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[Annual Report of the Ministry of Health for the year 1979] British Columbia. Legislative Assembly [1980]

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 To the Honourable Henry P. Bell-Irving, D.S.O., O.B.E., E.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 1979.
K. RAFE MAIR
Minister of Health
Office of the Minister of Health
Victoria, B.C., May 1, 1980.
  MINISTRY OF HEALTH, VICTORIA, B.C., MAY 1, 1980
The Honourable K. Rafe Mair,
Minister of Health, Victoria, B.C.
SIR:  I have the honour to submit the Annual Report of the
Ministry of Health for 1979.
CHAPIN KEY
Deputy Minister of Health
  MINISTRY OF HEALTH
THE HONOURABLE R. H. McCLELLAND, MINISTER OF HEALTH1
THE HONOURABLE K. RAFE MAIR, MINISTER OF HEALTH2
C. KEY, DEPUTY MINISTER
SUPPORT SERVICES
J. BAINBRIDGE
ASSISTANT DEPUTY MINISTER
W. DIETIKER
Director of Data Processing
H. J. PRICE3
Comptroller
R. A. MUNRO*
Senior Director
Financial Services
W. F. LOCKER,
Director of Personnel
J. H. DOUGHTY,
Director of Administration
W. 0. BOOTH5
A/Director,
Central Shared Services
P. LANGRAN
Director,
Management Services
COMMUNITY_HEALTH SERVICES
G. H. BONHAM6
Senior A.D.M.
PREVENTIVE SERVICES
K. I. G. BENSON7
A.D.M.
H. M. RICHARDS8
A.D.M.
L. M. CRANE,
Director, Division of Public
Health Nursing
A. GRAY9
Director, Division of Dental
Health Servics
A. A. LARSEN,
Director,
Division  of  Epidemiology
R. SCOTT1"
Director, Division of Public
Health Inspection
G. D. ZINK
Director, Division of Speech
and Hearing
A. HINDLEY
Director, Division of Public
Health Inspection
1Resigned Health portfolio Dec/79
3Retired June/79
5 Acting appointment effective Oct/79
7 Transferred Apr/79
9 Appointed March/79
^Appointed Apr/79
2 Appointed Dec/79
4Appointed Oct/79
6Appointed March/79
8Appointed Oct/79
10Retired March/79
 DIRECT CARE COMMUNITY SERVICES
I. KELLY, A.D.M.
LONG TERM CARE
J. McMAHON12
Acting Executive Director
J. McMAHON
Manager,
Field Operation & Mental Health
M. A. RHODES
Manager,
Administration and Licensing
P. KERR
Manager,
Field Operation & Hospital
Liaison
L. DAVIS
Manager
HOME CARE
D. Ouston
Home Care Co-ordinator
MENTAL HEALTH
A. PORTEOUS13
A.D.M.
R. S. McINNES14
Acting Executive Director
J. B. FARRY
Consultant in Social Work
E. LUKE
Consultant in Psychiatry
D. FERNANDEZ
Planning and Research Officer
A. G. DEVRIES
Consultant in Psychology
i * Acting appointment effective Feb/79
13RetiredMay/73
l^Acting appointment effective May/79
-    II    -
 MENTAL_HEALTH PROGRAMS
A. PORTEOUS13
Assistant Deputy Minister
VACANT
Consultant in Nursing
MRS. F. IRELAND15
Co-ordinator, Boarding-home program
J. B. FARRY
Consultant in Social Work
E. LUKE
Consultant in Psychiatry
D. FERNANDEZ
Planning & Research Officer
R. S. MCINNES
Co-ordinator of Mental Health
Centres
A. G. DEVRIES
Consultant in Psychology
HEALTH PROMOTION AND^INFORMATION
M. CHAZOTTES
Executive Director
P. WOLCZUK
Director,
Nutrition & Health Education
L. D. KORNDER
Director,
Occupational Health
E. WOODWORTH
Librarian
PROFESSIONAL & INSTITUTIONAL SERVICES
R. H. McDERMIT16
SENIOR A.D.M.
HOSPITAL PROGRAMS
" J. GLENWRIGHT
A.D.M.
P. M. BREEL
Senior Director
C. F. BALLAM
Senior Medical Consultant
A. C. LAUGHARNE
Director, Hsopital Finance
Division
J. D. HERBERT
Director, Administrative Services Div.
H. R. McGANN
Director, Hospital
Consultation & Inspection
Divis ion
R. H. GOODACRE
Director, Research Division
G. F. FISHER
Director, Hospital
Construction and Planning
Division
15Pre-retirement leave Aug/79
16Appointed Sept/79
III
 MEDICAL _S_ERVICES COMMISSION
D. H. WEIR
Chairman
R. B. H. RALFS
Director, Salaried & Sessional
Programs
D. M. BOLTON
Senior Medical Consultant
A. W. BROWN
Director, Plan Administration
R. MUNRO4
Director of Financial Services
EMERGENCY HEALTH SERVICES COMMISSION
D. H. WEIR
Chairman
P. RANSFORD
Executive Director
PLANNING _AND DEVELOPMENT
C. BUCKLEY17
Executive Director
P. PALLAN
Director, Program Development
S. BLAND
Consultant in Geriatrics
J. TALBOT
Consultant
F. G. TUCKER
Consultant in Mental Health
W. BURROWES
Director, Vital Statistics
17Appointed Aug/79
IV
 VANCOUVER BUREAU
J. H. SMITH18
A.D.M.
E. J. BOWMER19
Director,
Division of Laboratories
H.   K.   KENNEDY
Director,   Division of
Venereal Disease Control
W. A. BLACK20
Director,
Division of Laboratories
F. D. MacKENZIE21
Director, Division of
Tuberculosis Control
J. MALLOW22
Director, Community Vocational
Rehabilitation Services
J. CHAO24
Acting Director, Division of T.B. Control
ROSE MAGNUSSON 3
Acting Director, Community
Vocational Rehabilitation
Services
COMMISSIONS ETC.
H. F. HOSKIN
Chairman, Alcohol & Drug Commission
of British Columbia
J. BAINBRIDGE
Chairman, Provincial Adult Care
Facilities Licensing Board
M. DAHL
Chairman, Provincial Child Care
Facilities Licensing Board
J. DUFFY
Executive Director,
Forensic Psychiatric
Services Commission
I. MANNING25
Director of Government Health
Ins titutions
W. 0. BOOTH5
Acting Director of Government
Health Institutions
British Columbia Youth Development Centre
P.H. ADILMAN, Director, Residential & Day Care Unit
D.C. SHALMAN, Director, Psychological Education Clinic
Greater Vancouver Mental Health Services
J. SEAGER, Executive Director
Burnaby Mental Health Services
W. C. HOLT, Director
Integrated Services for Child & Family Development (Victoria)
J. RICKS, Director
18Appointed Oct/79
20Appointed Oct/79
22Resigned Nov/79
24Appointed Dec/79
19Retired Sept/79
21Retired Nov/79
23Appointed Dec/79
25On sick leave from Oct/79
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3DIJJ0  1YHJ.N33
 MINISTRY OF HEALTH
MINISTER
OF
HEALTH
DEPUTY
MINISTER
CHAIRMAN
FORENSIC
PSYCHIATRIC
SERVICES
COMMISSION
EXECUTIVE
DIRECTOR
HEALTH
PROMOTION 81
INFORMATION
SENIOR ADM
PROFESSIONAL
AND
INSTITUTIONAL
SERVICES
MINISTER'S
OFFICE
DEPUTY
MINISTER'S
OFFICE
CHAIRMAN
ALCOHOL
&DRUG
COMMISSION
EXECUTIVE
DIRECTOR
PLANNING
AND
DEVELOPMENT
SENIOR ADM
COMMUNITY
HEALTH
SERVICES
ADM
SUPPORT
SERVICES
CHAIRMAN
MEDICAL
SERVICES
COMMISSION
September, 1979
-  VII
 DEMOGRAPHIC FEATURES
Population growth in British Columbia continued at nearly
the same rate in 1979 as in the previous year. The increase
was about 1.5 percent, from 2,530,000 in 1978, to 2,567,000 in
1979.
The birth rate for the year was 15.1 per 1,000
population, compared with 14.7 recorded in 1978. There was a
17 percent increase in illegitimate births from 1978 to 1979,
and the proportion of all births these represented was at an
all time high of 15.6, a considerable increase from 14.0 for
the year before.
A greater number of marriages occurred in the province in
1979 than in 1978, and the rate of marriages per 1,000
population was higher at 8.6, compared to 8.5 in 1978.
The rate of deaths in 1979 was 7.5 per 1,000 population,
the record low rate recorded in recent years. Deaths from the
leading cause, heart disease, declined somewhat from the number
for 1978 and the rate was down to about the same level as in
1977, 245 per 100,000 population. The second leading cause of
death, cancer, again caused more deaths in the province. The
rate was up to 164, from 160 in 1978. The death rate of 75.2
from intra-cranial vascular lesions ("strokes") differed only
marginally in number from the previous year. Mortality from
accidents in 1979 increased from the low number recorded in
recent years, and the rate was up to 68 from the 1978 figure of
63.
Automobile accidents caused about a fifth more deaths
compared to the year before, and represented 44 percent of
accidents,  compared to 38 percent in 1978.  Mortality from
VIII -
 falls as a proportion of total accident mortality declined from
18 percent to 17, while the proportions for accidential
poisoning increased from 7 to 8 and for conflagrations, from 6
to 7.
The decline in the rate of suicides continued, as was the
case in 1978. There were 16 suicides per 100,000 population in
1979.
Infant mortality in 1979 continued at about the same rate
as in 1978, 13 infant deaths per 1,000 live births. While
neonatal mortality was slightly higher, the rate for infants 1
month to 1 year of age declined.
- IX
 THE YEAR IN REVIEW
An emphasis on the preventive health needs of British
Columbia's young people and a reorganization of the Ministry
that, over the years, will enrich such a focus were highlights
of this Ministry's activities during 1979.
By encouraging a healthy start on life, we fully expect
that later demands on the sickness-treatment system will be
reduced. The 1979 Year of the Child and the Family in B.C.
provided an opportunity to heighten public awareness of such
optimal maternal and child health.
One specific area of preventive services elevated to a
high profile last year were our prenatal classes for parents,
which now attract more than 40 per cent of all expectant
mothers and some 30 per cent of fathers, too.
The professional advice and guidance given at such
classes is reinforced by such publications as "Baby's Best
Chance" and the "B.C. Health Passport", first issued in 1979,
that now reach the parents of every newborn in this province.
"Baby's Best Chance", a 123-page book prepared with the
co-operation of the perinatal program of the British Columbia
Medical Association and the metropolitan health services of the
City of Vancouver, is a comprehensive guide on pregnancy,
prenatal care, and baby feeding and care. The publication has
been acclaimed throughout North America, and requests for
sample copies have come from many parts of the world.
The "Health Passport", originally introduced to
commemorate the Year of the Child and the Family in British
Columbia, was presented to parents of newborns throughout
1979.  Inevitably, parents of young children born before that
X -
 year began to request copies of the passport, and late in 1979,
the decision was made to continue the passport as a permanent
feature.
The Ministry's continuing concern with the health of
children received a new impetus during the year just elapsed.
We sponsored seminars on child health, funded the Child Health
Profile published by Dr. Roger Tonkin, participated in a child
abuse study and launched, in co-operation with the Ministries
of Human Resources and Education, a study of the needs of
handicapped children.
The health needs of children were also better served by
the formation of the Ministry of Health's children's committee,
designed to act as a clearing house for all information on this
topic within the ministry. In turn, the ministry committee
identifies needs and new directions in children's health care
and makes recommendations to the Executive Group for submission
to the Inter-Ministerial Children's Committee when appropriate.
The most prominent development in the Ministry was a
major reorganization along functional lines. Traditionally,
health services have been organized along lines of funding;
that is to say, programs were grouped more according to sources
of revenue than because of their similarities in objectives and
purpose. The efficiencies and effectiveness of the new
organization are expected to be evident in the coming years.
The  reorganization of  the  Ministry  was  followed  by
several new appointments to its senior management team.  The
appointees are included in the organization chart at the
beginning of this report.
The greatest change occurred among the Ministry's
community-based programs. Many of the linkages that had
occurred informally between the various programs over the years
XI
 had obvious advantages and our intention is to strengthen these
ties.
It is hoped that by placing all community-based
operations under the control of a senior assistant deputy
minister responsible for preventive services, various home
services, the long term care program and mental health
services, the development of alternate modes of care will occur
more rapidly.
Great pressure for resources continued on the community
side. For example, in spite of the increasing numbers cared
for by the long term care program, which at the year-end had
just over 15,000 persons in facilities (not including public
extended care hospitals) and slightly more than 17,000 who were
receiving homemaker services, acute hospitals, especially in
metropolitan areas, had backlogs of persons waiting for
placement in the long term care program.
While numbers often do not tell the whole story, a few
more statistics from the community side of the Health Ministry
illustrate the extent to which the Ministry is reaching out.
Last year, some 85,000 school children took part in the
Ministry's dental programs, 393,000 immunizations were given,
100,000 pre-school children were screened for various health
problems and public health nurses made more than 118,000 home
visits.
As well, the Ministry's intention to de-emphasize
in-patient care and place greater emphasis on preventive,
ambulatory and home care programs required reorganization of
community services to meet these contemporary needs. Such a
shift in emphasis from in-patient care in hospital beds to day
care and home care is based on the belief that such programs
are both better for the patient and less costly to the taxpayer.
XII
 Several important steps toward reforming and stabilizing
our hospital sector occurred during 1979. Major initiatives
were taken to resolve both long and short term problems.
The government dealt with our acute hospitals' operating
deficits, which in many cases had been accruing over the past
20 years. In many instances, such deficits were costly burdens
to individual institutions that often curtailed their options
for improvement of the quality of care programs. Those
deficits were eliminated through a special, one-time allocation
that was intended to establish a sound base for incremental and
new program funding.
Nevertheless, establishment of such a funding base does
not in itself provide all incentives for efficiency. Cost
control techniques now applied to our hospitals are still
short-term and somewhat arbitrary, emphasizing the necessity
for rational reimbursement mechanisms.
There are several complex reasons for this state of
affairs. First, hospital management in our health care system
has little control over the quantity of services it provides.
They respond to illness factors in the community. As well,
physicians have a major effect over the allocation of resources
by virtue of their decisions concerning admission, treatment
and discharge.
Secondly, in-patient care in hospitals is the end-point
of many of the failings and inefficiencies of other sectors of
the health system. For example, the lack of an adequate range
of alternative services prevention, ambulatory care and home
maintenance has resulted in higher than necessary utilization
of hospitals.
As mentioned earlier in the discussion of community
services, the Ministry intends to expand its range of options
to the patient and physician so that the system can operate
XIII
 more efficiently and effectively. Nevertheless, it will be
some time before all such options are universally available
and, until that time, we can expect continuing pressure for
acute hospital beds. There are indications, however, that the
demand for acute hospitalization is beginning to level off.
It will be of interest that while Hospital Programs
recorded just over 3.4 million days of hospital care for adults
and children during 1979, this utilization represented a
decrease of slightly under 27,000 patient-days compared with
the previous year.
The replacement of out-dated hospital facilities has been
a major goal of the Minisry of the past few years. During
1979, 19 major hospital projects of this cagegory were
completed, involving an estimated expenditure of $37 million.
While one of the Ministry's primary mandates is meeting
the day-to-day imperatives of the hospital system, it also has
to be very active in terms of planning for the future, due to
the system's increasing size and complexity.
In that context, the first phase of a major study of the
B.C. hospital funding system, done in co-operation with the
B.C. Health Association, was completed near the end of 1979.
It is concerned with the funding of the various levels of
intensity of care provided at each hospital and will take into
account the variations in volume noted earlier. This is one
initiative that will help us make more effective use of funds
available to hospitals over the long term.
The  work  of  the  Joint  Hospital  Funding Project  is
complemented by the ongoing Hospital Role Study which will
enter its second phase in 1980.  The first phase is designed to
provide a logical classification of hospitals based on expected
volumes and levels of service.  It will provide the ground
XIV
 rules for preliminary negotiations with hospitals in regard to
budget allocations. It should also provide the community, the
hospitals board and professionals with an annual opportunity to
negotiate with government and understand what are the mutual
expectations for service for that community in the following
year. Later phases of the role study should aid and pave the
way for overall provincial planning for services provided by
hospitals.
Feedback on the first phase of the hospital role
discussion paper is being integrated with the overall concept
of funding and we expect that a very clear picture of where we
should be heading with our hospitals will emerge over the next
few years.
All branches of the Ministry of Health are concerned with
professional-government relations but none more so that the
Medical Services Commission in its relation with the
physicians. A major event is the negotiating with the B.C.
Medical Association, as the physicians' representatives in
regard to the schedule of payments under the Medical Services
Plan. Potential settlements are arrived at by the bargaining
committees of the Commission and the B.C.M.A. Following this,
the recommended settlement is voted upon by the members of the
B.C. Medical Association.
In 1979, an agreement was reached by vote in the
profession and approval of the Treasury Board that provided for
increases of 8.11 and 8.55 per cent over each of two years.
This percentage increase applies to the fee for each item of
service but does not limit the level of income. This present
agreement upholds the commitment of both parties to the four
basic principles of medicare - portability, universality,
comprehensiveness and public administration.
XV
 The Ministry views its progress in 1979 with enthusiasm.
In order to make optimal use of available resources it is
imperative that all parts of the health system work together in
a co-ordinated fashion and that the recipients and providers of
care are responsible in their use of services. In 1979,
significant advances were made in attaining these objectives.
Chapin Key, M.D.
Deputy Minister
 TABLE OF CONTENTS
PLANNING AND SUPPORT SERVICES  1
Health Promotion and Information  7
Nutrition and Health Education  10
Occupational Health  20
Ac t ion B. C  24
Planning and Development  27
Community Care Facilities Licensing Board  29
Community Physiotherapy Program-Care Services  31
Tables	
 Adult Care Facilities  30
COMMUNITY HEALTH PROGRAMS  35
Community Health Program Highlights  35
Preventive Services  37
Communicable Disease  39
Tuberculosis Control  42
Venereal Disease Control  44
Specialized Community Health Programs  48
Public Health Nursing  54
Dental Health Services  61
Vital Statistics  66
Community Vocational Rehabilitation Services  72
Laboratory Services  74
Bacteriology  76
Parasitology  79
Mycology  82
Virology Service  83
Tropical and Parasitic Diseases Reference Services  85
Community Health Promotion  99
Tables	
 Reported Communicable Diseases, B.C., 1975-1979  89
 Reported Infectious Syphilis and Gonorrhoea, B.C  90
 Selected Activities of Provincial Public Health
Nurses September 1, 1978 to August 31, 1979  91
 Facilities or Projects Dealt with by the Public
Health Inspection Division, 1979  93
 Selected Activities of Provincial Health
Inspection, 1975 - 1979  94
 Registrations, Certificates, and Other Documents
Processed by Division of Vital Statistics,
1978 and 1979  95
 Caseload for Community Vocational Rehabilitation
Services, January 1 to December 31, 1979  96
 Tests Performed by Division of Laboratories in
1978 and 1979   97
- XVII
 DIRECT CARE COMMUNITY SERVICES  100
Long-Term Care Program  100
Home Care Program  109
Tables	
 Total Number of Long Term Care Clients by Level
of Care as of November 30, 1979  106
 Total Number of Service Providers  106
 Number of Assessments, Reassessments and Reviews
of Long Term Care clients during the period
January 1, 1979 to November 30, 1979  106
 Percentage of Homemaker Clients and Hours by
Level of Care  107
 Average Homemaker Utilization by Level of Care  107
 Project Planning and Development  108
 Treatment Services to Home Care and Long Term
Care Programs  112
 Treatment Services by Age Groups  112
 Preventive and Other Programs in Health Units  112
 Percentage Distributed by the Age Groups of Patients
Admitted to the Home Care Program  113
 Percentage Distribution by Age Group and Category
of Patients Admitted to the Home Care Program  113
 Percentage Distribution and Number of Home Care
Patients by Major Diagnostic Groups  114
MENTAL HEALTH SERVICES  115
Mental Health Services Highlights  115
Reorganization and Redefinition  116
Community Mental Health Centres  118
Greater Vancouver Mental Health Services  130
Burnaby Mental Health Services  137
Integrated Services For Child & Family Development  139
British Columbia Youth Development Centre, "The Maples"
Residential and Day Centre Programs  140
Psychological Education Clinic  143
Boarding Home Program  144
Consultative Services  147
Management Analyst Services  152
Research and Planning  153
Mental Health Pharmacy Committee  154
Statistics  157
Tables	
 Mental Health Services  156
 Patient Movement Data, Mental Health Facilities  159
 Patient Movement Trends, Mental Health Facilities  162
HOSPITAL PROGRAMS  165
Hospital Programs Highlights  166
XVIII
 Projects Completed in 1979  189
Projects Under Construction At Year-End  192
Medical Consultation Division  199
Administrative Services Division  201
Approved Hospitals  205
Statistical Data  211
Tables	
 Administration & Payments   to Hospitals,   1975-79    184
 Patients Separated & Proportion Covered by Hospital
Programs, B.C. Public General Hospitals Only  213
 Total Patient-days & Proportion Covered by Hospital
Programs, B.C. Public General Hospitals Only  214
 Patients Separated, Total Patient-days Average
Length of Stay According to Type & Location of
Hospital for Hospital Programs Patients Only  215
 Summary of the Number of Hospital Programs
In-patients & Out-patients, 1974-1979/80  216
 Summary of Hospital Programs Out-patient Treatments
by Category, 1974-1979/80  216
 Patients Separated, Total Days' Stay, & Average
Length of Stay  217
 Percentage Distribution of Patients Separated and
Patient-days for Hospital Patients Only  217
Charts	
 Percentage Distribution of Days of Care by Major
Diagnostic Groups, Hospital Programs, 1978  219
 Percentage Age Distribution of Male & Female
Hospital Cases & Days of Care  220
 Percentage Distribution of Hospital Cases by
Type of Clinical Service  221
 Percentage Distribution of Hospital Days by Type
of Clinical Service  222
 Average Length of Stay of Cases in Hospitals in
British Columbia, by Major Diagnostic Groups in
Descending Order, 1978  223
MEDICAL SERVICES COMMISSION  224
Medical Services Commission Highlights  224
Benefits Under the Plan  225
Services Excluded Under the Plan  227
Premium Rates and Assistance  228
Laboratory Approval  229
Profess ional Review Committees  229
Salaried and Sess ional  230
Statistical Highlights  231
Tables	
 Registrations and Persons Covered by Premium
Subs idy Level  233
 Persons Covered by Age-group  233
 Coverage by Family Size  234
XIX -
  Distribution of Fee-For-Services Payments for
Medical Services  236
 Distribution of Medical Fee-For-Service Payments
and Services, by Type of Service  237
 Average Fee-For-Service Payments by Type of Practice... 238
 Distribution of Fee-For-Service Payments for
Insured Services, Additional Benefits  239
 Average Fee-For-Service Payments by Type of
Practice, Additional Benefits  240
—Summary of Expenditures, 1969/70 to 1978/79  241
Charts	
 Coverage by Age-Group  234
 Coverage by Family Size  235
GOVERNMENT HEALTH INSTITUTIONS  242
EMERGENCY HEALTH SERVICES COMMISSION  253
FORENSIC PSYCHIATRIC SERVICES COMMISSION  257
ALCOHOL AND DRUG COMMISSION  260
Support Services  261
Treatment Services  266
Heroin Treatment Program  268
MINISTRY OF HEALTH EXPENDITURES, 1978/79
Financial Tables and Chart
Tables	
 Expenditure by Principal Categories in the Ministry
of Health for Fiscal Year 1978/79  270
 Detailed Expenditure by Principal Categories in the
Ministry of Health For the Fiscal Year 1978/79  272
 Statement of Financial Position as at March 31, 1979,
of the Medical Services Plan of British Columbia  274
 Statement of Operations & Working Capital Deficiency
for the Year Ended March 31, 1979, of The Medical
Services Plan of British Columbia  275
 Notes to Financial Statements for the Year Ended
March 31, 1979, Medical Services Commission of
British Columbia  276
Chart	
 Expenditures by Principal Categories in the Ministry
of Health for the Fiscal Year 1978/79  271
- XX
 PLANNING AND SUPPORT SERVICES
The main Support Services function is to provide support
to the managers of the various service programs of the
Ministry. Support Services includes Financial Services,
Personnel, Management Information Systems, Central Shared
Services, Management Engineering, and Legal Services.
In addition, Support Services provides initiative in
staff development, information on labour relations, and
provides a communication link for other ministries or agencies
of government. For example, the Support Services section is
responsible for co-ordinating the Ministry's relations with
B.C. Buildings Corporation, B.C. Systems Corporation, the
Government Employee Relations Bureau, and Treasury Board.
The Ministry is committed to the development of an
effective Support Services section, since this allows the
Deputy Minister and senior Managers of the Ministry to
concentrate on the provision of efficient and effective health
services to the public.
MANAGEMENT INFORMATION SYSTEMS
The primary objectives of the division are to assist
management throughout the Ministry in defining their data
processing and management informaion requirements, and to
ensure that appropriate systems are developed and maintained to
meet these requirements.
Significant events during the year included the following:
- Five system analyst positions were established and filled.
- Work on a completely redesigned Medical Services Plan
computer system progressed, and it was anticipated that
the first sub-system would be in operation by mid-1980.
 - A computerized case flow monitoring system for hospital
construction projects became operational in the latter
part of the year.
- Work began on a computerized system to monitor hospital
operating income, expenditures and performance indicators
on a monthly basis.
- The design and development of computer systems for the
proposed Dental Care Plan was initiated.
- Work continued on the design of a management information
system for Speech and Hearing Services.
- A library catalogue report/retrieval system was
implemented.
- The billing system for the Emergency Health Services
Commission became operational. At the year-end work was
continuing on the management information system.
PERSONNEL
During the year personnel headquarters moved to the 4th
floor of the Pandora Wing of the Blanshard Building. The move
provided additional meeting room facilities, a new and
efficient central telephone system, and a vastly improved
office arrangement. Personnel staff from the Medical Services
Commission joined the central group, to add a personnel officer
and support staff to the headquarters operation.
Two-day visits to health districts by teams of personnel
staff were continued. These visits produced an exchange of
information and ideas, and a general increase in the level of
awareness of the problems, concerns and ideas, of field and
office staff.
Extended and difficult negotiations wth the province's
medical doctors were successfully concluded with a two-year
agreement extending to March 31, 1981.  Most other health care
- 2
 professions also accepted terms extending beyond  the usual
twelve month terms.
Personnel again had direct input into negotiations for
government employees' contracts, with four officers serving on
teams working on either master or component agreements.
Ministry re-organization required on-going classification
and staffing actions, covering both new and revised ministry
pos it ions.
The area of establishment control was developed and, upon
direction of the Executive Group, a large number of vacant
positions were converted for immediate use in other divisions,
with priorities established at the Assistant Deputy Minister
level.
Personnel administration investigated the application of
computerized word processing equipment, and studies continued
to develop to relate this equipment to central computer
capability.
Personnel Officers were added to the existing complement
in Riverview Hospital and the Emergency Health Services
Commission, resulting in a total of three Personnel Officers in
each of those units. The task of training and development was
assigned to Personnel, and planning was initiated for employment of a Personnel specialist to head-up this important work.
Pre-retirement counselling sessions continued to be held
with assistance from Ministry personnel.
The summer student program ran successfully, and included
placing  14 handicapped students  in meaningful summer jobs.
3 -
 The Executive Benefit Plan and Executive Compensation
Plan with its attendant appraisal system, continued to be
administered by Personnel, in close co-operation with the
Executive Group of the Ministry, and the Government Employee
Relations   Bureau.
The Director of Personnel continued to serve as a member
of the Personnel Advisory Committee to the Government Employee
Relations   Bureau.
MANAGEMENT  ENGINEERING  SERVICES
During the year the division had the following
res pons ibilities:
Management Engineering Services: These services were
provided to the Senior management of Community Health Services,
Professional and Institutional Services, and of Support
Services. The Consultants and Analysts were involved in
studies and in the provision of consultative services which
were concerned with the better utilization of the Ministry's
resources. Included were projects such as the development of
staffing methodologies for hospitals, the establishment of a
Records Management System for the Ministry, and the study of
clerical work  in  field  clinics.
Space Occupancy Related matters: This involved the
co-ordination of the Ministry's accommodation needs and the
representation of these needs to the B.C. Buildings
Corporation, providing assistance with the resolution of
problem areas, and liaison with the Corporation on all matters
affecting space occupied by  the Ministry.
Operational       Support       Services: This       included       the
management of those services which were involved in the support
of the Ministry's headquarters operations, such as printing and
photocopying,   warehousing,   security,   and  space   planning.
-   4
 CENTRAL SHARED SERVICES
During the year a Central Shared Services Division was
developed to complement other Ministry of Health organizational
changes. The establishment of this service on April 1, 1979
reflected the need to consolidate related support services for
maximum resource utilization. The services extended to
communities and individuals throughout the province, and served
several ministries and agencies.
A wholesale pharmacy supply warehouse operation provided
pharmaceutical, surgical, and medical supplies to over 307
institutions, agencies, Public Health Districts, and
organizations, etc. The Kidney Dialysis/Hemophilia program
made life support services available to 182 individuals
throughout the province.
A total of $1.6 million was spent to re-equip and
renovate the Regional Linen Service Plant at Coquitlam. This
new high-production equipment was the most modern available and
would permit an increase in laundry output from 13 million to
17 million pounds per annum.
Victoria Regional Linen Service had its beginning in the
Glendale Laundry, which was transferred from Highways, to
Health, in March of 1979. Comprehensive linen supply and
services are provided to 6 hospitals and 4 other institutions
in the Greater Victoria region. Capital funds were provided
during the year and an up-grading program commenced, which
would permit the extension of services to meet the need of new
health care facilities planned for 1980.
The Mechanical Maintenance Division provides vehicle
inspection  and  replacement  services  for  Health  and  other
- 5
 ministries. The acquisition of garage facilities and staff in
November 1979 will upgrade the care and safety of provincial
vehicles.
A fleet of 48 radio-controlled vehicles headquartered at
Coquitlam established the core of a Central Shared Service
Transport Division. In addition to equipment and supplies
movement, a well-co-ordinated escort and ambulance service was
added, to provide an alternative to the use of Emergency Health
Service vehicles and staff, for transporting non-emergency
ambulant patients. At the year-end this latter program was in
the developmental stage.
The  Industrial  Division  provides  a  wide  range of
specialty manufacturing repair and maintenance functions for
Health and other ministries.  It was anticipated that a six
month operational study requested by the Executive Director and
completed in 1979, would result in organizational and
functional changes in 1980 that would greatly improve
utilization and types of services provided.
An operational review of the General Stores resulted in
the closure of the butcher shop and the re-deployment of five
staff. The Ministry's central stationery function, located at
the Roderick Street warehouse in Victoria, was assumed by the
Coquitlam General Stores operation. Mr. R. Boulter, supervisor
of the Stores, retired in December after 35 years of service.
Mr. W.O. Booth was appointed Executive Director of
Central Shared Services on April 1, 1979. He also continued
his responsibilities as Director of Finance for Government
Institutions, due to the illness of the Director of Government
Ins titutions.
 Health Promotion and Information
INTRODUCTION
As part of the Ministry of Health's growing commitment to
improving the health of residents of British Columbia, those
sections of the Ministry concerned with health education and
information and the general improvement of personal lifestyle
were brought together under the heading of Health Promotion
Programs early in the year.
The constituent divisions and sections now operating
under this general title are:
Division of Nutrition and Division of Health Education
(operating under one director), Division of Occupational
Health, Information Services, Art Services, Photographic
Services, Special Events and Displays, the Ministry of Health
Library) and a government funded agency, Action B.C., which
operates under the Societies Act with its own board of
directors.
Health Promotion Programs also operates the Ministry of
Health's audiovisual services (including the audiovisual
library) and is responsible for the staffing and operation of
the centralized television production centre, which is
available to all government departments for videotaped
information and education programs.
The Executive Director of Health Promotion and
Information, to whom the above operations report, is a member
of the Deputy Minister's advisory committee; the Executive
Group of the Ministry of Health; and the Community Health
management group, with a view to integrating health promotion
activities with all sections of the Ministry.
- 7
 Towards the end of 1979, Health Promotion had entered
into discussions with Hospital Programs to increase
co-operation with individual hospitals in the dissemination of
health  and  lifestyle  information.
INFORMATION SERVICES
Heightened public interest in the quality and costs of
British Columbia's health services continued to place unusual
demands on the Ministry's information services. During the
year the public's right to know details of available services
and program was satisfied with a variety of print and broadcast
materials.
Many of the problems of a contemporary health system have
their origins in public misunderstandings of its structural
features, systems or policies. The Ministry's information
services staff was constantly attempting to heighten general
awareness of the health system's general topography as well as
its   program content.
Approximately 110 press releases were prepared by information officers during the year. However, press releases were
only a formalized approach and information services encouraged
the Ministry's senior officials to handle media queries on a
continuing basis.
The preparation of speaking notes was another major
activity and during the year notes were prepared for approximately 95   engagements.
Information officers also wrote and edited scripts for
numerous audio-visual presentations. The development of a
modern audiovisual centre operated by the Ministry obviously
would result in much greater scripting activity during the
coming year.
 AUDIO-VISUAL  SECTION
Construction of the video production centre in the
Richard Blanshard Building, Victoria, started in May, continued
through the summer and was ready for the installation of equipment by August. All audio and video equipment was installed by
late fall and the first official tour of inspection was held in
October.
The TV production centre, located in the Health Building,
and operated by the Ministry of Health, is also available to
all departments of Government. In-service training video tapes
and public information material for television and radio, will
be  produced   in  the  centre.
The audio-visual section continued to operate film
library service for the Ministry of Health. A loan service for
audio-visual  equipment was   added early  in  1979.
During the year the inventory of films and equipment was
added to as part of an on-going program to improve the service
which provided 16 mm film, three-quarter inch video-cassette
programs, small format materials (e.g. audio tapes, slides,
etc.), as well as a wide variety of audio-visual and video
equipment. In addition the Audio-Visual Services Section is
responsible for the acquisition, inventory, and distribution of
this  equipment  for  the entire Ministry.
Several audio-visual workshops were held during the year
and, in response to a heavy demand for instruction from field
offices in the use of audio-visual equipment, more workshops
were  planned   for   1980.
Provision of material for display, as a public information   service,   has   been   the   responsibility   of   the   Division   of
 Health Education for many years. With the re-organization of
the division three years ago the responsibility passed to the
audio-visual section. Since that time the display service has
experienced a tremendous degree of development. The number of
displays created in 1978 were more than doubled in 1979, and in
the early fall the display section was transferred to the
jurisdiction of the Division of Nutrition and Health Education.
The photographic section continued to provide an
increasing volume of production for the Ministry. During the
year the section was provided with a darkroom and additional
equipment enabling the section to handle black and white, and
colour materials up to 20" x 16" format.
Students were hired during the summer for special
projects, including a three month's province-wide tour with a
special display planned and constructed in conjunction with the
Vancouver Junior League. The project was a joint contribution
to British Columbia's Year of the Child and the Family program.
Members of the audio-visual staff continued to provide an
audio-visual consultant service to other government departments
and health oriented agencies in the province.
Division of Nutrition and Division of Health Education
HEALTH EDUCATION
During the year the first priority of the Health
Education section was to improve the health education skills of
the staff and of other health care professionals, and to
encourage them to integrate health education concepts into
their programs.
10
 Two new positions were established in the Northern
Interior Health District and in North Okanagan Health
District. In addition, a position was relocated from the
Island Region, where service had been given for seven years, to
the Kootenay-Slocan area where no health educator services have
been available.
The inservice workshop is the primary vehicle for this
health education skill improvement, and workshops were
conducted for nurses in North Okanagan Health District to
discuss the design and evaluation of programs; for Community
Health Nurses in the Boundary area to discuss designing
audio-visual aids for teaching; and for the physiotherapy staff
at the Canadian Physiotherapy Institute Convention, on
audio-visual materials used in patient care and education.
In addition, workshops were conducted for community
college students and for staff of other agencies, including
workshops on audiovisual materials for the St. John's Ambulance
Industrial First Aid Program staff, and the staff of the
Variety Children's Treatment Centre. District Health Educators
also assisted in program evaluation related to Early Bird
prenatal classes in Nanaimo, the Butt Out smoking cessation
program in Courtenay, and the Fluoride Tablet Program in the
Queen Charlotte Islands. A photo story was published in the
Canadian Nurse on the Ministry's health circus for preschool
children.
District health educators were also involved in programs
to promote the adoption by the general public of healthful
lifestyle practices. Emphasis in health education changed from
province-wide promotions to specific promotions in specific
health districts. For example, because immunization status was
low in the Selkirk Health Unit, an intensive promotion was
conducted during November, Immunization Month.
11
 The promotion included full-page newspaper advertisements and a
six-part radio program to inform the public of immunization
schedules for infants and children.
A teaching kit for teachers of Grade .4 school children
was designed to promote general hygiene in Central Fraser
Valley Health Unit. The kit, entitled "Be a Health Detective",
will be available in 1980 after pretesting in the local
community. Kits were also prepared on food handling for use by
secondary school teachers and Public Health Inspectors, in
teaching students about proper food handling and safety
procedures, in Boundary Health Unit. A Poison Prevention
Campaign was conducted in Nanaimo.
Various promotional activities were undertaken during
Mental Health Week, in May, in the Courtenay area, including a
bookmark on mental health used in the library system; the
distribution of a videotape entitled "Helping Skills" to
district health care staff; newspaper articles and television
promotions, to promote family health.
During the year district health education services were
available in Central Fraser Valley, Boundary, Selkirk, West
Kootenay, North Okanagan and Northern Interior Health Districts.
The districts' health education staff also have
considerable input into the design and development of
audio-visual and printed materials. Four new publications were
underway as a result of this consultative input. These
included, "Understanding Communicable Disease"; "Immunization
is Still Important"; "Any Child Can Get Head Lice", and
"Pregnant?".
The latter publication was designed for pregnant
teenagers.   This  need  was  demonstrated  by  the  increasing
- 12
 incidence of teenage pregnancy throughout the province. Three
slide tape programs were also produced by district health
educators: "Poisonous Plants", "Children's Car Seats", and
"Birth Place, Royal Columbia Hospital". The latter slide tape
discussed delivery room procedures and was designed to
alleviate anxiety in mothers about to deliver their first
infant. An update package on health unit services was produced
in the Selkirk area for use in that district.
A survey of the immunization knowledge and status of
Grade 10 children showed that further work was needed in
promoting immunization to chilren in the school system.
Considerable work would be needed to develop and implement a
comprehensive compulsory school health education program for
the province of British Columbia. Further work was also needed
to enhance the instructional program planning and evaluation
skills related to health education of health district staff.
An additional area for future development included increased
local community participation in Ministry health education
programs .
NUTRITION
In 1979, the Nutrition component of the Division of
Nutrition and Health Education continued to increase nutrition
service for those individuals at high risk from nutritional
problems throughout the province. Target risk groups included
maternal and infant, individuals on limited income, and those
receiving care on the Long Term Care program.
The maternal and infant nutrition program was a major
program during the International Year of the Child and the
Family. An extensive perinatal health awareness campaign aimed
at the public include a large nutrition component. The
perinatal manual,  "Baby's  Best  Chance",  provided expectant
13
 parents with reliable perinatal information, including
nutrition, while an accompanying publication, "The Early
Pregnancy Profile", provided a means for screening potential
nutritional risks very early in pregnancy.
Additional short publications were prepared to augment
those already in use and included three pamphlets outlining the
recommended introduction to solids and suggested menu plans;
and two information statements outlining the correct procedures
for home pasteurization of milk, and the preparation of infant
formula using cow's milk and goat's milk.
A large perinatal health display was developed in
co-operation with the volunteer group, the Vancouver Junior
League. Two of these displays toured the province during the
summer months, and were set up in shopping centres in different
communities each week for a total of 22 locations. An
evaluation questionnaire indicated public contact and interest
was very high. A great deal of perinatal information was
dispensed via the displays and through the volunteers manning
them.
A considerable portion of the -local community
nutritionist's time was spent increasing the perinatal
nutrition teaching skills of the public health nurses, who have
the greatest contact with pregnant women and new parents.
Activities included many inservice workshops on prenatal and
infant nutrition. In the Northern Interior Health District a
series of demonstration prenatal classes were held.
Several projects were undertaken to contact people not
normally reached by the standard health district prenatal
classes. In the Northern Interior, a television show on
perinatal nutrition for East Indians was produced and aired,
and prenatal outreach projects in the Upper Island and Cariboo
14
 Health districts received funding from the International Year
of the Child program.
The second target risk group during the year were those
individuals on limited or low incomes. Concern was increasing
for this group because of the rapidly rising cost of food and
the resulting effect on the cost of living. A province-wide
food pricing survey was completed in November. A selection of
foods which covered the recommendations made in Canada's Food
Guide were priced in approximately 260 stores in 88 communities
in B.C. The various food costs were to be translated into the
cost of feeding individuals, and a family of four, in these
communities. A relative index based on food prices in Victoria
will be prepared so that adjustments could be made with future
increases in food costs. The actual food pricing was done by
public health nurses, nutritionists, and many hard working
volunteers. This information would be important -for
determining adequacy of food allowances, both for independent
living individuals receiving assistance, and as guidelines for
determining per capita raw food costs in institutions. It
would also assist all health care professionals involved in
teaching or counselling food budgeting.
The third target risk group were those individuals
receiving care on the Long Term Care program. Two full-time
and 10 half-time nutritionists were added to the Nutrition
staff late in 1978. Following an orientation and training
period, these nutritionists completed inspections of the food
service operations of 90% of the Long Term Care facilities in
the province, provided consultations and workshops to
facilities' operators and staff, provided orientation and
inservice education to homemakers and home care staff, and
provided nutrition counselling to Long Term Care clients when
requested. A diet manual was being planned for use in the
facilities, and to develop guidelines for Meals-on-Wheels
programs.
- 15 -
J
 The senior Chef television program was again aired in
several communities (e.g. Cranbrook, Creston, the Okanagan) and
was watched by a good representation of the target audience of
senior citizens living on their own. At the year-end three
health districts (Upper Island, Skeena and Peace River) were
without the services of a local Long Term Care (or Community)
Nutritionist.
The Division received federal funding to undertake a
Nutrition Aide program in the 1979/80 fiscal year. A
co-ordinator, assistant co-ordinator, and thirteen nutrition
aides were hired, for a nine to 10 month period ending March
31, 1980. The aides received four weeks intensive training in
nutrition and education techniques in Victoria before returning
to their communities, where they work under the supervision of
the community nutritionists. They were involved in many
activities, including the development of teaching aids,
conducting surveys, assisting in teaching classes and doing
research assignments. The project was an immense success and
additional funding had been requested to continue this type of
service.
The members of the Nutrition Division also participated
in many programs and activities related to professional
development, including acting as resource persons for a
Nutrition Council Workshop: Nutrition Legislation - Key for
Action; for a national seminar in Vancouver on Infant Nutrition
sponsored by the Heinz Company; revising and printing of the
British Columbia Diet Manual, in co-operation with the B.C.
Dietetic Association; producing the "Directory of Community
Nutrition Services '79'"; completing a literature review on
Diet and Hyperactivity; completing a survey on the nutrition
knowledge of public health nurses in the province; and
providing nutrition input into the first year class of medical
students at U.B.C.
16
 Other projects undertaken during the year included the
translation of certain nutrition publications into Chinese,
Hindi, and Punjabi; provision of a nutrition workshop to the
staff of the Heroin Treatment Centre in the Okanagan; participation in the publicity and other activities arranged for the
annual B. C. Nutrition Week; conducting a diet and cardiovascular disease awareness campaign in Tofino, Ucluelet and
Sparwood; and development of a nutrition information
publication for sponsors of the Vietnamese "boat people".
Future directions of the Nutrition Division included
expansion of nutrition services and education into the schools;
development of materials and programs to aid those on limited
incomes; and to obtain a nutrient data bank program, and
computer access for dietary nutrient analysis.
DISPLAYS AND SPECIAL EVENTS
During the year the Displays Section became a sub-section
of Health Education and Nutrition, a Division of Health
Promotion.
From a staff of one full-time employee and three contract
workers, the staffing changed to one full-time and three
auxiliaries. Two of the auxiliary positions were expected to
become permanent.
In the spring and summer, a public information display on
Emergency Health Services (the ambulance service) appeared at
the Victoria Jaycee Fair, a week long exposition. The
provincial ambulance service was also presented at the
Abbotsford Air Show. This was followed by four major displays
for the Pacific National Exhibition involving: Action B.C.,
Public Health Inspection, The Drug and Alcohol Commission, and
the provincial ambulance service.
- 17
 Ongoing programs included the British Columbia Winter
Games, in Kamloops; the British Columbia Summer Games held in
Richmond; and the B.C.H.A., B.C.M.A., and Ministry of Health
senior staff conferences. Services were also provided for the
opening ceremonies at three new health District offices:
Sicamous, Kamloops and Langley.
New displays were constructed during the year for:
Kamloops Ambulance, Duncan Ambulance, Hospital Programs,
Provincial Ambulance Services, Orthoptics, Dentistry, Child
Awareness Program: Emergency Health Services Commission, and
Health Clerical Services.
Displays in progress at the year-end included:
Physiotherapy, Public Health Nursing, Long Term Care,
Perinatal, Radiation Protection, and Speech and Hearing.
Displays in the planning stages, to be in production in 1980,
included: Mobile Unit; a permanent display for the Richard
Blanshard Building; Home Care, and a New Nutrition display.
As a special program, in co-operation with the Junior
League, two displays commemorating the "Year of the Child and
Family", toured the Province during the summer.
MINISTRY OF HEALTH LIBRARY
A number of significant developments in library service
were introduced in 1979.  These included:
1) Purchase of a microfiche collection of 3,000 documents,
entitled Health _Care 1970-78, which offer coverage in
health planning, statistics, manpower, facilities,
economics, education, and administration. Most of these
were U.S. state and federal publications which were
relevant to Ministry of Health current activities.
- 18
 2) The introduction of SDC's Infomart search service, which
provided the Ministry with on-line access to some 53 data
bases, including Chemical Ahstracts_, Biological
Abstracts, Dissertation Abstracts, Conference Papers
Index, ERIC, NTIS, Psychological Abstracts, Pollution
Abstracts, and many others.
3) The introduction of MEDLINE, which permits on-line
interactive access to the last two years of all the
medical and health information that has been indexed from
the world's 3,400 journals in the field.
4) The cataloguing of 1600 of the library's most recent
books and documents into a computer-produced book
catalogue. Access is by author, title, and subject, and
copies will be distributed to health offices throughout
the province.
5) The move of the library into more spacious quarters in
the Pandora Wing of the Richard Blanshard Building's
fifth floor.
19 -
 Division of Occupational Health
It is the responsibility of the Division of Occupational
Health, through a variety of programs, to encourage prevention
of both occupational and non-occupational injury and disease in
employees of all ministries and some crown corporations.
Activities are concerned with the provision of a safe and
healthy work environment, the placement of individuals in work
compatible with their physical and mental health, the promotion
of personal health maintenance and with ensuring high quality
treatment   and  rehabilitation   for   employee  health   problems.
The Division also acts extensively in an advisory and
service capacity to both government and outside organizations,
particularly in the area of radiation protection. Medical,
nursing, personal assistance and employee physical fitness
represent the other major areas of expertise. The Division of
Occupational Health offices are located in the greater
Vancouver, Victoria and Kamloops areas with travelling clinics
provided   for  other   locations.
The Division's Radiation Protection Service this year
assumed heavy responsibility in representing the Ministry of
Health at the Royal Commission of Inquiry into Uranium Mining.
Several briefs have been prepared for the Commission,
documenting environmental radiation measurements of both
natural and man made sources of ionizing radiation in British
Columbia and suggesting procedures necessary for protection of
worker  health.
Monitoring of natural radiation sources was greatly
increased over the past year with special emphasis on areas of
potential uranium mine development. In addition, follow-up
surveys    were    completed    for    radon    gas     in     the    Castlegar    and
-  20
 Vancouver area.  The effect of uranium deposits on food chains
and water supplies was also investigated.
Monitoring activities for the numerous x-ray units
throughout the province continued in order to ensure a safe
working environment for equipment operators and also to
minimize radiation exposure to the patient. The introduction
of computerized tomographic x-ray units at provincial hospitals
has expanded the need for consultative services.
A special study was carried out to ensure that
transportation and handling of radioactive materials within
provincial hospitals was carried out in a safe fashion. A
number of contaminated or leaking radioactive sources were
discovered in use in the province and were quarantined. The
Service was also asked to assist in the procedures required for
the disposal of 60 various radioisotope sources during the year.
Microwave monitoring activities increased for industrial
equipment and a cooperative study with the federal government
took place in a survey of radiofrequency generators used in
multiple industrial applications. This pointed out some
potential problem areas which will require further
investigation.
Activities of the Radiation Protection Service are
summarized as follows:
1979
1978
Radiation surveys (x-rays, radioisotopes
and microwaves)
Consultations and visits
Talks and lectures
Radioisotope leak tests
Analyzed water samples
Air samples
1,419
1,020
2,132
520
55
40
379
260
419
250
75
50
- 21
 Employee visits to the Division of Occupational Health
continued to increase with almost 11,000 visits recorded by
nursing and medical personnel. Services performed included
tuberculosis screening, immunization, health counselling and
assistance with personal problems. Requests for medical
evaluations for purposes of work placement and rehabilitation
continued to increase, exceeding the capacity of existing
staff. The Short Term Illness and Injury plan and the Long
Term Disability plan were again in part responsible for this
increase.
Periodic health exams were continued for limited high
risk occupations, such as firemen, and also implemented for air
crew participating in forest fire suppression activities. More
than 3,000 audiometric tests were performed under the Hearing
Conservation Program for noise exposed employees with the
assistance of the Division of Speech and Hearing and a private
testing service. Participation of medical personnel in an
advisory capacity for numerous environmental public health
problems was again evident, particularly with respect to
pesticides and insecticides, air and vegetation pollution and
other toxic hazards.
Planning for a data collection and storage system for
Occupational Health information was completed last year. This
will eventually allow an epidemiological correlation of
occupational category with adverse health manifestations.
Employee Development Services worked very closely with
medical and nursing personnel to provide appropriate
confidential help for government employees affected by marital,
family, legal, financial, stress and alcohol or drug problems.
The staff of two counsellors participated in over 1500
counselling interviews with employees from all ministries in
all areas of the province.  Most of the employees (or members
- 22 -
 of their families) were referred to a variety of community
helping resources. The return of almost 75% of these employees
to satisfactory job performance was of obvious benefit to both
employer and employee. A gradual increase in the numbers of
employees referring themselves to the program was evident.
The program also offers training seminars to supervisory
or shop steward personnel as well as awareness and education
workshops to line employees. Over the past year, 75 such
seminars made contact with over 1200 supervisors and shop
stewards. Talks were also given to business and industry in
the private sector because of their interest in using the
government's model to establish their own employee assistance
programs.
The Employee Fitness Program provided a wide variety of
fitness and nutrition opportunities in 1979. Services
available included fitness assessments, exercise and nutrition
counselling, exercise classes, individual activity programs,
behaviour modification of obesity plans, educational workshops
and recreational activities.
The Employee Fitness Program introduced three new
programs in 1979. October FITFEST '79, a three week
motivational project, resulted in nearly 3,000 individuals
participating in various forms of physical activity. A Fitness
Education Project in the summer of 1979 provided activity and
nutrition counselling sessions for approximately 500 employees
in 11 different ministries. A pilot program to aid in the
prevention of musculoskeletal injuries with a follow-up study
planned for 1980 was the third new program.
Provision of opportunities for positive lifestyle change
was the goal of the Employee Fitness Program. Several new
projects in 1980 will allow the Program an opportunity to reach
more employee groups throughout the province.
- 23
 Action B.C.
1979 was the year that Action B.C. was "on the move".
The various moves ranged from a change of office space, to
travelling the length and breadth of the province, to the
significant move of adding a professional nutritionist to the
Action B.C. staff. The bright, airy offices near Vancouver
city center have provided a central and accessible location,
which has allowed an easier co-operation with industry and
individual agencies.
The larger space has also provided the opportunity to
hold many in-service training sessions for the staff in the
fields of cardio-pulmonary resuscitation; the Dairy
Foundation's school nutrition program; general nutrition;
relaxation techniques, and smoking cessation information.
Throughout the year the three Action B.C. vans travelled
as far as Cassiar, the Queen Charlotte Islands, and Bella
Coola. The vans carried two Action B.C. staff, equipment and
materials, to bring to the communities the services of fitness
testing, counselling, nutrition analysis, smoking cessation, as
well as general positive lifestyle awareness. Travelling also
took the staff to many of the fitness festivals held throughout
the spring and summer months, culminating in the very popular
Vancouver Sea Festival and at the Pacific National Exhibition
in late August.
During the year, the entire Action B.C. operation at the
P.N.E. was given a "face-lift". The obstacle course, an annual
highlight for the 7,000 participating 5-14 year olds, became a
"Cross B.C. Challenge", allowing them to pit their physical
wits against carefully constructed and supervised equipment.
24
 On the adult side, the nutrition analysis was more
popular than ever and, along with the fitness testing and the
new lifestyle computer analysis, brought another 10,000
participants to the event.
Plans were underway to bring a "mini P.N.E." display to
every Health Unit District in the province. This would provide
fitness testing, and counselling, nutrition analysis and
lifestyle appraisal (using the micro-computer), together with
information on smoking cessation and local health events and
news. It would be run free-of-charge with the co-operation of
health district offices, the Heart Foundation, and other
interested agencies and individuals in the specific communities.
Providing lifestyle services to industry became a regular
part of Action B.C.'s program. The highlight of the
involvement with employee fitness took place in May when Action
B.C. staged its first "Corporate Cup". This event brought
together 40 teams of athletes and non-athletes, from
organizations in the lower mainland, for friendly competition.
The enthusiasm generated led Action B.C. to start organizing
for twice the number of participants in 1980, and a similar
event may be held in Prince George. Another successful event
for Action B.C., involving hundreds of delegates, was the B.C.
Bar Association Annual Mid-Winter Meeting in Vancouver. The
invitation to participate at their 1980 conference was a
positive indication of professional interest in lifestyle
awareness. This attitude was also present at the B.C.
Pharmacists Conference, where Action B.C. played a major role
in the "Lifestyle Day", which formed an integral part of the
meeting.
25 -
 The computerized nutrition program, in its 4th year, was
being constantly refined and adapted. This included a group
analysis for use in the classroom, special refinements for
pregnant and nursing women, and recommendations for weight
control. The program was being adapted and simplified for use
with Action B.C.'s newly acquired micro-computer, which will be
taken around the province for use in co-operation with the
Health Units in shopping malls and public events. During the
year an in-house professional nutritionist was hired which
allowed for greater co-operation with the provincial
nutritionists, schools, and concerned agencies and individuals.
1979 saw the end of the "Butt-Out" teenage smoking
cessation pilot project run by Action B.C., under grants from
the Federal/Provincial governments. The materials produced
under the project would continue to be available throughout the
province. While travelling with the "Butt-out" project, a
great interest in an adult smoking cessation program was
generated. To follow up on this, Action B.C. hoped to bring
the TARGET adult program to groups who wish to take advantage
of it.
To help Action B.C. communicate and share its news and
activities the newsletter, "Optimum", was sent to schools,
hospitals, health units, nutritionists, recreation professionals, industry, and to all who required it. It was hoped
this would provide the feedback which would ensure that Action
B.C. continued to fill the areas of the greatest need, in the
broad field of lifestyle and preventive health care.
- 26 -
 Planning and Development
The newly established division of Planning and
Development was created to provide leadership and support in
the establishment and maintenance of a coordinated planning,
research, evaluation, consultation, and policy development
capacity.
In September, Mr. Clair Buckley was appointed the
Executive Director and the division began to establish its
objectives, organizational structure, and priorities.
The following functions within the division were
identified: Planning and Policy Analysis, Program Development,
Vital Statistics, Research and Evaluation, Management
Information Services, Consultation Services, Manpower Planning
and Educational Liaison. Separate reports on Vital Statistics
and Management Information Services are presented elsewhere in
the Annual Report.
The projects that were developed, and/or administered, by
the Planning and Development Division in 1979 included:
1. Hospital Role Study - The development of Phase I, "A
Discussion Paper on Hospital Services in British
Columbia", was sponsored jointly by the Ministry of
Health and the B.C. Health Association, through the
Steering Committee of the Joint Funding Project. This
document was prepared by the Planning and Development
Division and Hospital Programs. It was distributed to
all health care agencies in the province for their
comments.
27
 2. Ministry and Departmental Objectives - The division
provided leadership in developing the overall purpose,
and long and short range objectives, for the Ministry.
3. Provincial Handicap Study - A review of the services
provided to the significantly handicapped children and
adolescents in British Columbia. The division directed
the initial phase which included terms of reference and
selection of project staff.
4. Rural Health Policy - The division worked with the Health
Care Planning Committee (Smaller Communities) in the
development of information that would lead to a rural
health policy for the Ministry.
5. Administration for the four Community Health and Human
Resources Centres (Queen Charlotte Islands, Granisle,
Houston and James Bay, Victoria). The responsibility for
these Centres was to be transferred to the new Special
Care Services Division.
6. Special Projects - The division was involved in the
establishment of several pilot projects including short
term geriatric assessment and treatment centres, and
palliative care units.
- 2£
 Community Care Facilities Licensing Board
THE PROVINCIAL CHILD CARE FACILITIES LICENSING BOARD
There was a 6 per cent overall decrease in capacity in
licensed child care facilities for the first seven months of
1979 (see Table 1).
However, there was a 17.8 per cent growth in licensed
Family Day Care, and a slight increase in Out of School Care
programs.
The amendments to the Summer Camp Regulations were being
processed at the year-end. There was a decrease of 6.8 per
cent in camp capacities over the first seven months of 1979
(see Table 1).
THE PROVINCIAL ADULT CARE FACILITIES LICENSING BOARD
1979 continued to be a busy year for the Provincial Adult
Care Facilities Licensing Board.
There was a decrease of 331 beds in the first seven
months of 1979, or a decrease of .5 per cent overall bed
capacity in licensed facilities (see Table 1).
Investigations of complaints of the Long-Term Care
Program were being done by Victoria and local Health staff.
29 -
 TABLE 1
Adult Care Facilities
Interior
Permit
Licences
Surrendered
Final Count
Year
Facility
Capacity
Facility
Capacity
Facility
Capacity
Facility
Capacit
1975	
. 59
1,792
1,291
1,734
1,805
1,527
453
449
465
481
524
14,534
15,085
15,008
15,407
16,178
130
78
30
37
1,928
1,281
511
824
382
424
486
539
549
14,398
15,095
16,231
17,212
16,881
1976	
. 53
1977	
. 51
1978	
. 58
1979 (first seven. .
months )
. 62
0.5 per cent decrease in capacity (331 decrease in capacity)
Cnild Care Facilities
197 5	
. 155
2,229
2,694
3,063
3,675
3,412
909
929
1,005
1,028
1,165
16,786
16,869
17,866
18,370
18,928
267
308
75
30
135
4,130
4,034
900
364
1,636
797
813
1,165
1,289
1,335
14,885
15,529
20,029
22,045
20,704
1976	
. 192
1977	
. 235
1978	
. 291
1979 (first seven
months )
305
6.1 per cent decrease in capacity (1341 decrease in capacity)
Camps
_
1975	
. 59
5,395
4,814
4,905
4,970
1,480
75
83
82
82
104
5,942
6,868
6,979
6,969
10,168
16
6
1
5
819
129
50
520
118
131
139
141
124
10,518
11,553
11,834
11,939
11,128
1976	
. 54
197 7	
1979 (first seven
months .)
. 58
. 59
25
6.8 per cent decrease in capacity (811 decrease in capacity)
- 30 -
/
 Community Physiotherapy Program — Care Services
During 1979 the goal of the Community Physiotherapy
Program was the promotion and maintenance of the population of
a  given  area,   at   the highest   possible   level  of   functioning.
This was achieved through the provision of services
directed towards treatment at the primary care level, active
participation in health maintenance programs, and involvement
in the preventive aspects of health care. Although the goal of
the program was to serve the total population of the area, a
ratio of one community physiotherapist to every 60,000
population dictated the delivery of services according to local
priority.
Services were directed towards all age groups in the
various setting of the community such as clinics, homes,
schools, and care facilities. The community physiotherapist
was required to be a multi-faceted community health care worker
involved in administration, education, consultation, research
and clinical practice. The scope of activities was broad and
diversified, and the demand for physiotherapy services from the
communities   in  general,   continued  to   increase.
During the year, the Community Physiotherapy Program
continued to provide direct treatment, consultative, and
preventive services to patients, families, physicians, public
health staff, hospitals, government ministries, and the general
public, through 12 healt'i units representing 18 office
locations. These services were provided to the three major
program areas, namely, Home Care, Long Term Care, and Public
Health Programs. The demand for community physiotherapy
services from physicians and the public generally continued to
outpace the available resources within the Ministry of Health.
In all health units in the province where community
physiotherapists were employed, services were utilized to their
maximum benefit, indicated by a total of approximately 2,500
new patients being referred to the service with an approximate
total  of  15,500   individual  visits.
31   -
 In addition to the treatment oriented visits, 10,300 separate
services were provided through the preventive program,
including 500 Long Term Care Program assessments, and 305
separate visits to schools in the province. An analysis of the
1979 caseload statistics by age shows the following
distribution:-
under 1 year -   1.38%        19 - 64 years   - 31.5%
2-5 years  -  2.01%        65 and over     - 61.38%
6-18 years -   3.7%
In 1979 there was an increase of approximately 30% in the
services provided to the over 65 age group, which was a direct
result of being able to offer services in the patient's home
where medical status, geographical location, transportation,
and cost, make domiciliary care more appropriate.
Services are provided through the following functions:
(1) Preventive care - Prevention is an integral part of all
physiotherapy and involves education and training in
self-care procedures, in order to prevent secondary
complications, deterioration of existing problems, or
recurrence of a treated problem. The therapist is also
involved in preventive services, such as school health,
"well child", sports injuries prevention and treatment,
industrial/occupational accident prevention, physical
fitness, mental retardation screening and assessment, pre
and post-natal programs, and recreation/activation
programs for senior citizens and disabled groups, etc.
These services are usually provided through the community
clinics, health care agencies, and organized community
programs, which are often multi-disciplinary.
(2) Treatment - Treatment services can be classed in terms of
location and type of care, and are provided to Home Care
and Long Term Care Programs.
- 32 -
 (a) acute care - provided through the hospital
replacement day, or non-hospital replacement day, program;
(b) active rehabilitation;
(c) convalescent, and some chronic care.
Emphasis in treatment service is placed upon the acute
care group, where physiotherapy is provided for patients
requiring continuous care and specialized treatments.
The community physiotherapists are involved in the
treatment of a high percentage of both acute medical and
surgical patients. Therapists are involved in a variety
of medical areas, including the following: acute and
chronic respiratory diseases, orthopaedics, prosthetics,
soft tissue injuries, post-surgical care, and
manipulations, etc.; coronary care, thoracic surgery,
neurological disease, head injuries, cerebrovascular
accidents, spinal lesions, progressive neurological
diseases; rehabilitation in spinal injuries, amputees,
etc.; general paediatrics, burns and plastic surgery,
psychiatry, renal dialysis, diabetic stabilization
programs, rheumatic disease units.
Home physiotherapy care is also provided on a periodic
basis for both nonacute, chronically iLl patients and for
patients requiring further rehabilitation following
hospital discharge.
(3)   Maintenance  and  follow-up  services  - These  services
provide  continuous  care  for  patients suffering  from
chronic disease processes, who may benefit from
intermittent therapy programs.
Programs usually involve either periodic treatment >r
supervision by the physiotherapist over many years, anJ
may  include  continuous  assessment,  special  training
33
 programs, specialized procedures, and the provision and
constant re-evaluation of aids and devices necessary for
independence.
(4) Consultant ^services - The final role of the physiotherapist in the community is that of adviser to members
of the health care team, particularly where the
multi-disciplinary approach has been taken. Physiotherapists act as consultants and/or advisers to local
universities, colleges, and schools, community and health
care agencies, industry, health care institutions,
government ministries, other health personnel, and
members of the physiotherapy profession. One of the most
important aspects of the advisory service is the
therapist's function in advising on features needed in
public buildings and facilities to avoid architectural
barriers to the disabled
Tut; establishment ol new services, and the evaluation of
pi^.scril services, were expected to be the major focus for 1980,
in Community Pliys iotiierapy Programs.
- 34
 COMMUNITY HEALTH PROGRAMS
Community Health Program Highlights
The largest outbreak of measles in ten years occurred in
the province in 1979. A special serological study was planned
for the coming year, to determine whether the current vaccine
was effective.
There continued to be a high incidence of salmonella food
infections, and undoubtedly many cases were not being
reported. Public health inspection spent a great deal of time
on this problem.
The Division of Public Health Nursing cooperated with the
epidemiologist in the development of a "Record of Basic
Immunization," available to each child on completion of the
basic immunization series.
A major change was implemented in the procedures related
to the Rheumatic Fever Prophylaxis Program. The changed
procedures should result in a more careful screening of those
no longer at risk from the disease, with more attention being
given to those at high risk.
In order to deal with the special health concerns of
those brought into the province under the refugee program,
special effort was taken to monitor the infectious and
immunization status of the group. The cost of the preventive
service was being borne by the province. A particular concern
related to tuberculosis, and guidelines were set up by the
Division of Tuberculosis Control for health officers and other
physicians involved with refugees.
3 5
 The new, broader approach to the control of venereal
disease continued in 1979. The term "Sexually Transmissible
Disease," or STD, was used in order to convey that there were
more diseases than gonorrhea and syphilis at issue.
There were improvements in both the quality and
effectiveness of the speech therapy program services during the
year, with the result that 60 percent of the severely
handicapped clients were reported to have achieved their
therapy goals.
During the year the Division of Vital Statistics
introduced Computer Output Microfiche (C.O.M.) indexes of vital
records, which proved of great value in searching of vital
records when dealing with applications from the general public
for certification.
The number of patients at home on Continuous Ambulatory
Peritoneal  Dialysis  (C.A.P.D.),  first introduced  in  1978,
increased to 7 1 from 35 in the previous year.  There were 27
kidney transplants during the year.  The Willow Dialysis Unit
had an average of 12 patients.
The publication of "Baby's Best Chance", a perinatal
manual for parents, was the result of several years
collaboration by physicians, nurses, nutritionists, dental
hygienists, physiotherapists and others. It was distributed
free of charge to expectant parents and physicians. An
exercise manual was being prepared to complement "Baby's Best
Chance."
During the year 67,000 school children used the self
applied fluoride tooth paste and rinse on a twice yearly basis.
36
 Preventive Services
1979 was a year of considerable change for those involved
in delivering preventive health services. Public Health
Programs of the Ministry of Health was renamed Preventive
Services.
At the year-end the Division of Public Health Engineering
(Environmental Engineering) was in a state of transition. It
was expected that all the engineers would ultimately be located
within the Ministry of Environment offices, and consulting
services to the Medical Health Officers continued without
significant change.
The Assistant Director's position was seconded to the
Ministry of Health, subject to periodic review. This position
was to be located in the offices of the Ministry of Health in
Victoria, and the incumbent would be responsible for the
provision of direct engineering services to the central office
of the Ministry of Health, and act as liaison between the
Ministry of Health and the Ministry of Environment on matters
relating to engineering services on environmental concerns.
After years of capable leadership, Dr. K.I.G. Benson
resigned as Assistant Deputy Minister of Preventive Services to
take up the position of Medical Health Officer of the Upper
Island Health District.  He was succeeded by Dr. H.M. Richards.
Preventive Services retained its objectives of promoting
positive health and preventing disease, through a variety of
direct services and control programs.
37 -
 A significant start was made to revise the Health Act of
British Columbia, in order to consolidate legislation
pertaining to public health, to eliminate redundant
legislation, and to revise and make appropriate new legislation
as required.
Ten Health Centre Building Projects were either
completed, or well under way, during the year.  These included:
1. North_Kamloops - A new 20,000 square feet centre was
occupied by the year-end.
2. Langley - The old 20,000 square feet Cedar Hill
Hospital was renovated and occupied in September.
3" ElAS£.e^SS.or^?  " A new 40,000 square feet centre,
under construction and due for occupancy in early
1980.
4. Terrace - A 32,000 square feet new centre, under
construction and due for occupany in early 1980.
5. Nanaimo - A 35,000 square feet new centre, under
construction and due for occupancy in early 1980.
6. Vernon - A new 32,000 square feet centre, under
construction and due for occupancy in late 1980.
7. Parksville - A contract was awarded to develop and
build an 8,000 square feet new centre, due for
completion in mid 1980.
8. North Delta - An architect was assigned and
functional planning and design for a new centre were
approved.  Problems in acquiring a suitable site were
expected to be resolved shortly.  Due for completion
and occupancy in latter 1980, provided a start was
made in early 1980.
9. Cranbrook - Final planning and design stages were
being completed and the contract was due for
tendering in early 1980.
38 -
 10. Kelowna - Functional planning and design stages were
near completion.  A mid 1981 completion and occupancy
date was expected.
All of the above centres were being financed by the B.C.
Buildings Corporation, except for 20% of such capital costs
being cost shared with each respective regional hospital
district board.
Communicable Disease
1979 saw the largest outbreak of measles in a decade.
Measles vaccine was first offered free of charge in 1969 and
has not been particularly well accepted by the people of this
Province. Despite this, and to help decide whether the current
measles vaccine is fully effective, a special serological study
was being planned for 1980.
Salmonella food infections were a continuing cause for
concern, with 810 cases reported. On the basis of cultures
submitted for investigation there were undoubtedly many more
not reported. This bacteria is found in food, particularly in
poultry, and the only practical defence available is through
sanitary food handling practices, both in restaurants and in
homes. A great deal of staff time was required to accomplish
this through public health inspectional and educational
programs.
39 -
 B.C. RHEUMATIC FEVER PROPHYLAXIS PROGRAM
After several years a major change took place in this
program. Patients who have reached the age of 19 years and who
have no evidence of cardiac damage subsequent to an initial
attack, and who have not had a recurrent attack for five years,
are no longer continued on the program unless they fall into a
relatively small high risk group. The Ministry of Health
provides free medication for as long as it is required.
Previously this had been discontinued when the patient became
21 years of age.
Thanks were due Professor (Emeritus) Maurice Young, Dr.
E. McLean and Dr. Michael W. H. Patterson for their
participation on the professional advisory committee to this
program.
HYPOGAMMAGLOBULIN PROGRAM
Normal Immune Serum Globulin was provided to infants and
children in need. Born without the ability to fight infection,
these children follow a reasonably normal life while receiving
these injections. One or two new patients are added to this
program each year.
INFLUENZA VACCINE PROGRAM
60,000 doses were given to those considered to be at
significant risk should they develop flu. All those in British
Columbia over 65 years of age were offered this vaccine, as
were those with chronic chest, heart, kidney or metabolic
diseases.     Little   influenza occurred   this  year.
-   40
 REFUGEE PROGRAM
A few acute and many chronic infectious diseases are
being brought into Canada by the refugee program. As it was
not possible to do all additional health tests immediately on
arrival, these were being done by local preventive service
staff after refugees arrived at their final destination.
Tuberculosis is a major problem in Indochina, so tuberculin
tests were done on all refugees, and those infected were
followed up and treated.
- 41 -
 Division of Tuberculosis Control
It was estimated that the number of new active cases of
tuberculosis in British Columbia for 1979 would be 410, the
same as in 1978. During the year approximately 38,000 visits
were made to clinics throughout the province. Tuberculosis
will continue to be a matter of public health concern in this
Province for many years because of the large number of
immigrants from countries where the disease is prevalent. This
took on greater dimensions in 1979 when British Columbia agreed
to accept a considerable number of Indo-Chinese refugees. In
order to ensure adequate screening and treatment of these
individuals the Division implemented a set of guidelines for
health officers, and other physicians who may be in contact
with these refugees, similar to those for the general
population, in order to prevent infected persons developing
active  disease  in   later  years.
During 1979 the Division adopted the shorter treatment
courses with the new drugs, because of their proven success.
Greater emphasis was placed on the investigation of contacts of
active cases, and a significant number of infected contacts
were   placed  on  prophylactic   treatment.
Efforts were increased to provide intermittent supervised
therapy to uncooperative patients, who could not be relied upon
to   take   their medication on  their  own.
The length of time for routine follow-up of adequately
treated patients was reduced. Emphasis was placed on good
treatment of active cases, and prophylactic treatment of
individuals  at  risk of developing active  disease.
The in-patient bed situation remained unchanged with 44
beds  available at Pearson Hospital.
42
 Gradual progress was made in persuading local health
institutions to treat tuberculosis cases, particularly if it
appeared the hospital stay would be short.
The great majority of cases continue to be treated on an
ambulatory basis, with every effort made to disrupt the
patient's normal routine as little as possible, consistent with
good treatment and limitation of the spread of disease.
It was hoped that the anticipated transfer of the
in-patient tuberculosis cases from Pearson Hospital to Willow
Chest Centre with its proximity to the Vancouver General
Hospital, would take place in the new year.
- 43 -
 Division of Venereal Disease Control
The new approach to the control of sexually transmitted
infections initiated in 1978 was continued in 1979. It
entailed introducing the new term STD (sexually transmissible
disease) to better convey the fact that there were more
diseases at issue than just gonorrhea and syphilis. Syphilis
remained under control and gonorrhea, while still very
widespread, was less pervasive than in past years. Other
diseases considered problematic included non-gonococcal
urethritis (NGU), candidiasis, herpes simplex virus,
trichomoniasis, chlamydia and two parasitic infestations, pubic
lice and scabies.
PUBLIC AWARENESS
During the year an informational campaign alerted the
public to the prevalence of STD (particularly gonorrhea), and
to the steps necessary to protect themselves and curb the
epidemic. Information messages were broadcast over Victoria,
Prince George, Kamloops, Trail and Kelowna/Penticton radio
stations. During the summer, announcements were broadcast on
an additional 40 stations throughout the entire province.
Display cards were placed in Vancouver buses to advertise the
V.D. Information Line and the hours of the main V.D. Clinic at
828 West 10th Avenue, Vancouver.
This campaign created a rising demand for clinical
services, and all health unit V.D. clinics reported increases
in attendance. In Vancouver there was a 23 per cent rise in
male patients, and a 40 per cent rise in female patients coming
into the main V.D. Clinic. Over the two year period
(1977-1979) since the campaign began, male clinic attendance
has increased by 37 per cent and female clinic attendance by a
substantial 58 per cent.
- 44 -
 During   this   same   period,   the   gonorrhea   rate   dropped  by   ten   per
cent.
Over 50,000 STD informational pamphlets were distributed
in 1979. The V.D. Information Line received 100,000 calls,
bringing its two year total to 150,000. Demand on the
Information Line was so heavy that a second answering device
had to be installed, allowing the line to simultaneously handle
two  calls.
A new program dealing with family planning education also
started in 1979. A health education consultant in family
planning, acquired by a federal grant, worked closely with the
Division's health education consultant and nurse education
consultant. Two posters on contraception were produced, as
well as teaching resource materials, bibliographies and several
charts and diagrams. A series of pamphlets on birth control
methods was prepared, with the first title in production at the
year-end.
A summer project with three students included developing
new poster and pamphlet graphics, researching literature on
contraceptive methods, and assisting in the completion of a
Nurse's Manual on STD and in the evaluation of the V.D.
promotion  campaign.
COMMUNITY HEALTH NURSES
The Division of Venereal Diseae Control continued to
provide nursing time and clinics throughout the province, to
ensure that local needs were met with respect to screening,
diagnosis and treatment of STD. Full or part-time nurses were
provided in Victoria, New Westminster, Kamloops, Dawson Creek,
Prince George, Prince Rupert, Quesnel, Williams Lake, Vernon,
Kelowna and Penticton. The responsibilities of these nurses
included  liaison with private physicians  involved with STD
- 45
 patients, and the provision of services for interviewing,
contact tracing and the diagnosis and treatment of named
contacts. The center of the V.D. Control Program, located in
Vancouver, provided the same services to physicians in the
Greater Vancouver and Lower Mainland area, and offered
telephone consulting services to physicians throughout the
province.
During the year new nurse-education and teacher-education
programs were developed. A number of different workshops were
designed by the three members of the health education group,
dealing with subjects related to contraception, sexually
transmitted diseases, sexuality, school programs, and improved
clinical diagnosis and treatment. Approximately 50 workshops
were presented in nine different health districts, to over 600
nurses, teachers, physicians, social workers, counsellors and
school      board      officials. In      addition,      health      educators
continued to give lectures to university students in nursing,
kinesiology  and  pharmacy.
PHYSICIAN   AWARENESS
One of the major difficulties in the control of STD was
the lack of cooperation from most physicians who see STD
patients. In particular, physicians were still reticent to
report positive cases of STD. Without such reporting, attempts
to notify infected partners (who may be asymptomatic) were
severely  constrained.
The Vancouver Clinic physician continued his involvement
in promotional and educational seminars with the UBC Faculty of
Medicine and local medical associations. A new Physicians's
Manual on the diagnosis, treatment and control of STD's was
produced, and on-going dialogue was maintained with the British
Columbia Medical Association. Unfortunately, these approaches
appeared      to     have      little     effect      on      increasing     physician
46
 reporting. Furthermore, the demand on public health clinics
was heavier than could be handled, so some clinic patients were
referred back to their physicians. At the year-end the
division was negotiating an arrangement with the local medical
societies, through which a list of physicians in an area
wishing to accept new STD patients could be provided to persons
attending clinics, who would otherwise be inconvenienced by
long waiting periods. Also being investigated were new fee
schedules and alternate methods of providing physicians with
epidemiological support, as ways to increase notifications of
physician-treated  patients.
The Division of Infectious Diseases continued research
into the etiological role of chlamydia in non-gonococcal
urethritis. This project was co-sponsored by the U.B.C.
Faculty  of  Medicine   and   the  Division  of  Veneral  Disease  Control.
PUBLIC HEALTH INSPECTION SERVICES
Public Health Inspection services provide an essential
part of Preventive Services, through the promotion of health
and the identification and control of health hazards in the
environment.
Table 4 indicates the types and numbers of facilities or
projects dealt with in the past year. Excluded are inspections
in the Cities of Vancouver, New Westminster, District
Municipalities of Burnaby or Richmond or the North Shore Health
District.
Table 5 presents a statistical summary of selected
activities of Public Health Inspectors from 1975 to 1979. It
should be noted that the Small Sewage Disposal Program
presented the heaviest workload, accounting for approximately
25% of the total time available; followed by food premises,
water supply, swimming pool and community care.
47
 Public Health Inspectors do not work in isolation from
other agencies. In fact, considerable effort was made to
develop programs in cooperation with many other agencies in
order to deliver a cost effective service. These agencies
included Health and Welfare, Canada; Ministries of Consumer and
Corporate Affairs; Environment; Lands, Parks, and Housing;
Municipal Affairs; and the planning and building departments of
Municipalities and Regional Districts.
TRAINING PROGRAM
The Ministry of Health sponsored a four day In-Service
Training Seminar for 65 Public Health Inspectors in November.
The Ministry also provided field training for 32 Public Health
Inspector trainees. This field training was a prerequisite to
their  professional  qualification.
Specialized Community Health Programs
MEDICAL  SUPPLY  SERVICE
The headquarters of this service is located at 1159 West
Broadway in Vancouver. The warehouse is at Riverview Hospital
in Essondale, and Pharmacy Services is located at 828 West 10th
Avenue,   Vancouver.
The largest function of the service is to provide for
patients wishing to do dialysis at home. The first method of
home dialysis, hemo or blood dialysis, is the most complex
method and the number of patients at home on this procedure
decreased from 71 to 53 during the year. Peritoneal dialysis
was carried out by various methods, but in 1978 a new method
called "Continuous Ambulatory Peritoneal Dialysis (C.A.P.D.)
was introduced, which became the most popular method. The
number of patients on peritoneal dialysis increased from 35 to
the  present  71.
-   48  -
 Hemodialysis equipment must receive regular servicing
from trained technicians. Following the transfer of one of the
two technicians, it became necessary to contract with an
equipment manufacturer to maintain this service.
In order to ensure that home patients carry out safe
procedures and do not encounter insurmountable social problems,
it was necessary to have a nurse visit the home on a regular
basis.  During the year two home visiting nurses were recruited
to visit patients.
Dietary supplements were provided to patients with renal
disease:  a) in order to delay the requirement for dialysis,
b) to assist children with growth, and  c) to provide weight
gain in debilitated  patients.   These  supplements  are high
calorie supplements but low in protein, sodium and potassium.
1979 was the second year in which the Kidney Foundation
supported a summer camp. The first one was a provincial camp
only while the summer camp was for children from across
Canada. This was a national project and the Kidney Foundation
collected the funds and bought the supplies from this division.
There were 27 kidney transplants during the year. This
Division arranged transportation when necessary to carry this
out. It is planned to provide a co-ordinator for the program,
in order to ensure that it could function throughout the
province. The co-ordinator would also participate in a public
relations program in order to encourage the donation of kidneys
and other organs.
The Willow Dialysis Unit located at 1159 West Broadway,
Vancouver, had an average of twelve patients "running"
themselves with minimal assistance. Other limited care units
were being discussed but at the year-end nurse dialysis
assistants were supporting one patient each,  in up to ten
49
 locations around the province. Hospital Programs was
co-operating with the Kidney Dialysis Service by providing a
space for some patients who were unable to dialyze in their own
homes and lived too far away to commute to one of the six renal
units.
There were 47 patients who were deficient in Factor 8
(Classical Hemophilia), and five patients deficient in Factor 9
(Christmas disease) who provided their own treatment at home.
The Medical Supply Service provided the intravenous materials,
and the Canadian Red Cross Society provided the plasma products
required. A grant was provided to the B.C. Hemophilia Society
so that they could employ a part-time nurse co-ordinator,
physiotherapist, and social worker for the Hemophilia
Assessment Clinic. A physician volunteered his service to
operate this program.
There were some patients with a severely diseased bowel,
who were unable to absorb food. It was necessary to feed these
patients by the intravenous route, called Total Parenteral
Nutrition. Six patients were trained to carry out this
procedure, and feed themselves at home. This Division supplied
their requirements.
SPEECH THERAPY PROGRAM
The Ministry of Health Speech Pathology Program provided
speech and language assessment, therapeutic and preventive
services, to all age groups residing in the Province of British
Columbia outside of Vancouver and the Capital Regional
District. These services were provided from local health
speech and hearing clinics, and through local school board
programs. Services were given to a number of school districts
this year through a cooperative agreement previously reached
with the Ministry of Education, Science and Technology.
Contracts for service were signed with eight school districts
50
 within the six local health regions.  Agreement was reached to
add service to an additional school district.
All program services were provided to communicatively
handicapped people by 21 speech pathologists, who provided
services from twenty local health clinics and, additionally, 15
speech pathologists delivering speech and language services
through the school program.
On the average, clients were referred for speech and
language services at the rate of 300 per month. Of those
assessed, 70 percent were recommended for treatment programs,
and each month an average of 780 communicatively handicapped
individuals received at least weekly treatment. Nine per cent
of all treatment cases were dismissed each month. Seventy
percent of staff time was devoted to direct clinical treatment,
and 39,100 individual therapy sessions were conducted during
the year. This represents a significant increase in direct
remediation of communication disorders.
Local staff improved both the quality and effectiveness
of the services delivered. Sixty percent of the severely
handicapped clients were reported to have achieved their
therapy goals on discharge from therapy.
HEARING CONSERVATION PROGRAM
The Division of Speech and Hearing delivered
comprehensive hearing services in most areas of the Province to
all age groups. The demand for speech and hearing services
resulted in the establishment of 17 audiology clinics. Through
contractual agreement, the government provided these services
to two independent boards of health.
A high level of local community and medical input was
achieved through the use of medical advisory committees in each
51 -
 hearing clinic locality. Programs were coordinated with other
community facilities and services such as hospitals, school
boards and other provincial Ministry offices.
Through the delivery of a standardized program, the
prevention of hearing loss, and the earliest possible detection
of unavoidable hearing loss, remained the primary objectives of
the hearing program.
Activities included:
(1) the High Risk Hearing Register for identifying
hearing impairment in newborns;
(2) the preschool and school hearing screening;
(3) the Industrial Hearing Conservation Program for
government workers exposed to high noise levels;
(4) environmental noise control and analysis.
In cooperation with the Ministry of Education, Science
and  Technology,  the  Health Ministry  provided  specialized
auditory training equipment to hearing impaired students
throughout the Province.
VISION SERVICES
The objectives of these services was to promote a program
to provide optimal visual function for the citizens of British
Columbia.
Emphasis continues to be placed on early detection of
visual defects. Suitable visual screening programs were
carried out at routine Child Health Conferences, allowing new
mothers access to these services before the age of six months.
By this age, the tendency for the baby's eyes to wander or
cross should be well under control, and if uncorrected, loss of
vision in the affected eye occurs. Uncorrected crossed eyes,
loss of vision due to lack of use, and certain uncorrected
- 52
 refractive  errors are  a  significant  cause  of  permanent
blindness, and the identification of these conditions at the
earliest  possible age  continued  to  be  of  considerable
importance.
Consultative services were provided by the Orthoptist to
over 200 public health nurses, aides, volunteers and summer
students. Visits were made to thirteen main health unit
offices and fourteen branch offices. During these visits, the
Orthoptist joins the staff in carrying out vision screening and
recheck assessments. A second revision and updating of the
Learning Module for Vision Services was completed. The Module
provides information and guidelines for various screening
tests, as well as a list of resources and educational matter
related to eye care.
General care of the eyes was emphasized, with particular
attention to eye protection from heat, chemicals, fireworks and
traumatic damage. Certain sports were identified as
particularily hazardous, and an information pamphlet was
produced listing tips on how to prevent eye injury.
During the year a Vision Services display was used
throughout the Province, suitable for educational exhibits in
health units, shopping malls, community centres, etc. Display
panels included such topics as "Your Eye and How You See",
"Nearsightedness", "Farsightedness", "Colour Vision",
"Cataracts", "Glaucoma", "Corneal Transplants", and "Eye
Safety", and outlined the services offered through child health
conferences, preschool centres, school and adult clinics.
Pilot studies and evaluation of procedures to assess
effectiveness and efficiency continued, in an attempt to
standardize vision services throughout the Province.
53
 Public Health Nursing
The overall goal of public health nursing is to assist
individuals and families in the attainment of an optimum level
of health and functioning, and to assess and evaluate community
health needs and services. The public health nurses promote
the development and appropriate use of resources required to
meet the identified needs. The focus is on contact with
individuals and families in their home or work environment, at
school, at clinics, or in group discussions.
During the year the Community Health Nursing Division was
separated as part of the reorganization of the Ministry of
Health. Community nurses working in the Home Care Program
became a part of Direct Care Services; Public Health Nursing
became a Division of Preventive Services. Due to the many
areas in which programs coincide, integration of the services
continued to exist and close cooperation was maintained. The
separation of the "Care" and "Preventive" programs permitted
the Public Health Nursing Division to concentrate on programs
for prevention of disease and disabilities, and on promotion of
health.
Public health nursing welcomed the opportunity to
participate in the newly formed Children's and Perinatal
Committees of the Ministry of Health. The committees provide a
structure for an unprecedented area of intraministerial
planning and programing. An inventory of all health related
services provided for children in B.C., which are funded wholly
or partially through the Ministry of Health, was prepared
jointly by Long Term Care and Public Health Nursing. This
inventory was available to all Divisions in the Ministry who
are providing services to children, to assist in coordinated
planning   and   service   delivery.    Continuing   work   on
54
 interministerial committees contributed to better understanding
and cooperation between Ministries.
The statistics which appear on Table 1, "Selected
Activities of Provincial Public Health Nurses, September 1/78
to August 31/79", and the following notes on programs, indicate
some of the areas in which public health nurses made a
contribution to bettering the health of people in British
Columiba.
PERINATAL AND INFANT
The past year was an eventful one in the field of
perinatal health for the Nursing Division. The completion and
publication of Baby's Best Chance," the perinatal manual for
parents, was the culmination of several years of work and
collaboration with many nurses, nutritionists, physicians,
dental hygienists, physiotherapists, parents, clerks and others
throughout      the      province. The      Health      Promotion      Division
arranged the technical aspects of publication, as well as the
excellent promotional campaign which emphasized the importance
of   the health of  the mother  on   the  developing baby.
"Baby's Best Chance" was distributed free of charge to
expectant parents and to physicians in British Columbia, and is
available free of charge from the local health units. Requests
for the book were received from health professionals and/or
parents from every Canadian province, the Yukon, several areas
of   the  United   States,   England  and  Finland.     In  addition:
• An Exercise Manual was being prepared as an adjunct to
Baby's   Best   Chance.
• The Early Pregnancy Profile was developed to help
mothers assess their need for health teaching and
lifestyle  changes.
-  55
 • A pamphlet for unwed pregnant teenagers was ready for
publication at the year-end.
The public health nurses participated in many events to
mark the International Year of the Child and Family, including:
• Collaboration in preparing the contents and
distribution of the Health Passports.
• Participation in the display promoting good perinatal
health, sponsored by the Junior League of Vancouver.
• Planning of the Outreach Projects to be held in the
Cariboo and Upper Island Health Units, to prepare
volunteers to work with specific groups of expectant
parents.
• Writing the Public Health Program section of the Child
Abuse Manual, and assisting in coordinating the manual
contents.
The statistics which appear in Table 1 show an increase
over the previous year in all aspects of infant and perinatal
health services: more parents attended prenatal classes; more
infants were visited during the first six weeks of life; and
more infants were brought to Child Health Conferences.
PRESCHOOL PROGRAM
The infant and preschool years are said to be the most
sigificant in the life of an individual, and this age group is
therefore, given high priority in program planning and delivery.
Services were provided by means of home visits, in child
health conferences and in special clinics. Formal screening
programs included testing for defects in normal vision or
hearing, delays in normal development, and the detection of
health  or  nutritional  problems  through  observation  and
56
 discussion with the parent. In addition to the identification
of problems follow-up and supportive services were provided to
ensure  that appropriate  action was   taken by  parents.
In the area of the province served by the 17 provincial
health units 67,068 visits to child health conferences were
made by children between the ages of 1 and 5, another 32,910
preschool-aged  children were seen at home or  office visits.
A total of 13,605 preschool children were screened for
visual defects and 10,295 for hearing loss. The Prescreening
Developmental questionnaire (PDQ) was completed by parents who
attended the screening clinics, which provided a quick guide
regarding the child's developmental progress. A complete
Denver Developmental Screening Test was given to 8,305 children
because some items on the questionnaire indicated a need for
further   investigation.
During the year over 4,000 consultative visits were made
by  public health nurses   to nursery schools   and  day  care  centres.
SCHOOL HEALTH PROGRAM
The overall purpose of the School Health Program is to
enable the student to achieve and maintain optimum health
throughout the school years, and to establish a basis of
knowledge, attitudes and life skills, upon which to build a
healthy, productive adult life.
Services for school aged children continued to account
for a significant percentage of the public health nurses' time.
There was a marked increase in the number of students
screened for both vision and hearing problems over the past two
years. The number of students screened for visual defects
increased by 13% during the school year ending in June, 1978,
57
 and there was a further 2% increase during the 1979 year. For
hearing screening there was an additional 10% increase during
the current year. This increase in screening service was
possible because of the replacement of a number of previously
frozen public health nursing positions.
There was a slight increase in the number of students who
completed all required immunizations by the end of Grade I.
The average immunization status of Grade I students in school
districts served by provincial health units in June, 1979 was
as follows: for diphtheria, tetanus and poliomyelitis 85% were
fully immunized, with 80% immunized for rubella; 90% of girls
in Grade V were immunized for rubella.
During the year our attention was directed toward
providing health information to students individually, in class
or groups, which would encourage positive attitudes towards
health, and promote interest and individual responsibility in
developing healthy lifestyles. This was particularly true in
secondary schools, where students are on the threshold of adult
life and family responsibility.
An analysis and review of the public health nursing
service in schools continued, in the attempt to more clearly
define various aspects of service, and identify those which
were most productive. It appeared necessary to perceive the
public health nursing workload in two parts. First there are
those services which are routinely supplied to all students.
These are the screening and immunization programs, the health
education and information services applicable to all.
Secondly, there are individual students with particular health
problems, who may periodically require increased surveillance,
guidance and support, to enable them to obtain maximum benefit
from their school years, and to plan appropriately for their
adult life. These students require varied amounts of nursing
time, depending upon their immediate needs and problems of
58 -
 adjustment. It is essential the public health nursing service
in schools be planned with both aspects of service receiving
due attention.
ADULT, GERIATRIC AND OTHER COMMUNITY SERVICES
Although many contacts with adults are initiated due to
concern for the health of infants and children, the public
health nurse also worked with adults, to help them attain their
best level of functioning. Group discussions are held
frequently with emphasis on fitness, nutrition and healthy
lifestyles.
During the year guidance and teaching was done with
adults who had special needs due to conditions such as
diabetes, heart surgery, multiple sclerosis, mental
retardation, or physical handicaps. Visits were also made to
help individuals who experienced difficulty coping with
increased stress, due to loss of a loved one, separation, or
family conflict.
Adults who had the potential to become child abusers were
given special attention, to gain insight into their problem.
In many instances clients were referred to other agencies for
therapeutic interventions, but the public health nurse maintained a coordinating role.
Public health nurses recognize the need to provide
services to the elderly, to help them enjoy their senior years,
and visits were made to homes and senior citizens residences,
to talk with them on an individual or group basis. The nurse's
work in relation to the licensing of Adult Care Facilities put
her in touch with the concerns and problems of many elderly
people and their families.
The public health nurse is keenly aware of the need to
collaborate with the Long Term Care, Home Care, and Mental
59
 Health Nurses within the health unit, to bring a high level of
professional nursing service to individuals and families. In
some of the more remote areas of the province the public health
nurse  continued  to  perform  these   functions.
THE   PUBLIC  HEALTH  NURSE  AND  DISEASE  CONTROL
The public health nurse plays a varied and active role in
disease control programs. Emphasis is on prevention, but
treatment  and  follow-up are also  provided.
• Health Education - information about communicable and
non-communicable disease, healthy lifestyles and other
health related topics, was offered through planned
discussions with school children, with pre and
post-natal, parenting and other groups in the
community.
• Immunization - renewed emphasis on the importance of
immunization, particularly for the young child,
resulted in a general improvement in the immunization
status  of  elementary  school  children.
• Health Records - a plasticized wallet size "Record of
Basic Immunization" was developed in cooperation with
the Division of Epidemiology and made available for
each child, on completion of their basic immunization
series and school entry booster. It was hoped this
more permanent type of card would encourage individual
responsibility   for   its  maintenance.
• Treatment and Follow-up - the public health nurse
continued to be an important contributor to the
identification, treatment, and follow-up of all
communicable diseases, particularly in cases and
contacts  of T.B.,   V.D.   and  parasitic   infections.
-   60
 Division of Dental Health Services
During the year the Division of Dental Health Services
continued  to  expand  its  services   throughout  the Province.
At the year-end the field staff was comprised of 6 dental
officers,   14  dental hygienists   and 27  dental  assistants.
One certified dental assistant received training in an
experimental public health module and the results of the
training were to be evaluated. One dental officer was on leave
to receive  public health   training.
THREE  YEAR OLD  BIRTHDAY   CARD  PROGRAM
This program operated in 49 school districts served by
the Provincial Health units. More than 12,000 three year old
children were started down the road to dental health through
the free examination and parental counselling by the family
dentist that this program provides. This was an increase of
more than 2,000 children from last year. A participation rate
of 70.8% of eligible children throughout the province was
achieved, an increased rate of 3% from last year. Again, this
indicates society's growing awareness of the desirability of
early     dental      care      for      children. An      intensive      follow-up
procedure    by     the    health     unit    dental    staff    has     caused    this
improvement.     Some  regions had almost 90%  participation.
DENTAL EXTERN PROGRAM
Last year 13 dental externs were involved in the largest
dental extern service in the division's history. The dental
population ratio improved to the point where more dentists were
expected    to   move    into   rural    location,    improving   accessibility
61  -
 to resident dental service. In 1979 the Division appointed
only 7 dental externs, 3 of them to our semi-permanent dental
facility in Prince Rupert. These dentists visited 31 separate
under-serviced communities to provide routine dental care and
rendered treatment to 11,344 citizens. The new Dodge Maxivans
which were used to carry packaged equipment to augment the
mobile  dental  units   functioned well.
SCHOOL DENTAL  HEALTH   PROGRAMS
During the year provincial dental hygienists and dental
assistants provided oral hygiene instruction, education,
prevention and motivation, to 84,062 elementary school
children, an increase of about 5,000 from last year. Of this
total, 67,000 used the self-applied fluoride paste and rinse on
a twice yearly basis. In addition, 55,000 children received
dental inspections at school, an increase of 7,000 over last
year. Of these, 16,830 children were referred for dental
decay,        and       growth       and       development       problems. Parents
voluntarily carried out most of these referrals, and a further
16,000 were followed up at home by the health unit dental
staff. Over 3,000 children were also referred home to parents
as having need to improve their oral hygiene habits, because of
harmful  amounts   of  dental   plaque  and   food  debris   on   the   teeth.
From the inspection data collected over the years, a
dental health profile of the children in many school districts
became discernible. In several school districts up to 90% or
more of the children had dental disease under control and
regularly visited the family dentist. Records indicated a
steady improvement in dental health in many areas, and a great
reduction in loss of teeth in children. This improvement was
dependent upon two factors. First, the close cooperation that
developed between the dental profession, teachers and parents
with the health unit dental staff. Second, the quality of the
program   delivered   to   the   public,   especially   the   inclusion   of   an
-   62   -
 effective  follow-up  system  that  was  essential  to  secure
treatment for the children who need it.
LONG TERM CARE
The dental care of the physically and mental handicapped,
and the long term care and extended care patients, particularly
those institutionalized or otherwise not able to visit the
family dentist, was becoming more important to the Division of
Dental Health Services. During the year the Division continued
to learn more about the special problems of these people.
Approximately 900 such persons (long term care residents and
homemakers' clients) were surveyed in 1979 for dental needs, 82
staff members of care facilities and 35 homemakers were trained
in the dental care of their patients or clients. Three hundred
and ninety-four persons received direct assistance from health
unit staff, such as ultra-sonic denture cleaning and marking.
Methods of improving the delivery of service to these people
include:
A coordinated provincial plan whereby appropriate
techniques of dental care would be taught to students at the
Dental Faculty at U.B.C.; a residency program established in
some major hospitals of B.C. for new graduates; the formation
and cooperation of the Institutionalized Care Committee of the
College of Dental Surgeons, along with new dental responsibilities identified in the Hospital Role Study and in
cooperation with the staff of this Division.
METRO HEALTH UNITS
In 1979 autonomous dental services existed in the metro
health units such as Victoria, Vancouver, Burnaby, West
Vancouver, North Shore and Richmond. Some of these health
units operate dental treatment centres for certain age groups.
Others operate educational and motivational programs, they
include thousands of children in addition to those serviced by
- 63
 the provincial health units.  It was hoped that even closer
cooperation with these areas could be developed.
DENTAL FACULTY, UNIVERSITY OF BRITISH COLUMIBA
This Ministry agreed to partially fund a dental
department to serve both the extended care and acute care units
of the new University Hospital. It was hoped that this
department would provide training for dental students and
dental hygiene students in the care of the elderly, retarded,
handicapped and other special needs people.
U.B.C. continued to develop a cooperative working
relationship with the Ministry in the special public health
training of dental hygienists and dental assistants, and the
Ministry supported the Faculty in the provision of a summer
dental clinic at the University. More than 1,000 children,
preselected by public health dentists, were provided with a
full range of dental care during the summer, which they
otherwise would not likely have been able to receive.
DENTAL CARE PLAN FOR BRITISH COLUMBIANS
During the year many of the Division's activities were
directed toward providing support to the proposed Dental Care
Plan. These included the hope to expand the Division's staff
in order to serve the entire province; the new Hospital Role of
Dentistry with respect to Long Term Care; closer cooperation
with the dental staffs of the metro health units and the
Department of National Health and Welfare; and working with the
University of British Columbia to facilitate the ability of the
dental profession to provide care to "special needs" people.
The Dental Care Plan would depend on cooperation with those
licensed by the Dental Technicians' Board to provide many
services as well. Plans included the use of dental health
surveys for children and adults.
64
 OTHER ACTIVITIES
Preschool programs were developed in many localities. A
prenatal tape slide series was produced as part of the health
units' perinatal dental program. Workshops for teachers were
organized in many school districts, so that the school would
provide continued reinforcement of dental programs. Teacher
Information Kits were developed for the use of school
personnel, and audio-visual aids and classroom lesson plans
were supplied for their easy use through all the health units.
A manual for use of the staff of institutions was being
developed, so that dental hygiene and dental treatment services
would be provided to long term care clients. Plans for the
Dental Survey of Children in B.C., to be carried out early in
1980, were ready to be put into action.
65 -
 Vital Statistics
The Division of Vital Statistics has two distinct
functions: it administers the Vital Statistics Act, the Change
of Name Act, the Marriage Act and the Wills Act-Part II; and it
provides a centralized statistical service to various community
health programs within the Ministry, and to certain other
health agencies.
REGISTRATION SERVICES
A substantial part of the Division's responsibilities is
connected with the administration of the Vital Statistics Act,
which governs the registration of births, stillbirths,
marriages, deaths, adoptions and divorces, as well as the
controlled issuance of documentation from the registrations on
file, in accordance with the conditions laid down in the Act.
Computer  Output Microfiche  (C.O.M.) indexes  of vital
records  were  introduced  in  1979,  but the  traditional
"hard-copy" (paper) indexes were retained as supplementary
sources.
Under the Marriage Act, the Division is responsible for
registering ministers and clergymen of recognized religious
denominations, for purposes of the solemnization of marriage in
this Province; for administering the issuance of marriage Act;
and for the solemnization of marriages by civil contract
throught the Province.
The  Change of Name Act  provides  the means  whereby
residents of the Province may change their given names or
surnames, and the names of their children, upon meeting the
prescribed requirements. The numbers of applications under
this Act continued to increase during 1979.
66 -
 The Registry of Wills Notices, maintained under Part II
of the Wi 11 s Act, provides for a testator to file voluntarily
with this Division a notice indicating the existence of a will
and where it is deposited. The Act provides for the Register
to be searched and information therefrom released after decease
of the testator, upon application to the Director in the
prescribed form. The number of wills notices filed each year
maintained its steady increase, and passed the 50,000 mark in
1979.
Table 6 shows the number of registrations of vital events
and the number of certificates and other forms of documentation
issued under the Acts administered by this Division, for the
years   1978  and   1979.
BIOSTATISTICAL  SERVICES
The Research Office in Victoria, and the Health
Surveillance Registry in Vancouver, have a combined staff of
22, including 9 Research officers, and are supported by a
14-member data processing office in Victoria. Under the
general direction of the Coordinator of Research and
Registration Services this group provides a wide range of
management information and research services to the Division of
Vital Statistics, to various components of the Ministry, and to
other  government  and  private  agencies  and  individuals.
During the year the Division's legal registration
services benefitted in several ways from computerization. One
example was the introduction of Computer Output Microfiche
(C.O.M.) indexes for searching vital records in dealing with
applications   from  the   public.
The Health Surveillance Registry located in the Vancouver
Research office of the Division, maintains a register of
chronic handicapping diseases, genetic and birth defects.
During    the    year    more     than     12,600    new    cases    of    congenital
-   67   -
 anomalies, genetic defects, and chronic handicapping
conditions, were submitted for registration. The Registry
supplied statistics on the incidence or prevalence of
registered conditions in the province to researchers, planners,
and health and educational agencies, both in B.C. and in other
provinces and countries. The continuing worldwide interest in
morbidity registers, particularly registers of birth defects,
was apparent as requests for information concerning the
Registry were received from other provinces, the United States,
Italy, and Australia.
A major effort was devoted to converting the diagnostic
codes of the entire Registry caseload to conform to the 9 th
revision of the International Classification of Diseases. The
computerized conversion methodology was documented for
publication, so that the format may be adapted to other medical
coding systems, and to future revisions of the LCD.
The Registry consultants in genetics, paediatrics and
cancer, provided invaluable advice and assistance in the
maintenance of the registry and in research projects which
utilized the Registry data.
The Health Surveillance Registry Annual Report, 1977, was
printed early in 1979, and at the year-end a report for 1978
was being printed.
The Cancer Register continued to operate as a distinct
unit within the Health Surveillance Registry, and the
computerization of its reporting system was completed during
the year. The Cancer Register staff collaborated closely with
the Cancer Control Agency of B.C., in their preparations for a
province-wide cancer information system.
The Register continued its collaboration with the Western
Canada Cancer Registers Association, contributing to an ongoing
68
 study of cancer incidence in the four western provinces, as
well as to an investigation into the etiology of malignant
melanoma in some provinces.
Two Research officers of the Division continued to serve
as members of the Continuing Advisory Subcommittee on Perinatal
care, which is a subcommittee of the medical Advisory Committee
to the Minister of Health. A working group of the subcommittee
recommended certain revisions of the Physicians' Notice of
Birth, which were to be adopted for introduction in January,
1980.
The Division was also represented on the internal
Perinatal Committee established during the year under the
chairmanship of Dr. G. Bonham, Senior Assistant Deputy Minister
(Community Health Services).
The International Year of the Child prompted many
requests for analysis of data on perinatal statistics, which
were dealt with by the Research section. Among the subjects of
these inquiries, interest centred mostly around the incidence
of prematurity and low birth weight, causes of stillbirths,
maternal risk factors in childbirth, cerebral spasticity, the
trend of caesarean sections, home births, and the development
of a Child Health Profile for the province. Information on
congenital anomalies occurring in British Columbia births was
provided on a weekly basis to the National Surveillance System,
maintained by the Federal Department of Health and Welfare.
Statistical consulting services were provided to the
Division of Dental Health Services, particularly in the
planning of a province-wide dental health survey of children to
be undertaken in 1980.
The Research section maintained the file of known
tuberculosis cases on behalf of the Division of TB Control.
- 69
 Alphabetical indexes were provided for use in the stationary
diagnostic clinic, and an annual report on tuberculosis was
prepared.
Monthly and annual statistics of the operations of the
Division of Venereal Disease Control were supplied to the
Director of that Division.
Monthly statistical analyses of Health Inspectors'
services to the public were prepared. Consulting services were
rendered to the Implementation Board appointed by the
Ministries of Environment and Health, in undertaking a water
quality study of the Okanagan Basin. A methodology was
developed and implemented for surveying eight beaches in this
area for fecal coliform levels.
Monthly and annual statistics of nursing activities were
prepared for the Director of Public Health Nursing. Monthly
statistics of Home Care services were also prepared for the
Associate Deputy Minister, Direct Care Community Services. The
volume of cases treated in this program increased rapidly, and
the diagnostic coding of these cases in 1979 was a major task,
which required the adoption of the new revision of the
International Classification of Diseases at the beginning of
the year.
A statistical information system was developed for
Community Vocational Rehabilitation Services (formerly the
Division for Aid to the Handicapped), which was designed to
produce information on client profiles, and on expenditures
involved in maintaining the rehabilitation program.
The Division assisted the Community Care Facilities
Licensing Board, by providing statistics of the operation of
personal care homes and day care centres.
70
 Consultative services in program evaluation were provided
to several Divisions of the Ministry, and to individual health
units. A major evaluative project, relating to the effect of a
post-cardiac exercise program on heart patients in the South
Okanagan, was funded by the B.C. Health Care Research
Foundation.
Services were given to the Division of Epidemiology in
the analysis of poison control reports, and in the maintenance
of registries of infectious diseases.
The B.C. Record Linkage Project, in which the Medical
Genetics Department of U.B.C. collaborates, made further
progress in the development of a computerized system for
monitoring congenital anomalies in the province.
The Research office in Victoria dealt with a wide variety
of inquiries for vital statistics and general demographic data,
and exchanged statistical services with Statistics Canada, in
pursuit  of  a  long-standing  Federal/Provincial  arrangement.
71
 Community Vocational Rehabilitation Services
The Division was involved in several changes in 1979.
First, the name was changed from the Division for Aid to
Handicapped to Community Vocational Rehabilitation Services.
It was felt that the new name more accurately reflected the
objectives of the program. The philosophy of C.V.R.S. is based
on the practical application of the idea that those persons
handicapped by a physical or mental disability require a wide
range of services from a variety of disciplines present in the
community. To be effective, these service must be applied in a
co-ordinated manner, and in the appropriate sequence, to assist
the handicapped person along the road to greater economic
independence.
The Director of the Division resigned at the end of
November, and it was expected that the position would be
filled early in 1980. Service to the South Fraser Valley and
Skeena regions was restored with the appointment of
Rehabilitation Consultants   to   those  areas.
A significant development during the year was in the job
placement      aspect      of     vocational      rehabilitation. "Project
BreakThru", a pilot project funded through an agreement with
the Government of Canada-Youth Job Core Program and Community
Vocational Rehabilitation Services, was established. The
mandate of "Project BreakThru" was to assist those handicapped
persons considered to be "job ready", to find suitable
employment. It was gratifying to note that the response from
the business  community was  extremely  positive.
Community Vocational Rehabilitation Services was also
involved in the development of two other special projects. One
was    for   interpreters   for   the   deaf,   implemented   in   co-operation
72
 with the Western Institute for the Deaf. The program's
objective was to develop a team of much needed interpreters,
who would be used primarily for deaf students attending
post-secondary training centres and rehabilitation workshops,
as well as providing interpretive service at employment
interviews,   and other  aspects  of  the  rehabilitation  process.
A three month project was also arranged at Opportunity
Rehabilitation Workshop to survey various aspects of the
facility. This       included      development      of      off-site      work
experience   programs,   and  client   follow-up  procedures.
REGIONAL OFFICES
In the Northern Interior region, with the expansion of
Job Readiness and Pre-employment Training programs available
through the local college, the quality of rehabilitation
service was  considerably  improved.
A significant development in the Central Vancouver Island
region was the formation of a committee at Malaspina College to
review the special needs of physically disabled people,
relative to the accessibility of the college's facilities and
programs. The work of this committee resulted in funds being
made available through the Ministry of Education to hire a
Project   Co-ordinator,   to   further   develop   the  objectives.
1979 was a time of change in the South Fraser Valley
region. With the appointment of a full-time Rehabilitation
Consultant in January, the Rehabilitation Committees in
Abbotsford and Chilliwack were re-activated, and more intensive
service provided in Surrey and Langley. The Consultant was
involved in the creation and expansion of resources to meet the
needs  of handicapped  clients  within   that  region.
73
 In the Okanagan region, more specialized services
available in the area continued to expand. Such facilities as
the Arthritis Clinic in Penticton, and the Prosthetic Services
offered in Kelowna, were a major factor in reducing the
dependency of the Okanagan Committees on services in the lower
mainland, and enabled rehabilitation programs to be carried out
more efficiently.
The continued co-operation of the Ministries of
Education, Human Resources, and Canada Employment and
Immigration Commission, as well as the many voluntary agencies,
was appreciated.
Laboratory Services
The Provincial Health Laboratories, with the main
laboratory in Vancouver and branches in Nelson and Victoria,
perform routine, referral and consultative services for
investigation, diagnosis, treatment and control of communicable
disease, and for amelioration of the environment. These
services include advice and laboratory tests for diseases
caused by bacteria, fungi, parasites, viruses and other
communicable agents; related immunology and serology, and
environmental microbiology. These are available to registered
physicians, hospitals and health-related agencies at all levels
of government; and specimens are shipped by couriers from all
parts  of  the Province.
The B.C. Hemophilia Society has been provided with a
Province grant in order to employ a part-time staff of a nurse
co-ordinator, physiotherapist, and social worker. A physician
volunteers his service to operate this program. The number of
patients on the home program has increased from 38 to 47 Factor
8    patients    which    is     the    standard    form    in    hemophilia.       The
74
 number of Factor 9 (or Christmas disease) patients has remained
constant at five. The Kidney Dialysis Service supplies the
intravenous materials for these patients to treat themselves.
These plasma products are obtained from the Canadian Red Cross
Society.
The malabsorption syndrome which requires total
parenteral nutrition is called Crohn's disease. In this past
year one patient was able to transfer to oral supplements and
two patients have been added to total parenteral, so that there
are now six patients being totally fed intravenously. Advances
have been made in the production of oral supplements and
products are now available such as Vivonex, Flexical, Ensure,
and Nutramigen. There are now five patients being maintained
on these oral supplements.
Between 1978 and 1979 the work load of the Division of
Laboratories increased by 6 per cent. In Table 8 the numbers
of tests performed at the Main Laboratory and at the Branch
Laboratories in Nelson and Victoria during 1979 are compared
with the corresponding figures for 1978. An 18 per cent
increase in work performed occurred in the Virology Service;
examinations for intestinal parasites increased 13 per cent;
enteric bacteriology by 16 per cent and miscellaneous
bacteriology by 3 per cent. The workload in the rest of the
laboratory remained the same as in the previous year.
During 1979, tests for the diagnosis of infections with
Campylobacter species by bacteriological techniques and
Bordetella J>?r_Lu^s_is > toxoplasma and Beta hemolytic
streptococci, Group A, by immunofluorescent techniques were
among new procedures performed at the Provincial Health
Laboratories.
- 75
 Bacteriology
CORYNEBACTERIUM DIPHTHERIAE
The number of patients from whom toxigenic
Corynebacterium diphtheriae was isolated decreased from 165 in
1978 to 61 in 1979. The number of patients from whom non-
toxigenic C. diphtheriae was isolated in 1979 totalled 241.
BORDETELLA PERTUSSIS
The number of patients from whom Bordetella pertussis was
isolated increased from 13 in 1978 to 20 in 1979.
HAEMOPHILUS INFLUENZAE AND H. PARAINFLUENZAE
Haemo£hil_us_ isolates increased from 50 in 1978 to 77 in
1979.  Most organisms were isolated from genital sources and
the  eye.   Other  sources  included nose  and  throat,  ear,
cerebrospinal fluid, and blood.
NEISSERIA GONORRHOEAE
In 1979, 4,723 cultures yielded N. gonorrhoeae, 13 per
cent more than in 1978. The number of genital smears showing
gonococci microscopically decreased from 4800 in 1978, to 4700
in 1979. Bacteriological confirmation of gonococcal infection
represents only about 50 per cent of reported cases.
NEISSERIA MENINGITIDIS
The number of first isolates of N. meningitidis was 173
in 1978 and 416 in 1979. Of the 416 cultures, 370 were
recovered from nose and throat specimens, and 46 from other
76
 sources, such as blood, cerebrospinal fluid and genito-urinary
tract. The serogroups of 237 isolates were B (85), C (23), X
(8),   Y   (10),   Z   (20),   29e   (27)   and   W135   (64).
OPPORTUNISTIC  PATHOGENS
:'      1
Opportunistic infections are often caused by
micro-organisms       formerly       considered       non-pathogenic. Such
infections are common in immuno-suppressed patients. While
some 2,500 opportunistic pathogens were identified in 1978,
more than 2,700 were recovered in 1979, an increase of more
than 9 per cent. The three most often recovered were
Escherichia coli, Acinetobacter calcoaceticus and Acinetobacter
lwoffi.
ANAEROBIC BACTERIA
Of 253 anaerobic strains identified, the three most
common were Clostridium perfringens, Bacteroides fragilis and
^e_ptococcus _asaccharolyticus.
ENTERIC BACTERIA
The number of specimens submitted for culture for
Salmonella, shigella and enteropa thogenic Escherichia^ coli
(EEC) increased by 16 per cent. First isolations from 1,425
persons included Salmonella (994), Shigella (198) and EEC
(303). The common human Salmonella types were Salmonella
typhimur ium and S. typhimurium var. Copenhagen (557), S.
infantis (50), S. saint paul (48), S. heidelberg (29), S_._
newport (18), S. block ley (17), S. enteritidis (14), S. javiana
(13), S. san diego (12) and S. typhi (12). Types isolated for
the first time in British Columiba were S. haardt, S. harder
and S._ness-ziona; for the first time in Canada were S. hardio,
S. dar-es-salaam, S_. gassi and S. _mbandaka.  Twelve cases of
typhoid  fever  were  confirmed bacteriologically,  Salmonellae
77 -
 were identified from 92 non-human sources; animals such as
bovines, dogs, felines (Jaguar), hogs, horses, mink and moose;
birds such as chickens, pigeons and turkeys; reptiles such as
chameleon, iguana, knightanole, snake and tegu lizard; food and
fertilizer    such    as    shrimp    and    fish    meal;    and    environmental
swabs.      Of   27   types   identified,   most   common  were   S_. typhimurium
{24),   S.   infantis   (12),   S.   saint  paul   (8)  and  S.   tennessee   (8).
The 198 Shigella strains included Sh^^onnei^ (138), Sh.
f lexneri (57), Sh ■ boydii (2) and Sh. dysenter iae (1). The
most common enteropathogenic E. coli were 018:K77 (64),
0111:K67 (51), 026:K60 (44), 055:K59 (21), 0126:K71 (18) and
0125:K70   (10).
FOOD  POISONING
During the investigation of 218 incidents of suspected
food poisoning in 1979 (compared with 233 in 1978) 4121
specimens were cultured. Food poisoning organisms were
isolated in 26 incidents: Staphylococcus aureus (12); Bacillus
cereus (11); Salmonella (2) (S. typhimurium and S. nienstedten)
and  Clostridium  perfringens.
The Food Poisoning Section reported 144 incidents of
food-borne disease in 1975. Health Protection Branch Ottawa
collected and collated such information from all parts of
Canada, and published "Food-borne and Water-borne Disease in
Canada  - Annual  Summary   1975"   in   1979.
MYCOBACTERIUM  TUBERCULOSIS
The number of specimens cultured for Mycobacterium
tuberculos is and other mycobacteria decreased from 30,464 in
1978 to 29,660 in 1979. The number of microscopic examinations
decreased from 28,156 in 1978 to 27,465 in 1979. Nine hundred
sixty-four      requests      were      received      for      antimicrobial      drug
78   -
 susceptibility  tests.   Investigation  of  other  mycobacteria
decreased from 986 in 1978 to 964 in 1979.
BACTERIAL SEROLOGY
Screening tests for syphilis increased from 181,000 in
1978 to 185,000 in 1979. Confirmatory Microhaemagglutination-
ZfelE0J2.£F^J^yjjiiiiJ2 (MHA~TP) tests and Fluorescent Treponemal
Antibody-Absorption (FTA-ABS) tests increased 20 per cent each
from 6,000   in   1978   to  7,200   in  1979.
During 1979 exudates from 357 patients were examined by
darkfield microscopy, and by the Direct Fluorescent
Antibody-Treponema pallidum (DFA-TP) technique. In 42 patients
(12  per  cent)   the  examinations  were reactive.
Serological tests for the diagnosis and control of
febrile illnesses increased from 11,000 in 1978 to 11,500 in
1979.
Sera were referred to Reference Laboratories for
titration of bacterial antibodies. The 63 reactive sera
included: Yersinia (33), Bordetella pertussis (14), Neisseria
gonorrhoeae (6), Legionella pneumophila (3), Listeria
monocytogenes (1); Diphtheria anti-toxin (3) Tetanus anti-toxin
(2),   Anti-streptolysin   (1).
Parasitology
The number of specimens submitted for examination for
parasites increased by 14 per cent from 30,166 in 1978 to
34,455 in 1979. Parasites were found in 5,742 specimens — 17
per  cent  of  those  examined.
-   79
 INTESTINAL   PARASITES
The number of faecal specimens showing protozoan
parasites   in   1979 were:
Usually considered  pathogenic  — Giardia  lamblia   (1,557)
and Entamoeba histolytica  (298);
Generally considered non-pathogenic  — Entamoeba coli
(1,626),    Endolimax   nana    (1,164),    Iodamoeba butschlii
(211);   and Chilomastix mesnili   (63);   and
Pathogenicity uncertain -- Entamoeba hartmanni   (522),
Entamoeba    polecki     (1),     unidentified    Entameoba    cysts
(77)  and  damaged  cysts   (62).
I , .. ■
The number of faecal specimens showing helminthic eggs in
1979 were Trichuris trichiura (793), hookworm (597), Ascaris
lumbricoides (361), Clonorchis sinensis (304), Hymenolepis nana
(98), Enterobius vermicularis (75), Trichos trongylus spp (30),
Schistosoma mansoni (22), Diphyllobothrium latum (10), Taenia
spp. (8), Schistosoma japonicum (7), Hymenolepis diminuta (3),
Dicrocoelium dendriticum   (2),   Fasciolops is buski   (2),
Strongyloides s tercoralis  (2),  Echinos toma  spp.  (1)  and
Toxocara canis (from a dog) (1).
The finding of the Schistosoma japonicum eggs is a first
for the British Columbia Provincial Laboratories.
Helminthic larvae found were as follows:
Larvae of Strongyloides s tercoralis (93), hookworm
larvae (87), damaged larvae (8), Trichos trongylus spp.
larvae (2), adult Strongyloides stercoralis were found
in 1 specimen.
The following mature helminths were identified: ascaris
lumbricoides (34), Enterobius vermicularis (7), proglottids of
taenia saginata (5), Diphyllobothrium latum (4), Dipylidium
caninum (2). (The latter two specimens were from the same
child.)
30 -
 Cysticerci from moose meat were identified as Taenia
krabbei. Ascari_dia__lineata found in a hen's egg was submitted
for   identification.
The number of anal swabs examined for enterobius
vermicularis (pinworm) increased from 1040 in 1978 to 1129 in
1979.     Eggs  were   found  in   146   (13  per  cent).
Insects    and    insect    larvae    identified:       Pb^hirus pubis
(5),      Pediculus humanus      (3);      ticks      Ixodes Pfcificus      (3),
rhipicephalus sanguineus (dog tick) (1); nits of lice (3),
larva of Derma tobium hominis (1). Twenty non-pathogenic
insects   and  larvae were  also submitted.
BLOOD AND TISSUE PARASITES
The number of patients submitting specimens for
examination for blood and tissue parasites was 438, of these
431 were blood films for malarial parasites. The following
malarial species were identified: Plasmodium vivax (296), P.
falciparum (4), P. malariae (2) and not speciated (10).
Examinations for Filaria (2), Leishmania (2), Toxoplasma
(2) and Trypanosoma (1) all proved to be negative but one
culture series for Leishmania grew the fungus Sporotrichix
schenkii.
SEROLOGY OF PARASITES
Antibodies to parasitic helminths and protozoans were
demonstrated at the Institute of Parasitology (or other
reference laboratories) in 84 serum specimens: Helminthic
parasites -- Toxocara spp. (39), Trichinella (8), Schistosoma
(2), Echinococcus (1), Filaria (1); protozoan parasites
toxoplasma (20), ^tjnj!P^bjj__his_tolyt_ica (9), Leishmania (3) and
Trypanos oma (1).
81
 The Indirect Haemagglutination (IHA) and Indirect
Fluorescent Antibody (IFA) tests for Toxoplasma increased by 10
per cent from 964 in 1978 to 1,060 in 1979.
Mycology
The number of specimens examined for fungi showed a small
increase from 3,958 in 1978 to 4,068 in 1979. Cultures yielded
483 dermatophytes and 25 systemic and other fungi.
DERMATOPHYTES
The following were isolated: Trichophyton rubrum (191),
Trichophyton __mentagrophytes  (73),  Malassezia  furfur  (70),
Microsporum  canis   (67),   Epidermophyton floccosum  (35),
Trichomycosis axillaris (4), Scopulariops is brevicaulis (4),
Trichophyton violaceum (2), Microsporum gypseum (1), Microporum
nanum (1).
SYSTEMIC AND SUBCUTANEOUS FUNGI
The  following were isolated:  Aspergillus niger  (from
ears) (5), CrypJ:oi;o£_cus neogormans (from cerebrospinal fluid)
(3), Aspergillus species (from ears) (2), Geotrichum candidum
(from faeces,  from vagina)  (2),  Coccidiodes immities  (from
lung), Fusarium species (from eye), Aspergillus fumigatus (from
sputum), Nocardia as teroides (from brain abscess), Sporotrichix
schenkii (from cheek ulcer), plus Streptomyces spp. (5),
Sporotrichum spp. (3).
FUNCAL SEROLOGY
Fungus antibodies were demonstrated at reference
laboratories in 40 serum specimens: 5_istjD^lasma (30),
Blastomyces (4), Coccidioides (3), Candida (2) and Cryptococcus
(1).
82 -
 ENVIRONMENTAL MICROBIOLOGY  OF WATER
The number of water samples examined by the Coliform Test
increased from 39,723 in 1978, to 40,120 in 1979. Of these
samples, 3,037 labelled Drinking Water, were also examined by
the Completed Coliform Test, 6 per cent fewer than in 1978. In
addition, 499 drinking water samples gave 5/5 Confirmed Test
results, an increase of 5 per cent over the previous year. The
Faecal Coliform Test was done on 10,377 samples. Samples from
bathing beaches increased 17 per cent from 2,988 in 1978, to
3,481 in 1979. The Standard Plate Count was done on 3,509
samples. Two samples were examined for algae. The number of
water samples submitted by the public for the Coliform Test
increased by   10  percent   from 637   in  1978,   to  698   in  1979.
The Okanagan Basin Water Quality Study of six beaches,
employing two "Standard Methods" techniques, was conducted by a
research officer of the Division of Vital Statistics, during
June, July and August 1979. A total of 519 samples were
submitted to the Division of Laboratories for this study, and
examined by the Faecal Coliform Test (Multiple Tube
Fermentation Technique). Samples were also submitted to the
Environmental Laboratory in Vernon, and examined by the Faecal
Coliform Test   (Membrane  Filter  Technique).
Virology Service
A diagnostic and consultative service in medical virology
is provided for physicians in British Columbia, through the
Provincial Laboratories. During 1979 over 1,000 viral and
other agents were identified as causes of human disease.
Included were adenovirus (57) cytomegaloviruses (21)
enteroviruses (48) herpes simplex virus (480) influenza A and B
viruses (67) measles virus (119) mumps virus (4) mycoplasma
pneumoniae virus (10) parainfluenza virus (6) psittacosis virus
83
 (1) respiratory syncytial virus (4) rotaviruses (68) rubella
virus (151) varicella-zoster virus (9) Dengue fever (1)
Legionnaires'   disease   (1).
The increase in workload in the Virology Service during
1979   ranged   from a  low of   17%  to  a high of 24%,   averaging 20%.
INTRAUTERINE   VIRAL   INFECTION
A number of viruses, such as cytomegalovirus,
enteroviruses, herpes simplex virus, and rubella virus, can
infect the developing fetus if the mother contracts the disease
during her pregnancy. The result may be abortion, stillbirth,
or   live born  infants  with  congenital  anomalies.
The rubella (german measles) outbreak, which began in
1978, continued into 1979. One hundred fifty-one laboratory
proven cases of rubella were identified by the Virology
Laboratory during 1979. One rubella baby was identified,
suffering   from a variety  of anomalies.
Herpes simplex virus and cytomegaloviruses were also
associated  with   a  number   of   fetal   infections   during   1979.
POLIOMYELITIS
The outbreak of polio reported in 1978 was confined
strictly to the members of a religious sect which does not
condone vaccination. There was no sign of spread of the
infection   to  anyone   in   the  surrounding community.
INFLUENZA
Influenza experienced in British Columbia during 1979 was
mainly due to the A/USSR strain. The first signs of high
absenteeism from schools and industry began in December 1978
84
 and extended well into February of 1979. In late February a
second wave of influenza appeared throughout the province, due
to influenza type B. Although the viruses differ, the clinical
effects of influenza are indistinguishable.
MEASLES
An epidemic of measles also occurred in 1979 in British
Columbia. Whle most cases had the characteristic clinical
picture of measles, there were many cases of so called atypical
measles. These patients had an atypical rash that may appear
vesicular or purpuric. They are often quite seriously ill with
complications such as pneumonia. It is felt that atypical
measles occurs mostly in people who were immunized with killed
measles vaccine during the late sixties. This vaccine did not
produce a very effective immunity, and when these individuals
encounter the wild measles virus during an outbreak, they
develop an atypical form of the disease.
ACUTE GASTROENTERITIS
A number of viruses can produce an acute gastroenteritis,
particularly in young children—e.g. adenoviruses, enteroviruses, rotaviruses. These viruses can be readily visualized
by using the electron microscope, hence rapid diagnosis is
poss ible.
Tropical and Parasitic Diseases Reference Service
The Tropical and Parasitic Diseases Reference Service
provides advice on preparation for travel to the tropics, and
on the diagnosis and treatment of tropical and parasitic
diseases acquired by travellers returned from the tropics, and
immigrants to Canada.
85
 During the year exotic drugs, not available commercially
in Canada, were supplied for the treatment of 17 patients with
parasitic diseases, such as amoebiasis, filariasis, malaria and
schistosomias is.
In September Dr. E.J. Bowmer retired after 23 years as
Director of the Provincial Health Laboratories. Dr. Bowmer was
well known and respected for both the breadth and the depth of
his knowledge of Laboratory Medicine and Tropical and Parasitic
Diseases.
Dr. W.A. Black, who joined the staff of the Provincial
Heath Laboratories in June 1978, was appointed the new Director.
In May Dr. A.J. Clayton, Director General of the
Laboratory Centre for Disease Control, Health Protection
Branch, Department of National Health and Welfare, Ottawa
visited the British Columbia Provincial Laboratories.
ACKNOWLEDGEMENTS
The services, biological reagents, expertise and advice
provided by reference laboratories in Canada and elsewhere are
gratefully acknowledged.  These reference laboratories include:
1. Laboratory Centre for Disease Control (Ottawa) and its
reference laboratories:
botulism (Ottawa); staphylococcal enterotoxin typing
(Ottawa); arboviruses (Toronto); yersiniosis
(Toronto); leptospirosis (Toronto); parasitic diseases
(Montreal).
2. Other Canadian Laboratories: Ontario Provincial
Laboratories (Toronto); Ontario Agricultural College,
University of Guelph; Environment Canada (Vancouver);
86
 ACKNOWLEDGEMENTS (cont'd)
City  Analyst  (Vancouver);  University  of  British
Columbia (Vancouver).
3. Foreign Laboratories:   Center  for  Disease  Control
(Atlanta, Georgia); National Jewish Hospital (Denver,
Colorado);  Royal  Infirmary  (Edinburgh,  Scotland).
87
 VOLUNTARY HEALTH AGENCIES
During the year the Ministry of Health continued to give
financial support to a wide range of voluntary health
agencies. Most of these agencies provide specialized or
supplemental health services to persons suffering from chronic
debilitating conditions, who have exceptional needs beyond the
scope of health services routinely available, and to certain
disadvantaged socio-economic groups in the population. Over
$3.5 million in grants was awarded to these agencies for the
1979/80 fiscal year.
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89   -
 TABLE       -  REPORTED   INFECTIOUS   SYPHILIS  AND  GONORRHOEA
BRITISH  COLUMBIA,
1946,   1951,   1956,   1961,   1966  and  1971 - 79
Year
Infectious
Syphilis
Gonorrhoea
Number
Rate
Number
Rate
1946	
834
36
11
64
71
73
98
101
146
174
106
70
121
130
83.0
3.1
0.8
3.9
3.8
3.4
4.4
4.4
6.1
7.2
4.3
2.8
4.8
5.1
4,618
3,336
3,425
3,670
5,415
7,116
7,921
8,955
9,284
9,793
9,728
9,800
9,004
9,390
460.4
1951	
286.4
1956	
244.9
1961	
225.3
1966	
290.8
1971	
325.7
1972	
353.4
1973	
388.9
1974	
390.8
1975	
402.5
1976	
394.4
1977	
393.0
1978	
355.9
19792	
365.8
Rate  per   100,000  population.
Preliminary.
90
 TABLE  - Selected Activities of Provincial Public Health Nurses
September 1, 1978 to August 31, 1979
A. Family and Child Health
Expectant Parent  Classes  - Series  Enrollment  - Mothers 12,589
-  Fathers 8,658
Total  class  attendance 62,111
Prenatals  -  numbers  of home visits 4,892
Postnatals   and new  infants  - number  of home visits 40,251
Infants   -   number   of   first  visits   of  Child  Health   Conferences 21,424
- total number  of visits   to Child Health Conferences 63,936
- number  of home visits 50,475
Preschool - number  of visits   to Child Health Conferences 67,068
- number   of home  visits 32,910
Special  assessments  -  infant  and  preschool 35,249
School -  screening  tests 226,642
- follow up 23,532
- conferences with  students 21,372
- conferences with  staff 68,358
- home visits 26,062
Special group classes (Parenting, Child Growth and Development,
etc)
- number  of adults   enrolled  in series 5,627
- total class  attendance 12,467
B. Adult,   Geriatric  and  Other Community  Services   (excluding Home Care
Program)
Adult   (ages   19-64  years)  - number  of home visits 104,029
Adult   (ages   65   and  over)   -   number   of  home   visits 25,351
Geriatric   clinic  attendance 466
Family planning clinic attendance 1,086
Community  Care  Facilities  -  number   of visits 7,056
Mental  retardation  -  number   of home  visits 1,313
Mental  illness  - number  of home visits 2,932
Mental health   (preventive  counselling)   - number   of home visits 4,442
Family   problems  -  number   of home  visits 8,602
Health   promotion -  number  of home visits 37,653
Episodic  care   (periodic)  - number  of home visits 8,985
-  91
 cont'd
C. Disease  Control
Immunizations   - number  given 393,190
Tests   (tuberculosis,   diphtheria  and  other) 35,095
Venereal  disease  - number  of visits 7,805
Tuberculosis  - number  of visits 7,121
Other Epidemiological  visits 6,019
Other  communicable  diseases  - number  of visits 4,834
Chronic  disease  - number  of home  visits 14,328
Assessment  and   treatment  -  number  of home  visits 32,298
D. Total  -  Home  Visits  by  public  health  nurses 118,034
- Professional  services  by  telephone 272,546
- Community   liaison meetings 13,765
*Statistics provided are for activities of provincial public health nurses and
New Westminister, but do not include activities of public health nurses
employed in Greater Vancouver and Capital Regional District areas.
- 92
 TABLE   - FACILITIES OR PROJECTS DEALT WITH BY THE
PUBLIC HEALTH INSPECTION DIVISION, 1979
Type
Number
Food  Premises
7,500
Community  Care  Facilities
1,090
Summer  Camps
200
Camps ites
950
Hairdressing  Places
1,250
Water   Systems
1,000
Schools
1,400
Industrial  Camps
400
Swimming  Pools
800
Small   Sewage  Disposal  Projects
10,500
Subdivision  Proposals
3,500
- 93
 TABLE
- SELECTED ACTIVITIES OF PROVINCIAL HEALTH INSPECTION
1975 - 1979
Ty_pe of Inspect ion or Activity
Inspection -
Food premises -
Eating and drinking places
Food stores
Other
Factories
Industrial camps
Community care'
Schools
Summer camps
Hous ing
Mobile home park
Camps i tes
Other hous ing
Hairdressing places
Farms
Parks and beaches
Water and waste investigation -
Swimming pools
Inspect ion
Samples (Pools & Beaches)
Surveys (Sanitary & Other)
Waste Disposal
Public Water Supplies
Inspection
Samples
Private Water Supplies
Inspect Lon
Samples
Pollution and survey samples
Private sewage disposal
Municipal outfalls and plants
Other sewage control
Land Use Investigation -
Subdivis ions
Site inspections
Nuisance Investigation -
Sewage
Garbage and refuse
Other (pest, etc.)
Disease Investigation
Educational Activities
Meetings
1975
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
1976
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
1977
861
790
3,221
3,273
512
26,608
320
4,726
6,225
13,749
3,370
1,373
2,345
609
1,255
2,819
17,294
4,594
2,811
157
345
3,294
1,058
318
1,803
629
1,273
713
874
364
740
3,585
3,060
713
705
2,876
11,524
4,094
4,-414
1,782
35,986
262
8,308
8,355
13,589
3,699
2,168
3,998
1,056
1,511
3,433
1978
19,291
4,879
3,851
224
497
4,337
1,237
487
1,967
583
1,350
879
906
346
851
4,197
5,420
976
711
3,633
14,367
4,427
4,317
1,864
36,134
323
7,868
9,522
14,964
4,278
2,595
4,553
1,530
2,043
3,599
1979(2)
20,000
6,006
4,304
320
300
4,300
1,200
400
1,713
363
1,500
680
800
350
1,400
4,200
7,300
1,880
672
3,900
15,000
4,500
4,500
1,400
31,000
300
6,500
9,000
16,000
4,300
2,600
4,600
1,100
2,600
3,500
NOTE: Activities of the Capital Regional District Community Health Services Inspectors are
included for 1977 to 1979 only.
1. Includes boarding-homes, youth hostels, day care centres, hospitals and other
ins titutions.
2. Preliminary.
- 94 -
 TABLE
REGISTRATIONS, CERTIFICATES, AND OTHER DOCUMENTS PROCESSED BY
DIVISION OF VITAL STATISTICS, 1978 AND 1979
egistration accepted under Vital Statistics Act -- 1978
Birth registrations   37,176
Death registrations  19,017
Marriage registrations  21,166
Stillbirth registrations  317
Adoption orders   1,520
Divorce orders  9,199
Delayed registrations of birth  296
Registrations of wills notices accepted under Wills Act  46,217
Total registrations accepted  134 ,908
Legitimations of birth effected under Vital Statistics
Act  250
Alterations of given names effected under Vital Statistics Act   322
Change of name applications granted under Change of Name Act   3,594
Materials issued by the Central Office —
Birth certificates  92,198
Death certificates  9,821
Marriage certificates   10,582
Baptismal certificates  20
Change of name certificates  3,089
Divorce certificates  307
Photographic copies   13,621
Wills notice certification  12,733
Total items issued  142 , 37 1
Nonrevenue searches for Government ministries by the Central Office. . . . 12,649
Total revenue $615,021
1979
38.5501
19.0101
21.1801
3001
1.6101
9.2901
320
50,854
141,114
289
372
3,827
99,437
8,859
12,189
13
3,419
298
13,876
12,374
150,465
11.2101
$662,6301
1.  Preliminary
95
 TABLE   - CASELOAD FOR COMMUNITY VOCATIONAL REHABILITATION SERVICES
January 1 to December 31, 1979
CASES CURRENTLY UNDER ASSESSMENT OR RECEIVING SERVICES, January 1, 1979 1389
New cases referred to Aid to Handicapped Committees in
Vancouver Metropolitan Region (7 Committees) 382
New cases referred to Aid to Handicapped Committees outside Vancouver Metropolitan Region (40 Committees) 639
Cases re-opened (all regions) 227
Total new referrals considered for services, January 1, 1979
to December 31, 1979 (includes re-opened)  1248
Total cases provided with service in 1979  2637
ANALYSIS OF CLOSED CASES
January 1 to December 31, 1979
EMPLOYED:
Employment placement made:
Canada Manpower 25
Aid to Handicapped 26
Self 183
Other __82
TOTAL '" 316
SERVICES COMPLETED:
Referred to Other Service 260
Competitive Employment not Feasible 116
Vocational Rehabilitation not Feasible   231
Increased Independence    30
Maintained Employment. .    13
Self Care    4
Sheltered Employment     7
Other. _29
TOTAL " 690
SERVICES NOT COMPLETED:
Declined Services 215
Unable to Locate Client 100
Left Province 27
Other 55
TOTAL " 397
OTHER:
Consultation Only 51
Decreased    6
TOTAL  57
Total cases closed in 1979  1460
Cases remaining in assessment or receiving services   1177
GRAND TOTAL  2637
- 96
 TABLE   - TESTS PERFORMED BY DIVISION OF LABORATORIES IN 1978 and 1979
Main Laboratory, Nelson Branch Laboratory and Victoria Branch Laboratory
ITEM
1978
1979
Main
Nelson
Victoria
Main
Nelson
Victoria
BACTERIOLOGY  SERVICE
Enteric  Section:
Cultures   -  Salmonell/Shigella
14,681
125
6,488
17,654
179
6,546
- Enteropathogenic  E.   coli
3,348
-
840
4,074
-
1,732
- Sensitivity  tests
1,265
-
-
704
-
-
Food Poisoning  Section
419
-
7
422
-
-
Miscellaneous  Section:
Cultures  -  C.   diphtheriae
4,029
43
1,838
1,757
70
1,353
-  Haemolytic   Staph/Strep
6,095
367
428
4,717
751
468
- Miscellaneous
35,253
318
56
43,772
719
43
-  N.   gonorrhoeae
25,150
347
8,152
28,502
200
8,125
Smears   -  N.   gonorrhoeae
101,571
1,543
450
99,460
1,278
358
Immunofluorescence   -  N.   gonorrhoeae
7,756
-
-
8,297
-
-
-  other
-
-
-
2,892
-
-
Anaerobes
338
-
-
416
-
-
Animal Virulence
350
-
-
471
-
-
Tuberculosis   Section:
Cultures  - M.   tuberculosis
30,464
-
2,392
29,660
-
2,452
Smears  - M.   tuberculosis
27,960
-
2,331
27,560
-
2,279
Sensitivity   test
986
-
-
964
-
-
Atypical  Mycobacteria
323
-
-
292
-
-
Parasitology   Section:
Faeces
30,166
-
3,643
34,455
-
4,881
Pinworm swabs
1,040
32
-
L, 129
33
-
Malaria  blood   film
939
-
-
903
-
-
Mycology   Section
3,954
-
-
4,068
-
-
Water  Microbiology   Section:
Presumptive/Confirmed   coliform   test
39,723
3,413
4,358
40, 120
3,680
6,655
Completed  coLiform   test
3,248
513
335
3,037
390
208
Faecal  coliform  test
10,891
-
295
10,37 7
-
59
Faecal  streptococcal   test
-
-
-
-
-
-
Standard   plate   count
3,332
-
-
3,509
-
-
Other   tests   (Algae,   Shellfish)
-
-
-
n
-
-
Serology   Section:
Syphillis
Screening
181,148
-
184,608
-
-
Confirmatory
12,358
4
14,803
-
-
ASTO
6,983
-
726
7,381
-
796
Febrile   Diseases
4,031
-
968
4, 169
-
925
Toxoplasmos is
4,560
-
-
2,424
-
-
- 97 -
 TABLE   - TESTS PERFORMED BY DIVISION OF LABORATORIES IN 1978 and 1979
Main Laboratory, Nelson Branch Laboratory and Victoria Branch Laboratory
Continued
ITEM
1978
1979
Main
Nelson
Victoria
Main
Nelson
Victoria
VIROLOGY SERVICE
Virus Isolation:
Tissue culture
5,477
-
-
7,027
-
-
Rubella
174
-
-
657
-
-
Embryonated egg
1,191
-
-
663
-
-
Mouse
72
-
-
-
-
-
Serological Identification:
Haemagglutination inhibition
Rubella
63,971
-
-
74,785
-
-
Other viruses
9,210
-
-
10,497
-
-
Reverse Protein Haemagglutination
-
-
-
601
-
-
Complement fixation
17,529
-
-
21,693
-
-
Neutralization
5,338
-
-
5,973
-
-
Electron Microscopy
1,307
-
-
1,614
-
-
Fluorescent Microscopy
795
-
-
895
-
-
TOTALS
667,425
6,701
33,311
707,004
7,300
36,880
COMBINED TOTAL
707,437
751,184
- 98
 Community Health Promotion
The Vancouver Bureau of the Ministry of Health includes a
variety of services located in Vancouver which are grouped
together for administrative purposes. The major services
included are tuberculosis and venereal disease control;
provincial laboratories; vocational rehabilitation; kidney
dialysis services and Pearson hospital. Several of these
services e.g. laboratory and the control services, act as
support or operation centres for the total provincial program.
The Assistant Deputy Minister in charge of the Bureau
represents the Ministry of Health on a variety of committees
and performs special functions as required.
- 99
 direct carp: community services
Long-Term Care Program
The Long Term Care Program commenced operations in
January 1, 1978. The Program is a positive approach to the
needs of that segment of the population who cannot live without
support, because of health-related problems which do not
wjrranr care in an acute care hospital. The primary aim of the
program is to permit those who qualify for benefits to remain
in their own homes, among their own families, for as long as it
is desirable and practicable to do so. Placement in an
approved community care facility, or admission to an extended
care hospital,   is   provided when  this   is   no  longer   possible.
As of November 30, 1979, 15,090 persons were under care
in 631 community care facilities participating in the Long Term
Care Program. These facilities consisted of 98 non-profit
facilities, 498 profit facilities and 35 licensed private
hospitals. At the same time, 18,092 persons were receiving
home support services in their homes from 115 homemaker
agencies, for a total of 33,182 persons under care as of Nov.
30, 1979. These figures do not include the patients receiving
extended care services in public extended care facilities and
acute  hospitals.
ORGANIZATION
The organizational units responsible for the function of
the program at the community or local level, are the 17
provincial health districts and five municipal health
departments. A Long Term Care Administrator is based in each
of the 22 health districts throughout the province. This
administrator is a member of the health unit team and is
responsible, through the district director (Medical Health
Officer), to the Director of the Long Term Care Program, for
100 -
 the implementation and direction of the Long Term Care Program
in the community served.
The primary role of the Long Term Care Administrator is
the development and direction of the organization required by
each health unit for:
a) the reception of inquiries in respect to the program;
b) the reception, • processing and assessment of all
applications for entry into the program;
c) the chairing of the teams responsible for the assessment
of all applications for benefits of the program. These
teams generally have as a core a community health nurse,
a mental health worker, and a homemaker supervisor,
augmented as required by physiotherapists, occupational
therapists, the family physician, representatives of the
Ministry of Human Resources, the local hospital or
community care facility, and/or such other resource
persons in the community who may contribute to the
assessment and placement of the applicant;
d) the monitoring of the program in the community; and
e) the development and improvement of community resources.
The senior official responsible for the functional
direction of the Long Term Program is the Director, Long Term
Care, who reports to the Assistant Deputy Minister, Care
Services.
The Provincial Adult Care Facilities Licensing Board
(PACFLB) is the organizational body responsible to the Minister
of Health for the licensing and inspection of community care
facilities participating in the program, recommending approval
of the construction of new long term care facilities in the
various communities of the Province, and liaison with other
programs that may have desirable input to the Long Term Care
Program.
- 101 -
 SERVICES PROVIDED
The point of entry to the Long Term Care Program is the
Long Term Care Administrator of the health unit serving the
community in which the need arises. To be eligible, the
applicant must meet the physical and mental criteria that have
been developed to identify this need, must be a Canadian
citizen or a landed immigrant, and must have resided
continuously in British Columbia for a period of not less than
12 months immediately prior to application for benefits. The
residency requirement is three months if applying for extended
care. If eligible, the applicant will be placed within the
program at the level of care determined by the Long Term Care
Administrator, after consultation with the health unit's
assessment team.  This placement could be:
- Home Support Care
- Residential Care in an intermediate care or personal
care facility
- Residential Care in a specialized residential care
facility (Mental Health Boarding Home)
- Hospital Care in an extended care hospital
Beneficiaries receiving institutional care (personal,
intermediate, and extended care) were required (in 1979) to pay
a universal charge of $6.50 per day. Clients unable to pay
these charges may apply to the Ministry of Human Resources for
assistance. Preferred accommodation is also available in some
privately operated facilities at an additional charge to the
residents. Homemaker services and agencies providing support
to clients in their own homes, are allocated funds based on
their individual budgeting requirements. Clients receiving
these services may be charged a fee which is in keeping with
their ability to pay. Three pamphlets describing Long Term
Care services, who can use them, and how much they will cost,
were developed during the year and made available throughout
the  province.   One  pamphlet  primarily  describes  Homemaker
102
 Services, the second outlines Residential Care Services, and
the third describes Home Care Services. During the year the
Long Term Care Program continued its overall administrative and
development responsibilities and, in addition, was involved in
the following projects:
Adult Da^__Care - Adult day care provides a formal program of
social and health services for the people who require
assistance. The program is similar to that provided in a good
residential facility, and can be viewed as a supplement to the
home support system. A day care centre may be freestanding or
part of a residential care facility, and provides recreation
and exercise programs, occupational programs, medication
supervision, and assistance with the activities of daily
living. As of November 1979, six Adult Day Care centres were
receiving funding, and as of January 1, 1980, an additional
eight centres were to be transferred from the Ministry of Human
Resources to Long Term Care. Additional Adult Day Care centres
were planned for the 1980/81 fiscal year.
Co-operative Independent Living - Effective April 1979, the
Long Term Care Program assumed responsibility for funding
eligible Long Term Care clients living in Co-operative
Independent Living Homes. The cost of the direct care
component of these homes is funded by Long Term Care. The goal
of the care to be provided is to promote increased health and
maximum independence of all residents. As of October 1979, the
Ministry of Lands, Parks and Housing subsidizes the shelter
costs of these homes, but the residents retain their
independence and responsibility for the normal activities of
daily living. At the year-end there were 17 such homes
receiving funding from Long Term Care.
Geriatric Assessment and Treatment Centres - To ensure the
people with complex disorders be correctly assessed, and that
103
 those with reversible conditions be properly treated and
rehabilitated, "Short Stay Assessment and Treatment Centres"
were introduced to do this preventive diagnostic assessment and
treatment work. These centres are a useful way of preventing
unnecessary and unsuitable admission to Long Term Care
facilities, and are situated in an acute General Hospital so
that the backup services for full investigation are readily
available. As of 1979, there was one centre in active service
at Mount Saint Joseph Hospital, Vancouver, with three
additional  centres   planned   for   the   1980/81   fiscal  year.
Long Term Care Information System - The Long Term Care Central
Registry and Payment Sub-Systems became operational in
November. The system generates automatic advances to all care
providers, and payments to care facilities. It also serves as
an up-to-date information system for headquarters staff and the
local health unit. There were two terminals in the program
headquarters offices, and 19 additional terminals in selected
health units. Continual enhancement of this system was
expected to include a Homemaker Payments sub-system, and
extension of terminals to additional health units in the
Province.
Development of New Facilities - During the year, the Program
assisted and encouraged the development of 17 facilities
involving 965 beds by grants and by guarantees to the Canada
Mortgage and Housing Corporation. These facilities were
developed through the guidance of the program, the energies of
non-profit societies, and by the co-operation of CMHC, mainly
using the provisions of Section 56.1 of the National Housing
Act. In addition, several existing facilities had been, or
were, in the process of upgrading from personal care standards
to intermediate care standards. Most new facilities provided
for Adult Day Care, for which grants are paid in a proportionate     share    of     construction    costs.       The     success     of     the
-   104   -
 Program was due not only to those staff within the Program, but
also to the many community care facilities, hospitals, and
homemaker agencies who have elected to participate in the
Program. Over the year, the Program saw an acceptable level of
growth, and the development of a number of new projects. Much
of this growth was due to the success of the Home Support
Program, whereby individuals received required services in
their own homes .
105 -
 STATISTICAL DATA
LONG TERM CARE
TABLE   - Total Number of Long Term Care Clients by Level of
Care as of November 30, 1979.
Levels of Care
Personal Care
Intermediate Care 1
Intermediate Care 2
Intermediate Care 3
Extended Care
Facilities
Home Support
Total
5,389
10,777
16,166
3,973
3,523
7,496
2,655
2,036
4,691
2,029
823
2,852
1,044
933
1,977
15,090
18,092
33,182
TABLE
Total Number of Service Providers (November 30, 1979)
Community Care Facilities
98 Non-profit
498  Proprietary (including Mental
Health Boarding Homes)
35  Private Hospitals
631  TOTAL*
Homemaker Agencies
99  Non-Profit
16  Proprietary
115   TOTAL
* This   includes  unlicensed   facilities   providing  care   to
two  or   less   clients.
TABLE       -  Number  of Assessments,   Reassessments   and Reviews  of
Long Term Care  clients  during   the  period January   1,   1979   to
November   30,   1979
Assessments
Reassessments
Reviews
20,854
3,844
7,320
TOTAL
32,018
106
 TABLE  - Percentage of Homemaker Clients and Hours by Level of
Care (Jan. - July 1979)
Level of Care
Personal Care
Intermediate Care 1
Intermediate Care 2
Intermediate Care 3
Extended Care
Hours
37.4%
19.0%
15.8%
11.1%
16.7%
Clients
60
7%
18
8%
10
8%
4
6%
5
.1%
TABLE  - Average Homemaker Utilization by Level of Care
(July 79)
Level of Care
Personal Care
Intermediate Care 1
Intermediate Care 2
Intermediate Care 3
Extended Care
Average Number of Hours  Maximum Allowed
14.1
40
23.1
46
33.7
64
55.0
98
74.9
120
107
 TABLE
PROJECT PLANNING AND DEVELOPMENT
1. New beds constructed since January 1978 and in full
operation:
626
2. Beds under construction and projected to be operational
early in 1980:
Vancouver*
Kelowna*
Cranbrook*
Victoria*
Prince George*
598
82
20
147
50
897
Beds to be approved for construction and should go to
tender early in 1980.  These beds should be operational in
late 1980 or early 1981:
Vancouver
Kelowna
Cranbrook
Victoria
Prince George
537
65
247
849
Beds approved for construction and should go to tender in
early 1981:
Vancouver
Kelowna
Cranbrook
Victoria
Prince George
275
155
115
340
180
1065
5.  Beds to be approved for construction and should go to
tender in 1982:
Vancouver
Kelowna
Cranbrook
Victoria
Prince George
355
205
60
100
40
760
These refer to the CMHC regions rather than the individual
cities.
The table does not include the Kamloops region which was
established during the current year.
108 -
 Home Care Program
The Home Care Program is designed to provide, or assist
in coordinating, the variety of professional and nonprofessional services required to assist patients to remain in
their own homes. Each patient is referred by his attending
physician, who continues to direct the medical care of his
patient while the patient is on the Home Care Program.
The Home Care Nurse is a Registered Nurse working under
the administration of the  local health district or health
department, and is the major provider of care to patients on
this Program.
• an estimated number of nursing visits made during the
1979 calendar year was 673,262 or an average of 56,105
nursing visits per month.
The Program provided care to persons of all ages with
either acute, chronic, or long term conditions, and admitted
patients from hospital and the community.
The Home Care Program consists of two categories;
(a) The Hospital Replacement category is for patients
who are discharged early, or in place of admission to an
acute care hospital. Patients admitted for hospital
replacement receive the necessary services, such as
nursing, physiotherapy, homemaker, meals on wheels,
medication, and equipment. The services are coordinated
and paid for by the Home Care Program. Approximately 20
percent of the population of British Columbia do not have
the Hospital Replacement category available to them.
This category has the potential for making efficient use
of hospital beds by enabling more patients to be cared
for in their homes.
109
 s
as
(b) The Non-hospital Replacement category is for
patients who do not need acute hospital care, but require
nursing and/or other services in order to remain at
home. This category is available throughout the Province
and provides nursing care and a limited amount of physiotherapy at no charge to the patient. The patient i
responsible for payment of other services such
homemakers, medication, or equipment that may be required.
RELATIONSHIP OF ACUTE CARE HOSPITALS AND THE
HOME CARE PROGRAM
The following statistics were derived from the 1977/78
annual Home Care Program computer data, as the 1978/79 annual
statistics data were not available at the time this report was
being prepared:
• Of the 44,638 patients admitted to the Home Care Program,
15,739 or 35 per cent were replacing acute care hospital
days, i.e. those patients would have remained in hospital
or been admitted to hospital if the Home Care Program had
not been available to them.
• 6.69 persons per 1,000 population (B.C. population) were
admitted to the Hospital Replacement Category of the Home
Care Program.
• 15,739 patients replaced 174,987 acute care hospital
patients days or 74,46 hospital patient days per 1,000
population (B. C. population).
The Home Care staff continued to develop close liaison
with the acute care hospitals by making regular rounds on the
wards to discuss referrals, sharing in joint orientation and
inservice programs, and participating on hospital medical and
nursing committees.
110
 RELATIONSHIP OF THE HOME CARE PROGRAM AND THE
LONG TERM CARE PROGRAM
The Home Care Program provided professional nursing care
services to assist persons, who were eligible for benefits
under the Long Term Care Program, to remain in their own homes.
• During 1979 an average of 4,250 patients per month who
were under the Long Term Care Program received Home Care
nursing visits.
• These 4,250 patients received an average per month of
22,334 nursing visits, for an estimated total of 268,000
nursing visits for the year.
• 40 per cent of all Home Care nursing hours were utilized
in providing service to Long Term Care Program clients.
The availability of Home Care nursing services to Long
Term Care clients delayed, or eliminated, the need for
admission of many of these clients to Long Term Care facilities.
Ill
 New Patients
TABLE of TREATMENT SERVICES to HOME CARE and LONG TERM CARE ..PROGRAMS
% of
Hospital Replacement
- Long Term Care
- Home Care
Non Hospital Replacement
- Long Term Care
- Home Care
TOTAL
1)
2)
3)
4)
5)
Actual Number
   81
" 614"
839
954'
2488
New Patien
3
25
34
38
100%
Visits
Hospital Replacement
(include first
- Long Term Care
6)
455
visit to new
- Home Care
7)
2866
patients)
Non Hospital Replacement
- Long Term Care
- Home Care
8)
9)
6090
6219 "
TOTAL
10)
15650
TABLE of TREATMENT SERVICES
by
AGE GROUPS
Age Groups
0-1 year
2 to 5 years
6 to 18 years
19 to 64 years
11)
12)
13)
14)
57
-- 83  "
" 153
1301
65 +
15)
2534
__3
18
39_
40 "
100%
TOTAL
16)
4128
TABLE of PREVENTIVE AND OTHER PROGRAMS in HEALTH UNITS
A
Group Work - Health Care
17)
464
Lecture
18)
212
Long Term Care
19)
476
Hospital Liaison
20)
978
Consultation + Assessments
21)
2705
School Program
22)
305
Agency Visit
23)
866
Liaison + Other
24)
4307
TOTAL
25)
B
6610
~244lT
0
10313
0
0
"948"
* _0_
0
10004
112 -
 Percentage Distributed by the Age Groups of
Patients Admitted to the Home Care Program
April 1, 1977 - March 31, 1978
PERCENTAGE
PERCENTAGE
AGE
HOSPITAL
NON-HOSPITAL
TOTAL
REPLACEMENT
REPLACEMENT
PERCENTAGE
00-01 yr.
2
1
3
01-19 yr.
2
2
4
20-44 yr.
11
7
18
45-60 yr.
6
9
15
61-74 yr.
8
18
26
75-84 yr.
4
18
22
85+  yr.
2
10
12
TOTAL
35
65
100
Percentage Distribution by Age Group and Category
of Patients Admitted to the Home Care Program
April 1, 1977 - March 31, 1978
113
 No. of
Percentage of
Diagnosis
Patients
Total Patients
Circulatory
7,238
16.50
Accidents
4,930
11.00
Digestive
4,557
10.25
Symtoms Undiagnosed
4,099
9.00
Neoplasms
3,048
7.00
Musculo-skeletal
2,852
6.50
Endocrine
2,623
6.00
Genito-urinary
2,383
5.50
Nervous System
2,200
5.00
Skin
1,973
4.50
Childbirth
1,858
4.00
Respiratory
1,748
4.00
Blood Disorders
1,263
3.00
Mental Disorders
769
2.00
Infection
371
1.00
Congenital
192
.50
Perinatal
113
.25
TOTAL
44,638
100.00
Percentage Distribution and Number of
Home Care Patients by Major Diagnostic
Groups in Descending Order.
April 1, 1977 - March 31, 1978
- 114
 MENTAL HEALTH SERVICES
Mental Health Services Highlights
The Ministry of Health received the report of the Mental
Health Planning Survey Team headed by John Cumming, M.D. and
was examining the policies of Mental Health Services, in the
light of this and other proposals, to improve the effectiveness
of services to the chronically and acutely mentally ill. A
reorganization of programs brought together the management of
Riverview Hospital and Community Mental Health Services.
Consideration was also being given to the most effective
regional distribution of resources.
During the year the staff of the Province's 30 mental
health centres continued to respond to the demand for therapy
and consultation services. There were approximately 9000
therapy sessions per month provided to clients, with an
additional 6000 hours of agency services rendered.
Services were extended to outlying regions of the
Province through sub-offices and through travelling clinics.
Specialized services were provided to children and their
families through the British Columbia Youth Development Centre,
the Burnaby Children's Team, and Victoria's Integrated Services
for Child and Family Development.
The Continuing Education Committee sponsored over 80
inservice workshops and a Provincial Conference, which were
widely attended by staff from other agencies.
Admissions during 1979 to the Greater Vancouver Mental
Health Service totalled over 1582 cases, and the year-end
caseload was over 2954 cases.
115
 Reorganization and Redefinition
Two significant changes took place during 1979 in Mental
Health Services. One of these was a reorganization in the
administration of the Ministry, while the second one was a
redefinition of service priorities.
The reorganization of the administration of the Ministry
will be phased in over a period of time and will have a number
of implications for the Mental Health Services. One change
will be the equalization of catchment areas for the various
sections of the Ministry. As a result, the five Mental Health
Regions will become approximately 14 Health Districts.
Additional changes might occur in order to be able to provide
better complementary services where needed by the Health
Ministry, other Ministries, and the various School Districts.
A second change due to the new reorganization will be the
implementation of a clearer distinction between central
management functions and district management functions. The
implications at the district level will be that the Mental
Health Administrator will report to an Assistant District
Director for Care Services. The latter will be responsible for
the supervision of the work of the Mental Health Centres in the
Health District, the Long Term Care Health Program and the Home
Care Program.
Specific responsibilities of the Director of Mental
Health include the responsibility for the central management of
Mental Health Services and also for the Riverview Hospital.
The transfer of the administration of this hospital to Mental
Health Services from Hospital Programs is also part of the
reorganization.
116
 Another change in 1979 which had significant implications
for Mental Health Services was the redefinition of priorities
for the mentally ill into four overlapping programs: 1. care
of the chronically disabled; 2. care of the acutely ill; 3.
child and family programs; and 4. care of adjustment problems.
The aim of the redefinition of priorities and the
reorganization of the administration of the Ministry is to
prevent fragmentation of health services and to encourage the
integration and complementation of services provided by various
Sections of the Ministry. As a result, considerable time was
being devoted to define the types of services needed to
implement the respective service priorities and to determine
the budgets. A cost-benefit procedure was finalized to
determine the effects of changes in program emphasis on both
direct and indirect costs.
Mr. Alex Porteous, the Assistant Deputy Minister of
Mental Health Programs, retired in May, following 30 years in
government service.
- 117
 Community Mental Health Centres
During the past two decades 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 local mental health needs.
Established 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, Squaraish, Surrey, Terrace, Trail,
Vernon, Victoria, Whalley, and Williams Lake. At the year-end
additional services were being expanded to cover Dawson Creek,
Merritt, Osoyoos, Port Hardy, Queen Charlottes, Quesnel, Salmon
Arm, Smithers, Sparwood, and Vanderhoof.
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:
t
Direct treatment services for adults and children.
Consultative services  to  physicians,  health, welfare,
education, and correctional agencies.
Education 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.
- 118
 Members of a mental health centre may make periodic
visits to outlying districts of the area served by the centre,
primarily to provide diagnostic assessment, consultation, and
referral services. This travelling clinic usually utilizes
facilities provided by the local health units, and on an
appointment basis sees patients who have been referred by the
family doctor, or the district public health or welfare
services. When necessary, after seeing the patient, the clinic
may refer the patient back to the family doctor, in some cases
to school authorities, or on occasion may recommend admission
to a residential treatment facility. Treatment by the clinic
team is usually given in close co-operation with the family
doctor, the health unit, or other agency.
Regional reports of the community mental health centres
follow:
VANCOUVER ISLAND REGION
Services to the Vancouver Island Region were increased by
the addition of an office in Port Hardy, bringing Mental Health
services within a reasonable distance of all population centres
on the Island. Other existing centres of service included
Campbell River, Courtenay, Duncan, Nanaimo, Port Alberni,
Powell River (part of the V.I. region for administrative
purposes), Saanich and Victoria. In the capital region of
Victoria, children's services are provided by Integrated
Services for Child and Family Development, and adult services
by the Victoria and Saanich Mental Health Centres. In the
remainder of the area, teams serve all ages. During the year,
the number of cases carried by the teams in the Vancouver
Island region was 2093. The number of new cases officially
opened was 1393. Besides these individuals, there were
probably an equal number of cases briefly activated but not
opened officially.
- 119
 Therapy services to individual citizens, often with
serious mental or emotional problems, was a major effort of the
centres. Additional time was spent at consultation to agencies
and other care givers, and in community education. A few
thinly populated areas distant from a centre continued to be
served by travelling clinics.
Services of the Courtenay Centre to the northern part of
the island were greatly enhanced by the establishment, in May,
of a satellite office located in Port Hardy. A full-time
psychologist, supported by a half-time clerk, was recruited to
handle the increased clinical pressures at the parent centre,
and a number of therapy groups were established. These
included life-skills for young schizophrenic males, a similar
group for women with chronic problems, a group of deeply
troubled adolescents, parenting of special needs children, and
divorce trauma survival. In addition to the new office at Port
Hardy, services continued to be delivered from a sub-office in
Campbell River.
The Duncan Centre continued to offer a wide variety of
services to the Cowichan area. A minimally funded activity
program for chronically ill adults was developed, with the
Volunteer Society assuming sponsorship. It operates two days
per week, from a church, providing recreational, social and
occupational outlets for as many as 40 people on a given day.
Efforts were under way toward establishing a Group Home for
eight to ten persons, under the Wisteria Society of Duncan. At
the year-end active planning was underway with the Cowichan
District Hospital in the relocation of its psychiatric unit,
permitting expansion of the Day and In-patient Programs.
Children's services were highlighted at the First Annual
Children's Fair, held in recognition of the International Year
of the Child. The addition of the Community Mental Health
nurse permitted a more effective follow-up, and additional
120
 consultation, to Public Health Nursing, Home Care Programs, and
the Psychiatric Unit.
Integrated Services for ChiJld__and^_Family__pevelopment -
Victoria experienced a very busy year with an increase of
nearly 60% in referrals over the previous year. The greatest
increase was in referrals of adolescents. Because of the
concentration of skills in working with children at Integrated
Services, a number of workshops were given locally and
throughout the province to assist others in working more
effectively with children and their families. Integrated
Services assisted a variety of community service and planning
groups concerned with children, including the Interministerial
Children's Committee, International Year of the Child Steering
Committee, TRACY of B.C., Pediatric Advisory Committee of the
Capital Region and the Saanich Interagency Committee on
Children.
The Nanaimo Centre has a number of staff who recently
passed their initial orientation, and during the year there was
an emphasis on increasing the efficiency of their operation, in
order to give more service to individual citizens and to
agencies. Effective use was made of the Management Information
System to reflect actual improvement in these areas. As a
consequence of much effort by centre staff in May, Columbian
House opened. This is a halfway house for nine seriously
mentally ill young adults. During the year, through radio,
local newspapers and the cable T.V. station, a variety of
messages were brought to the general public on problems on
Mental Health and illness.
The Port Alberni Centre continued with a heavy caseload
of patients, both in hospital and in the community. Final
approval was given for an Inpatient Psychiatric Unit and a Day
Program in the local hospital. The Centre held a number of
therapy groups  for children,  adolescents and adults.  This
121 -
 program was augmented during the summer with the help of two
students. The centre provided consultation to the Canadian
Mental Health Association, the Vancouver Island Programs for
Special Children, Homemakers Society of Port Alberni, Port
Alberni Day Care Society and Family Guidance Association. A
limited service was provided throughout the Tofino-Ucluelet
area.
The Powell River Centre experienced a dramatic increase
in Crisis Intervention and emergency admissions to the
hospital, resulting from an influx of construction workers.
Plans were underway to develop a Day Care Program in
co-operation with the hospital, to deal with some of these
problems. The centre's increase in geriatric assessments was a
consequence of the development of the Long-Term Care Program in
the area. The centre provided assistance to a wide variety of
community groups, including the Interministerial Youth
Committee, the Parent-in-Crisis Chapter, and two co-ordinating
bodies. Staff were also active in assisting self-help and
volunteer services, to families in distress.
The Saanich Centre moved into new quarters in the spring
in a busy shopping mall, and experienced increased drop-ins and
inquiries regarding services. Psychiatric services were
increased with the addition of one more half-time psychiatrist.
The Peninsula Community Homemakers commenced operation in May,
to serve the northern Saanich Peninsula. This agency came into
being as a result of efforts of a number of groups including
the Mental Health Centre. Staff serve as consultants to a
variety of agencies including the Canadian Mental Health
Association, which provides a number of essential mental health
services in the area. Augmented activity services to Boarding
Home residents were permitted with the aid of a summer student.
As the unit serving a central urban core, the Victoria
Centre continued to focus on chronic care, long-term care, and
psycho-geriatric care.  Halfway through the year the centre
122 -
 added a second full-time psychiatrist and was able to provide
more psychiatric coverage, particularly for Boarding Home
residents. In      addition,       the       centre      had      a       full-time
psychologist for the first time in several years, increasing
its capacity for patient assessment and program evaluation.
The Victoria Centre also worked actively with the Canadian
Mental Health Association, both in their efforts to provide
services,   and  community  planning.
OKANAGAN  -  THOMPSON REGION
Significant growth in the professional complement
provided the impetus for new and imaginative programming within
the Okanagan - Thompson region during 1979. In addition to new
long-term care staff, responsible for interests of the
psychogeriatric population of the region, a number of new
clinical staff effected a more comprehensive and well rounded
program of direct and indirect services to the seriously
mentally  ill,  both  adults   and  children.
Notable among the operational events of the Kamloops
Mental Health Centre during the year was the Summer Student
Program, which provided significant program support to the
Boarding Home System, and the Developmental Achievement
Resource Centre for children with emotional mental and learning
handicaps. With the establishment of the Merrit sub-office,
travelling clinics were limited to Ashcroft and Clearwater.
Monthly Interagency meetings continued in 1979, with an average
attendance of 30. In addition, staff meetings with Long-Term
Care and Senior Public Health officials were conducted with a
view to addressing the issues involved in setting new Mental
Health  priorities.
Highlights from the Vernon Mental Health Centre
operations during 1979 included the establishment of a weekly
Socialization   Clinic   for   the   chronic  mentally   ill;   the   opening
123
 of two developmentally oriented residential community care
facilities for severely disturbed patients; the institution of
regular monthly meetings between the staff of the psychiatric
ward of the general hospital, the Day Care Centre and the
Mental Health Centre; plus the commencement of regular meetings
between the Mental Health Centre and the Public Health Unit
staff. Regular consultation was provided to the Children's
Interministerial Committee, Transition House (a service for
women in crisis), and the school system in connection with
identified behaviour problems as well as potential at-risk
s tudents
A program for the mentally disabled, including placement,
supervision and support services, continued to have first claim
on Kelowna Mental Health Centre staff  time   in  1979.
Specialized services to the at-risk school aged child
were developed and expanded, through the addition of a
sessionally paid pediatrician and psychologist, to assist the
clinical social worker and child psychiatrist already committed
to   this   function.
Through the Kelowna General Hospital's psychiatric unit,
treatment and follow-up was given in conjunction with hospital
personnel, and regular consultation was provided to the
hospital's      Psychiatric      Day      Care     Program. Assessment      and
diagnostic services, including forensic assessments for the
court, were included in direct counselling and psychotherapy
through the full range of referrals including children,
adolescents, single adults, couples, and families. Group
consultation was provided to Probation and Family Court, the
Ministry of Human Resources, the Okanagan Neurological
Association, Single Parents Association, Elizabeth Fry Society,
Special Services Department of School District #23, Public
Health,   and other  community  groups.
-  124  -
 Noteworthy among the year's events was the granting of
the first non-academic award of the B.C. Health Research
Foundation to Dr. Keith Barnes, the Mental Health Centre
Director. Dr. Barnes was granted a year's leave of absence to
attend Stanford University, where he enrolled as a visiting
scholar.
The Penticton Mental Health Centre was able to offer a
more varied and comprehensive service to the South Okanagan in
1979, as the result of staffing increases and the opening of
new facilities in Penticton and in Osoyoos. By the year-end it
was expected that a weekly full-day program for the chronic
mentally ill will have been instituted, with expansion of the
program to follow in the new year.
Quarterly meetings between the Mental Health Centre
staff, the R.C.M.P., Magistrates, and Probation officers, were
instituted to cope with the continuing jurisdictional problems
surrounding apprehension and responsibility for delivery of
patients to Riverview Hospital. Okanagan College, the
Psychiatric Unit of the Penticton General Hospital, and Mental
Health Centre staff, joined forces in presenting a Fall course
dealing with Stress Management in the '80's. The course was
over-subscribed.
The Boarding Home Program focussed efforts in two main
areas during the year:
1) The furthering of good relationships with employees, so
as to expand the number of paid sheltered work situations
for the chronic mentally ill and;
2) The development of good relationships with landlords, in
order to secure suitable low rental apartments for those
patients who had progressed to the stage of independent
living.
125
 The use of Homemakers Service was a most useful adjunct
in reaching levels of independent functioning with these
residents.
The main thrust of the Long-Term Care worker's efforts
were aimed at keeping people in their own homes, by means of
public and agency education. The staff member developed and
co-ordinated support programs to accomplish this objective, and
the need for immediate placement in care facilities decreased.
Early in 1980, a four bed psychogeriatric intermediate care
facility will open, to relieve the existing need for placements.
NORTHERN BRITISH COLUMBIA REGION
The Northern British Columbia region is now served by
Mental Health Centres in Williams Lake, Quesnel, Prince George,
Vanderhoof, Smithers, Terrace, Kitimat, Prince Rupert, the
Queen Charlotte Islands, Fort St. John, Dawson Creek, and Fort
Nelson. In addition, travelling clinics provide limited
services to Hazelton, Stewart, Houston, 100 Mile House,
Mackenzie, MacBride/Valemount, Fort St. James, Burns Lake, and
Fraser Lake/Endako.
The Prince Rugert _Jfental__Health_ Centre moved into new
premises in 1979. Shortages in office space in the Queen
Charlottes made it necessary for the Mental Health
professional for that region to temporarily work out of the
Prince Rupert office on a travelling clinic basis.
The close liaison which has developed in Prince Rupert
between the hospital psychiatric unit and the Mental Health
Centre has facilitated referrals from this unit, as well as
the coordination of continuing services for patients moving
from the unit into the community. Coordination of services was
also stressed between  the Mental Health  Centre and other
126 -
 community agencies including the School District, the
Inter-Ministerial Committee, Long Term Care Assessment, Aid to
the Handicapped, Community Care Licensing, The Alcohol Advisory
Board, the Volunteer Bureau, and the Youth Enrichment Society.
During the year, the arrangement between the Terrace
Mental Health Centre and the local hospital was strengthened
through the fact that the centre's psychiatrist was also a
member of the hospital's medical staff, as well as Head of the
Department of Psychiatry. This resulted in an improved
coordination and provision of continuing services, for both the
chronically and acutely emotionally disturbed.
Other mental health services which the Terrace Mental
Health Centre provided included a counselling treatment
program, a group therapy program, and a weekly medication
maintenance clinic. The Community Education Program of the
Centre included such activities as parent effectiveness
training, workshops on child development, and workshops on
stress reduction. Community Support Program activities
included representation of the Inter-Ministerial Youth
Committee, the Inter-Agency Coordinating Committee, Long Term
Care, Aid to the Handicapped, and on the Drug and Alcohol
Committee. In addition, staff worked closely with community
societies in planning and implementing services related to
rape, crisis, battered women, child abuse, and residential care
for chronically mentally ill persons. Consultation services
provided to physicians, other ministries, and community
agencies, focused on case management regarding individual
treatment or therapy, and on advise concerning program
development, and staff education requirements.
The filling of all vacant personnel positions in Williams
Lake Sll^-.S-6^6'- resulted in a considerable increase in
treatment referrals from agencies and physicians. The centre
gave special attention to the coordination of services between
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 the various community agencies. As a result, staff were
involved with the Board of the Child Development Centre, the
Board of the Crisis and Counselling Centre, Inter-Agency
Committees, and a number of committees appointed by the Town
Hall. Community Education services were aimed at both the
public and at workers of the various agencies. A very active
and extensive volunteer program continued to operate, and
provided many valuable services which significantly supplement
available community resources.
During the year the Prince George Mental Health Centre
moved into a new government building. Newly developed services
involved coordination with a new day hospital program for long
term chronic hospital patients, and with a new day program for
acute patients living in the community. These new programs
were scheduled to begin early in 1980. Other centre activities
included a weekly medication maintenance program, and a basic
skills program for emotionally disabled adults. The centre's
Boarding Home program continued to expand, in order to take
care of the demand for placement. In cooperation with the
staff of a local forestry camp, and with a summer student hired
under the Youth Employment Service, it was possible to have
nearly all the Boarding Home residents participate in a 4-day
Special Socialization and Learning-to-use-Free Time Program.
Although only a very brief program, it proved to be very
popular and successful.
Staff recruitment was a continuing concern in the Fort
St. John/Dawson Creek Mental_Health Centres. Three new staff
positions were approved. Two of these were allocated to the
Fort St. John/Dawson Creek area, and one to the Fort Nelson
area. Recruitment to fill these vacancies had top priority.
During the year considerable efforts were made to alleviate the
office space problems. The Dawson Creek office was relocated
and at the year-end negotiations were underway for relocating
the  Fort  St.  John office.   The number  of referrals  from
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 physicians, agencies and community agencies continued to
increase in 1979. In addition, there was an increasing demand
for agency and community education, as well as for clinical
consultation. Coordination, and collaboration with the various
groups in the community, particularly public health continued
to be a major goal for maintaining an effective network of
community services.
KOOTENAY REGION
The Kootenay Region is located in the southeastern
section of the Province and contains a population of over
138,000 people. The area is served by mental health centres in
Cranbrook, Nelson, and Trail, with sub-offices located in
Sparwood, Castlegar, and Grand Forks. Surrounding communities
such as Golden, Kimberley, Creston, Salmo, and Nakusp are
serviced through travelling clinics and consultation to local
profess ionals.
Staff of the mental health centres provided services to
an average combined caseload of over 1000 clients. Added to
the caseload were over 800 hours per month of crisis and
short-term services, to individuals and families who were
treated as unregistered clients. The Kootenay Region staff
also continued to provide community education and support
services to other agency personnel in the area. Staff
participated in co-ordination and development activities in the
region to insure efficient service delivery.
Through the efforts of the Boarding Home and Long Term
Care workers in the centres, the quantity and quality of
residential services available to those in need continued to
improve. The concerted efforts of all staff in this endeavor
appeared to be bringing favorable results.
- 129
 Staffing in the centres continued to present some
problems. Difficulties were experienced in recruiting well
qualified professionals to this region, and vacant positions
remained that way for longer than was desirable. At the
year-end efforts were increased to recruit staff from across
Canada.
Greater Vancouver Mental Health Services
The Greater Vancouver Mental Health Service (G.V.M.H.S.)
continued to be an integral part of the mental health delivery
system for the Vancouver and Richmond areas.
CLINICAL SERVICES
During the year the service continued to be responsible
for the operation of eight Community Care Teams providing
direct treatment in the community to a current caseload of
approximately 3,000 patients. An integral part of the Teams'
functioning was to establish good working relationships with
other agencies in the community, especially Public Health,
Human Resources, local hospitals, and police. A natural goal
of the therapeutic program offered by the Teams is to enable
the patient to make use of community resources.
During 1979 the G.V.M.H.S. continued to deliver a high
calibre of mental health service to those persons suffering
severe mental health problems. Much of the treatment time was
devoted to individual, family, or group therapy. Medications
were administered and supervised. Many patients need
rehabilitation programs to help them re-enter the community,
and programs are developed to meet this need. The Teams offer
a variety of therapeutic activities. These programs could
include exercise groups, relaxation groups, swimming, hiking
and bowling groups.  Weekly social activities were available
- 130
 for senior citizens, young adults and middle-aged women who may
be suffering from a mental illness. A special area of focus
for the Strathcona Team in 1979 was working with, and
developing programs for, referrals coming from the new "boat
people"  population.
Each multi-disciplinary Team is uniquely designed to meet
the diversity of the ethnic communities within its service
area. Each Team services an area with a population of 25,000
to 100,000. 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.
Blenheim House is a treatment program for emotionally
disturbed pre-school children and their families; it has been
under the G.V.M.H.S. for five years. In addition to direct
therapy of clients, Blenheim House offers treatment/consultative services to those community agencies which are also
involved  in  the  care of young  children.
During the year, the G.V.M.H.S. programs continued to
function as an educational setting for students doing their
practicums in medicine, psychology, social work, nursing -ind
occupational   therapy.
SUPPORT   SERVICES
Over the years, a number of developments, notably the
transfer of the two residential facilities, Vista and Venture,
to the Greater Vancouver Mental Health Service; the
introduction of the joint After-Hours Emergency Service with
the Vancouver Police Department; and the assignment of the
Mental Health Liaison Program (Long Term Care) under Long Term
Care funding to the Greater Vancouver Mental Health Service,
suggested    the   need    for   a   clearly   defined   central   role    in    the
131
 development, direction, coordination and administration of
support services. The review and recommendations of the Finch
Report of the Role of the G.V.M.H.S. in Support Services in the
area of vocational rehabilitation, social-recreational
programming and housing, led to the appointment of one Area
Administrator to the position of Administrator of Support
Services.
In addition to the broad function of administrative ties
with the management of related public, private or non-profit
organizations involved in support services for the mentally
ill, the Support Services component has direct administrative
responsibility for:
Mental Health Liaison Program (Long Term Care)
Vista
Venture and Venture Annex
After-Hours Emergency Service
Most of the time and energy of the Administrator of
Support Services has had to be devoted to the program directly
administered by the Greater Vancouver Mental Health Service.
MENTAL HEALTH LIAISON PROGRAM (Long Term Care)
This program was assigned to the Greater Vancouver Mental
Health Service under Long Term Care funding in July of 1978 and
came under the direction of the Support Services component in
October of that year. A series of meetings with the three Long
Term Care Administrators in the North Shore, Richmond and
Vancouver area resulted in the present service pattern.
The staff of the program carries responsibility for:
(i)   assessment of all persons referred for Long Term Care
benef i ts.
- 132
 (ii)  liaison with psychiatric units of acute care hospitals,
as  well  as  Riverview,  Valleyview  and  the  Forensic
Psychiatric Institute,
(iii) Supervision of those Long Term Care facilities used
exclusively for the placement of persons with psychiatric
disorders,
(iv)  consultation to Long Term Care staff on request, as well
as consultation to other agencies and families of clients.
(v) determining the appropriate number and type of beds
required for the placement of psychiatric patients in
facilities for the Long Term Care Facilities Planning
Committee on which the program is represented. The
development of an independent living program, with some
measure of home support, was started on a small scale
with the operation of two townhouses for six clients in
the Champlain Heights social housing project.
MENTAL PATIENTS ASSOCIATION
The Administrator of Support Services participated
actively in the development of the funding and service
agreement between Long Term Care and the Mental Patients
Association which came into effect on April 1, 1979. The
M.P.A. Liaison Worker funded by Long Term Care, but on the
staff of G.V.M.H.S., is part of the Mental Health Liaison
Program. He has established an effective working relationship
with this self-help group which should ensure a reasonably
harmonious relationship between Long Term Care and the Mental
Patients Association.
VISTA
Since October 1, 1978, this rehabilitation residence has
been part of the Mental Health Liaison Program. A staff member
of this program is responsible for assessment, placement and
- 133
 discharge of all residents of this facility and the program.
The facility is considered a desirable resource and frequently
the first choice for placement of women clients of referring
agencies.
VENTURE
The 10-bed emergency residence has continued to meet the
demands of the Community Care Teams and the After-Hours
Emergency Service for emergency placement, effectively and with
dispatch. In addition, it handles all after-hours calls and
service requests for the eight Community Care Teams and
provides   the base   for   the  operation of Car 87.
CAR 87
This mobile emergency service is a joint program with the
Vancouver Police Department and operates nightly from 20:00 to
04:00 hours. An independent review of Car 87 and a similar
program between the Ministry of Human Resources and the
Vancouver Police Department (Car 86) has been sponsored by the
Vancouver City Social Planning Department. At the year-end the
report was being reviewed by senior staff of the three
organizations involved.
VENTURE ANNEX
This 4-bed residence, next door to Venture, has become
the base for a program of independent living with an
educationally oriented  life-skills   training  program.
EVALUATION AND RESEARCH
The principal activities of the Evaluation and Research
Department during the year are summarized according to the
following areas of responsibility:  Health Records, Management
134
 Information System and Evaluation and Research.
(a) Health Records: Health Records personnel are responsible
for the processing of Client Information System forms prior to
submission to Mental Health Programs in Victoria. A Master
Client Index is kept of all referrals, activations, and
terminations of clients within the Greater Vancouver Mental
Health Service. This index also lists clients of our
After-Hours Emergency Service, Venture and the Mental Health
Liaison Program (Long Term Care).
(b) Management Information System: The activities of the past
year involved the ongoing process of information contained in
the Monthly Service Report and the introduction of changes at
various stages of the information-gathering system.
The most important change was the introduction of a Group
Service Report form for recording client groups involving two
or more clinical staff.
At the year-end, the data collecting phase of the
Management Information System had been temporarily suspended,
and the System was undergoing an extensive review.
(c) Evaluation and Research: A number of research activities
were undertaken during the past year. In addition,
consultative services were provided to Team staff regarding
research methodology and data analysis.
Major projects during the year involved the submission of
grant applications in conjunction with the University of
British Columbia World Health Organization Joint Centre for
Research and Training in Mental Health. The first grant
application, submitted to Health and Welfare Canada, requested
funds of approximately $400,000 for a three-year period. The
project,  entitled  "The  Outcome  of  Schizophrenia",  is  a
135
 longitudinal study of the outcome of the condition in a group
of newly-identified, previously untreated schizophrenics.
A second grant application covers a three-year project
entitled, "An Evaluation of Tertiary Prevention in
Schizophrenia". This project is designed to evaluate how the
Greater Vancouver Mental Health Service is succeeding in its
objective of providing rehabilitation and the prevention of
deterioration among schizophrenics discharged after their first
experience of hospitalization.
At the year-end this grant application was being prepared
for submission to the National Institute of Mental Health in
Washington, D.C. This research project will involve
cooperation with both the University of British Columbia and
the University of Oregon.
ADMINISTRATION DEPARTMENT
The Administration Department helped develop a new system
of compiling budgets, which made it easier for each Team to
contribute realistically to the overall financial planning.
The Administration Department continued to work toward the two
projected Team moves - West Side and Blenheim House, both
facilities are over-crowded. A new staff benefit package was
developed and a purchase order system was introduced to provide
more efficient purchasing for the Teams, and better control of
expenditures.
During the past year, the G.V.M.H.S. enjoyed excellent
relations and support from the Ministry of Health, Mental
Health Programs, and the City and Municipal Health
Departments. In 1980 the G.V.M.H.S. will study the
recommendations of the Cumming Report, and continue to improve
and develop services to meet the needs of the mentally ill in
the community.  With the continued support of the Ministry of
136 -
 Health, the G.V.M.H.S. should continue to have a system of
community mental health delivery unequalled in Canada.
Burnaby Mental Health Services
Burnaby Mental Health Services provides a regionalized,
decentralized,   integrated and  comprehensive  program  of
psychiatric  services  for adults,  families  and  children,
resident in the community.
INPATIENT UNIT
The 25-bed acute psychiatric Inpatient 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 maintains a high turn-over.
Assistance and co-operation is provided by Riverview
Hospital Intensive Care Unit, and Vancouver General Hospital
Emergency Department, for the occasional care of dangerous,
unmanageable patients.
ADULT DAY PROGRAMS
Burnaby offered three distinct Adult Day Programs during
1979; an intensive 5-day per week milieu program designed to
produce major behavioural change; a part-time more gradual
re-educative and socially rehabilitative program; and an
intermediate group-oriented program meeting three times per
week. A gardening group; formal courses for patients in
cooking and nutrition and in social skills; an "Introduction to
Assertiveness" course, and the "Creative Job Search Program",
continued to be popular additions to the regular programs.
Regular  liaison  meetings  with  the  Outpatient  Teams,  the
- 137 -
 Inpatient Unit, and the Burnaby Achievement Centre continued to
facilitate interactions with these programs.
ADULT OUTPATIENT DEPARTMENT
The three geographic Adult Outpatient Programs continued
to consolidate their position in the community, treating the
acutely disturbed, as well as participating in the
rehabilitation of the chronically mentally ill. The Teams
continued to develop specialized group treatment programs for
patient groups with special needs, such as abusing spouses,
parents of schizophrenic patients, and widows.
CONSULTATION PROGRAM
The psychiatric consultation program to Burnaby General
Hospital was expanded with the appointment of a half-time
consultant on a regular basis. This improved the quality and
continuity of the service, and relationships, with the
physicians and nurses in Burnaby General Hospital and the
community.
CHILDREN'S OUTPATIENT SERVICES
The Children's Outpatient Department remained somewhat
overloaded during 1979 in spite of development of additional
group programs for disturbed children. Consultation work with
Burnaby schools and the Ministries of Human Resources and the
Attorney General continued. The popular summer programs for
preschoolers, latency children, and their parents, were
continued with the assistance of summer students.
BOARDING HOME PROGRAM
The Boarding Home Social Worker was extremely busy with
placements, especially from the Inpatient Unit.
138
 LONG-TERM CARE PROGRAM
The addition of a Long-Term Care Social Worker early in
1979 facilitated the provision of increased services to
psychogeriatric  patients   in  the Burnaby community.
CONSULTATION AND EDUCATION SERVICES
Burnaby Mental Health Services continued to consult with
community groups and organizations, including Burnaby
physicians, Canadian Mental Health Association, Burnaby Health
Department, Long-Term Care Program, Burnaby General Health,
Burnaby Preschools, Dogwood Lodge, Burnaby Achievement Centre,
Parents in Crisis, etc. As well, many staff members served on
advisory boards for community organizations, a gratifying
recognition of the skills and service they provide the
community.
Burnaby continued to offer educational placements for
students in registered and psychiatric nursing, psychology,
social work, and occupational therapy.
Regular in-service training experiences offered during
the year included half-day workshops on the following topics:
The Behavioural Approach to Problems in Living; Effective
Communication and Therapy in Parenting; Expressive Art Therapy;
Families in Stress (Child Abuse); Borderline Syndromes; Working
with the Resisting Client.
Integrated Services For Child & Family Development
During 1979 Integrated Services experienced a dramatic
increase in referrals, compared with the preceeding year. In
the first six months of 1979, there were 489 referrals,
compared with 303 the same period in 1978, a 61% increase.
Referral sources were parents, schools, the Ministry of Human
139 -
 Resources, general practitioners, and miscellaneous others, in
that order of referral rate.
Major increases in referrals existed across all age
groups, but adolescent referrals were most significantly
increased. This seemed due to the commencement of an
identified adolescent service, with a full range of assessment,
treatment, and consultative activities being offered.
The year was also marked by major demands of staff for
training, particularly in the area of pre-school services. An
increase in demand for workshops was evidenced, particularly in
more northern communities.
Integrated Services actively participated in community
and agency network building, through the Interministerial
Children's Committee, International Year of the Child Steering
Committee, TRACY of B.C., the Pediatric Advisory Committee of
the C.R.D., the Saanich Interagency Committee on Children, and
many other groups and committees.
The year represented a time of shifting from a model of
single case service, to a model of case service plus programs.
By the end of the year, Integrated Services was offering group
programs for parents of teens, teens and younger children,
single parents, parents of specially disabled children, and
families interested in total health. The centre began to more
fully explore the many uses of volunteers, client participation
in service activity, and other methods of bringing a greater
interchange between the centre and the community at large.
British Columbia Youth Development Centre, "The Maples"
Residential and Day Centre Programs
The Adolescent Residential and Day Centre Programs are
located in Burnaby and provide a variety of services which
- 140 -
 include comprehensive consultation, assessment, inpatient and
day care treatment of psychological, social and learning
problems in adolescents. While in treatment, the adolescents
inter-act in a milieu which promotes interpersonal relationships, personal growth, life skills, and responsibilities.
Staff serve as healthy role models by encouraging 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 program attend the 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. The
adolescents are given a comprehensive educational assessment
and are then placed in individual programs that allow them to
progress at their own rate. 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 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 activities program. Camping,
skiing, movies, social events and regular outings promote and
develop social skills by bringing the adolescents into contact
with the community.
141
 The Residential and Day Centre Programs endeavour to
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 coordinator, 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 the areas of milieu, family, individual and
group therapy, interpersonal and group dynamics, assessment,
supervision, administration, and personality and growth
development. The residential 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,
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 to
an interdisciplinary team for assessment and diagnostic
recommendations.
During 1979 the Residential and Day Centre Programs of
the B.C. Youth Development Centre received 197 referrals.
Throughout the year, all of the residential beds and day centre
places were filled. A constant waiting list of between 30 and
40 adolescents prevailed throughout the year. Approximately 25
per cent of all admissions came from outside the Lower
Mainland. In addition, there were 903 family conferences held,
and 276 adolescents received some type of aftercare service.
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 A comprehensive brief was submitted and approved in
principle, to expand the existing facilities at the residential
unit. The proposal stresses the need for more comprehensive
services for adolescents, other than that offered by
residential treatment alone. Such expanded facilities would
include a secure unit for acute crisis intervention and long
stay care; an assessment, follow-up and outpatient department;
community-based transition homes; and expanded day centre,
educational,   and recreational  facilities.
Psychological Education Clinic
The Psychological Education Clinic is a provincial
resource for children and their families. The main thrust of
the Clinic is to operate a therapeutic school for children with
emotional and learning problems. There is a teaching and
treatment staff, who act as the change agents for both the
children and their families.
The Maples School accommodates 45 children between the
ages of 6 to 12 years, with the average length of stay just
over one year. The major academic problem is concerned with
reading. First, there is the child who is unable to read even
after the special services within the school system have been
exhausted. This requires using a variety of specialized
programs or developing ones to meet the child's unique
problems. Next, is the child who lacks the motivation to
learn, even though thought to be capable. In both cases, an
emotional component is present and exists to a debilitating
degree. Another category of concern is the child with no
learning problem, but with emotional problems within the home
and school. A final group of children are those with an
individual psychopathology, where no external cause is noted.
- 143
 Treatment of these children involves working with their
learning disability, which takes considerable time as it
entails one-to-one therapeutic tutoring. This is necessary
because of the uniqueness of the child, which requires the
program to be altered almost daily. Also, these children
function best when they have immediate and accurate feedback of
their performance. The approach used is a pragmatic
behavioural one, using task analysis, rewards, and helping the
child accept responsibility for behaviour and recognize that he
possesses the ability to change. The families are seen by
psychologists who offer counselling in child management
techniques, family relationships, marital and individual
problems.
The travelling Clinic is a very important aspect of
out-patient service. Travel is mainly to the northern parts of
the Province. Some limited direct service is provided, as well
as consultation, workshops and training sessions.
Boarding Home Program
1979 was an active year in the Mental Health Boarding
Home Program, characterized by a modification of previous
trends in the Program. This was the result of a considerably
expanded responsibility for psychogeriatrically disabled
persons in residential care facilities, as well as persons in
the age group receiving services in their own homes.
Long Term Care funded social work positions were seconded
to the Mental Health Boarding Home Program early in 1979, and
the incumbents provided such services as consultation to Long
Term Care staff, staffs of facilities and home support staffs;
assessment and placement services; resource development;
presentation of workshops and seminars for facilities and home
support staffs.
- 144
 There was close liaison with officers of the Long Term
Care Program and with Public Health licensing personnel. In
several jurisdictions formal Licensing, Mental Health, and Long
Term Care committees were established, in order to facilitate
this needed co-ordination. An outcome of this type of formal
co-ordination was an upgrading in the standards of facilities.
A three day workshop was held in March for the Mental
Health Social Workers - Long Term Care, and an evaluation
instrument was developed to measure the impact of these
employees on the Long Term Care Program. The results of this
study will be tabulated early in 1980. During the year there
was a significant increase in the caseload of the program (193
persons as compared to 65 persons in 1978), which appeared to
be a result of a significant increase in the number of persons
already resident in community care facilities who were referred
for supervision (approximately 100 persons as compared to 27 in
1978).
The Boarding Home Co-ordinator continued to serve on the
Development Committee of Long Term Care, and to attend all
meetings of the Provincial Adult Care Facilities Board as a
liaison person from Mental Health Services.
During the year meetings were held with officers of the
Ministry of Human Resources regarding transfer of the
responsibility for community residential care of retarded
persons from Mental Health programs to the Ministry of Human
Resources.
During the year, a committee, established under the aegis
of the Ministry of Human Resources, with representation from
the Mental Health Boarding Home Program, developed an
evaluation instrument for community residential care facilities
for retarded persons.
- 145
 The services of Occupational Therapists and Activity
Workers were augmented by the employment of summer students.
This section of the Boarding Home Program provided activation
programs for clients of the program throughout the province in
order to rehabilitate to independent living as many of the
clients as possible.
The more liberal funding available under the Long Term
Care Program during the year, made it possible to develop small
specialized resources for psychiatrically disabled persons,
particularly those in the younger age group who require an
intensive program in order to prevent the development of a
chronic state of disability. Some resources were also
developed to serve persons suffering from brain damage.
The incumbent Boarding Home Co-ordinator, who had held
the position for 18 years, retired from public service
effective July 31st. During her tenure the program grew from
an initial agreement for the placement of 100 patients out of
Riverview Hospital, to the placement of approximately 3,500
persons from all B.C. institutions serving psychiatrically
disabled, psychogeriatric, and retarded persons. Additionally,
some 2,700 persons from the community have been served by the
Program. This latter source represents 75% of the referrals to
the Program today.
Goals of the Program have altered over the years, as new
knowledge and techniques have become available, and today the
emphasis is on rehabilitation of the clients served by the
Program. To this end many ancillary services are required such
as activity centres, work activity programs and sheltered
employment.
The Boarding Home Program is very grateful to the many
volunteer organizations and individual volunteers who provide
their services to enhance the lives of clients.
- 146
 Caseload as  of January  1,   1979
Caseload  as  of December 31,   1979
January  1,   1979  - December 31,   1979
Number of  placements  made
Number  of discharged  to  independent  living
Number  outgoing other  reasons   (death,
heavier   level  of care,   supervision of
other  agency,   etc.)
Number  of Hospitalizations   (institutions  or
psychiatric  unit)
2,095
2,280
531
183
160
99
Consultative Services
PSYCHIATRIC CONSULTATION
The Consultant in Psychiatry reports on the feasibility
of proposals submitted to the Minister, and provides
consultation and written reports in matters relating to mental
health practise.
As a member of the Medical Records Committee the
Consultant has been involved in planning and initiating a pilot
study of a method of standardizing clinical records, in two
mental health centres. Acting as the Committee's
representative the Consultant visited both the centres to
explain the rationale for the proposal, and its implication for
improved record keeping. The attempt to standardize record
keeping throughout mental health centres and thus promote
quality assurance will continue in 1980.
As a member of the Research Committee the Consultant made
contributions to the original mandate and philosophy of this
Committee. The Committee encourages the submission of research
proposals from the field, and assists the researcher in the
147
 organization of the proposal in order to meet the requirements
of the funding agencies.
The Consultant was actively engaged in research on a sample of
the aged population. Other evaluation research projects were
in the planning stages at the year-end.
Various mental health centres were visited to discuss
concerns about psychiatric input into a multi-disciplinary
team, and to establish direct liaison with regard to questions
arising over professional issues and concerns.
Liaison continued throughout the year with the University
of British Columbia's Outreach Department. The need for
outreach facilities varied with the availability of
psychiatrists giving service to northern regions.
Assistance in the development of priorities in program
planning, was an ongoing responsibility of the consultant.
At the year-end the Consultant was working with the
mental health centres in the Fraser Valley to establish a
short-term half-way house which could also be used as an
emergency centre to prevent admission, where possible, to
Riverview Hospital. Useful liaison with other agencies
involved in providing community resources for the chronic
mentally ill was provided by the Consultant's membership in the
Inter-Ministry Service Committee, which included representatives from Riverview Hospital, Woodlands, and the Ministry of
Human Resources. The Consultant also maintained liaison with
other specialized hospitals and their community affiliated
groups, to promote rehabilitation where possible of a self-help
nature.
As a contribution to continuing education the Consultant
prepared several workshops to be given to mental health centres
and invited agencies.
- 148
 Liaison with the Canadian Mental Health Association
continued as an important function in promoting involvement in
prevention and patient rehabilitation.
CLINICAL SOCIAL WORK CONSULTATION
Recruitment of professional staff to an expanding rural
mental health system occupied a considerable portion of the
Consultant's time during the first quarter of 1979. Heading a
recruitment team comprising a Health Personnel Officer, and a
member of the Executive and Professional Division, Canada
Manpower Services, resulted in the filling of virtually all of
the position vacancies. This necessitated personal interviews
conducted across Canada including Vancouver, Calgary, Regina,
Winnipeg, Toronto, Ottawa, Montreal and Halifax. The use of
Canada Manpower Services proved to be a most helpful resource
throughout this recruitment exercise.
During the year a significant increase was found
necessary in connection with orientation and consultation
services on the part of the Consultant, due to a sizable
increase in the professional social work complement. Special
training and orientation seminars were developed for the 18 new
Long Term Care social workers, and considerable effort was
applied to the development of an appropriate functional
definition of the responsibilities of this staff to the needs
of the psychogeriatric population.
The Series Review Committee continued to meet throughout
1979 and by the final quarter had completed its work with
respect to the redefinition of each of the classification
levels for clinical social workers within the system. The
final drafts were submitted to the Government Employee
Relations Board for scrutiny and further processing.
149 -
 The Committee on Social Work Education continued to meet
throughout 1979, with special emphasis being placed upon the
development of a curriculum within the two major professional
training schools which would address mental health interests
and the training needs of mental health professionals in rural
areas.
As chairman of the Continuing Education Committee, the
Consultant was responsible for organizing the 1979 Annual
Provincial Mental Health Conference held at U.B.C. With 550 in
attendance, this conference hosted a variety of excellent
workshops aimed at helping mental health professionals to
consider new and innovative approaches in the area of primary
prevention.
Highlights of this Conference were addresses given by Dr.
William Stuart, of the University of Utah; Dr. Kenneth
Pelletier, Psychosomatic Medicine Clinic, Berkeley, California;
and two of the principals with Bonneville Productions in Salt
Lake City.
The Electives Program, also a responsibility of the
Consultant in Social Work, continued to expand in the number of
faculty, and workshops funded. A total of 180 workshops were
planned for the 1979-80 academic year. A specialized training
service for Electives faculty was added during the year, to
ensure that workshop content was relevant to local community
need. At the year-end the Ministry of Health was examining the
Electives Model with a view to assessing its potential
application to other components of the health system generally.
In terms of headquarters activities the Consultant
continued to contribute to the development of overall mental
health planning and policy setting.
- 150
 PSYCHOLOGY CONSULTATION
During the year the Consultant spent considerable time
defining the types of services needed to implement service
priorities and to determine budgets. The primary aim was to
determine the most appropriate package of services to meet the
respective local needs. Specific service definitions included
proposals for the implementation of services for the
chronically emotionally disabled, the full utilization of
community services and volunteers, and a proposal to initiate a
central emotional mental health crisis telephone service.
Other involvements during the year included the
development of an on-line Cost-Benefit Analysis Computer
Program to determine the effects on both direct and indirect
costs, where changes are made in program emphasis in any of
five different Mental Health programs. The latter included
hospitalization for more than one year, hospitalization for one
month or less, Mental Health Centre treatment services, crisis
intervention services, and prevention type services.
The Consultant prepared a standard set of information to
be used both for program and budget planning and development
purposes, and for integration into a data base with other
health information.
As part of the development of new programs a study was
done to determine the characteristics of successful and
unsuccessful volunteer programs, including organization,
administration and supervision, and the effectiveness in
relation to the client, the volunteer, and the mental health
facility.
The Province's suicide rate continued to be the highest
in Canada. Among native Indians the attempted suicide rate was
extremely high, and the Consultant was endeavoring to determine
- 151
 if  it was  possible  to  develop specific methods  for  the
prevention of suicide epidemics.
During the year a high priority intensive recruiting
program resulted in the filling of 13 of 14 positions for
psychologists.
Management Analyst Services
The year began with the continued progression of the
Mental Health Surveys which had started in November of the
previous year. On completion of the review at the three
Greater Victoria centres, it was decided that the remaining
centres would be surveyed using a self-recording and
questionnaire process. The necessary forms and instructions
were prepared and distributed to all centres for completion.
Assistance was provided in a review of the Management
Information System. New input forms were designed by the
Management Analyst reflecting proposed procedured changes.
These were reviewed with representatives of the British
Columbia Systems Corporation regarding intended use,
programming impact, and eventual output requirements. Final
implementation of the changes were under review at the
year-end.
The last of three transportable sets of Audio Visual
equipment were made available to the centres. This completed
the placement of the units at centrally located centres (Prince
George, Pentiction, New Westminster) for use by all other
centres as required.
Assistance was provided to the senior administration in
the preparation of a submission to Treasury Board requesting
authorization to engage an outside consulting firm to conduct a
152
 Clerical Support study within Community Health. During the
year an audit was carried out and a report submitted on a Long
Term Care Work Measurement Study of Assessor staff
requirements. In July, as part of a Ministry re-organization,
the Management Analyst was re-assigned to the office of the
Director of Managment Services, to provide a Management
Consultant Service to Community Health. Response to direct
Mental Health requests was provided and included:
a. the co-ordination of printing new forms and Medical
Records survey proposals;
b. the co-ordination of placing additional audio-visual
equipment in the field;
c. the completion of a review, the amending, and the
distribution of the amendments of the Client Information
Systems Procedures Manual;
d. a proposed review of the Clerical Support
requirements of Headquarters Mental Health Services.
Research and Planning
The Research and Planning Section continued to maintain
the Management Information System during the past year. The
large amount of data coming in on both caseload and service
activity necessitated considerable effort on the part of the
statistical clerks to keep the system functioning. Due to
various processing difficulties the monthly reports from the
system have fallen behind schedule; however, efforts were under
way at the year-end to remedy the situation. The quarterly
training sessions to teach new staff how to use the Management
Information System were continued, and served to take the
training burden off the local mental health centre.
Research grants received from the B.C. Health Care
Research Foundation allowed for the completion of two research
projects.  The Goal Attainment Scaling Follow-up Project was
- 153
 completed, and data from 40 client interviews was being
analyzed. The Problem Prevalence Survey was successful in
developing a validated problem assessment instrument, and the
application of that instrument in a sample of the general
population in the Capital Regional District was in the latter
stages of completion.
Consultation in research and data analysis was provided
to field staff and to other government agencies. A Research
Committee was developed to review proposed research within
mental health, and to outline areas of priority research.
During the year, the Research and Planning Officer served
on a National Health Research and Development Program grant
review committee, and as a continuing member of the B.C.
Program Evaluation Task Force. Research papers were submitted
to various journals for review, and six reports were issued as
Applied Research Unit Reports.
Mental Health Pharmacy Committee
During the year the Mental Health Pharmacy Committee
emphasized the rationalization of pharmaceutical services
provided by Mental Health Programs. A total of 15 dispensaries
were in operation in various Mental Health Centres.
Following  the  development  of  a  rational  for the
continuation  of  pharmaceutical  service,   a  policy and
interpretation statement was developed, endorsed as policy and
sent for implementation to field staff.
In the area of quality control, a standardized medication
profile was developed and implemented in the dispensaries.
At the year-end a series of four session seminar blocks
were being conducted at  the Port  Coquitlam Mental Health
- 154
 Centre. This was an initial attempt to involve both Mental
Health and Long-Term Care staff with a base of information
related to psychotropic drugs. A total of 50 staff would be
involved  in  these  sessions.
155
 MENTAL HEALTH SERVICES
Mental Health Centres
Boarding Home Programs
Burnaby Psychiatric Services
B.C. Youth Development Centre
Riverview Hospital
TOTALS
Typical
Typical
%  of Total
Annual
Annual
Staff
Budget
Budget
Admissions
Caseloads
201
6.8M
13.4
6,400
10,400
23
0.5M
1.0
500
2,200
106
2.3M
4.6
840
1,000
148
3.6M
7.0
50
35
1,775
37.6M
74.0
1,400
1,100
2,253
50.8
100.0
9,190
14.Z15
156
 Statistics
Maintenance of the community mental health statistical
systems and the provision of statistical reports to a wide
variety of agencies and government departments are the
statistician's primary areas of responsibility. During 1979,
efforts were concentrated on maintaining an accurate data base
and providing timely reports, while modifications were made to
data collection and processing procedures.
The Management Information System was transferred to a
new computer by the B.C. Systems Corporation early in the
year. The inevitable disruptions to procedures and schedules
resulting from the move were offset by the advantages of the
new interactive system. Some data entry and file maintenance
previously handled by the Division of Vital Statistics was now
carried out on a terminal installed in the statistical section.
Some changes were made to data collection procedures
during the year, among them a decrease in the amount of staff
activity information collected from the mental health centres.
Analysis of the activity data collected over a one year period
demonstrated that a sample is sufficient to meet management
information requirements. A sampling procedure was instituted
to collect staff activity data in April of this year.
Reporting on goal attainment scaling for each client
treated by teams and centres became an optional feature on the
Client Information System in August.
Twelve new sub-offices were brought onto the statistical
systems during the years. Like the main centres, the sub-
offices received reports on clients and staff activity on a
monthly basis.
157
 The conversion of active research files for processing on
the Honeywell computer was among the projects undertaken by the
statistician during the year. The ease with which the files
could be accessed, edited, and the data retrieved from the
computer, was expected to decrease the time needed to fulfill
requests for statistics. The possible advantages of other
systems for statistics production and research were being
explored.
The statistician participated on several committees, and
maintained liaison with the Division of Vital Statistics, the
B.C.  Systems Corporation, and other agencies throughout the
year.
158
 PATIENT MOVEMENT DATA, 1  MENTAL HEALTH
FACILITIES, 1979.
MENTAL HEALTH FACILITIES
ENTRIES
EXITS
H
cd
o
H
a
O
■H
P CO
o cn
CD -H
u e
•H TD
Q <
Return
From
Leave
P u
C U
CD CD
C <H
CO CO
6 G
IH 3
CD <h
CL, H
-~i
Cfl
-P
0
H
CO
CD
M
U
cfl
a
o
CO
■H
Q
CO
CD
>
Cfl
CD
J
-P CO
C u
CD CD
Cfl CO
6 a
U   crj
CD u
a, eh
CO
J5
-P
cfl
CD
Q
All Mental Health Facilities
9989
9675
270
44
9151
8092
812
44
.203
Hospital Programs Riverview
1359
1075
253
31
1340
567
716
20
37
Geriatic facilities
248
232
16
—
345
102
73
4
166
Valleyview
145
179
16
—
240
53
72
—
115
Dellview
37
37
—
—
76
32
1
3
40
Skeenaview
16
16
—
—
29
17
—
1
11
2
Mental Health Services
8382
8368
1
13
7466
7423
23
20
—
Total Impatient
405
391
1
13
400
357
23
20
—
Burnaby
345
336
1
8
336
295
22
19
—
BCYDC
60
55
—
5
64
62
1
1
—
Venture
Vista
Total Outpatient
7977
7066
All Mental Health Centres
6236
5451
Abbotsford
295
213
Burnaby Central
144
123
Burnaby Children
58
5S
Burnaby Day Program
85
85
Burnaby North
150
80
Burnaby South
85
131
Burns Lake
21
	
Campbell River
13
	
Chilliwack
96
301
Courtenay
139
209
Cranbrook
93
138
Delta (1979)
51
	
>4
Dawson Creek (1979)
165
	
Duncan
56
71
Fort St. John
109
74
Grand Forks
76
71
Kamloops
303
86
Kelowna
305
141
- ]
.59 -
 PATIENT MOVEMENT DATA1, MENTAL HEALTH FACILITIES, 1979
ENTRIES
FXITS
MENTAL HEALTH FACILITIES
H
Cfl
4^
O
Eh
C
0
-H
•P CO
O CO
CD -H
Sh e
•H TJ
Q <
Return
From
Leave
C
CD
5
cfl
E
In
CD
CL,
CO
u
CD
Ch
(0
fi
Cfl
r>
E-i
H
Cfl
0
H
CO
CD
M
U
CO
£.
o
CQ
•H
Q
CO
CD
>
Cfl
CD
P CO
C  JH
CD CD
C <n
Cfl CO
6 S
U   (0
CD U
a-  H
CO
_c
-p
cfl
CD
a
Kitimat
48
9
Langley
173
58
Maple Ridge
113
154
Merritt  (1979)
3
	
Nanaimo
140
176
Nelson
324
523
New Westminster
59
85
Osoyoos  (1979) 4
53
	
Penticton
326
175
Port Aloerni
106
248
Port Coquitlam
261
171
Port Hardy (1979)
	
	
Powell River
129
155
Prince George
44
70
Prince Rupert
86
46
Queen Charlotte (1979)
9
2
Quesnel (1979)
71
2
Saanich
64
203
Salmon Arm (1979)
50
	
Sechelt
96
53
Smithers (1979) 4
31
	
Sparwood (1979)
46
8
Squamish
4
2
Surrey
181
206
Terrace
65
71
Trail
165
114
Vernon
449
366
Victoria
218
160
vise
529
384
Whalley
70
89
Williams Lake
79
140
- 160 -
 PATIENT MOVEMENT DATA1, MENTAL HEALTH
:ACILITIES,
1979
MENTAL HEALTH FACILITIES
ENTRIES
EXITS
-P CO
CO
CD
4J CO
01
c u
OO
C u
s
CD CD
u
CD <D
P 0
c
C <M
cfl
CO
C <H
CO
H
O -H
U           CD
CO CO
rH
_c
CD
Cfl CQ
si
cfl
CD CO
3 e >
e c
CO
o
>
e S
p
P>
U   co
4P O CO
U   (0
P
CO
Cfl
Sh Cfl
cfl
0
■H -H
CD U    CD
CD U
o
•H
CD
CD !^
CD
Eh
CC   tn J
Q< H
H
P
J
Cu  H
a
All Community Care Teams
1582
1472
Blenheim House
34
89
Broadway Clinic
226
244
Kitsilano
166
220
MHBH North Shore 5
12
12
Mt. Pleasant
139
108
Richmond
165
114
Secure
48
60
South Vancouver
159
105
Strathcona
203
213
West End
205
164
West Side
225
143
BCYDC  (Out Patient)
159
143
1
Table complied from actual data through £
eptember 1979 and proje
cted for
the
remainder of the year.
2
Subtotal does not include Community Care
Teams.
3
Venture stopped reporting as of July 1.,
1979 and Vista stoppec
reportir
g as
Of
January 1, 1979 when the nature of these
facilities changed.
4
New suboffice commenced reporting in June
1979.
5
Opened in September 1978 and closed in
September 1979.
- 161 -
 PATIENT MOVEMENT TRENDS, MENTAL HEALTH FACILITIES
1976 - 1979
MENTAL HEALTH FACILITIES
Yearly Sum of Entries
Resident or
from  —
Caseload
Oct.76
Oct.77
Oct.78
End of
End of
End
to
to
to
Sept.
Sept.
Sept
Sept.77
Sept.78
Sept.79
1977
1978
1979
All Mental Health Facilities
15278
10680
10344
17445
16325
1707'
Hospital Programs, Riverview
1432
1448
1362
1150
1111
109;
Geriatric Facilities
386
323
293
909
866
80!
Valleyview
270
197
224
581
551
53.
Dellview
81
96
48
185
189
is:
Skeenaview
35
30
21
143
126
Hi
2
Mental Health Services
11139
6951
6945
12690
11544
1212
Total Inpatients
800
803
672
77
70
5',
Burnaby
351
341
380
23
19
2d
BCYDC
57
50
62
35
35
3;
3
Venture
347
374
230
9
6
c
3
Vista
45
38
	
10
10
—
Total Outpatients
12660
8106
8017
15309
14208
1511a
Mental Health Centers
10067
5969
6146
12506
11373
1207C
Abbotsford
283
232
315
296
276
34£
Burnaby Central
128
143
160
240
245
28S
Burnaby Children's
72
68
59
127
134
125
Burnaby Day Program
65
89
93
17
15
21
Burnaby North
194
106
157
419
397
477
Burnaby South
170
100
100
302
298
245
4
Burnaby Lake  (1979)
	
	
17
	
	
17
Campbell River  (1979)
	
	
10
	
	
IC
Chilliwack
245
170
97
455
440
244
Courtenay
277
242
169
179
252
212
Cranbrook
210
206
102
251
193
114
Delta  (1979)
	
	
41
	
	
41
, 4
Dawson Creek  (1979)
	
	
14
	
	
132
Duncan
169
134
56
207
123
112
Fort St. John
143
31
90
563
180
209
Grand Forks
127
82
71
65
31
33
Kamloops
368
136
296
613
572
785
Kelowna
455
369
330
681
583
705
Kitimat   (July 1977)
20
- 1
97
62 -
39
107
85
112
 PATIENT MOVEMENT TRENDS, MENTAL HEALTH FACILITIES
1976 - 1979
MENTAL HEALTH FACILITIES
/early Sum of Entries
Resident or
from  —
Caseload
Dct. 76
Oct.77
Oct.78
End of
End of
End of
to
to
to
Sept.
Sept.
Sept.
Sept.77
Sept.78
Sept.79
1977
1978
1979
Langley
247
118
195
384
309
446
Maple Ridge
316
184
122
634
504
467
Merritt  (1979) 4
	
	
2
	
	
2
Nanaimo
289
92
138
360
328
315
Nelson
372
243
303
428
530
325
New Westminster
287
150
75
362
330
308
Osoyoos   (1979) 4
	
	
42
	
	
42
Penticton
241
316
348
610
576
782
Port Alberni
239
88
107
290
345
242
Port Coquitlam
241
263
261
349
337
407
Port Hardy
	
	
	
	
	
	
Powell River
208
161
133
273
218
200
Prince George
193
119
49
486
424
355
Prince Rupert
131
36
75
47
32
62
Queen Charlottes  (1979)
	
	
7
	
	
6
Saanich
340
33
80
577
304
184
Salmon Arm (1979) 4
	
	
40
	
	
40
Sechelt
120
105
95
79
168
213
Smithers  (1979)
	
	
25
	
	
25
Sparwood  (1979)
	
	
37
	
	
31
Squamish
76
30
7
80
109
115
Surrey
375
280
196
726
797
776
Terrace
328
61
58
135
99
98
Trail
221
234
175
374
367
443
Vernon
612
404
447
637
699
780
Victoria
389
226
212
397
369
415
V.I.S.C.
279
367
536
238
281
459
Whalley
434
102
81
279
204
210
Williams Lake
245
142
84
239
219
87
All Community Care Teams
2321
1958
1744
2696
2734
2954
Blenheim House
61
76
35
104
127
83
Broadway Clinic
371
- i
319
:3 -
247
703
667
660
 PATIENT MOVEMENT TREiJDS, MENTAL HEALTH FACILITIES
1976   -    1979
MENTAL HEALTH FACILITIES
Yearly Sum of Entries
Resident or
fr
Dm  —
Caseload
Oct. 76
Oct.77
Oct.78
End of
End of
End
to
to
to
Sept.
Sept.
Sept.
Sept.77
Sept.78
Sept.79
1977
1978
1979
Kitsilano
264
201
184
286
294
236
MHBH North Shore
	
	
19
	
	
	
Mt. Pleasant
224
230
149
214
260
356
Richmond
140
163
192
248
228
287
Secure
136
77
59
83
58
65
South Vancouver
183
167
170
203
192
253
Strathcona
383
248
231
365
342
331
West End
252
224
233
281
236
295
West Side
302
253
225
354
279
388
B.C.Y.D.C.   (Out-Patients)
272
179
127
107
101
95
1 For the residential facilities, this includes permanent transfers,
admissions from the community, returns from leave and escapes.
2 Subtotal does not include community care teams.
3 Venture stopped reporting as of July 1, 1979 and Vista stopped reporting;
as of January 1, 1979 when the nature of these facilities changed.
4 New suboffice commenced reporting in June 1979.
5 Opened in September 1978 and closed in September 1979.
164
 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 within 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.
165 -
 Hospital Programs Highlights
The gross expenditure approved by the Hospital Rate Board
for public general, rehabilitation, and extended care
hospitals for 1979/80 amounted to approximately 9)748
million.
A total of 401,583 adult and child patients were
discharged in 1979/80, a decrease of 7,023 or .017 per
cent less than in 1978/79. Of all patients discharged,
94.7 per cent were covered by Hospital Programs.
Hospital Programs was responsible for 3,402,049 days of
care for adults and children in public hospitals, a
decrease of 26,660 days from 1978/79. The average length
of stay was 8.95 days.
In 1979/80, 19 major hospital projects were completed
involving an estimated $37 million. These included a
major services expansion at Lions Gate (North Vancouver);
and three major extended care projects: Prince George
(75 beds), Victoria at Glengarry (150 beds) and Victoria
at the Priory (75 beds). Additional extended care beds
were also provided at Castlegar, Ganges, Ladysmith,
Princeton and Revelstoke. A new 10 bed acute care
hospital was completed at Port McNeill, and additional
acute care beds were constructed at Mission.
The Planning and Construction Division handled an
especially heavy volume of work during 1979. In addition
to the completed projects listed above, nine
multi-million dollar projects were in planning stages or
under construction. These, coupled with other projects
in various preliminary stages, represented over $600
million in total project costs.
166 -
 A neurosciences construction project was completed at
Vancouver  General  Hospital  in  October,  1979,  which
included the installation of the province's first whole
body  computerized  tomography  scanner.   Whole  body
scanners also became operational at the Royal Jubilee
Hospital in Victoria and A.  Maxwell Evans Clinic  in
Vancouver; headscanners began operating in Prince George,
Kamloops, and Kelowna.
Hospital Programs  provided  in excess  of $23 million
dollars to erase the entire 1978/79 operating deficits of
public hospitals.  Hospitals were also advised that an
amount equal to the 1978/79 deficits was being added to
the overall budget base for 1979/80.
Grants  totalling  $11  million  were  approved  toward
purchases  of  movable  and  fixed  technical  equipment
amounting to about $19 million.  About 9,100 applications
for such grants were received from hospitals.
More than 2,400 patient accounts, and 2,800 emergency
service and minor surgery accounts, were processed daily
by Hospital Programs.
In excess of 204,000 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.
Over      8,000      out-of-Province      hospital      accounts      were
processed,   resulting  in  an  estimated   total   expenditure   of
more  than  $8.5  million.
Increased       payments       are      now      allowed       for       patients
authorized  to  obtain hospital benefits  outside Canada.
In   October,    1979,    the    firm   of   Ernst   and   Whinney   tabled
their  study  of   the  B.C.   Hospital  Funding  Program.     If   the
recommendations   contained   in   this   report  are  accepted,   it
will    involve    the    introduction    of    a    revised     financial
system  which   will   have   far-reaching   implications    for   all
public hospitals   in   the Province.
-   167   -
 The Hospital Role Study - A draft of the Phase I project
was completed during 1979. This phase provided all
sectors of the health care system with a commonly
understood method for describing different levels of care
in medicine, surgery, obstetrics, pediatrics,
rehabilitation, psychiatry, and dental care.
Effective April 1, 1979, hospital admitting staff were no
longer required to verify the information given by
patients concerning eligibility for benefits. Hospital
Programs assumed the verification function in order to
assist hospitals in their efforts to meet fiscal
restraints.
168 -
 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. (See following
sections.)
• 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.
• Operating grants to public general hospitals are based on
approved annual budgets; 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 the per diem rate approved for that particular
hospital minus the co-insurance charge paid to the
hospital by the patient. The patient is responsible
(1979) for paying a daily co-insurance charge of $4 for
acute-care, $6.50 for extended-care, or $1 for
extended-care patients under 19 years of age. The
Provincial Government pays the co-insurance charges on
behalf of Provincial recipients of Income Assistance from
the Ministry of Human Resources.
• A wide range of in-patient and out-patient benefits is
provided under   the  Act.
• Qualified persons who are temporarily absent from British
Columbia  are  entitled   to  certain benefits   during  a   period
-   169
 which ends at midnight on the last day of the twelfth
month following the month of departure.
In addition to the payments 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.
Also, the Province may provide additional financial
assistance in respect of the approved cost of equipment
for facilities which have been designated by the Minister
as Provincial referral centres. The grants are made on
the basis of 100 per cent of the initial or first
purchase and installation cost of equipment, and 75 per
cent of the replacements costs of existing equipment,
where the Minister classifies it as being of a type
required for operating a Provincial referral centre.
HOSPITAL ACT
One of the important functions of Hospital Programs is
the administration of the Hospital Act. The Assistant Deputy
Minister of 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 hospital: Non-profit hospitals caring primarily
for acutely ill persons.
• Private hospital: This category includes small
hospitals, most of which are operated in remote areas by
industrial concerns primarily for their employees, and
170
 licensed nursing-homes which are not under hospital
insurance coverage.
Rehabilitation and extended-care hospitals: These
non-profit hospitals are primarily for the treatment of
persons who require long-term rehabilitative and extended
hospital care.
BRITISH  COLUMBIA  REGIONAL  HOSPITAL DISTRICTS  ACT
The Regional_Hospital JJistricts 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.
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 capital expense
proposal by-law has been approved by the Lieutenant-Governor in
Council 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
-  171
 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 form 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.
The purposes of a regional hospital district, as
described in section 21 of the Act, are basically to acquire,
construct, enlarge, operate and maintain hospitals; to grant
aid   for   these  purposes;   and  to act  as  an agent  of  the Province
-   172   -
 in receiving and disbursing monies granted out of the Hospital
Insurance Fund. In order to exercise these powers that board
is authorized, with the approval of the Minister, to raise by
taxation an amount not exceeding the greater of $200,000 or the
product of one-quarter of a mill on the assessed value of lands
and improvements within the district.
BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS
FINANCING AUTHORITY ACT
The  British Columbia  Regional  Hospital Di^t^i^JL-
Financing Authority Act establishes an authority to assist in
the financing of hospital projects, medical and health
facilities, community human resources and health centres, and
any other community, regional, or Provincial facilities for the
social improvement, welfare and benefits of the community or
the general public good approved by the Minister of Health.
The financing authority purchases sinking fund debentures
issued by regional hospital districts to finance approved
hospital construction projects. The financing authority
obtains its money by marketing its own debentures. The raising
of funds by a Provincial Authority helps ensure a better market
and, on average, a lower interest rate.
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.
173
 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 increases or reduction 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.
174
 About 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
semi-monthly basis, so that hospitals do not have to wait for
payment until patients' accounts are submitted and processed by
Hospital Programs. The co-insurance charges paid by patients
are deductible when calculating payments to hospitals from the
division.
Nonqualifying residents are charged the hospitals'
established per diem rate, which is all-inclusive; that is, the
daily rate covers the cost of all the regular hospital
services, such as X-ray, laboratory, operating-room, etc.,
provided to patients, in addition to bed, board, and nursing
care.
HOSPITAL  CONSULTATION AND  INSPECTION DIVISION
This division provides consulting services to public and
private hospitals, and to other division 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 consultants
in hospital administration, biomedical engineering, dietetics,
clinical laboratory, laundry and housekeeping, nursing,
pharmacy, physiotherapy, social services, and X-ray. The
consultants in laundry and housekeeping, pharmacy and
physiotherapy, were all new additions to the division's
authorized  complement  during   the year.
175
 During the year the ongoing work of consultation and
inspection saw 164 visits made to general hospitals and 188 to
private hospitals.
/
Division personnel continued to participate actively on
advisory and working group committees at both the federal and
provincial levels.
The division's consultant in laboratory services was
appointed to a British Columbia Medical Association - Medical
Services Commission Joint Committee, responsible for directing
a study on the cost accounting of laboratory fee schedule
items. Equipment evaluations and assessments were conducted,
in conjunction with the Laboratory Advisory Council. A review
of laboratory planning parameters was carried out in
co-operation with the Construction and Planning Division and
the Laboratory Advisory Council. The laboratory consultant was
a resource person in the development of a functional program
for the Provincial Health Laboratory.
During the 1979/80 fiscal year, computerized tomography
head scanners commenced operating in Prince George, Kamloops
and Kelowna. Whole body scanners approved for the Vancouver
General and Royal Jubilee Hospitals and for the A. Maxwell
Evans Clinic in Vancouver became operational. CT head scanners
were approved for the Royal Columbian and St. Paul's Hospitals
and were expected to be operational in 1980. The Cancer
Control Agency's computerized radiotherapy treatment planning
systems commenced operating in the cancer treatment centres in
Vancouver and Victoria. Ultrasound services continued to be
expanded and by the year-end were widespread throughout the
province. Encouragement in the planning stage was given to
"Departments of Diagnostic Imaging", to allow the fullest
176 -
 interlinking of X-ray, ultrasound and the imaging aspects of
nuclear medicine for the greater benefit of the patient.
Perinatal care continued to be a major commitment of the
nursing consultants of the division, which included membership
in a number of planning and project committees, liaison with
various professional organizations, and consultation with
hospitals providing or developing provincial and regional
referral obstetrical and newborn services. Other major
commitments were the involvement with the Planning and
Construction Division in the preparation of design and space
guidelines for various nursing areas of acute care hospitals,
and the revision of the Guide for Operation of Extended Care
Programs and the Extended Care Hospitals - Design Guide, in
co-operation with the Medical Consultation Division.
A dietetic department methodology to assist in the
evaluation of departments of dietetics was completed and
circulated to all hospitals. This methodology provides the
only complete and pertinent source of information available
regarding the evaluation of staff usage. The revised B.C. Diet
Manual was printed and circulated to all hospitals. The
availability of this manual helped to update and standardize
nutritional care throughout the province. A slide/tape
presentation on dishwashing techniques was completed and made
available for staff training programs, and a presentation on
vegetable handling and preparation was being developed at the
year-end.
The division and Hospital Programs' Management
Engineering component continued an active interest in the
various systems relating to patient classification and staffing
by work load index.
177
 During 1979, several major developments occurred in the
field of hospital social work services in British Columbia.
The division's consultant in social work, and the B.C. Society
of Hospital Social Work Directors, worked jointly in producing
a paper on quality assurance and accountability for hospital
social work. Research was underway with the objective of
developing and implementing, in 1980, a uniform reporting
system for hospital social work services which will lend itself
to the development of hospital and interhospital profiles.
RESEARCH DIVISION
The division performs a statistical resource function for
Hospital Programs, and serves as a focal point for data
collection and analysis for use in program planning and
monitoring.
Toward the latter part of the year the scope of the
division was enlarged to encompass the provision of a
co-ordinated management information service for Hospital
Programs. Through the establishment and management of a
comprehensive data base, the Research Division supports all
divisions in meeting Hospital Programs' responsibilities for
program and facility planning, medical audit and expenditure
control.
Projects during 1979 included:
1) Co-ordination for the development of a Capital Budget and
Cash Flow Monitor System, to serve the needs of Planning
and Construction Division, as well as all other divisions;
2) Development and enhancement of a system to estimate the
impact of capital development to the mill rate of any
regional hospital district;
- 178
 3) Collection and maintenance of a computerized data base
containing hospital utilization and financial
information, for all hospitals, for the years 1974 to
1978-79;
4) Development of a system whereby information stored on the
computer could be presented in graphical format,
utilizing the Calcomp plotting facilities supported by
the B.C. Systems Corporation. Examples included graphs,
bar  charts,   pie  charts,   and  provincial maps;
5) Development of a Hospital Rated Bed Capacity Register,
used to keep an up-to-date record of the number of rated
beds for each hospital, and calculate available patient
days   for   the  current  fiscal year.
The preparation of recommendations for additional
hospital capacity, in the face of an ever-increasing range of
benefits and services covered by Hospital Programs, required
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 reviewed by Hospital Programs' Planning Group and,
if approved, are submitted to the Minister for approval.
During the course of the year, a number of meetings were held
with representatives of regional hospital districts and
hospitals, to review their 1981 and 1986 acute care bed
requirements.
The division also compiles statistical data relating to
all hospitalization in the Province. The admission/separation
records submitted by hospitals for each patient form the basis
of  this   information.     All  diagnoses   and operations   are  coded
179
 according to the Ninth Revision of the International
Classification of Diseases. Through this classification
system, the incidence of disease is analysed by age, sex, and
geographical location, as well as other variables.
In connection with morbidity analysis, the division
publishes a number of annual reports. "Statistics of Hospital
Cases Discharged" includes the standard morbidity tables
consistent with other provinces, affording an opportunity to
make interprovincial comparisons of hospital data. "Statistics
of Hospitalized Accident Cases", also prepared annually,
provides a broad analytical coverage of hospitalized accident
cases by circumstance, type of accident, and nature of injury.
"Day Care Surgery in British Columbia Hospitals" is prepared by
the division to show the potential and development of this type
of service. In addition to these reports, the division
supplies data to many agencies, both inside and outside the
Government. The demand for hospital morbidity data continues
to grow and has become particularly useful in planning
specialized hospital services.
HOSPITAL FINANCE DIVISION
The Hospital Finance Division is responsible for
assembling relevant information and preparing 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
1979/80 amounted to approximately $748 million.
180 -
 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
re-payment of debentures. Total regional hospital district
debenture sales to the financing authority amount to $480
million,   of which  $90  million was   added  during  1979/80.
Another function of the division is the processing of
admission/separation records (accounts), which hospitals submit
for each patient, and approving for payment all acceptable
claims and 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 33 1/3 per
cent on all other movable depreciable equipment. In 1979/80
after a review of some 9,100 applications received from
hospitals, grants totalling $11 million were approved on
purchases of movable and fixed technical equipment amounting to
about  $19  million.
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   any   new   addition,    compare    favourably   with   other
181
 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 more
than $460,000, included within 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, 1975-79 inclusive.
182
 ADMINISTRATION & PAYMENTS TO HOSPITALS, 1975-79
1975
1976
1977
1978
1979
Adminis tration
Payments to hospitals
Totals
2,438,265
370,927,805
373,366,070
3,556,066
483,107,890
486,663,956
3,619,325
536,939,951
540,559,276
4,253,000
606,186,000
610,439,000
4,640,000
707,398,000
712,038,000
- 183
 FINANCE   CLAIMS  SECTION
More than 2,400 patient accounts were processed per
working-day during 1979, as well as more than 2,800 emergency
and minor  surgery accounts.
The staff of Admission Control reviews each Application
for Benefits under the Hospital Insurance Act. Patient
accounts are checked to ensure that proper signatures appear on
the forms and that sufficient information for verification
purposes and related matters has been provided. During the
year, 7,000 claims had to be returned to the hospitals because
they were incomplete or unacceptable, and more than 1,800
letters were written regarding more involved problems with
specific  claims.
The In-patient Claims Section pre-audits the charges made
to Hospital Programs and ensures that all information shown on
each claim is complete, so that it can be coded for statistical
purposes, and charged to the correct agency, such as Hospital
Programs, Workers' Compensation, the Department of Veterans
Affairs, or other provinces and territories. The In-patient
Claims Section returned more than 3,600 claims for
clarification of information. Preliminary figures for 1979
show that more than 475,000 accounts (excluding out-of-
province) were  processed.
The day-care surgical services, day-care/night-care
psychiatric services, out-patient psychiatric services,
day-care diabetic services, and dietetic counselling accounts
increased in volume to more than 17,000 per month in 1979.
Payment for out-patient physiotherapy patients was provided and
preliminary figures indicate that accounts for more than
460,000   treatments  were  processed.     During  the  year,  more   than
184
 19,500  renal dialysis   treatments were  given  for out-patient
treatment   of   chronic   renal    failure.      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 involves establishing
eligibility and the payment of the claims. During 1979, more
than 8,000 accounts were processed, resulting in an estimated
total  expenditure  of more  than  $8.5 million.
The     Claims     Distribution Centre     receives,     sorts, and
distributes    all    the    forms    and correspondence   received   in the
Hospital    Claims     Section;     over 15,000    claims,     documents, and
letters  are handled daily.
HOSPITAL  PLANNING  AND  CONSTRUCTION  DIVISION
During the year, this Division continued to work towards
its objective of providing maximum assistance to hospitals to
enable them to achieve the best possible facilities within
existing fiscal restraints. This task became more difficult as
inflation increased at a faster rate than during the previous
year and, in the latter part of the year there was a noticeable
reduction in the degree of competitive bidding, which was
likely attributable to a general upswing in construction
industry activities. The Planning and Construction Division
continued to work closely with hospital boards of management,
project building committees and their consultants, and regional
hospital districts, in the planning of new facilities,
additions to and renovations of existing buildings, including
minor building  improvements.
185
 In all cases, the perception of the need for an expansion
program is first of all reviewed with regard to a hospital's
overall master plan, which is based on the role of that
particular hospital in relation to the provision of hospital
services in that area or region of the Province. In order that
planning may progress in an orderly manner once approval-in-
principle has been given by the Minister, building committees
are provided with advice by one of the Division's planning
coordinators, through the various planning stages up to the
award of a contract. During these planning stages, assistance
in reviewing the hospital's functional program and design
drawings is given by various professions represented in the
Hospital Consultation and Medical Consultation Divisions, as
well as organizations such as the Radiology Advisory Council
and Laboratory Advisory Council.
This Division is responsible for the processing of, and
recommending for approval the financing of projects through
regional hospital districts, for major expansion and
improvement projects, as well as minor renovations, in addition
to processing direct grants for minor building improvement.
The volume of work was particularly heavy during 1979, with
some nine multi-million dollar projects underway or in planning
stages. These expansion projects totalled over $317 million
and included the Cancer Control Agency, Vancouver; Lions Gate
Hospital, North Vancouver; Royal Jubilee Hospital, Victoria;
St. Paul's Hospital, Vancouver; Vancouver General Hospital; and
Victoria General Hospital, as well as the replacement of
Vancouver's Children's/Grace Hospitals, a new acute hospital on
the campus of the University of British Columbia, and a new
acute and extended care hospital in Port Moody. These
projects, coupled with other major projects, either in planning
stages or under construction in the Province, represented over
$600 million in total project costs. In addition, numerous
other projects were being assessed at the year-end so that
recommendations     could    be    made     to     the     Minister     of    Health.
186
 As some of the projects involved the construction of
facilities which provided a combination of acute/extended
care/intermediate care, this Division continued to work closely
with the staff of the Long Term Care Program.
The original cost control process for health facilities,
developed by Hospital Programs in 1970, was under review with
the aim of making improvements.
The Planning and Construction Division continued to
foster closer relations with several professional agencies.
These included the Architectural Institute of British Columbia
and the Consulting Engineers' Division of the Association of
Professional Engineers of the Province of British Columbia.
This involved the development of new contracts for
client/architect agreements and construction contracts, and
also the resolution of the basic fee structure to be accepted
by Hospital Programs, as well as resolving other mutual
problems. In the latter connection, the Division worked with
other Ministries, such as Forests & Lands, Parks and Housing.
Good liaison was continued between this Division and the
staff of the British Columbia Construction Association,
including its regional officers and sub-trade associations, and
the Division maintained its representation on the Public
Construction Council, which resolves various contractual
disputes.
During 1979, the Division continued its work of producing
guidelines to aid in the planning of acute and extended care
facilities, in particular for medical and surgical nursing
units, surgical suites, and construction standards.
187
 The staff of this Division was actively involved with the
Canadian Standard Association (C.S.A.), having representation
on vario'us committees of the C.S.A.'s Health Care Technology
Branch. Staff also played a major role in the review of
Standards being generated by the C.S.A., with particular
attention to: "Use of Electricity in Patient Care Areas";
"Essential Electrical Systems"; and "Medical Gas Piping
Systems" Standards, and also the development of a mechanism to
establish the need for the Standards together with a
cost/benefit analysis.
Other work was carried out with the National Research
Council of Canada, in reviewing proposed changes to the
National Building Code of Canada and the National Fire Code of
Canada. This Division was also represented on the British
Columbia Plumbing Advisory Board, which was preparing a new
B.C. Plumbing Code; and also on the National Standing Committee
on Plumbing Services.
The Division's input to these regulatory agencies was
primarily twofold, i.e. improved safety for patient, staff, and
public, combined with fiscal accountability. A detailed study
of the Kelowna General Hospital, carried out in 1978 with a
view to finding ways to conserve energy, resulted in a report
in January 1979, and many of the recommendations were
implemented. Over 40 other hospitals were visited during the
year, which resulted in recommendations for energy management
improvements, primarily in the "low-no-cost" areas. To further
promote energy conservation, the Division invited the Ministry
of Energy, Mines and Petroleum Resources, and the British
Columbia Health Association, to form a Provincial Task Force on
Energy Conservation. The objectives of this group are to
promote a positive attitude towards energy conservation in
hospitals,  and  to  identify  common  problems  and  implement
188
 techniques for conserving energy and costs. A series of
regional workshops on energy conservation was under
cons ideration.
In January 1979, Treasury Board approved the development
of a computer system designed to monitor construction budgets
and expenditures, as well as the projection of capital cash
flow. Working closely with the B.C. Systems Corporation, the
Ministry of Health contracted the system's development portion
of the project in March to a national consulting firm
specializing in Management Information Systems. The Capital
Budget and Cash Flow Monitoring System (CBCFM) which, it is
hoped, will become operational early in 1980, will provide the
Ministry, regional hospital districts, and hospitals, with a
continuous, up-to-date, account of funds allocated and expended
over the life of every hospital construction project.
Projects Completed in 1979
Castlegar _and_Dis_tr ict Hospital
On November 24, 1979, 10 additional extended care beds,
made available by the completion of a previously unfinished
area, were opened by the Minister of Health, Honourable K. Rafe
Mair. The rated extended care capacity of the hospital is now
15 beds.
Creston Valley Hospital
An expansion program involving the emergency department
and boardroom was completed in October, 1979.
Lady Minto Gulf Islands Hospital, Ganges
A project which provided 10 additional extended care beds
and expanded services, was completed in May, 1979. The
hospital's rated extended care capacity is now 25 beds.
189
 22}£-JfeSE, Health _Cj.inic
A project involving renovations to administrative and
service areas was completed in 1979.
Kamloops, Royal Inland Hojjsital
Renovations to accommodate the computerized tomographic
scanner were completed in December, 1979.
Ladysmith and District General^ Hos_g_ital
The first patients were admitted to a new 10-bed extended
care unit on August 1, 1979, which was opened by the Hon. R.H.
McClelland.
Miss ion Memoria1 Hospital
An additions and alterations project, resulting in an
additional 30 acute beds, was opened by the Hon. Mr. McClelland
on August 5, 1979, and the first patients admitted to the new
beds on September 14, 1979. The acute care rated capacity of
the hospital is now 84 beds.
Lions_jGate Jlos£ital^_J)orth Vancouver
A services expansion project was opened by the new
Minister of Health, Honourable K. Rafe Mair, on December 1,
1979. The project included intensive care, coronary care,
emergency and ambulatory departments. The radiology part of
the project will be completed in March, 1980.
Pj^rJ^McNeill Hospital
A new 10-bed acute hospital was opened by the Hon. Mr.
McClelland on August 6, 1979.
Eagle Ridge Hospital and Jl.^l,th__Care J^entjre^Poj^Jfoody
Phase I, which consisted of site preparation for the new
acute and extended care facilities, was completed in 1979.
190
 Prince George Regional Hospital
A new 75-bed extended care unit was opened by the Hon.
Mr. McClelland on May 14, 1979. A nursery and boiler plant
project was completed in April, 1979.
Queen Victoria Hospital, Revelstoke
On September 24, 1979, the first patients were admitted
to 5 additional extended care beds. The extended care rated
capacity of the hospital is now 15 beds.
St. Mary's Hospital, Sechelt
A services' expansion project, which included a new
operating room, enlarged radiology and dietary departments, was
completed in September, 1979.
Trail Regional Hospital
Phases II and III of a services expansion project were
completed at the year-end. The project included expansion of
the Emergency Department, day-care and post-anaesthetic
recovery room, plus renovations to central sterilizing, electro-
diagnostic services, nursing floors, and staff facilities.
A project including renovations to the paediatric ward,
the installation of an elevator, and the upgrading of
corridors, floors, and walls, was completed in June, 1979.
VANCOUVER
Cancer _Cont£o\^J^eacj^o£  B.C.
Phase I of the expansion program, an addition to the
radiotherapy department, was completed in December, 1979.
Vancouver General Hospital
A neurosciences project, which included the installation
of the first whole body scanner, was completed in October 1979,
and opened by the Hon. Mr. McClelland.
- 191 -
 VICTORIA
Glengarry Hospital
A new 150-bed extended care unit was opened by the
Honourable Mr. McClelland, on January 5, 1979. The addition
increased the rated capacity of the hospital to 225 extended
care beds.
Priory Hospital
A new building to house 75 extended care patients was
opened by the Honourable Mr. McClelland on June 29, 1979.
Victoria General Hospital - North
Site development, which forms Phase I, Stage I of the new
hospital project, was completed in November 1979.
Victoria General Hospital - South
A radiology renovation project was completed in February
1979.
Projects Under Construction at Year-End
Mj^t^q^i^uji^sj^bbots^ford_ General Hospital
An expansion project, including an additional 32 acute
beds, plus 22 in "shell", and enlargement and upgrading of
services.
Bella Coola General Hospital
A new hospital of 10 acute, 2 extended, and 3
intermediate care beds.
192 -
 Burnaby - _S t._Mich_ae 1 '_s__Extended _Care Hospital
^formerly St. Luke's)
A new 40-bed extended care unit, being constructed in
conjuction with 40 intermediate care beds.
Chilliwack General Hospital
Fire protection upgrading program.
St ■ Joseph '_s General Hospital, Comox
Expansion of services  including emergency,  laboratory,
radiology, central sterilizing room and medical records.
Cranbrook and District Hospital
Phase I, expansion of services including radiology and
emergency departments, and administration areas.
De11a Centennial Hospital
A     new     75-bed    acute    hospital,     with     no    maternity    or
paediatric  services.
Tilbury  Regional _Hospital _La_nnd_ry_,   Delta
Laundry    facilities    to    replace    the    existing    facility    at
Shaughnessy        Hospital, and        to        serve        Children's/Grace/
Shaughnessy,   and  other  hospitals.
Fraser Lake Diagnostic and Treatment Centre
A new Diagnostic and Treatment Centre with 2 overnight
observation beds.
Bojondary _Hos_pital,_ Grand Forks
An expansion of radiology, laboratory, medical records,
and administration departments.
Royal Inland Hospital, Kamloops
Stage  II  addition  to  replace  the  1945  East  Wing,
- 193
 resulting in a net gain of 15 acute beds plus 37 in "shell".
The program will also provide new service areas.
Maple Ridge Hospital
A new addition of 32 acute beds, (7 existing acute beds
will be lost due to renovations). Also new service areas
including radiology, laboratory, surgical suite, and central
sterilizing facilities.
Prince George Regional Hospital
Stage III, addition to allow expansion of services,
including surgical, obstetrical, and radiology suites, central
sterilizing and laundry.
Princeton General
An extended care addition of 6 beds to provide a total of
10 extended care beds.
Richmond General Hospi cal
Expansion program including 76 additional acute beds, and
upgrading of services.
Richmond General Hospital Annex
Renovations to existing facility to accommodate 20
extended care beds, 16 psychiatric beds, and 13-17 psychiatric
day care spaces.
Tahsis
Alterations and additions to administrative, lounge and
dining areas, morgue and storage.
194
 VANCOUVER
Children's Hospital/Grace Hospital
New replacement hospitals on Shaughnessy site with 200
paediatric and 90 obstetrical beds respectively, and some
service areas to be shared jointly by these two hospitals and
Shaughnessy Hospital. The new Children's Hospital will also
replace the existing Health Centre for Children at the
Vancouver General Hospital.
St. Paul's Hospital
Phase I, replacement of 250 acute beds, and renovations
to existing structure and services.
Shaughnessy Hospital
Development of shared services' facilities for Children's/
Grace/Shaughnessy Hospitals. Interim improvements and Building
Code upgrading.
Sunny Hill Hospital for Children
An expansion program, including the provision of 45
activation/rehabilitation beds, 30 extended care beds and 30
day care spaces.  Expansion of treatment and service facilities.
U.B.C. Health ^ciences Centre
A 240-bed Hospital, including teaching facilities.
Vancouver General Hospital
A new Emergency Department and coronary care unit;
general upgrading of Centennial and Heather Pavilions to meet
requirements of the Building Code.
- 195
 VICTORIA
Queen Alexandra _Hosp_ita 1 for _Chi 1 dr_en
Development of an unfinished area, for long-term
placement of 14 paediatric extended care patients presently
housed in the Eric Martin Institute, Royal Jubilee Hospital.
TENDERING STAGE AT YEAR-END
Kel_owna _Genera 1 Hospi tal
Completion of an unfinished area for 50 extended care
beds.
Pentictoji Regional _Hos_pi_tal
Laboratory expansion.
VANCOUVER
A. Maxwell Evans Clinic, Cancer^ Control Agency of B.C.
Phase II (parking structure).
VICTORIA
Victoria General Hospital (North)
Phase II of new hospital:   diagnostic,  treatment  and
services building.
PROJECTS IN ADVANCED STAGES OF PLANNING
Campbel 1 River & District Hospital
Completion of an additional 15 extended care beds.
196
 Enderby_ c^JDis_tr^ct_Memorial Hospital
12     additional    extended    care    beds,     and    renovations    and
alterations  of necessary services.
Kimberley and District  Hosjjita 1
Expansion  of  emergency  and   physiotherapy  departments.
Slocan Community Hospital,   New Denver
Replacement    of    existing    hospital    with    a    health    care
centre,   including  10  short-term extended and acute  care beds.
Port Hardy Hospital
A new 25-bed acute hospital  to replace existing  facility.
l.agl£._l:L48.^J1°sP:L?£L_€.n.l^^It^Care^ejitre, _POT^Jtoody
A new 110-bed acute hospital and 75-bed extended care
unit.
St. Mary's, Sechelt
Upgrading of dietary department.
Shuswap Lake General Hospital, Salmon Arm
Expansion of central supply and operating rooms.
VANCOUVER
Shaughnessy  Hospital
New  150-bed extended  care  unit   for Veterans.
ADDITIONAL   PROJECTS   APPROVED  AND
IN   VARIOUS   STAGES   OF   PLANNING
AHL^ °nal  and/or  r e p 1 ac erne n t  a cu t e beds
Alert    Bay    (10),    Duncan    (12    psychiatric),    Langley    (40),
Nanaimo       (number      undetermined),       New      Westminster       -      Royal
197
 Columbian (number undetermined), Prince George (number
undetermined), Salmon Arm (12), Squamish (21), Surrey (24),
Vancouver - Cancer Control Agency of British Columbia (100),
Vernon (73), Victoria - Royal Jubilee (redevelopment).
New extended care £acilities
Creston (35 deferred), Parksville (55), Squamish (8),
West Vancouver (125).
Additional and/or__rep 1 acement extended__care beds
Alert Bay (2 extended care/3 intermediate care), Comox
(75), Kamloops - Overlander (50), Kelowna (150), Langley (75
extended care with 25 in "shell"), Salmon Arm (15), Surrey
(78), Vernon (113).
Expansion and/or updating of services
Campbell River; Chilliwack; Clearwater; Kelowna; Langley;
Nanaimo; New Westminster - Royal Columbian, St. Mary's; Prince
George; Surrey; Vancouver - Cancer Control Agency of British
Columbia, Shaughnessy, Vancouver General; Vernon; Victoria -
Royal Jubilee.
198
 Medical Consultation Division
This division provides medical consultation within
Hospital Programs, to other government ministries, to hospitals
at all levels of care, and to regional hospital districts.
Within Hospital Programs, in addition to medical consultation,
the division assists in planning and implementing new services
by having representatives in the Planning Group, and on the
Equipment Committee and the Functional Program Review
Committee. Evaluating the effectiveness of present programs,
and estimating the probable effectiveness of those proposed, is
a  special  interest of  this  division.
The Medical Consultation Division has a responsibility in
the general auditing of the quality of medical care for
hospitals. This function is performed by on-site visits, and
by a central review of discharge diagnoses and related
information, prevalence statistics, lengths of stay, and
patterns of care. Divisional staff includes a physiatrist, as
well as occupational and physiotherapists, in order to perform
similar functions for rehabilitation services. Regular visits
by the Medical Records Librarian Consultants assist hospitals
in maintaining a high standard of medical documentation. The
auditing process also involves assessment of eligibility for
acute care, other types of care, or insured benefit. During
1979, registered nurses within the division audited and
medically coded about 450,000 admission/separation records and
90,000      day      care      surgical      services       records. The      coded
information is used by the Research Division to produce both
the regional and hospital profiles needed for planning and
auditing   functions.
199
 -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, the B.C.
Health Association, and the Faculty of Medicine at U.B.C.
Understandably, in a Province with more than 100 hospitals,
problems relating to medical staff activities occasionally
occur, and these organizations provide valued assistance in
resolving these 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 very worthwhile.
The Medical Consultation Division has responsibility for
both the program and eligibility status of extended care
patients. Through cooperation with the Long Term Care Program,
it is possible for all extended care applicants to have their
needs assessed through the local long term care administrator's
office; the Central Registry provides coordination and
management of all hospital waiting lists. It is probable that
during 1980 responsibility for maintaining the waiting lists
will be delegated to the Long Term Care Section of the
Ministry. Information would continue to be available through
Hospital Programs.
These extended care institutions receive a regular
quarterly review by a special team of nursing, physiotherapy,
and occupational therapy consultants. This function emphasizes
a consultation 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 continued to be very useful, as more and
more units take part, supporting and encouraging relatives who
wish to take care ot extended care patients in their own homes,
but who require an occasional holiday or other relief.
200 -
 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.
Reviewing requisitions and vouchers for all divisions,
including travel expenses and requisitions for supplies and
equipment.
Receiving  and  depositing  all   incoming  cheques.
Handling and distributing all hospital forms and sorting
and  distributing mail.
Co-ordinating the preparation of the annual estimates for
Hospital Programs.
Preparing  and  publishing   the  Hospital  Programs   Bulletin.
Preparing and distributing information pamphlets for
Hospital  Programs.
LEGISLATION
The drafting of legislation, regulations, and Orders in
Council related to the various statutes administered by
Hospital Programs. In performing these duties the division
works  closely with   the Ministry of  the Attorney-General.
201
 Statutes which  relate  to   the  Division's  activities   include:
• Hospital Insurance Act;
• Hospital Act;
• Regional Hospital Districts  Act;
• 2Ei£ii!L^2lii^i5_J!?SSi55£i_^osJ)J-i-iLL Districts   Financing
Authority  Act;
• Practical  Nurses  Act.
SOCIETIES
Hospital  Societies
Providing assistance to hospital societies in connection
with the drafting of hospital constitutions and by-laws and
their   interpretation  and  application.
Reviewing hospital by-laws, or amendments to hospital
by-laws, prior to their submission for government approval as
required  under   the  Hospital  Act.
The processing, in collaboration with the Hospital
Consultation and Inspection Division, of transfers of private
hospital property and transfers of shares in the capital stock
of  private hospital  corporations.
Co-ordinating the acquisition and disposal of hospital
sites   and  private hospitals.
In conjunction with the Land Registry Office, maintaining
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.
202
 Long-Term Care Societies
The Administrative Services Division is also responsible
for reviewing society matters and land transactions for
long-term care societies.
FEDERAL  PROVINCIAL  HOSPITAL ARRANGEMENTS
The drafting and processing of the necessary amendments
to  the Federal-Provincial  Agreement  and associated matters.
REGIONAL   HOSPITAL  ARRANGEMENTS
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
Reviewing applications for benefits made by or on behalf
of  persons  admitted  to hospitals.
Maintaining uniform standards of eligibility in all
hospitals and providing assistance to hospitals in training
admitting  staff.
Handling        applications to the        Health Insurance
Supplementary  Fund.
203   -
 THIRD-PARTY  LIABILITY
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, 1979, a total of
$4,189,116.36 was   recovered   through   this   process.
204
 Approved Hospitals
Hospitals as defined under the Hospital Insurance Act
designated by Order in Council 2044, 1977, published as B.C.
Reg. 233/77.
(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.
- 205 -
 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.
Kitmat General Hospital, Kitimat.
Kootenay Lake District Hospital, Nelson.
Lady Minto Gulf Islands Hospital, Ganges.
Ladysmith and Districts 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-Abbots ford General Hospital, Abbotsford.
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.
Port McNeill and District Hospital, Port McNeill.
Powell River General Hospital, Powell River.
Prince George Regional Hospital, Prince George.
Prince Rupert Regional Hospital, Prince Rupert.
Princeton General Hospital, Princeton.
- 206
 Queen Charlotte  Islands  General Hospital,   Queen Charlotte
City
Queen Victoria Hospital,   Revelstoke.
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.
St.  Mary's  Hospital,   Sechelt.
St.   Paul's Hospital,   Vancouver.
St.   Vincent's  Hospital,   Vancouver.
Saanich Peninsula Hospital,   Saanichton.
Shaughnessy Hospital,   Vancouver.
Shuswap Lake  General Hospital,   The,   Salmon Arm.
Slocan  Community  Hospital,   New  Denver.
South  Okanagan General Hospital,   Oliver.
Sparwood General Hospital,   Sparwood.
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.
207   -
 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.
- 208 -
 (D) DIAGNOSTIC AND TREATMENT CENTRES
Arthritis Centre of British Columbia, The, Vancouver.
Cumberland General Hospital, Cumberland.
Elkford and District Diagnostic and Treatment Centre,
Elkford.
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.
209
 (H) HOSPITAL FACILITIES
Division of Laboratories, Community Health Programs,
Vancouver.
Provincial Drug and Poison Information Centre, Vancouver.
- 210
 Statistical Data
The tables which follow 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 1979/80 there were 104 public general hospitals and
seven diagnostic and treatment centres. Care was also provided
by six Red Cross outpost hospitals; two Federal hospitals; one
contract hospital and five public rehabilitation hospitals.
There was also the specialized out-patient facility of the
Canadian Arthritis Society at its Vancouver Centre which
provides services in several facilities throughout the
Province. Hospital coverage under the "Hospital Insurance Act"
for patients in extended-care hospitals and units attached to
hospitals started December 1, 1965, and by the end of 1978 had
increased   to 72   facilities.
Data for the year 1979/80 has been established, based on
reports submitted by hospitals to September 30, 1979 and is
subject to revision when the actual figures for the year are
available.
Table 18 shows that 401,583 adult and children patients
were discharged (separated) from British Columbia public
hospitals in 1979/80, a decrease of 7,023 or .017 per cent less
than in 1978/79. This table also shows that 94.7 per cent of
the total adult and child patients discharged (separated) from
British Columbia public hospitals were covered by Hospital
Programs. Table 19 indicates that, in 1979/80 Hospital
Programs was responsible for 3,402,049 general hospital days of
care for adults and children in British Columbia, a decrease of
26,660  from  1978/79.
-  211
 As shown in Table 20, the average length of stay for
public hospitals' adult and child patients in British Columbia
during 1979/80 was 8.95 days, and the days of care per 1,000
population was 1,328. For comparative purposes, the data for
extended-care facilities were not included in the above
observations, although an additional 732 days of care per 1,000
population were  provided  for   these  patients.
Table 21 is supplemented by Table 22 because the number
and volume of ambulatory services covered by Hospital Programs
is expanding each year. 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 British Columbia, and the G.F.
Strong Rehabilitation Centre. The growth of ambulatory
services continued to reflect a broader provision of
hospital-based services, provided greater patient convenience,
and reduced the pressure for construction and maintenance of
in-patient beds.
212
 HOSPITAL PROGRAMS
Table      —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
Covered by Hospital
Public Hospitals
Programs
Adults
and
Newborn
Total
Adults
and
Newborn
Total
Children
Children
Patients separated—
1974
412,500
35,566
448,066
394,507
34,665
429,172
1975
415,805
36,538
452,343
398,279
35,700
433,979
1976
408,278
36,117
444,395
390,641
35,292
425,933
1977
406,180
36,980
443,160
386,872
36,119
422,991
1978/792
408,606
37,938
446,544
389,922
37,293
427,215
1979/803
401,583
45,306
446,889
380,249
44,294
424,543
Percentage of total
patients separated
1974
—
—
—
95.6
97.5
95.8
1975
—
—
—
95.8
97.7
95.9
1976
—
—
—
95.7
97.7
95.8
1977
—
—
—
95.2
97.7
95.4
1978/792
—
—
—
95.4
98.3
95.7
1979/803
—
—
-
94.7
97.8
95.0
1 Includes rehabilitation and Long Term Care Statistics.
2Amended as per final reports received from hospital.
3Estimated, based on hospitals reports to September 30,1979.
-  213  -
 Table      — Total Patient-days and Proportion Covered by Hospital Programs, British Columbia Public General
Hospitals1 Only (ExcludingFederal, Private, Extended-care, and Out-of-Province Hospitalization)
Total Hospitalized
in
Covered by Hospital
Public Hospitals
Programs
Adults
and
Newborn
Total
Adults
and
Newborn
Total
Children
Children
Patient-days—
1974
3,582,774
213,439
3,796,213
3,400,873
206,376
3,607,249
1975
3,565,532
213,846
3,779,378
3,413,630
207,471
3,621,101
1976
3,488,179
207,316
3,695,495
3,343,172
201,111
3,544,283
1977
3,473,838
208,574
3,682,412
3,337,330
202,751
3,540,081
1978/792
3,565,659
208,969
3,774,659
3,428,709
203,299
3,632,008
1979/803
3,551,315
230,876
3,782,191
3,402,049
223,968
3,626,017
Percentage of total
patient-days—
1974
—
—
94.9
96.7
95.0
1975
—
—
—
95.7
97.0
95.8
1976
—
—
—
95.8
97.0
95.9
1977
—
—
—
96.1
97.2
96.1
1978/792
—
—
—
96.2
97.3
96.2
1979/803
-
-
—
95.8
97.0
95.9
1 Includes rehabilitation and Long Term Care Statistics.
2Amended as per final reports received from hospital.
3Estimated, based on hospital reports to September 30,1979.
-  214
 Table       — Patients Separated, Total Patient-days 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 Population1
Other
Total
B.C. Hospitals,
Institutions4
(Excluding
B.C.
Including Federal
Outside
Extended Care)
Public Hospitals
and Private
British Columbia
Adults
Adults
Adults
Adults
Extended
and
New
and
New
and
New
and
New
care
Children
born
Children
born
Children
born
Children
born
Hospitals
Patients separated-
1974
404,271
34,979
394,507
34,665
3,572
78
6,190
237
2,449
1975
406,000
36,059
398,279
35,700
1,425
72
6,296
287
3,022
1976
400,675
35,832
390,641
35,292
475
80
9,559
460
3,592
1977
394,727
36,496
386,872
36,119
350
65
7,505
312
4,026
1978/792
397,273
37,636
389,922
37,293
213
31
7,138
312
3,483
1979/803
387,863
44,661
380,249
44,294
108
7
7,506
360
3,244
Patient Days—
1974
3,565,198
208,224
3,400,873
206,376
103,064
464
61,261
1,384
1,227,949
1975
3,486,573
209,631
3,413,630
207,471
15,517
336
57,426
1,824
1,357,352
1976
3,424,979
204,156
3,343,172
201,111
1,647
390
80,160
2,655
1,498,797
1977
3,399,729
205,059
3,337,330
202,751
1,615
250
60,784
2,058
1,734,227
1978/792
3,488,887
205,431
3,428,709
203,299
718
130
59,460
2,002
1,841,089
1979/803
3,461,670
226,104
3,402,049
223,968
432
27
59,189
2,109
1,876,866
Average days
of stay—
1974
8.81
5.95
8.62
5.95
28.85
5.95
9.90
5.84
501.41
1975
8.59
5.81
8.57
5.81
10.89
4.67
9.12
6.36
449.16
1976
8.55
5.70
8.56
5.70
3.47
4.88
8.39
5.77
417.26
1977
8.61
5.62
8.63
5.61
4.61
3.85
8.10
6.60
430.76
1978/792
8.78
5.46
8.79
5.45
3.37
4.19
8.33
6.42
528.59
1979/803
8.92
5.06
8.95
5.06
4.00
3.86
7.89
5.86
578.57
includes rehabilitation and Long Term Care.
2 Amended as per final reports from hospital.
3Estimated, based on hospital reports to September 30, 1979. Estimated patient-days (including newborn) per 1,000 of
population covered by Hospital Programs: 1974, 1531; 1975, 1512; 1976, 1474; 1977,1432; 1978/79,1355; 1979/80,
1328. (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 502 in 1974; 555 in 1975; 603 in 1976; 639 in 1977; 728 in 1978/
79 and 732 in 1979/80. Population figures according to latest census figures.
"Estimated for 1978/79 and 1979/80.
215  -
 Table     — Summary of the Number of Hospital Programs In-patients and
Out-patients, 1974-1979/80
1974
1975
1976
1977
1978/791
1979/802
Estimated Number
Total Adults,
of Emergency,
Children &
Minor Surgery,
Total
Newborn
Day Care and
Receiving
In-patients
Out-patients
Benefits
441,669
1,045,460
1,487,159
445,081
1,191,650
1,636,731
440,099
1,228,723
1,668,822
435,249
1,297,510
1,734,363
438,392
1,383,500
1,821,892
435,768
1,390,000
1,825,768
i Amended, as per final reports received from hospitals.
2Estimated, based on hospital reports to September 30,1979.
HOSPITAL PROGRAMS
Table
-Summary of Hospital Programs Out-patient Treatments by Category,
1974-1979/80
1974
1975
1976
1977
1978/79
iCommenced October 1972.
Commenced April 1973.
3Commenced January 1975.
4Commenced June 1976.
5 Includes (a) cancer out-patient and (b) rehabilitation day care.
6 Estimated.
1979/806
Psychiatry-
Out-patient
12,771
17,915
22,352
23,974
26,222
26,420
Day Care
19,737
34,219
40,392
46,323
53,725
58,300
Minor and emergency surgery
503,492
571,055
542,223
575,000
645,634
700,000
Day care surgery
55,920
62,019
66,663
76,405
82,979
92,364
Diabetic Day Care1
1,493
2,354
3,426
4,126
4,515
5,264
Physiotherapy 2
296,863
338,583
368,867
387,993
454,697
463,132
Dietetic Counselling3
5,937
10,218
12,942
18,189
21,064
Renal Dialysis, D.C.4
10,481
18,351
19,717
19,140
Other5
155,184
159,568
164,101
158,565
159,121
174,512
Totals
1,045,460
1,191,650
1,228,723
1,303,679
1,464,799
1,560,196
216
 Table     —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, 1979/801 (Excluding
Extended-care Hospitals).
Total
250 & Over
BED CAPACITY
100 to 249 50 to 99
25 to 49
Under 25
1979/80   (excluding
extended care hospitals)
Patients separated—
Adults & children
Newborn
377,597
44,200
196,400
18,800
97,300
14,500
46,800
7,400
26,400
2,400
10,697
1,100
Patient-days—
Adults & children
Newborn
3,296,600
224,300
2,018,300
115,800
752,100
51,600
309,000
41,000
161,100
11,000
56,100
4,900
Average days' stay —
Adults & children
Newborn
8.73
5.07
10.28
6.16
7.73
3.56
6.60
5.54
6.10
4.58
5.24
4.45
1 Estimated, based on hospital reports to September 30,
Statistics are included in adults & children.
1979,roun
ded to nearest 100.   Long Term Care
Table     — Percentage Distribution of Patients Separated and Patient-days for Hospital Programs Patients
Only, in British Columbia Public Hospitals, Grouped According to Bed Capacity, 1979/801 (Excluding
Extended-care Hospitals)
BED CAPACITY
Total
250 & Over
100 to 249
50 to 99
25 to 49
Under 2£
1979/80   (excluding
extended care
hospitals)
Patients separated—
Adults & children
Newborn
Per Cent
100.0
100.0
Per Cent
52.01
42.53
Per Cent
25.77
32.81
Per Cent
12.39
16.74
Per Cent
7.00
5.43
Per Cent
2.83
2.49
Patient-days—
Adults & children
Newborn
100.0
100.0
61.22
51.63
22.82
23.00
9.37
18.28
4.89
4.90
1.70
2.19
1 Estimated, based on hospital reports to September 30,1979.
217  -
 CHARTS
The statistical data shown in the following charts
prepared by the Research Division are derived from
admission/separation forms submitted to Hospital Programs.
Note that the figures given are for 1978.
Readers interested in more detailed statistics of
hospitalization in British Columiba may wish to refer to
Statistics of Hospital Cases Discharged During 1978 and
Statistics of Hospitalized Accident Cases, 1978, available from
the Research Division.
218 -
 HOSPITAL PROGRAMS
Chart I — Percentage Distribution of Days of Care* by Major Diagnostic Groups,
Hospital Programs, 1978
MALES
Neoplasms
Skin
1.4%
Congenital
anomalies
1.4%
Metabolic
diseases
2.5%  1
IJ*
Infective and para-   /
sitic diseases    2.3%[>
•
•
Nervous
system
3.6%y
Bones
5.5%V
Genito-urinary
system              5.9%
-\—•
Mental
disorders
FEMALES
Skin
1.0%^
Ill-defined
conditions
2.0%
Infective and
sitic diseases
para-
1.9%
Metabolic
diseases
2.7%   i
Nervous
system
3.3%//
•
5.8% If
Respiratory
system
•
Bones
7.1% /
\^
Deliveries
13.6%
\               r
Mental
Disorders I.1
Genito-urinary
system 6.!
Digestive
system
Circulatory
system 13.-
Accidents 14.2%
including rehabilitative care.
219
 MINISTRY OF HEALTH REPORT, 1979
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220
 HOSPITAL PROGRAMS
Chart III — Percentage Distribution of Hospital Cases* by Type of Clinical Service,
Hospital Programs, 1978
MALES
Adult Surgical
FEMALES
Adult Surgical 41.4%
*Including rehabilitative care.
-   221
 MINISTRY OF HEALTH REPORT, 1979
Chart IV — Percentage Distribution of Hospital Days* by Type of Clinical Service,
Hospital Programs, 1978
MALES
Adult Surgical
FEMALES
Psychiatric
7.9%       N
Paediatric Medical
4.2%
Rehabilitative Care
3.4%
Paediatric Surgical
2.3%
*Including rehabilitative care.
222
 HOSPITAL PROGRAMS
Chart V — Average Length of Stay of Cases* in Hospitals in British Columbia, by Major
Diagnostic Groups in Descending Order, 1978 (Excluding Newborns)
Mental disorders
13.3
Diseases of the circulatory
system
13.1
Certain causes of perinatal
morbidity and mortality
12.8
Endocrine, nutritional, and
metabolic diseases
12.2
Neoplasms
12.1
Diseases of the musculoskeletal
system and connective tissue
11.0
Congenital anomalies
8.7
Accidents, poisonings, and
violence
8.6
PROVINCIAL AVERAGE
LENGTH OF STAY
8.5
Diseases of the digestive
system
8.5
Diseases of the blood and
blood-forming organs
8.4
Diseases of the skin and
subcutaneous tissue
8.3
Diseases of the nervous
system and sense organs
7.5
Diseases of the genito-urinary
system
6.6
Infective and parasitic
diseases
6.4
Diseases of the respiratory
system
6.1
Complications of pregnancy,
childbirth, and the
puerperium
Symptoms and ill-defined
conditions
4.8
4.5
"•Including rehabilitative care.
223   -
 MEDICAL SERVICES COMMISSION
On July 1, 1968, the Government established the Medical
Services Plan of British Columbia, 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
prepaid medical coverage 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.
Medical Services Commission Highlights
During the year the Commission continued 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. Considerable
progress was made during the year on the preliminary design of
a complete revision of the Plan's computer processing system.
The new system, scheduled for implementation during 1980 and
1981, should further improve the quality of service to the
public  and   the health  professions.
224   -
 The taxable income ceiling for premium assistance was
raised during the year from $1,680 to $1,720.
The total expenditure for insured benefits under the
Medical Services Plan rose 13.18 percent to $378,130,607 in
1978/79, from $334,086,613 in 1977/78.
The increased costs to the Medical Services Plan were 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 performed in a hospital as provided under the
Medical Care Act (Canada).
Until March 31, 1977, funds were received from the
Government of Canada under shared-cost programs. Commencing
April 1, 1977, these programs were replaced by transfers to the
Province under new Federal-Provincial fiscal arrangements, and
the Province now provides the entire Government contribution to
the Medical Services Plan.
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
225 -
 payments are paid only at a tariff of fees approved by the
Commission. "Year" means calendar year. A brief description
of these additional benefits (1979) 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.
i
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, 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.
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
- 226
 than on the instructions of, or referral by, a medical
practitioner within the year. There is no payment of 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.
The extended role services of a registered nurse where;
(a) an arrangement for the rendering and for the payment of
these services is approved by the Commission, and
(b) these services are rendered in an area of the province
where a medical practitioner is not normally available.
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.
- 227
 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
the senior medical consultant 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:
(a) Applicants who had a taxable income (combined taxable
income if married) for the immediately preceding taxation
year, not in excess of a specified amount determined each
year, qualify for a subsidy of 90 per cent of the full
premium rate. (This amount was $1,720 for the 1978 tax
year.)
Monthly premiums payable by' subscribers', effective July
1, 1976 are as follows:
228
 (b)
If Qualified for -
Full 90 per Cent
Premium Subsidy
$ $
One person    7.50 0.75
Family of two 15.00 1.50
Family of three or more. . .  18.75 1.87
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, continued to provide advice and recommendations
to the Commission with regard 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, for controlling the
expansion of facilities or provision of new facilities until
there is reasonable utilization of existing facilities, and for
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 continued to work closely
with the peer review committees of physicians and other
practitioners providing services under the plan.
229
 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 services in British Columbia are paid
for on a fee-for-service basis, there is, nevertheless, a
substantial volume of services paid on a salary or sessional
fee basis.
Apart from the Provincial Government, which employs
physicians in this way, there are many other organizations
within the Province which make arrangements with physicians to
provide insured services on this basis, and arrange with the
Medical Services  Commission  for  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 approved 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, to compensate the physician
for continuing overhead costs in his additional private
practice.
-   230   -
 In the year 1978/79 the total expenditure on insured
services by the Medical Services Commission was $378,130,607,
of which $358,145,676 was in the form of fee-for-service
payments and $19,984,931 for salary and sessional payments.
231 -
 Statistical Tables
STATISTICAL HIGHLIGHTS
The total expenditure for  insured services under the
Medical  Services  Plan  for  the  1978/79  fiscal year was
$378,130,607,  up  $44,043,994,  or  13.18  percent over the
previous year.
A similar increase was reflected in the per capita costs
for insured services, which rose from $133.91 in 1977/78 to
$149.53 in 1978/79, an increase of 11.7 percent.
Administration costs at $16,856,376, representing 4.27
percent of total plan costs for 1978/79, showed an increase
from the previous year due to a significant increase in the
cost of data processing.
All statistical tables related to claims payments for the
two years were compiled on a cash basis. As 23 payments were
made to practitioners in 1977/78, and 24 in 78/79, the data can
not be considered comparable.
232
 SUBSCRIBER STATISTICS
Table   Registrations and Persons Covered^ by Premium Subsidy Level at March 31, 1979.
Subsidy
(Per Cent)                               Subscribers Persons
90           276,600 448,402
50       	
Nil    . 856,557 2,100,648
Total    1,133,157 2,549,050
Table  —Persons Covered by Age-group at March 31, 1979.
Age-Group Persons
Under 1  32,522
1-4          144,139
5-14         401,290
15-24  479,688
25-44  720,667
45-64  500,578
65-69  94,116
70-79  114,665
80-89  45,933
90 and over  9,150
Unknown  6,302
Total  2,549,050
1 Coverage data do not include members of the Canadian Armed Forces, RCMP, and
inmates of Federal penitentiaries.
233
 CHART -  COVERAGE BY AGE-GROUP AT MARCH  31,   1979
o
o
o
o
o
to
I
-p
W
■H
IW
o
01
Under 1 1-4 5-14 15-24 25-44 45-64 65+ Unknown
Age-group
Table   Coverage by Family Size at March 31, 1979
Family Size Number Of
(Persons) Families
1    491,144
2    267,426
3    125,385
4  148,488
5    67,230
6    23,171
7  6,787
8  2,275
9 or more  1,251
Total  1,133,157
- 234 -
 CHART   —COVERAGE, BY FAMILY SIZE, AT MARCH 31, 1979
Number of Registrations (100,000)
Family Size (Persons)
tn  3
491,144
i
i
i
1
267,426
■
148,48
3
1125,38!
ll
1
'67,230
■
23,171
■i
6,787
2,275
1,251
8   9 or More
Family Size (Persons)
- 235 -
 MEDICAL  SERVICES   COMMISSION
FEE-FOR
-SERVICE   PAYMENTS
MEDICAL  PRACTITIONERS
AND  DENTAL  SURGERY   IN  HOSPITAL
TABLE          -  Distribution  of  Fee-For-Service  Payments   for  Medical   Services   (Shareable)
PERCENTAGE
COST PEF
PERSON
AMOUNT
^AID^D
OF  TOTAL
(2)
SPECIALTY
1977/78
1978/79
1977/78
1978/79
1977/78
1978/79
$
$
$
$
General Practice
124,791,368
140,155,866
42.97
42.47
50.02
55.42
Dermatology
3,250,763
3,812,576
1.12
1.16
1.30
1.51
Neurology
2,259,449
2,580,532
0.78
0.78
.91
1.02
Psychiatry
8,241,292
9,407,347
2.84
2.85
3.30
3.72
Neuropsychiatry
275,854
273,477
0.10
0.08
.11
.11
Obstetrics   and Gynaecology
10,321,327
11,816,717
3.55
3.58
4.14
4.67
Oph th almology
10,804,395
12,213,994
3.72
3.70
4.33
4.83
Otolaryngology
4,992,076
5,505,183
1.72
1.67
2.00
2.18
Eye,   Ear,   Nose,  Throat
23,840
33,075
0.01
0.01
.01
.01
General  Surgery
17,321,077
19,085,898
5.96
5.78
6.94
7.55
Neurosurgery
1,504,199
1,708,942
0.52
0.52
.60
.68
Orthopaedic   Surgery
7,844,253
8,747,494
2.70
2.65
3.14
3.46
Plastic   Surgery
2,130,013
2,364,869
0.73
0.72
.85
.94
Thoracic   Surgery
1,783,085
1,971,525
0.62
0.60
.72
.78
Urology
4,682,651
5,106,208
1.61
1.55
1.88
2.02
Paediatrics
6,125,164
6,939,687
2.11
2.10
2.46
2.74
Internal  Medicine
18,839,807
21,539,981
6.49
6.53
7.55
8.52
Radiology
21,380,257
24,222,560
7.36
7.34
8.57
9.58
Pathology
25,185,101
30,312,532
8.67
9.18
10.10
11.99
Anaes thes iology
10,839,860
12,641,778
3.73
3.83
4.35
5.00
Physical   Medicine
402,193
450,160
0.14
0.14
.16
.18
Public   Health
86,765
93,033
0.03
0.03
.04
.04
Dental   Surgery   In Hospital
1,142,858
1,342,282
0.39
0.41
.46
.53
Osteopathy
264,384
316,588
0.09
0.10
.11
.13
Nuclear  Medicine
192,132
540,887
0.07
0.16
.08
.21
Unclassified
5,724,579
6,822,768
1.97
2.06
2.30
2.70
TOTAL
290,408,742
330,005,959
100.00
100.00
116.43
130.52
1. Includes only those payments which have been made during the respective fiscal periods.
As 23 payments were made in 1977/78, 24 in 1978/79, the figures are not truly comparable.
2. Rounded to two decimals and based on insured population as at October 1, as derived from
Statistics Canada Data (October 1, 1977 = 2,494,800;  October 1, 1978 = 2,528,800).
236
 TABLE
DISTRIBUTION OF MEDICAL FEE-FOR-SERVICE PAYMENTS AND SERVICES, BY TYPE OF SERVICE
Type of Service
Number of Services
1977/78
1978/79
Amount Paid (1)
1977/78
1978/79
General Practitioners
Complete examination 	
Partial examination	
Subsequent office visit	
Night, Sunday, holiday, or emergency visit
First house visit	
Subsequent house visit 	
Hospital visit 	
Subtotals 	
915,871
5,119,693
1,773,645
543,568
118,834
48,044
1,494,821
1,012,441
5,525,403
1,750,156
569,289
117,823
46,772
1,459,770
18,851,791
52,375,048
11,195,382
13,686,480
2,300,897
729,593
8,447,352
22,879,223
61,583,091
11,114,876
14,578,519
2,295,510
714,542
9,415,535
10,014,476
10,48 L, 654
107,586,543
122,581,296
Consultation .
House visit. .
Office visit .
Hospital visit
Specialists
846,305
8,561
457,934
577,402
918,500
9,989
489,264
608,049
32,210,484
304,440
4,001,333
5,297,692
37,107,785
379,597
4,585,093
5,874,640
Subtotals
1,890,202
2,025,802
41,813,949
47,947,115
Other  Medical
Anaesthesia	
Obstetrics   	
Surgery	
Special procedures 	
X-ray	
Laboratory 	
Common office procedures . .
Psychotherapy	
Electrodiagnosis 	
Pulmonary function 	
Miscellaneous	
Subtotals
TOTALS
,913
53
445
702
,146
,653
,201
182
30
5
14
,457
,456
,099
,636
,177
,367
,537
,016
,526
,268
2,086
56
466
743
1,181
7,572
1,192
198
45
25
 15
,612
,002
,236
,536
,870
,020
,658
,582
,870
,664
,803
13,581,487
8,314,764
37,007,970
12,068,588
20,133,503
31,781,171
7,254,956
6,227,736
1,365,194
63,243
3,209,639
15,520
9,093
40,578
13,417
22,314
36,986
7,805
7,250
2,279
309
3,921
,742
,187
,248
,304
,634
,381
,471
,994
,461
,788
,338
12,348,130
13,584,853
141,008,251
159,477,548
24,252,808
26,092,309
290,408,743
330,005,959
(1)  As 23 payments were made in 1977/78, 24 in 1978/79, the figures, which are prepared on a cash
basis, are not truly comparable.
237
 TABLE
AVERAGE  FEE-FOR-SERVICE  PAYMENTS  BY  TYPE  OF  PRACTICE!
NUMBER OF  ACTIVE
AVERAGE
MEDIAN
PRACTITIONERS
PAYMENT2
PAYMENT2
TYPE  OF  PRACTICE
1977/78
1978/79
1977/78
1978/79
1977/78
1978/7
General Practice
1,681
1,764
68,111
73,824
67,125
74,005
Dermatology
38
40
83,575
95,062
75,887
89,722
Neurology
27
28
87,045
98,298
89,578
99,186
Psychiatry
129
139
59,873
63,041
58,430
61,760
Neuropsychiatry
2
2
137,724
136,309
137,724
136,309
Obstetrics   &  Gynaecology
112
117
89,308
99,516
84,604
95,685
Ophthalmology
120
127
91,416
100,077
83,936
93, %9
Otolaryngology
53
53
95,602
104,321
95,042
100,658
General  Surgery
166
17 1
85,068
91,864
83,430
89,515
Neurosurgery
18
20
83,414
86,559
79,311
84,063
Orthopaedic   Surgery
90
91
86,667
93,849
84,324
92,768
Plastic  Surgery
24
27
87,298
87,914
83,367
85,383
Thoracic &  Cardiovascular  Surgery
13
14
143,391
149,179
116,179
136,871
Urology
50
50
92,135
99,554
90,916
96,134
Paediatrics
63
67
73,072
74,755
66,442
72,736
Internal Medicine
194
208
88,918
94,811
83,046
89,865
Anaesthesia
195
213
58,455
63,893
59,323
64,985
Physical Medicine
5
7
69,632
60,278
66,980
60,675
Osteopathy
5
5
52,877
63,318
26,766
30,385
Surgery,   General Practice-*
43
44
63,021
69,678
59,213
69,604
Paediatrics,   General Practice-*
19
20
63,681
72,650
58,998
62,263
Internal Medicine,   General Practice-^
16
17
51,671
57,939
51,932
52,521
1. Type  of  practice  is  based on  practice being  carried out  rather   than certification.
2. Includes only those physicians whose services on a fee-for-service basis grossed $20,000 or
more. Since 23 payments were made in 1977/78, and 24 payments made in 1978/79, the figures
are  not   truly  comparable.
3. These are special classifications created for statistical purposes. Physicians in these
categories are certified specialists, but derive 50 percent or more of their income from
general  practice  services.
-   238   -
 ADDITIONAL BENEFITS
FEE-FOR-SERVICE PAYMENTS
Table       Distribution of Fee-For-Service Paynents for Insured Services,
Additional Benefits
TYPE OF SERVICE
AMOUNT PAID
(1) (2)
PERCENTAGE OF
TOTAL
COST PER PERSON
(3)
1977/78
1978/79
1977/78 1978/79
1977/78
1978/79
Special Nursing 	
Victorian Order of Nursing
Red Cross 	
Chiropractic 	
Naturopathic 	
Physiotherapy (Office)  . .
Physiotherapy (Hospital)
Orthoptic 	
Podiatry 	
Optometric 	
Orthodontic 	
Unclassified 	
$
2,242
820
14,846
7,831,627
384,653
3,278,521
11,558
1,695,300
4,266,804
101,364
10,915
$
2,060
2,274
14,636
8,924,459
407,686
3,985,386
3,295
2,155,797
4,916,627
110,470
9,520
0.02
0.00
0.09
44.50
2.19
18.62
0.07
9.63
24.24
0.58
0.06
0.01
0.01
0.07
43.46
1.98
19.41
0.02
10.50
23.95
0.54
0.05
$
0.00
0.00
0.01
3.14
0.15
1.32
0.01
0.68
1.71
0.04
0.00
TOTALS
17,598,650
20,532,210
100.00
100.00
7.06
$
0.00
0.00
0.01
3.53
0.16
1.58
0.00
0.85
1.94
0.04
0.00
.11
(1)
(2)
(3)
Includes only those payments which have been made during
the respective fiscal periods.  As 23 payments were made
in 1977/78 and 24 payments in 1978/79, the figures are
not truly comparable.
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.
Rounded to two decimals and based on insured population
as at October 1, as derived from Statistics Canada Data
(1977 = 2,494,800;  1978 = 2,528,800).
 TABLE
AVERAGE FEE-FOR-SERVICE PAYMENTS BY TYPE OF PRACTICE,
ADDITIONAL BENEFITS
TYPE OF PRACTICE
NUMBER OF ACTIVE
PRACTITIONERS
1977/78
1978/79
AVERAGE
PAYMENT
1977/78
1978/79
MEDIAN
PAYMENT
1977/78
1978/79
Chiropractic
Naturopathic
Physiotherapy
Podiatry
Optometry
192
10
96
31
139
209
11
113
33
144
$
40,107
37,956
35,379
52,986
29,541
$
42,187
37,051
36,246
65,022
33,103
$
35,969
37,127
29,460
52,625
28,250
$
38,999
33,979
30,149
63,040
32,003
Includes only those practitioners whose payments from the British Columbia Medical Services Commission grossed $10,000 or more. It must be emphasized that these payments in
no way represent the practitioners' total income or net income.
The Commission made 23 payments in 1977/78, 24 payments in 1978/79.
compiled on a cash basis, is therefore not truly comparable.
The average payment,
240
 Table
—Summary of Expenditures, 1969/70 to 1978/79
Medical
Salaried and
Additional
Fee-For-Service
Sessional
Benefits
Adminis tration
Total
$
$
$
$
$
1969/70
105,700,011
3,677,387
6,929,779
5,687,035
121,994,212
1970/71
122,818,267
4,375,798
6,611,815
6,030,059
139,835,939
1971/72
127,000,505
4,788,365
5,534,520
6,567,847
143,891,237
1972/73
139,532,341
6,022,920
7,897,244
7,320,137
160,772,642
1973/74
159,614,356
7,991,062
8,963,080
8,581,794
185,150,292
1974/75
190,452,494
10,424,602
11,089,892
12,501,015
224,468,003
1975/76
250,026,093
15,437,520
15,045,516
12,659,521
293,168,650
1976/77
268,496,749
14,880,410
17,090,707
13,040,063
313,507,929
1977/78
298,900,495
17,749,957
17,436,161
13,207,188
347,293,801
1978/79
337,513,465
—.. ■ —, , , , ■ ,
19,484,932
21,132,210
16,856,376
394,986,983
Whereas preceding statistical tables are prepared on a cash basis, the above sumnary is
compiled on an accrual basis.
241 -
 GOVERNMENT HEALTH INSTITUTIONS
Government Institutions, as a definitive treatment
entity, will cease to exist at the conclusion of the 1979/80
fiscal year. Mr. Ian Manning, Director of Government
Institutions, commenced a program of integrating Government
Hospitals into the community in the fall of 1978, but became
ill early in 1979 and had to leave the Service. He was
replaced by Mr. W.O. Booth, in an acting capacity.
New Denver Pavilion was placed under the administrative
jurisdiction of the Slocan Community Hospital & Health Care
Society. A new 10 bed hospital will be built on the New Denver
site to serve the East Kootenay region. The existing New
Denver Hospital will be up-dated to serve extended care needs
of the area.
During the year much work went into the development of a
hospital society for Riverview, and it was expected the board
would be in place in 1980.
Several operating models were considered for Pearson
Hospital. Preference was given to a community board operation
but this was not possible to achieve in 1979, and the hospital
was subsequently placed under the jurisdiction of Dr. J. Smith,
Assistant Deputy Minister of the newly established Vancouver
Bureau.
Valleyview Hospital and Dellview Hospital were
transferred to Long Term Care. Plans were developed to
consolidate the Dellview and Vernon Jubilee Hospital
properties. It was proposed that Vernon Jubilee would expand
its facilities and assume a portion of Dellview patients, and
the population balance remaining would be cared for through
Long Term Care.
242 -
 The process of community integration of mental health
took another major stride in 1979.
DELLVIEW HOSPITAL
Dellview Hospital operates a Long Term Care service under
the Government Health Institutions, providing for the needs of
the geriatric person over seventy years of age with mental
illness.
The Honourable Robert H. McClelland, Minister of Health,
at the time, visited the Hospital on January 19, 1979, and
announced the Ministry policy to care for the elderly in their
home communities, through the intermediate care facilities.
Hospital operations were to be phased down over an eighteen
month period. By the end of 1979 the patient population had
been reduced from 190 to 150, with 22 staff positions vacant; a
Nurse 4 (Education) transferred to Nurse Supervisor Administration Office, and one Nurse position was seconded to the
local Health Unit to assist in co-ordinating placement of the
patients, and to assist in the implementation of appropriate
community programs for the geriatric person.
The total hospital patient population was accommodated
within the main' building, and the male and female annex
programs were closed at the end of October. Community requests
for admissions continued at a reasonable level, to maintain
waiting lists throughout the year.
A number of meetings were held during the year with
representatives of the Unions, Government Employee Relations
Bureau, and Ministry officials, to discuss personnel problems
created by the phasing down of operations.
243 -
 Dellview's Nursing Program continued to maintain close liaison
with the nursing education programs of Okanagan College and
BCIT. Preceptorships and practicums were provided for three
students during the year.
The Recreational Therapy Program maintained a wide
variety of services for patients including cooking, bowling,
shopping trips, movies, bingo, parties and dances, musical
sing-a-longs, arts and crafts, remedial exercises, outdoor
barbecues, pub therapy, and outings to local areas of interest.
During the summer Dellview Hospital employed a total of
20 students for 44 man/months, providing a most worthwhile
contribution to the activities and life styles of our patients.
In-Service Education conducted 49 programs for 261
sessions, and covered all subjects from orientation to
superannuation, and from electrolytes to recreation for seniors
and aging.
Medical coverage was provided through the part-time
services of a physician, with dental services available through
a local dentist operating in the hospital's dental suite.
Physiotherapy, radiological, and regional laundry services,
were available under contract from the Vernon Jubilee Hospital,
with psychiatric support available through the Vernon Mental
Health Centre.
A modified work week was implemented for all clerical
staff on January 1, 1979.
During the year numerous groups and individuals from Long
Term Care facilities and community hospitals visited the
hospital, while planning for a 'Chronic Behavioral Disorder
Unit' in their own facility.
- 244
 VALLEYVIEW HOSPITAL
1979 proved to be a year of assessment, review and future
planning for Valleyview. In conjunction with the work done by
the Mental Health Planning Group the hospital assessed its
position within the health delivery system.
It was expected that the next decade would see great
changes in the care and treatment of the aged with psychiatric
problems in British Columbia. During the year Valleyview was
preparing its plant and programs to meet these needs within the
framework of the total health system. This would be through a
redirection of resources and the introduction of a number of
outreach programs designed to support the Ministry's community
services, especially the Long Term Care Program.
At the end of 1979 there were 560 in-patient beds in
service.
The number of patients prepared for discharge but blocked
because of lack of suitable community accommodation was a
continuing problem.
At the year-end all aspects of service to patients were
under review. It 'was expected that the basic format for the
new delivery system would be in place by the fall of 1980, with
September 1981 being the target date for the completion of the
introduction of the enriched programs. The prime purpose of
this is to keep the patient living as close as possible to
their normal life patterns.
- 245 -
 PEARSON HOSPITAL
Pearson Hospital, located in South Vancouver, provided
several unique programs for both the local community and the
citizens of the province as a whole. Programs included in-
hospital and out-patient care for persons suffering severe
respiratory disabilities, mainly from poliomyelitis or spinal
cord injury; an enriched extended care program for young
adults; an enriched extended care program for middle-aged
persons; an in-hospital program for treatment of tuberculosis
patients, and a therapeutic out-patient program for persons
eligible for either intermediate or extended care, but not yet
hospitalized.
The Willow Chest Centre in-patient unit, also
administered by Pearson Hospital, continued to be vacant
pending completion of additional structural alterations ordered
by the Fire Marshal's office.
During the year Pearson Hospital completed arrangements
with Shaughnessy Hospital to accept high quadraplegic patients
from the Spinal Cord Unit who required continuing hospital
care. A close association with the G.F. Strong Rehabilitation
Centre continued, and a number of patients requiring longer
term care were admitted from that facility.
The average age of female patients in the Extended Care
program dropped from 51.6 in 1978, to 48.2 in 1979, and for
males the average age dropped from 48 in 1978 to 46.6 in 1979.
Problems continued to be encountered in proceeding with
long planned structural alterations, although some progress was
made. Full feasibility studies were completed jointly by the
British Columbia Building Corporation staff, hospital staff and
private consultants, in regard- to the proposed new centralized
246
 food service system, educational facilities, heating conversion
and critical emergency stand-by power. Renovations to the
wards were started and one ward was completed.
Mrs. B.J. Deans was appointed as Director of Nursing and
was active in continuing with the implementation of the
reorganization plan for the Nursing Department. The Nursing
Department produced the hospital's first Infection Control
Manual for the Infection Control Committee, as well as a
Nursing Policy and Procedure Manual. Staff development was
accelerated and remained a high priority.
Considerable improvements were made in Pharmacy and
General Stores distribution procedures. Studies underway were
expected to result in a number of additional improvements.
The hospital's new therapeutic pool was expected to be
opened in the near future to serve the therapeutic and
recreational needs of patients from this and several other
hospitals, as well as organized groups of disabled people in
the local community.
The volunteer program continued to build and was an
active and effective part of the total patient care picture.
Along with the fund raising efforts of the Women's Auxiliary
the patients were able to enjoy many activities that would not
otherwise be available to them.
While the degree of physical disability among patients
admitted during the year seemed to be greater than previously
experienced, the improvements in lifestyle for all patients had
gradually improved.
247 -
 RIVERVIEW  HOSPITAL
1979 was a year of consolidation for Riverview Hospital;
one that witnessed the development of patterns for change and
reorganization in the early '80's. Efforts were underway to
coordinate the mental health system by integrating Riverview's
operations into the service spectrum to an extent not
previously accomplished. The hospital continued to strive to
improve standards of patient care, to be more responsive to
community needs, and to increase both the efficacy and
efficiency of  its  many  and varied operations.
Riverview's patient population, admission rate, and
general range of services, remained relatively constant during
the year. Effective April 1, 1979, three major departments -
Laundry, Industrial and Transport - were transferred from the
hospital to fall under the aegis of Central Shared Services.
Other 'administrative housekeeping' items entailed delineation
of the many support services provided to outside agencies, and
the development of appropriate invoicing arrangements for such
services rendered. The hospital also reviewed its relationship
with the Canadian Mental Health Association with respect to
volunteer services. While C.M.H.A. would continue to provide
numerous needed services to Riverview, the former agency's
volunteer committee was abolished during the year in favour of
a Riverview Hospital Volunteer Association, to be registered
under   the   Societies   Act.
A major thrust over the year was the hospital's move
towards Board status. At the year-end the Riverview Hospital
Society's Constitution and Bylaws were reaching their final
stages of development, and would hopefully be presented to the
Registrar of Companies for incorporation before the end of the
calendar year.
248
 Development of the Constitution was a process embracing
input from many sources within the hospital, from Hospital
Programs and other sectors of the Ministry, and from thorough
reviews by Attorney-General and Finance Ministry personnel.
Pending Board members were named but not officially appointed.
Nonetheless, considerable activity was undertaken by way of
orientation tours, and the development of information
'packages' for prospective trustees.
Perhaps the most cogent force for change during the year
was the facility's thrust towards geographic reorganization, in
light of recommendations from the Mental Health Planning
Survey. A conceptual blueprint for development of three
regional services for Greater Vancouver, the Fraser Valley, and
the rest of the Province was developed, and concomitant
administrative changes were jointly reviewed by the hospital
administration and Mental Health Planning Survey Team. Formal
approval from senior Ministry levels was received, and at the
year-end the hospital was commencing the implementation of
geographic service development.
One specific component of hospital reorganization
focussed on increased pressures for same-day admissions to the
facility from all parts of the Province. In addition to the
development of regional services to facilitate
community-hospital planning, Riverview assumed a central role
in negotiating regional triage systems and admissions-discharge
reciprocity arrangements with various regions of the Province,
with a view to ultimately providing 'guaranteed' same-day
admissions for appropriate referrals. In addition, the
hospital increased its acute services by 40 beds using current
available resources; and has reviewed and modified bed
utilization, length of stay, and internal transfer practices
within the facilicy.
249
 Numerous recommendations from the Ministry of Finance
regarding fiscal control policies within the institution,
resulted in the formation of a group representing Ministry
hospitals, and Management Engineering, to develop appropriate
accounting policies and procedures. This led to the review and
modification of numerous Business Office procedures in the
hospital. Similar changes occurred in the Personnel
Department, preparatory to the anticipated delegation of
recruitment and classification functions from the Public
Service Commission. Of the numerous self-initiated hospital
changes occurring during the year, the following were among the
highlights:
~ Laboratory:  Riverview's Laboratory formally joined
forces with the Regional Laboratory Services for the
Lower Mainland. This enables the hospital to operate its
laboratory more efficiently by reducing manpower and
equipment costs; it also affords both extended and better
quality services to Riverview patients. The hospital's
role in the regional laboratory system is to provide
specialized services relating to blood level analyses for
various psychopharmacological agents.
- Dietary:  Treasury Board approved implementation of a
thermal tray system, pending finalization of a
contractual agreement acceptable to both the supply
company and the hospital. Benefits of this system would
be apparent in improved food services to patients, as
well as increased cost effectiveness in reducing dietary
manpower requirements. Ultimately, it was hoped this
system would permit the hospital to totally eliminate
production in one of its five operating kitchens.
250
 This would represent the first step towards development
of a centralized commissary kitchen - a feasibility study
for which was underway at the year-end.
Physical Plant: A tender was accepted for the purchase
and installation of new X-Ray equipment for North Lawn
Unit, and was hoped that renovations and installations
could be completed before the end of the 1979/80 fiscal
year. Other major plant modifications included elevators
for Crease, Centre, and East Lawn Units.
Public Relations/Community Education: The hospital's
major public relations event comprised a "Professional
Day" Open House, in May, with more than 300 visitors
attending. Hospital personnel were also involved in
numerous media events and publications during the year.
In all, over 60 major tours were conducted for a total of
nearly 600 visitors; 54 talks were given to students and
community groups involving a total of close to 2,000
persons. This was in addition to active participation in
numerous conferences, symposia and inter-agency events
relating to health services.
Special Projects: In addition to further development
of the recently introduced Hospital Policy and Procedures
Manual, major thrusts towards accreditation status were
reflected in special projects involving the upgrading of
Quality Assurance Programs, conducting of hospital-wide
patient security studies, and active updating of the
hospital's disaster contingency plans.
251
 Other activities included sponsorship of active research
projects both from within and outside of the hospital, as
well as projects involving development of a hospital
museum, a security study of pharmacy services, and
development of Patient Councils to serve as formal
vehicles for consumer participation within the hospital.
Other changes reflecting Riverview's commitment to
increase its responsiveness to community need included the
following:
-A position involving a full-time physician, functioning
as a screening agent and placement advisor for all
admission requests, was created during the year.
-The hospital initiated numerous contacts with local
community agencies, hospitals and health care providers,
by way of attempting to better coordinate service
delivery.
-Riverview both continued and augmented its participation
in U.B.C.'s Outreach Program -- providing twice monthly
consultation and follow-up services to the Prince Rupert
and Terrace regions.
252 -
 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 continuous, continual, or temporary basis to
those residents of the Province who are not, in the
opinion of the Commission, adequately served with existing
health services;
(f) to recruit, examine, train, register, and licence
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
such medical aspects of the Provincial Emergency Program as
medical involvement in disaster planning, responsibility for
Federal stores stockpiled around the Province, and involvement
when actual disasters occur.
- 253
 The following full-time crew additions were completed
during 1979: Cranbrook was converted from a part-time crew
operation to being staffed with two full-time employees and
supplemented with part-time personnel; Fernie, Mission and
Salmon Arm each received a second full-time crew member; crew
establishment at Prince George increased by two, Victoria
increased by two, and Vancouver increased by nine. A Regional
Dispatch Centre was opened at Nanaimo and staffed with five
full-time dispatchers. This eliminated local dispatch in ten
communities, including three on the Sunshine Coast.
Advanced Life Support crews were added to Vancouver, and
new Advanced Life Support services were introduced in Victoria,
Kamloops and Chilliwack.
New ambulance stations manned by part-time personnel were
opened at Alexis Creek, Bella Coola, and Port Washington on
Pender Island. Arrangements were completed with the Ministry of
Highways to provide ambulance service on the Stewart-Cassiar
Highway from their operations at Meziadin Lake, Bob Quinn Lake,
and Dease Lake.
The training program for both full-time and part-time
ambulance personnel was expanded during 1979 and, as a
consequence, the Commission was able to upgrade the skills of a
substantially larger number of people than in the previous year.
The training programs consist of three levels of
instruction:
(a) Emergency Medical Assistant 1-80 hours; basic course;
(b) Emergency Medical Assistant II - 240 hours; more advanced
training;
254 -
 (c)  Advanced  Life  Support   (formerly  Emergency  Medical
Assistant III) - (15 months)
During 1979 fifty-seven E.M.A.-I courses were held at 49
centres throughout the Province, involving 495 part-time
personnel. Twelve E.M.A.-II courses were given - four of which
were in Vancouver, involving a total of 146 part-time and
full-time personnel.
Advanced Life Support-I courses were conducted at Kamloops
and Chilliwack, with nine and five graduates respectively. Both
centres were operating Advanced Life Support vehicles.
Advanced Life Support-II courses were held in Vancouver
involving 20 students and upon completion, two Advanced Life
Support units would be added to the Vancouver area.
A large number of Industrial First Aid courses were held
throughout the Province involving part-time and full-time
personnel, with 840 certificates being issued.
During July and August, an upgrading course for
instructors was held in Vancouver, with 11 instructors
participating.
A second Infant Transport Team was under training at the
year-end.
Commission instructors participated in Cardiopulmonary
Resuscitation (CPR) training in the field, which involved 2,317
people including police, firemen and hospital staff, as well as
lay groups.
A physician was again employed by the Commission to
provide medical coverage for the fishing fleet for a ten-week
period, divided between Rivers Inlet and Port Renfrew.
255
 The Vehicle Modification Depot produced 79 new ambulances,
all of which were placed in service, allowing the removal from
service of 65 older, high mileage units. The higher production
of ambulances in 1979 was a result of late deliveries of chassis
ordered in 1978.
The use of air ambulance again increased, bringing the
number of patients carried to 2,752.
Call volume on road ambulances increased 13%, bringing the
total patients carried to 171,420.
In May the Executive Director was invited by the
Government of Ontario to speak at a seminar on pre-hospital
emergency care.
The four Western Provinces meet each year to discuss
matters of mutual interest in connection with their respective
ambulance services, and the Executive Director and Director of
Ambulance Services attended the 1979 meeting held in Edmonton.
The Director of Ambulance Services was invited by the
British Ambulance Service to attend their annual meeting in
Guernsey, where he presented a paper on Advanced Life Support
programs.
- 256 -
 FORENSIC PSYCHIATRIC SERVICES COMMISSION
Throughout 1979 the emphasis was on improvement of
existing services and a very gradual expansion of the
Travelling Clinic concept, which made forensic psychiatric
services available to those parts of the province outside the
lower mainland. Services included travelling clinics to Prince
George and Kamloops; and Duncan, Nanaimo, Campbell River,
Courtenay and Port Alberni on Vancouver Island.
Cooperation between the staff of the Forensic Commission,
Crown Counsel, and the Courts, was well established, efficient
and substantial. Greater emphasis was laid on helping the
staff of the Courts in Vancouver and Victoria, to divert
suitable persons through the mental health service from the
criminal justice system, and this trend was to continue in
outlying areas.
The continuing task of inservice education occupied
Commission staff throughout the year. Assistance was given to
the inservice education programmes of referring agencies such
as the Courts, the Court Clerks, and Sheriffs. The Commission
staff provided seminars on a regular basis at the Justice
Institute, and preceptorships in Forensic Pyschiatric Nursing
were offered to student nurses.
Although the number of referrals to the inpatient service
was relatively stable, the proportion of inappropriate
referrals continued to drop. This improvement appeared to be a
direct result of the ease of consultation with counsel prior to
fitness hearings, and the ability to recommend appropriate
courses of clinical action for certain patients. The inpatient
assessment time decreased to 15 days, compared to the 27.7 days
in 1977.
- 257
 A very simple arrangement with the Corrections Service
permitted the immediate transfer of persons serving a sentence
in a correctional institute, who became mentally ill and were
certifiable. Such persons were treated in the Forensic
Psychiatric Institute until recovery.
In contrast to the small and stable number of inpatients,
referrals to the outpatient clinics accelerated. The Vancouver
Clinic received an estimated 850 new referrals during the year,
while the Victoria Clinic's new referrals were up to 140.
A number of patients were released to the community under
conditions of strict supervision. Over the years this patient
population has risen in size, and in 1979 it was nearly the
same as the inpatient population. It was very gratifying to
see disturbed, ill-equipped patients gradually return to useful
positions in society, even though the process takes several
years. It was also reassuring to see that the discharge
population had an exceedingly low rate of recidivism.
Social attitudes towards these discharged patients alter
much more slowly than the behaviour of the patients, and apathy
and negative attitudes were encountered from boarding home
proprietors, landlords, and so on.
Not all of the activities of the Commission refer to
direct services, and a very successful International Symposium
on Law and Psychiatry was held under the auspices of the
provincial government in May, 1979. This Symposium attracted
worldwide comment because of the calibre of the faculty. As a
direct result of the exercise, the Commission staff were
invited to give papers in conferences in England, the United
States and Canada. The number of international representatives
who came to observe the workings of the Commission included
visitors  from the United States, Europe and Australia.  The
258
 Commission staff were also involved in liaison and planning
meetings for other Forensic Psychiatric Institutes throughout
Canada.
During the year the first prospective research by the
Commission was initiated, a study of the evaluation of fitness
to stand trial. This research was being undertaken in
collaboration with the Criminology Research Centre of Simon
Fraser University.
259 -
 ALCOHOL AND DRUG COMMISSION
During the year there were rewarding new developments in
the field of prevention, treatment, and rehabilitation, for
alcohol and drug abuse.
Although the progress towards objectives is detailed in
the following sections of the report, special mention should be
made of the initiatives of the commission during this period.
By agreement with two of the funded agencies in Kelowna and New
Westminster, the ground was broken for the construction of a
new 32-bed residential treatment centre in Kelowna and a new
38-bed teaching and treatment centre in New Westminster. It
was anticipated that both units would be completed in April
1980. In addition, the new 24-bed Native Indian Residential
Centre at Round Lake, B. C., staffed and operated by the
Interior Native Alcohol Society and funded and supported by the
commission, opened in May.
The Commission continued to expand out-patient services
with the opening of a new out-patient counselling service in
the Burnaby-New Westminster area.
New, exciting initiatives were underway in the field of
prevention with a pilot preventive education program being
designed for the school and home, Grades 4 through 11, dealing
with home drugs including alcohol and tobacco. A second pilot
project will serve as an" early intervention model for the
identification and treatment of students experiencing alcohol
or other drug related problems.
The Heroin Treatment Program experienced a considerable
number of start-up problems including legal difficulties, but
at the year-end it was anticipating an increasing patient load.
260
 Support Services
Personnel Division
The Personnel Division was organized late in 1979 to
assume responsibility for all personnel services within the
Alcohol and Drug Commission. During the first half of 1979,
recruitment and documentation took priority, with the major
thrust being the staffing of approximately 300 positions for
the Heroin Treatment Program. During the third and fourth
quarters, personnel and training staff combined to present
Personnel Management seminars to all supervisory staff.
Organization reviews and classification studies also progressed
throughout the year.
Med_ical_ Services _Diy is ion
In 1979, a Medical Consultant to the commission was
appointed to develop medical services and policies for the
Heroin Treatment Program. Program requirements for physicians
were determined and additional physicians recruited and
oriented as needed. One full-time and seven sessional
physicians were provided for all treatment facilities.
Patients applying for treatment were given a complete medical
examination, and medical problems related to drug abuse were
treated. Standardized approaches to medical detoxication were
developed and instituted, for patients requiring medical
assistance in entering the drug-free programs. Medical
consultation and support was provided to new patients
throughout their assessment and treatment, while continuing
treatment was given to patients on methadone maintenance. An
additional full-time physician was hired for the alcohol
treatment services, bringing the number of full-time physicians
- 261
 to two. The physicians provided medical coverage for the
direct treatment facilities of the alcohol program, while
part-time physicians provided coverage for funded agencies.
The medical staff met regularly to discuss programs and
policy and to formulate recommendations. Liaison with the
medical profession throughout the province was initiated to
develop awareness of the various treatment programs available.
Meetings also took place with the College of Pharmacists to
determine an approach to the increasing problem in this
province of the mis-use of prescription drugs.
Professional Development Division
The Professional Development Division offers a broad
range of educational and training workshops for professionals
and paraprofessionals, whose work brings them into contact with
alcohol and other drug dependent people.
In 1979, the division gave 59 community presentations and
lectures, and 38 training workshops throughout the province.
In addition, staff were involved in numerous consultations, and
taught a 10-week course on alcoholism at Vancouver City College.
The commission committed $241,000 to develop an Employee
Assistance Program information kit, and to find various
approaches to providing assessment and referral services for
troubled employees.
Services provided to employers and unions included over
50 presentations, 20 policy developments, and 15 major training
programs. In addition, staff maintained contact with a number
of existing Employee Assistance Programs.
- 262 -
 Information and Education Services Divis ion
The Information Services Division creates and
disseminates information about alcohol, narcotics, and other
drugs; producing pamphlets, handbooks, reports, press releases,
and speeches. Staff of the division also assist in the
preparation, editing, and layout of commission print materials.
This year, the division continued its advertising and
public relations activities. A $500,000 multi-media campaign
with the theme "You Can Say No to the Drink You Don't Need",
began on September 3, and the second annual "Alcohol Awareness
Week" was held October 22-26.
Staff also assisted in organizing opening ceremonies for
new and proposed facilities, issued news releases, arranged
news conferences, and prepared articles. A film on the Heroin
Treatment Program was produced and distributed. In September,
a monthly in-house newsletter was started for distribution to
all commission agencies.
The commission's design for new publications was
completed and a series of new materials aimed at the general
public was produced.
Planning for a special prevention project for the
schools, designed by Western Education Development Group, was
begun late in the year.
With the hiring of Heroin Treatment Program staff, the
role of the library continued to expand. The collection
consists of 3300 books, and circulation increased by an
estimated 40% throughout the year. In July, the library began
a conversion to a computerized cataloguing system which will be
completed early in 1980.
263
 Audio-visual services also increased during the year.
Equipment was ordered for the Heroin Treatment Program and for
other programs and the film library continued to expand.
Research Divis ion
In 1979 the Research Division increased its staff and was
reorganized into three sections: Epidemiology, Evaluation, and
Monitoring and Data Systems.
The Epidemiological Research Section completed a
comprehensive needs assessment of treatment services for youth,
and published a project report. A Gallup Poll survey of
alcohol and drug use of a random sample of British Columbians
fifteen years of age and over was conducted, and a study on the
costs of alcohol and drugs to British Columbia was undertaken.
The section also did an in-depth analysis of the social impact
of the Heroin Treatment Program over time, and a province-wide
ecological analysis of socio-demographic and health
indicators.  Work on these projects will continue into 1980.
The Evaluative Research Section worked with treatment
staff to develop a comprehensive system to evaluate the
treatment provided by the Heroin Treatment Program; performed
an evaluation of the Commission's $500,000 advertising
campaign; and developed a pilot evaluation system for Employee
Assistance Programs.  These projects will also continue in 1980.
During the year the Monitoring and Data Systems Section
finished processing the backlog of data created by the
Client/Agency Monitoring System for the Alcohol and Drug
Services. Each participating agency was visited and given
feedback about its operations, " and data processing and
computing procedures were streamlined. In addition, staff of
this section worked with treatment staff to upgrade and improve
- 264
 the system, with a view to implementing a revised system in
1980.  The section also initiated a major long-term project to
develop proper data processing and computing procedures, to
handle data collected for the Heroin Treatment Program.
Agency__Rel_ations Division
The Agency Relations Division serves as the communicating
link between the Alcohol and Drug Commission, and the Boards
and staff of the 52 funded programs. Responsibilities included
the continuing orderly development of the System of Care
throughout the four regions of the province, and the
familiarization of senior program staff with all treatment
resources throughout the region and province.
An important focus of the division was the development of
twice yearly regional workshops for Program Directors.
Program Development Division
The Program Development Division is responsible for
developing and recommending new treatment initiatives to the
commission. Areas under development throughout the year were:
provincial and regional priorities of the System of Care;
services to Native people; services to family and youth; and
the refinement and expansion of detoxication, in-patient, and
out-patient services.
The division also coordinates the evaluation of the
funded and direct services. In 1979, 12 residential and five
detoxication audits were evaluated.
265
 Staff Development and Training
The Staff Development and Training Division was
established in May, 1979, to develop training programs to
up-grade and increase the skills of workers in the field.
Workshops conducted by the division included four-day
orientations for new staff, and training for detoxication
workers throughout the province. A major initiative was the
identification of basic skills and knowledge needed for workers
in the field, from which information/training programs will be
designed.
Treatment Services
Ai^c_ohol__and Drug_ Counselling Services
A new Burnaby/New Westminster out-patient clinic opened
early in the year, with an immediate response of referral from
local sectors.
During the year, there was an increased demand on
treatment capacities and a total of 735 persons were assessed
and admitted for on-going treatment, of whom 83% had no
previous admissions. Involvement of other family members,
collaterals, and employers, continued as a major treatment
focus.
Treatment services were provided through 6,045 individual
and family sessions, plus a further 2,102 attendances in group
therapy sessions.
A major effort will be made in 1980 to integrate the
adult and youth services through-closer liaison and joint work.
266 -
 Youth and Family Counselling Services
Youth and Family Counselling Services in Vancouver
continued to operate as the major early intervention program of
the Alcohol and Drug Commission. The core program engages
young people and their family members in counselling, to
establish alternatives to drug abuse. Throughout the year, the
service expanded its backup and consultative services to other
commission services, as well as many community and governmental
youth service programs. Workers from the service were utilized
as resource people to assist other alcohol and drug programs,
in the development of more relevant and effective help for
young people.
At the same time, the Youth and Family Counselling
Services continued to maintain a comprehensive support program
for the other 300 individuals using its facilities. The client
load was comprised mainly of young people under 20 years of
age, with the majority of clients aged between 13 and 17. Over
90% of the Vancouver admissions were new clients or families
having no previous contact with the agency. In 1979, requests
for brief service and family crisis intervention increased by
about 40% over the same period during 1978.
P_erid_e^_S^re_et^J3e toxica tion Centre
During the period between April and December 1979, the
22-bed Pender Detoxication Centre admitted 1,177 people. Of
these, 53.8 per cent had no previous admissions; 15.3 per cent
had one previous admission; 10.8 per cent had two previous
admissions, and 20.1 per cent had three or more previous
admissions. Of the first admissions, 31.9 per cent were
females, 68.1 per cent were males. In addition to the 1,177
clients admitted to the facility, there were 159 drop-ins
(prior to being admitted) whose average length of stay was 7.1
hours. Over 72 per cent of the drop-ins had no previous
contact with the centre.
- 267 -
 Of all clients admitted, less than 14.3 per cent left the
centre during the first 20 hours after admission. An
encouraging 77.6 per cent of the total clients admitted
completed treatment, and 69.5 per cent of the clients were
referred to ongoing treatment services.
M.<LP_le. Cottage Detoxication Centre
The Maple Cottage Detoxication Unit provides a safe,
supportive environment for chemically dependent persons. From
April to December of 1979, the centre admitted 1,128 people, of
whom 24% were women.
Of the clients admitted, 57% completed detoxication in an
average of 63 hours, while 21% of the clients required a longer
average stay of 136 hours. Of the total admissions, 22% did
not complete detoxication, staying an average of 10 hours each.
Heroin Treatment Program
The Heroin Treatment Program began operations on January
1, 1979, assuming responsibility for the treatment of narcotic
and other drug abuse patients in British Columbia. The program
also offered treatment to the methadone maintenance patients
previously cared for by the Narcotic Addiction Services.
Although the program was created in part as a compulsory
treatment program for narcotic abusers, its compulsory elements
were not and would not be implemented, until the
constitutionality of the Heroin Treatment Act is finally
resolved.
268
 All patients coming into treatment, including those
abusing drugs other than opiates, were voluntary. Patients
were either self-referrals or were referred from various
community agencies, physicians, or the criminal justice system.
Patients first arriving for treatment presented
themselves at regional centres or Area Co-ordinating Centres
located in Vancouver, Kelowna, Prince George, Nanaimo and
Victoria. They had a complete assessment to determine their
drugs of abuse, their current physical and psychological
status, and whether treatment should take place on an
in-patient or out-patient basis. The Heroin Treatment Program
is designed to be drug-free except for the initial detoxication
procedures, with only the remaining Narcotic Addiction Services
patients receiving methadone.
In-patient care took place at the Brannan Lake
Residential Treatment Centre near Nanaimo. The Brannan Lake
facility is a 150-bed hospital used for patients requiring
extended detoxication, and for those individuals who benefit
from the support present in a residential treatment setting
away from the stresses of their own community.
Out-patient care was provided in the community clinics
throughout the province: four in the Lower Mainland, two on
Vancouver Island (excluding Victoria), and one each in
Victoria, Kelowna, and Prince George. Treatment consisted of a
structured approach emphasizing counselling, physical and
psychological health, vocational training, social skills, and
effective use of leisure time.
The final phase of the program emphasized the re-entry
and integration of the patient back into the community, with
the support of community workers.
269
 EXPENDITURE BY PRINCIPAL CATEGORIES IN THE MINISTRY OF HEALTH
FOR FISCAL YEAR 1978/79
Total Expenditure
Fiscal Year Ended
March 31, 1979
Minister's Office
Administration & Support Services
Community Health Services
(including Long-Term Care)
Hospital Programs
Government Institutions
Forensic Psychiatric Services
Alcohol & Drug Commission
The Medical Services Plan of B.C.
Emergency Health Services
Building Occupancy Charges
Computer & Consulting Charges
TOTAL
150,228
5,824,561
160,469,470
631,382,771
56,452,427
3,658,897
8,940,033
394,986,983 (1)
25,115,808
21,789,863
6,242,113
1,315,013,154
(1)  The expenditure of $394,986,983 shown for Medical Services Plan
is the gross operating costs as shown in detailed statements in
Section F of the Public Accounts.  The actual charge to Vote 136 was
$221,542,573 and covered the 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 $1,315,013,154, whereas the net total is $1,314,616,169.
This latter figure was $396,985 less than the total shown in
Section D of the Public Accounts as half of the Accounting Divison
expenditures were made on behalf of the former Ministry of
Provincial Secretary and Travel Industry.
270
 Chart —Expenditures by Principal Categories in the Ministry of Health for the
Fiscal Year 1978/79
Government Institutions
$56.5 million
Building Occupancy and
Computer Consulting
$28.0 million
Alcohol and Drug
$8.9 million
Senior Administration and
Community Health Services
(including Long Term Care)
$166.4 million
Emergency Health Services
$25.1 million
Forensic Psychiatric Services
$3.7 million
TOTAL HEALTH SERVICES
IN 1978/79-$1,315,013,154.00
-  271
 DETAILED EXPENDITURE BY PRINCIPAL CATEGORIES IN THE MINISTRY
OF HEALTH FOR THE FISCAL YEAR 1978/79
Minister's Office
Administration & Support Services
Community Health Services:
Public Health Programs
Long-Term Care
Mental Health Programs
Special Health Services
Other Health Expenditures
Total, Community Health Programs
Hospital Programs:
Administration
Payments to Hospitals
Claims
Grants in Aid of Equipment
Capital & Debt Service
Total, Hospital Programs
Government Institutions:
General Administration
Riverview Hospital
Valleyview Hospital
Dellview Hospital
Pearson & Willow Chest Clinic
New Denver
Total, Government Institutions
Forensic Psychiatric Services
Alcohol & Drug Commission
The Medical Services Plan of B.C.
Expenditure:
Benefits -
Medical Care
Additional Benefits
Administration -
Salaries & Employee Benefits
Data Processing Expense
General Office Expense
Total, Medical Services Plan of B.C.
Emergency Health Services
Building Occupancy Charges
Computer and Consulting Charges
TOTAL, MINISTRY OF HEALTH
33,321,186
96,994,928
15,395,346
9,841,903
4,916,107
4,237,159
587,412,858
15,884,637
23,848,117
1,470,739
33,657,213
11,326,754
2,773,198
6,864,883
359,640
356,998,397
21,132,210
378,130,607
9,903,520
5,285,151
1,667,705
16,856,376
Total Expenditure
Fiscal year Ended
March 31, 1979
$
150,228
5,824,561
160,469,470
631,382,771
56,452,427
3,658,897
8,940,033
394,986,983
25,115,808
21,789,863
6,242,113
1,315,013,154
- 272 -
 MEDICAL SERVICES _PLAN
Financial Statement
AUDITOR'S REPORT
To the Chairman of the
Medical Services Commission of British Columbia, and
To the Minister of Health,
Province of British Columbia:
I have examined the statement of financial position of
the Medical Services Plan of British Columbia operating under
the direction and control of the Medical Sevices Commission of
British Columbia as at 31 March 1979 and the statement of
operations and working capital deficiency 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
c ircums tances.
In my opinion, these financial statements present fairly
the financial position of the Plan as at 31 March 1979 and the
results of its operations for the year then ended in accordance
with generally accepted accounting principles, as modified by
note 1 to the financial statements. Further, in my opinion,
except for the change to the policy of recognizing premiums
from group subscribers as referred to in note 2 to the
financial statements, such accounting principles have been
applied on a basis consistent with that of the preceding year.
ERMA MORRISON, CA.
Auditor General
Victoria, B.C.
18 July 1979
273
 EXHIBIT A
MEDICAL SERVICES PLAN OF BRITISH COLUMBIA
OPERATED BY AND UNDER THE
MEDICAL SERVICES COMMISSION OF BRITISH COLUMBIA
STATEMENT OF FINANCIAL POSITION
31 MARCH 19 79
ASSETS
1979
1978
Cash
Accounts receivable
Due from the Province of
British Columbia
$    828,880
1,842,049
16,200,000
$  2,026,029
1,707,487
12,500,000
$ 18,870,929
$ 16,233,516
LIABILITIES
Bank overdraft
Accounts payable
Premiums received in advance
Estimated liability for
unpresented and unprocessed
benefit claims
WORKING CAPITAL DEFICIENCY
-  EXHIBIT B
$ 14,111,966
318,978
15,457,223
45,500,000
75,388,167
56,517,238
188,014
15,023,691
38,000,000
53,211,705
36,978,189
$ 18,870,929
$ 16,233,516
The three accompanying notes are an integral part of these financial
statements.
Approved by the Commission on 18 July 1979:
- 274 -
 EXHIBIT B
MEDICAL SERVICES PLAN OF BRITISH COLUMBIA
OPERATED BY AND UNDER THE
MEDICAL SERVICES COMMISSION OF BRITISH COLUMBIA
STATEMENT OF OPERATIONS AND WORKING CAPITAL DEFICIENCY
FOR THE YEAR ENDED 31 MARCH 1979
1979 1978
REVENUE
Subscribers' premiums (Note 1(a)) $ 148,424,227
Province of British Columbia
Premium assistance 31,531,322
Interest income 150,332
EXPENDITURE
Benefits
Medical care
Additional benefits
180,105,881
356,998,397
21,132,210
$ 146,287,327
29,917,948
169,915
176,375,190
316,650,452
17,436,161
Administration
Salaries and employee benefits
Data processing expenses
General office expenses
378,130,607
9,903,520
5,285,151
1,667,705
334,086,613
9,449,260
2,308,862
1,449,066
16,856,376
13,207,188
394,986,983     347,293,801
EXCESS OF OPERATING EXPENDITURE
OVER REVENUE
CONTRIBUTIONS
Province of British Columbia
WORKING CAPITAL DEFICIENCY -
beginning of year
WORKING CAPITAL DEFICIENCY -
end of year - EXHIBIT A
195,342,053
19,539,049
214,881,102     170,918,611
177,041,625
(6,123,014)
36,978,189     43,101,203
$  56,517,238   $  36,978,189
275 -
 MEDICAL SERVICES PLAN OF BRITISH COLUMBIA
OPERATED BY AND UNDER THE
MEDICAL SERVICES COMMISSION OF BRITISH COLUMBIA
NOTES TO FINANCIAL STATEMENTS
FOR THE YEAR ENDED 31 MARCH 1979
1. Significant Accounting Policies
These financial statements have been prepared in accordance with
generally accepted accounting principles except that:
(i)  Premiums from individual subscribers are included in
revenue only when cash is received.  Premiums from
other sources are recognized as revenue on an accrual
basis.
(ii)  The cost of furniture and equipment is charged to administration expenses in the year of acquisition.
(iii)  No accrual for holiday pay is provided for salaried
employees.
2. Change in Basis of Accounting
During the year the plan adopted the policy of recognizing
premiums from all group subscribers as revenue on an accrual basis.
In prior years, premiums from certain groups were recognized as
revenue on a cash basis.  The effect on operations for the
current year is an increase in premium revenue of approximately
$565,000.
3. Comparative Figures
For comparative purposes, the 1978 Administration figures have
been restated to conform with the statement presentation adopted
for the year ended 31 March 1979.
- 276 -

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