during the year, with a number of
grievances being dealt with and major classification reviews being implemented.
Several studies were completed and reports submitted. These included Staff Development and Training; Emergency Services Plan (Strike); Fire Emergency
Instructions; Nursing Reorganization Plan, and a Ministry Organization Proposal.
An Assistant Executive Director, B. Swan, was recruited and a number of
projects were commenced, including hospital forms review, metric conversion,
review of nursing clerical and record systems, medical records procedures, key
control system, accounting and trust fund procedures, duplicating facilities, etc.
One of the highlights of the year was the celebration of the hospital's silver
anniversary, including an open house on September 23, with the Honourable
R. McLelland, Minister of Health, as a special guest. There was considerable
patient involvement in the activities of the day and a tremendous amount of
enthusiastic staff input. The original Medical Director, Administrator, and Director
of Nursing were among the many visitors.
The year 1977 was productive, marked by progress in program development
and provided the promise of future improvement, and efficiency, in the delivery of
care to the patient and the community.
 o
>
EMERGENCY HEALTH SERVICES COMMISSION
The commission was established pursuant to an Act of the Legislature effective
July 1, 1974, with the following powers and authorities:
(a) To provide emergency health services in the Province:
(b) To establish, equip, and operate emergency health centres and
stations in such areas of the Province that the commission considers
advisable:
(c) To assist hospitals, other health institutions and agencies, municipalities, and other organizations and persons to provide such services, and to enter into agreements or arrangements for that purpose:
(d) To establish or improve communication systems for emergency
health services in the Province:
(e) To make available the services of medically trained persons on a ^1
continuous, continual, or temporary basis to those residents of the
Province who are not, in the opinion of the commission, adequately             >a
served with existing health services:                                                                   tmm
(/) To recruit, examine, train, register, and license emergency medical
assistants:
(g) To provide ambulance services in the Province; and
(h) 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 m
Provincial Emergency Programme, such as medical involvement in disaster plan- |^%
ning, responsibility for Federal stores stockpiled around the Province, and involvement when actual disasters occur.
During the year, one full-time crew member was added to each of the following volunteer-manned stations: Fort Nelson, Burns Lake, Nakusp, Sicamous, and
Revelstoke. New services were opened at Lions Bay and Kitwanga, and authorization has been given to open stations at Wells and Field, bringing the total number
of operational stations throughout the Province to 159.
The commission provides three levels of instruction to ambulance crews:
Emergency Medical Assistant I—80 hours, basic course. ^P
Emergency Medical Assistant II—240 hours, more advanced training.
Emergency Medical Assistant III—1 year, advanced pre-hospital care
("paramedic").
Thirty-three EMA I courses were given involving 351  students; seven EM A II ^J
courses were given involving 120 students; three EMA III courses involving 32
students are at present in progress. Each EMA III course is preceded by a pre-
entrance course and examination and 67 students took this course.   Four instructor Ui
training courses were arranged involving 32 potential instructors, and covered such t^
subjects as infant transport, driver training, and instruction techniques.   In addition, 2J
840 Industrial First Aid Certificates were either renewed to existing full-time or UB
part-time employees, or were presented to new part-time employees. UJ
This year, the EMA I course has been given on week-ends to part-time crew
members who were prepared to give up the necessary time. The response to this
approach has been overwhelming, and this program is fully committed for the
next year. The present program allows for six such courses to be carried on
simultaneously.
139
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 G 140 MINISTRY OF HEALTH REPORT, 1977
For the fourth year, the commission employed a physician to provide medical
coverage for the fishing fleet for a 10-week period divided between Rivers Inlet and
the Port Renfrew area.
Funds were made available during 1977 to increase the ambulance production
program, with the result that 42 new units were placed on the road during the year.
In addition to the ambulance production program, the commission workshop outfitted and modified 14 vehicles provided for the Ministry of the Attorney-General
for use as mobile breath/alcohol testing units.
The commission was authorized to institute an air ambulance service effective
February 1, 1977. To co-ordinate this program, a Provincial Dispatch Office has
been established in Victoria, and all air movements are now channelled through
this Dispatch Office. It is estimated that, since inception of this service in February,
approximately 1,180 flights will have been co-ordinated by the end of 1977.
As in former years, two meetings were held with representatives of the Provinces of Alberta, Manitoba, and Saskatchewan responsible for ambulance services.
The Executive Director of the commission also participated in the following meetings: International Congress on Disaster Medicine in Germany; a two-day meeting
with the Swiss Air Rescue Service in Zurich, on the subject of air ambulance service
and rescue techniques for mountainous terrain; a meeting of the American College
of Emergency Physicians; the B.C. Road Safety Committee; meetings of the Interdepartmental Working Committee on Traffic Safety; and several meetings of the
Vancouver City Disaster Committee in relationship to disaster planning for the
Lower Mainland. A two-day seminar on ambulance techniques was held in Kamloops, attended by both full-time and part-time crew members, and was opened by
the Minister of Health. The Executive Director was also responsible for the
organization of the annual meeting of the American Association for Automotive
Medicine held in Vancouver, at which meeting he presented a paper on the functions
and organization of the commission. Visits were also made to some of the more
remote services in the Province during the year.
At the request of the B.C. Ferry Corporation, medical emergency kits were
placed on 12 of the ferries, containing equipment suitable for use by physicians in
an emergency. These kits will be maintained by the commission. Staff will check
the contents periodically and arrange replacement of out-dated medication.
The commission has experienced an increase in call volume of approximately
9 per cent compared with the previous year.
 FORENSIC PSYCHIATRIC SERVICES COMMISSION
A number of significant developments occurred over the past year in the
provision of forensic psychiatric services in this Province and it was gratifying to
note that the program was receiving national recognition as an exemplary service.
Heavy demands were made upon the Forensic Psychiatric Institute, which continued as the major in-patient assessment and treatment service. Admissions to this
unit increased by 15 per cent over the past two years, with a relative increase of
93 per cent in the number of individuals remanded for psychiatric assessment.
These latter cases were particularly demanding on professional time. Recognizing
that the institute must fulfil its statutory obligation, and that it cannot function
effectively at the current high bed utilization rate of 94 per cent, there was agreement in principle to an increase of the bed capacity from 130 to 155 beds, and the
provision of the necessary staff and services.
The commission has co-operated closely with the Ministry of the Attorney-
General in the establishment of a full-time, as opposed to a part-time, Chairman
of the Review Board backed by the necessary staff. This has facilitated the regular
review of the status of Order in Council patients and the new procedure is proving
most effective, particularly in assisting in the rehabilitation of the longer term patients.
At the year-end the Victoria Clinic was in full operation and was providing a
very satisfactory level of service to southern Vancouver Island. The Vancouver
Clinic was also fully operational and in August assumed full responsibility from the
Ministry of the Attorney-General for providing services to the Vancouver City Jail
and Lower Mainland Regional Correctional Centre. A court liaison officer was
appointed who worked closely with the Crown Prosecutor's office in the disposition
of individuals charged with an offence who are mentally ill. The commission also
continued to provide assessment services for juveniles referred by the court either
on an out-patient basis or at Willingdon Detention Centre, and they have accepted
the responsibility of providing psychiatric services to the containment program
when this service becomes operative.
During the year the administration moved to 805 West Broadway where the
commission occupies the Seventh Floor. The provision of additional space allowed
not only the extension of the clinical service, but the relocation of the administrative
offices for the commission as a whole. The new services and expanded case load
placed a heavy burden upon the administrative staff and there was an urgent need
to augment the personnel, medical records, and business offices. The kitchen equipment of the Forensic Psychiatric Institute was being replaced and it was anticipated
that a building program will be initiated in the coming year.
A co-ordinator of education will be appointed in January 1978. In the meantime, a great deal of formal and informal education was provided to the community
at large and to the various professional groups. The Executive Director was
particularly involved in discussions with the judiciary, lawyers, correctional staff,
and police. Only when mutual trust and understanding exists^ can the forensic
service hope to be effective in the complex sphere in which it operates. Dr. Duffy,
the Executive Director, was honoured by being asked to participate as a resource
person to a national conference of judges in November. In the field of research,
the commission was initiating a study on diversion and hoped to receive funds to
commence a full-scale research project in this area in 1978.
In September, eight of the original 10 Commissioners appointed in August
1974 were replaced by four new appointees, thereby reducing the board to six
members. A great deal of credit was due the original commission members, who
guided the forensic service through its difficult formative years, and had the satisfaction of seeing a soundly based program in operation at the time of their retirement.
141
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  ALCOHOL AND DRUG COMMISSION
COMMISSION DIRECT TREATMENT SERVICES
Alcohol and Drug Counselling Services
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55
During 1977 there was a consistent and increasing capacity on the part of the
commission, and its direct and indirect service agencies, to provide support to the
individual caught up in an alcohol or other drug dependency.
The regionalization of the Province into four areas was completed and a more
effective and equitable distribution of services had been achieved.    In November %v9
1977 a Regional Supervisor responsible for the direct services in the Lower Mainland was appointed.
By the end of the third quarter, December 31, 1977, one new 20-bed detoxica-
tion centre, two intensive residential treatment centres totalling 55 beds, and three
out-patient clinics had become operational. Two narcotic out-patient clinics had
been taken over as a direct service, and a number of existing out-patient clinics had
been adapted to serve a wider geographic area.
To determine future funding priorities the commission was evaluating the \J
impact of the Revelstoke Dam project and the Alcan Pipeline on Northern and
Interior communities.
Where treatment services did not exist, or would not be an effective means of
bringing treatment to the area, the commission staff played a supportive role to
existing community agencies and groups through consultative service, audio-visual
and print materials, workshops, and training programs.
In conjunction with the Regional Director, Health and Welfare Canada, the
commission assumed co-ordinating responsibility for native Indian matters relating
to alcoholism.
At the year-end the Commission was developing a health entry program for
the treatment of heroin addiction in B.C., with a target date of December 31, 1978,
for implementation.
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Alcohol and Drug Counselling Services continued to be offered at the four
Vancouver area offices. Plans were under way to broaden the base of operations
and relocate units in Burnaby/New Westminster and the North Shore areas.
During the year a counsellor visited Pender Street Detoxication Centre to provide
a "Film and Group Program" to clients on a daily basis.   This approach proved I J
effective and resulted in a significant increase in the number of clients willing to j
pursue some form of ongoing treatment.   Another attempt to work more closely ^^
with other agencies in the system was the monthly on-site visits with the Victoria ^9
Life Enrichment Society; these visits also had a positive effect on the referral
procedure, allowing for an easier transition from one facility to another.
The service put a special emphasis on their work with Industrial Alcoholism
Programs and assigned one counsellor to concentrate on four companies, which
resulted in a doubling of referrals from the Industrial Programs.
Another area of increased referrals was from the legal sources; such referrals
were largely through the "Driving While Impaired" groups coming from Whatcom
County, Wash. Next year could see a heavy influx of drivers picked up through
the new BATmobile program and the changes in legislation related to blood
alcohol levels.
During the past year, there was a significant increase in all areas of service to
clients, collaterals, and the community at large.
143
 G 144 MINISTRY OF HEALTH REPORT, 1977
Youth and Family Counselling Services
The Youth and Family Counselling Services in Vancouver provides out-patient
counselling and supportive activities for young people. During the period April 1,
to December 31, 1977, the services provided treatment to about 250 young people.
Significantly, 88 of these were new contracts and over 60 per cent were 19 years
of age or younger; the majority were between 15 to 17. About 70 per cent of the
new contacts were considered as identified patients/clients, slightly more than 50
per cent were assessed during intake as having a major drug-abuse problem with
almost daily use of multiple "street drugs" and/or alcohol. Another 40 per cent
were considered "at risk" because of their frequent regular drug use.
The total clientele of the services consists of an almost equal number of men
(55 per cent) and women (45 per cent). There were a greater number of young
people 19 years of age or less (60 per cent plus) than last year (40 per cent). The
largest group of clients came to the program on their own (20 per cent) or through
friends (5 per cent); 10 per cent were referred by Probation Services and police;
15 per cent from schools, and the Ministry of Human Resources services.
The services were used as a training resource for professional students, and
over 20 students from various disciplines used the services for their field instruction
placement. Other students from community education and clinical research programs were also involved, most students stayed for more than 10 weeks in the
program.
The services continued to develop and strengthen liaison with other community
agencies and youth service groups.
Narcotic Addiction Services
Treatment Clinics
There are five out-patient clinics located in Vancouver; the average case load
in 1977 was 300 clients. In October 1977 the out-patient clinics in Coquitlam and
Kelowna also became direct service programs. The clinics provide treatment for
opiate-dependent individuals and their families, using methadone for the medical
management of their addiction. Heavy emphasis is placed on individual, marital,
family, and vocational counselling. Many clients remained longer in treatment in
1977, thus increasing their chances for positive change.
In addition to the treatment component of the program, the clinics offer
information about drug use to families, individuals, social and health service agencies, and to all other community-based agencies. In 1977 there were great advances
in developing and strengthening liaisons with other agencies and groups involved
with the clients, such as the Parole Services, Community Mental Health, and the
Child Welfare/Abuse team.
The clinics also serve as a training resource for professional students from The
University of British Columbia, BCIT, and Douglas College.
Pender Street Detoxication Centre
During the first seven months of the year 1,342 clients were admitted to the
Pender Street Detoxication Centre; of these 46 per cent had no previous admissions,
28 per cent had one or two previous admissions, and 25 per cent had three or more
previous admissions. Of the first admissions, 30 per cent were females, 69 per cent
were males. In addition to the 1,342 clients admitted there were 268 dropwns,
whose average length of stay was over five hours. Over 68 per cent of the drop-ins
had no previous contact with the centre.
Of the clients admitted, only 8 per cent left the centre during the first 20 hours
after admission, as compared to 18 per cent the year before.   An encouraging
 ALCOHOL AND DRUG COMMISSION G 145
81 per cent of the clients admitted completed treatment, most leaving the centre
the fourth day after admission.
Self-referrals continue to make up the largest category (31 per cent) of admissions, with 15 per cent being referred by the hospital. There was an increase in
referrals from employers (4.5 per cent) as compared to 0.5 per cent last year, and
from physicians 2.1 per cent, as compared to 1.1 per cent last year.
An impressive 75 per cent of the clients completed treatment and were willing
to accept a referral to ongoing treatment. As there was limited space at some of the
treatment programs, only 64 per cent of the clients were referred. However, with
the opening of PACIFICA Treatment Centre, this situation improved.
Hypnotherapy Program
The hypnotherapeutic program was started in April 1975. The fundamental
approach is to offer a non-chemical treatment service, utilizing the principles and
techniques of strategic hypnotherapy for chemically dependent individuals.
The client population is made up of individuals who are chemically dependent
or involved in the use of one or more drugs. The client may also be involved in
other treatment programs such as methadone maintenance or another social service.
Referrals come from other Alcohol and Drug Commission services, probation,
police, other agencies, and self-referrals, often based on contacts with individuals
who have participated in the program.
During the year the program showed considerable promise in effecting significant behaviour change in drug-dependent individuals.
NEW TREATMENT SERVICES
Maple Cottage Detoxication Centre
In response to the need for more detoxication beds in the Lower Mainland, the
commission opened a 20-bed detoxication facility on the Woodlands grounds in
New Westminster. Maple Cottage Detoxication Centre, opened December 7, 1977,
provides the setting for voluntary withdrawal for men and women who are chemically dependent. The centre will serve the Lower Fraser Valley as far as Hope,
excluding Vancouver, which already has two such facilities. The Royal Columbian
Hospital provides the emergency medical services.
Clients may be self-referred, or be referred by family, social service agencies,
public and mental health units, the police, and the hospital. The average stay will
be three days. As at the Pender Street Detoxication Centre, clients completing their
withdrawal are referred to ongoing treatment facilities within the system of care.
PACIFICA Residential Treatment Centre
PACIFICA, a 30-bed residential treatment centre for chemically dependent
men and women willing and able to participate in a structured treatment program,
was opened in October 1977. This 30-bed facility is ideally located at the YW/
YMCA in New Westminster, which provides a comfortable location with recreational facilities in a central area, for clients from the Lower Fraser Valley. PACIFICA is the first such residential program available to men and women in the
Lower Mainland and, at the year-end, was already booked up weeks in advance.
Treatment North
Treatment North, a 20-bed residential treatment centre administered by the
Prince George Regional Hospital, provides a 28-day program for chemically dependent men and women. The centre was opened in September 1977, to provide residential care for residents of Northern British Columbia.
  Table 33—Expenditure, by Principal Categories, in the Ministry of Health
for the Fiscal Year 1976/77
Total Expenditure in
Fiscal Year Ended
March 31, 1977
$
     55,820,460!
  542,460,143
Government Institutions     43,982,953
Forensic Psychiatric Services       2,416,316
The Medical Services Plan of British Columbia . 313,507,929!
Emergency Health Services      17,861,281
Community Health Services
Hospital Programs
Total Health Services  976,049,082
Chart VIII—Expenditure by Principal Categories.in Ministry of Health
for the Fiscal Year 1976/77
Is
O
Community Health Services
$55,820,460
Emergency Health Services
17,861,281
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Government institutions
$43,982,953
Forensic Psychiatric Services
•$2,416,316
Total Health Services
in 1976/1977
$976,049,082
iThe expenditure of $313,507,929 shown for the Medical Services Plan is the gross operating cost as shown
in the detailed statements in Section F of the Public Accounts. The actual charge to Vote 96 was $195,445,000
and covered the return of the Federal sharing under the Medical Care Act (Canada) and Hospital Insurance
and Diagnostic Services Act, subsidy by the Province for low-income residents, and the estimated deficits not
covered by premiums and other revenues. Similarly, the total for the Ministry of Health is shown as
$976,049,082, whereas the net total is $857,986,153. This latter figure is $269,273 less than the total shown
in Section D of the Public Accounts as half of the Accounting Division expenditures are made on behalf of
the Ministry of the Provincial Secretary and Travel Industry.
147
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 G 148 MINISTRY OF HEALTH REPORT, 1977
Table 34—Detailed Expenditure, by Principal Categories, in the Ministry of Health
for the Fiscal Year 1976/77
Total Expenditure in
Fiscal Year Ended
March 31, 1977
Community Health Services: $
Minister's Office  96,665
Deputy Minister's Office and Branch Support Services 226,879
Branch Executive and Administrative Support  3,746,734!
Local Health Services  28,205,324
Special Health Services  11,749,315
Other Health Care expenditures  11,795,5432
Subtotal, Community Health Programs  55,820,460
Hospital Programs:
Office of Deputy Minister of Medical and Hospital Programs    52,515
Administration     3,725,325
Payments to hospitals—
Claims   507,165,564
Grants in aid of equipment  15,254,344
Capital and debt services  16,262,395
Subtotal, Hospital Programs  542,460,143
Government institutions:
General Administration   811,752
Nursing Administration  276,231
Riverview Hospital'  26,023,560
Valleyview Hospital    8,914,736
Dellview Hospital  2,231,098
Pearson Hospital and Willow Chest Clinic  5,725,576
Subtotal, Government institutions   43,982,953
Forensic Psychiatric Services  2,416,316
The Medical Services Plan of British Columbia expenditure:
Benefits— $
Medical care   300,180,459
Additional benefits      17,837,407
318,017,866
Adjustment of provision for unpresented
and unprocessed benefit costs     17,550,000
  300,467,866
Administration—
Salaries and employee benefits       9,835,061
General office expenses       3,205,002
13,040,063
Subtotal, The Medical Services Plan of British Columbia3  313,507,929
Emergency Health Services      17,861,281
Total, Ministry of Health  976,049,082
i This figure is $269,273 less than the total shown in Table D of the Public Accounts as half of the Accounting Division expenditures are made on behalf of the Ministry of the Provincial Secretary and Travel Industry.
2 Pursuant to sections 12a and 12b of the Constitution Act, administration of part of this vote (Action
B.C.) was transferred to the Ministry of Recreation and Travel Industry effective October 29, 1976.
s The complete 1976/77 Financial Statements and notes for the Medical Services Plan are on pages 149
to 151.
 MINISTRY OF HEALTH EXPENDITURES,  1976/77 G 149
MEDICAL SERVICES PLAN
Financial Statement
AUDITOR'S REPORT
I have examined the statement of working capital and financial position of The Medical
Services Plan of British Columbia operating under the direction and control of the Medical
Services Commission of British Columbia as at March 31, 1977, and the related statements of
operations and changes in cash position for the year then ended. My examination was made
in accordance with generally accepted auditing standards, and accordingly included such tests
and other procedures as I considered necessary in the circumstances.
In my opinion these financial statements present fairly the financial position of The Medical
Services Plan of British Columbia as at March 31, 1977, and the results of its operations for
the year then ended, in accordance with generally accepted accounting principles applied on a
basis consistent with that of the preceding year.
K. M. LIGHTBODY
June 28, 1977 Acting Comptroller-General
Victoria, B.C.
Table 35—Statement of Working Capital and Financial Position as at
March 31,1977, of The Medical Services Plan of British Columbia
1977 1976
$ $
Working capital deficiency—beginning of year     54,695,066 1,544,256
Excess of expenditure over revenue     27,347,041        70,779,366
82,042,107        72,323,622
Working capital funding—Province of British Columbia   (38,940,904)     (17,628,556)
Working capital deficiency—end of year     43,101,203        54,695,066
Represented by:
Liabilities—
Bank overdraft      9,373,013 —
Estimated liability for unpresented and
unprocessed benefit claims
(Note 1)—
Medical care      27,850,000        44,653,300
Additional benefits       1,700,000 2,446,700
29,550,000        47,100,000
Premiums received in advance     15,404,807        11,373,175
Accounts payable  218,383 —
54,546,203        58,473,175
Deduct assets—
Cash   — 3,778,109
Due from the Province of British Columbia      11,445,000 —
11,445,000       " 3,778,109
Working capital deficiency     43,101,203        54,695,066
See accompanying notes to financial statements.
 G 150 MINISTRY OF HEALTH REPORT, 1977
Table 36—Statement of Operations for the Year Ended March 31,1977,
of The Medical Services Plan of British Columbia
1977 1976
Revenue: $ $
Premiums (Note 1)—
Subscribers' premiums   133,504,908        96,334,358
Adjustment of provision for premiums
received in advance      (4,031,632)       (2,324,871)
129,473,276        94,009,487
Government of British Columbia—premium assistance      28,363,560        18,832,849
157,836,836      112,842,336
Interest income (Note 1)   183,517 1,791,946
Government of Canada contributions—
Medical Care Act  106,717,451        86,368,370
Hospital Insurance and Diagnostic Services Act     21,423,084        21,386,632
128,140,535      107,755,002
286,160,888      222,389,284
Expenditure:
Benefits—
Medical care   300,180,459      256,933,126
Additional benefits      17,837,407 14,759,859
318,017,866      271,692,985
Adjustment of provision for unpresented
and unprocessed benefit claims  (17,550,000)        8,816,144
300,467,866      280,509,129
Administration—
Salaries and employee benefits       9,835,061 8,880,645
General office expenses       3,205,002 3,778,876
13,040,063        12,659,521
313,507,929      293,168,650
Excess of expenditure over revenue     27,347,041        70,779,366
See accompanying notes to financial statements.
 MINISTRY OF HEALTH EXPENDITURES, 1976/77 G 151
Table 37—Statement of Changes in Cash Position for the Year Ended
March 31,1977, of The Medical Services Plan of British Columbia
1977 1976
Cash provided:                                                                      $ $
Subscribers' premiums   133,504,908 96,334,358
Province of British Columbia—
Working capital funding     38,940,904 17,628,556
Deduct received subsequent to year-end    11,445,000 —
27,495,904 17,628,556
Premium assistance     28,363,560 18,832,849
55,859,464 36,461,405
Government of Canada  128,140,535 107,755,002
Interest income           183,517 1,791,946
317,688,424 242,342,711
Cash applied:
Medical Plan benefits  317,966,589 271,692,985
Administration      12,872,957 12,659,521
330,839,546 284,352,506
Decrease in cash      13,151,122 42,009,795
Cash—beginning of year       3,778,109 45,787,904
Cash (overdraft)—end of year     (9,373,013) 3,778,109
See accompanying notes to financial statements.
NOTES TO FINANCIAL STATEMENTS FOR THE YEAR ENDED MARCH 31, 1977
1. Significant Accounting Policies
(a) Income determination—Premium and interest income are recognized only when cash
is received. Premiums received in advance are not included in income until the period in which
income is earned.
(b) Liability for benefits—The liability for benefits, consisting of unpresented and unprocessed claims for medical care and additional benefits, has been estimated on the basis of past
experience of the commission.
(c) Fixed assets—The cost of fixed assets acquired is charged to administration expense.
2. Comparative Figures
The 1976 comparative figures have been restated, where necessary, to conform with the
classification adopted for the year ended March 31, 1977.
 G 152 MINISTRY OF HEALTH REPORT, 1977
ANNUAL REPORT ADVISORY COMMITTEE
Editor: R. H. Thompson.
Assistant Editors: J. Matters, J. Mackin.
Co-ordinators: J. Doughty, K. Williams, J. Berry.
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1978
8,430-278-7721

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